bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does the Mode of Conception Influence Early Postpartum Depression? A Prospective Comparative Study from South India
Authors: Muruganandam Partheeban , Shanmugam Deepa , Ramachandran Niranjjan 
Published: July 2020

Background: Besides infertility, the treatment associated with it is potentially related to psychological stress to mothers. This study was conducted to know whether the mode of conception has any association with early postpartum depression. Method: A prospective cohort study was conducted on postnatal mothers at a tertiary care hospital from January to June 2019. The study participants were divided into two groups: postnatal mothers who delivered following spontaneous conception and assisted conception. Basic sociodemographic and obstetric details were collected. Postnatal depression assessment was done at the end of first and sixth week after delivery on all the mothers by using the Edinburgh Postnatal Depression Scale (EPDS) Results: In total, 110 subjects (55 in each group) were included in the study. The primary outcome measured was the presence of postpartum depression (EPDS score ≥10). The mean (±SD) age of the participants was 29 ± 6.4 years. The sociodemographic profiles of the two groups were comparable except for mean age, mode of delivery, socioeconomic status, prepregnancy body mass index —the group differences in these variables were statistically significant (P ≤ 0.05). There was no significant difference in the EPDS scores at one week or six weeks of postpartum among the two groups. Comparison of EPDS score among the two groups by Fisher’s exact test showed that those mothers with a past history of depression were more likely to have postpartum depression immediately after delivery. Conclusion: Mode of conception was not associated with an increase in postpartum depression among women who underwent infertility treatment.
Mental-Illness-Related Stigma in Health Care in South India: Mixed-Methods Study
Authors: Munisami Thenral , Namasivayam Rajesh Kannan , Annamalai Arunkumar 
Published: July 2020

Background: Stigma related to mental illness is a reality among health care providers. This study is an attempt to understand the attitudes of doctors from different specialties toward mental illness and the stigma related to it. Methods: We used a concurrent nested mixed-methods approach to understand and identify the various factors of mental-illness-related stigma in medical practitioners. Between November 2018 and March 2019, 100 medical practitioners from South India were administered a self-reporting OMS-HC (Opening Minds Scale for Health Care Providers), followed by in-depth interviews among 25 of the 100 participants selected using purposive sampling. Quantitative surveys were analyzed using SPSSv23. In-depth interviews were transcribed as extended notes, translated, and initially explored using focused coding and the constant comparative method. Results: Though findings from quantitative analysis show low to moderate stigma (Mean = 53.52, SD = 7.61), the qualitative study revealed unintended and covert negative attitude toward mental illness. Conclusion: As stigma occurs at various levels—structural, institutional, interpersonal, and personal—anti-stigma measures also need to be systematically designed. Qualitative studies give more insight regarding the nature of stigma in medical practitioners toward mental illness
Efficacy outcomes in the MDD-1 India study: First episode major depressive disorder outcomes in antidepressant-treated real-world patients in India
Authors: Andrade Chittaranjan , De Sousa Avinash , Shah Nilesh 
Published: July 2020

Objectives: Little is known about the outcome of major depressive disorder in India, especially in primary care contexts not usually associated with research. This large, prospective, naturalistic observational study examined the feasibility of studying first-episode major depressive disorder outcomes in such contexts, and examined outcomes after antidepressant drug treatment. Methods: A convenience sample of 205 psychiatrists across India each recruited five adults with first-episode major depressive disorder. No patient had clinically significant suicidal ideation, psychotic symptoms, or significant medical or psychiatric comorbidity. Patients were naturalistically treated with antidepressant medication and rated using the Montgomery-Asberg Depression Rating Scale and other instruments, including patient-reported outcome measures. Assessments were obtained at baseline and at a 6-week follow-up. Results: Of 900 patients recruited, 92 did not meet selection criteria, and there were 10 dropouts, leaving 798 evaluable patients. The most common antidepressants received were desvenlafaxine, vilazodone, and escitalopram. The primary outcome, response (50% attenuation of Montgomery-Asberg Depression Rating Scale score), was identified in 66.1% of the sample. The patient-reported outcome measures-defined response rate was 53.1%. Remission (endpoint Montgomery-Asberg Depression Rating Scale score of 10 or less) was observed in 36.7% of the sample. Response (but not remission) was very slightly but significantly better in women than in men on some but not all measures. Conclusions: It is feasible to conduct simple but meaningful observational studies in primary care contexts that are not usually associated with research. About two-thirds of real-world adults in primary care in India diagnosed with uncomplicated first-episode major depressive disorder respond to 6 weeks of antidepressant medications; about one-third of the adults remit.
MKG Angle: A True Marker for Maxillomandibular Discrepancy
Authors: Chachada Achint , Ostwal Payal , Jain Megha , Khandelwal Piyush , James Jamoy , Nahta Mayank 
Published: July 2020

Aim: To evolve a new cephalometric estimation called the MKG angle using three skeletal landmarks—point key ridge (KR), point M, and point G to evaluate the sagittal relationship between the maxilla and mandible. Materials and methods: A total of 60 pretreatment lateral cephalograms were selected and segregated into classes I, II, and III groups on the basis of ANB angle, Wits appraisal, and W angle. The MKG angle was constructed between the lines drawn from point M to point KR and point KR to point G. The MKG angle was measured to calculate the mean and the standard deviation. Results: After using the one-way analysis of variance and the Newman–Keuls test and running ROC curves, the results showed that an MKG angle in the range 51º–59º can be considered to have a class I skeletal pattern. The MKG angle more than 59º indicates a class II skeletal pattern and less than 51º indicates class III skeletal pattern. Conclusion: The MKG angle can be used as a dependable marker to assess sagittal jaw discrepancy.
Bone Mineralization Changes in the Subchondral Bone of the Medial Gutter in Chronic Lateral Ankle Instability
Authors: Nakasa Tomoyuki , Ikuta Yasunari , Ota Yuki , Kanemitsu Munekazu , Sumii Junichi , Nekomoto Akinori , Adachi Nobuo 
Published: July 2020

Background: Chronic ankle instability (CAI) induces osteoarthritis (OA) by inflicting abnormal stresses on the medial gutter. It is important to detect early OA change and to explore factors likely to induce the OA. The purpose of this study was to evaluate subchondral bone change in the medial gutter of CAI using computed tomography (CT) scans. Methods: Thirty-five ankles with CAI (CAI group) and 35 ankles without CAI (control group) were included. The region of interest (ROI) in the subchondral bone of the medial gutter on CT axial images was set on the tibia and talus. The Hounsfield unit (HU) in ROIs was measured and corrected by the HU of the fibula in the same slice. HU ratios were compared between the CAI and control groups. In the CAI group, the relationship between the HU ratio and the talar tilt angle (TTA), OA change, and the anterior talofibular ligament (ATFL) remnant quality were analyzed. Results: The mean HU ratio in the CAI group was significantly higher than that in the control. In the CAI group, HU ratios in ≥10 degrees of TTA were significantly higher than those in <10 degrees. But there was no significant difference in the HU ratios with or without OA change in the medial gutter. A good-quality ATFL remnant showed a low HU ratio compared with that with poor quality. Conclusion: CAI patients exhibited subchondral bone change in the medial gutter, which suggests that the elimination of instability may help to prevent or decrease the development and/or progression of osteoarthritis. Level of Evidence: Level III, comparative series.
Association of Depressive Symptoms with Perceived Stress and Proinflammatory Cytokines in Treatment-Naïve Patients with Breast Cancer
Authors: Li Jie , Zhang Rongmei , Li Shanshan , Gao Wei , Zhang Huihui , Bai Huayu , Shao Di , Zhou Chengchao , Cao Fenglin 
Published: July 2020

Objectives: This study aimed to explore the levels and associations among depressive symptoms, perceived stress, and proinflammatory cytokines (interleukin-1β, interleukin-6, and tumor necrosis factor-α) in treatment-naïve patients with breast cancer. Methods: A cross-sectional study with one case and two control groups. Patients with breast cancer, matched patients with depression, and matched healthy women completed questionnaires and blood collection between May 2015 and March 2017. Data were analyzed using the general linear model and linear regression model. Results: The severity of depressive symptoms and perceived stress among patients with breast cancer was significantly higher than that in healthy controls and lower than those in patients with depression. Interleukin-1β was lower in patients with breast cancer than the other two groups. Perceived stress was independently and positively associated with depressive symptoms in patients with breast cancer. There were no significant associations between cytokines and depressive symptoms. Conclusion: Women with breast cancer experienced increased perceived stress prior to anticancer treatment, which was a strong contributor to severe symptoms of depression. Results emphasize the need to screen and identify patients with high perceived stress shortly after the disclosure of the diagnosis of breast cancer. Further research in larger sample is needed to investigate the relationship between proinflammatory cytokines and depressive symptoms.
Revision total hip arthroplasty in patients with femoral bone loss using tapered rectangular femoral stem: a minimum 10 years’ follow-up
Authors: Wang Jian , Dai Wen-Li , Lin Ze-Ming , Shi Zhan-Jun 
Published: July 2020

Background: Revision total hip arthroplasty (THA) remains a significant challenge when there is severe femoral bone loss. The purpose of this study was to evaluate the clinical and radiographic outcomes of revision THA in patients with femoral bone loss treated with Zweymüller SLR-Plus stem. Methods: A retrospective review of 82 patients who underwent revision THA using tapered rectangular femoral stem between 1997 and 2007 was undertaken. Of the 82 patients, 9 patients were lost to follow-up and were excluded from the study. The most common reason for revision was aseptic loosening (92%), periprosthetic femur fracture (5%), and infection (3%). Bone loss was categorised preoperatively according to the Paprosky classification. The mean clinical follow-up was 14 years (range 10–19 years). Their mean age at the time of index surgery was 54.7 ± 15.3 (range 30–82) years. Results: The mean Harris Hip Score was significantly improved at final follow-up (68.1 ±10.3) compared with that before the revision surgery (30.4 ± 7.7) ( p < 0.0001). Of the 75 stems, 69 (92%) stems were radiographically stable at the last evaluation. Among the 69 stems, 64 hips (85%) had radiographic evidence of bone ingrowth and 5 (5%) had stable fibrous fixation of the stem. Among the 7 hips that were re-revised, 5 hips were re-revised for aseptic loosening, whereas 2 were re-revised for an infection. Kaplan-Meier survivorship analysis, with removal of the stem for any cause as the endpoint, revealed that the 15-year rate of survival of the components was 90% (95% CI, 0.83–0.97). Conclusion: Revision THA in patients with proximal femoral bone loss using Zweymüller SLR-Plus stem led to a high rate of osseointegration of the stem and good clinical results at long-term follow-up.
Progressive multifocal leukoencephalopathy on dimethyl fumarate with preserved lymphocyte count but deep T-cells exhaustion
Authors: Garcia Jeanne , Hendel-Chavez Houria , De-Goer Marie-Ghislaine , L’Honneur Anne Sophie , Dubessy Anne Laure , Taoufik Yassine , Stankoff Bruno 
Published: July 2020

Background: Progressive multifocal leukoencephalopathy (PML) among multiple sclerosis (MS) patients receiving dimethyl fumarate (DMF) is associated with iatrogenic lymphopenia, predominating on CD8+ T-cells. Objectives and Methods: We report an unusual case of DMF-related PML in a 66-year-old MS patient with preserved lymphocyte count (nadir: 810/mm3) and normal CD8+ T-cells count. Results: A massive overexpression of the inhibitory receptor Programmed Cell Death 1 (PD-1) on CD8+ and memory effector T-cells together with an impaired anti-JC virus (JCV) specific T-cells response were found, compatible with exhaustion. Following DMF withdrawal, PML progressively regressed, PD-1 was downregulated, and a functional anti-JCV response was established. Conclusion: T-cells exhaustion may favor PML onset on DMF independently of lymphocyte count.
Telehealth during the coronavirus disease 2019 pandemic: Rapid expansion of telehealth outpatient use during a pandemic is possible if the programme is previously established
Authors: Schulz Thomas , Long Karrie , Kanhutu Kudzai , Bayrak Ilana , Johnson Douglas , Fazio Timothy 
Published: July 2020

Introduction The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the health-care system both in Australia and internationally, and has rapidly transformed the delivery of health care in hospitals and the community. Implementation of social isolation and distancing measures to stop the spread of the disease and to reduce potential harm to patients has necessitated the use of alternate models of health-care delivery. Changes that would normally take months or years have occurred within days to weeks. Methods We conducted analysis of outpatient clinic data during the period of the pandemic and compared this to previous telehealth use. We also present the results of clinician and patient telehealth experience surveys. Results We describe a 2255% increase in the use of telehealth at a tertiary hospital within a period of six weeks, and a significant simultaneous reduction in the outpatient clinic failure-to-attend rate. The vast majority of patients and clinicians agreed that the standard of care provided by telehealth was the same as that provided by on-site appointments. Discussion Telehealth that previously had only limited utilisation has now become a main method for the delivery of outpatient care. Clinicians and patients agreed that consultations provided by telehealth were of the same standard as those provided on site. Health care in the post-pandemic period should embed the use of telehealth for outpatient care and consider the range of other clinical contexts where this can be utilised.
The Simon effect in bilingual language brokers: A role for emotion and proficiency
Authors: López Belem G , Zhang Minyu , Arredondo Maria M , Kim Su Yeong 
Published: July 2020

Aims and objectives/purpose/research questions: Language brokering (LB) is an informal translation experience where bilinguals serve as linguistic and cultural intermediaries for family members. LB may have long-term socio-emotional and cognitive outcomes, yet little is known about its effects on executive functions (EFs). This study examines how first language (L1) proficiency and negative emotions tied to language brokering experiences affect EF performance on a Simon task (ST). Design/methodology/approach: Fifty-three Mexican American Spanish–English bilinguals with LB experience performed a ST, and reported their feelings towards LB for their mother. Data and analysis: Mean reaction times (RTs) and accuracy rates for correct ST trials were analyzed using linear mixed effects modeling, with trial type, proficiency and negative emotions tied to LB experience as factors and their interactions as additional predictors. Findings/conclusions: The L1 proficiency and negative emotions tied to brokering experiences have divergent, but combined effects on EF. Contrary to our hypotheses, low L1 proficiency predicted better performance and the smallest Simon effect was found for brokers with low L1 proficiency and low negative emotional brokering experiences. However, high L1 proficiency predicted better performance (smallest RTs) regardless of negative emotions tied to brokering experiences. Originality: This study takes a different perspective on the examination of individual differences among bilinguals, in which we examine how negative emotions tied to brokering experiences coupled with L1 proficiency relates to EF performance. Significance/implications: Our results provide support for the need to understand how individual differences in bilingual language experiences, such as L1 proficiency and negative emotions tied to LB, interact with performance on the ST.
Atezolizumab in a

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o

H

ort of pretreated, advanced, non-small cell lung cancer patients with rare HistologiCal Subtyp

E

s (CHANCE trial)
Authors: Gelsomino Francesco , Lamberti Giuseppe , Tiseo Marcello , Rocco Danilo , Pasello Giulia , Cecere Fabiana Letizia , Chella Antonio , Grilli Giada , Mandruzzato Marcella , Tognetto Michele , Garassino Marina Chiara , Macerelli Marianna , Novello Silvia , Roila Fausto , Colantonio Ida , Grossi Francesco , Fiorentino Michelangelo , Ardizzoni Andrea 
Published: July 2020

Background: Although immunotherapy with immune-checkpoint inhibitors (ICIs) has profoundly changed the therapeutic scenario in the treatment of advanced non-small cell lung cancer (NSCLC), trials of ICIs only enrolled NSCLC patients with common histology. Atezolizumab was approved by the United States Food and Drug Administration (US FDA) in October 2016 and by the European Medicines Agency (EMA) in September 2017 for the treatment of patients with metastatic NSCLC whose disease progressed during or following platinum-containing chemotherapy, regardless of PD-L1 expression. Methods: We designed a single-arm, multicenter, two-stage phase II study and plan to enroll 43 patients. The primary objective of the study is to evaluate the antitumor activity of atezolizumab in advanced NSCLC patients with rare histology subtypes. Patients with prior atezolizumab or ICI treatment and with untreated, symptomatic, or progressing brain metastases will be excluded. The primary endpoint is disease control rate. Secondary objectives are toxicity and safety, overall response rate, progression-free survival, overall survival, and time to progression. Diagnosis of NSCLC with rare histology will be confirmed by central pathology revision, and will include: colloid carcinoma, fetal adenocarcinoma, non-endocrine large cell carcinoma, sarcomatoid carcinoma, salivary gland-type tumor, lymphoepithelioma-like carcinoma, and NUT-nuclear protein in testis carcinoma. Archival tumor tissue is required for correlative studies of PD-L1 expression on tumor cells and tumor infiltrating lymphocytes. Conclusions: Therapeutic options in NSCLC with rare histology subtypes, to be assessed in specifically designed trials, are an unmet need. This trial will help elucidate the role of atezolizumab as a viable option in this setting.
Building an innovation system of medical devices in China: Drivers, barriers, and strategies for sustainability
Authors: Cheong Sok Teng , Li Jian , Ung Carolina Oi Lam , Tang Daisheng , Hu Hao 
Published: July 2020

Objectives: This article aimed to discuss the emergence of medical device sector in China from a sectoral innovation system perspective, to explore the drivers and barriers to the successful building of an innovation system of medical devices, and to highlight the policy implications and suggestions for sustainable innovation of medical devices. Methods: A theoretical framework of sectoral systems of innovation was applied in the analysis of data, and materials were collected from multiple sources with particular attention paid to the evolutionary phases, structure, and function of the innovation system. Results: The evolution of medical device sector in China could be divided into four phases: initialization (1960s–1970s); exploration (1980s); steady growth (1990s); and rapid growth (since 2000). Through analyzing the innovation system’s structural components of technology, actors, and networking, as well as institutions, this study indicated that the government policy decision was the most important driver that affected the virtuous cycle of the Chinese medical device innovation system, followed by market demand and entrepreneurial activities. However, barriers against the innovation cycle such as knowledge base development and diffusion, legitimacy, and resource mobilization still remained. Conclusion: In its endeavor to build an innovation system, the Chinese medical device sector had made some progress in meeting the local medical demands and improving its industrial competence. Although a Chinese innovation system for medical devices was initiated under the guidance of the government, knowledge advancement and diffusion had become the main challenges for the sustainability of innovation in this sector. The future development depends on China’s effort and ability to establish education and health research systems specific to medical devices.
Series of 55 pregnancies following ulipristal acetate treatment of symptomatic uterine fibroids
Authors: Costa Ana R , Carvalho Ana P , Martins Diana R , Carvalho Maria J , Silva Pedro T , Roque Sílvia C , Silva Daniel P 
Published: July 2020

Introduction: Treatment with ulipristal acetate effectively controls excessive bleeding due to uterine fibroids and reduces their size. Uterine fibroid size reduction is expected to improve the results of the myomectomy and the reproductive prospects of the patient. Methods: Retrospective and descriptive analysis of a series of 53 patients who achieved pregnancy after being treated for symptomatic uterine fibroids. The primary endpoints were pregnancy and birth outcomes in women with symptomatic uterine fibroids that conceived following at least one course of therapy with ulipristal acetate 5 mg/day. The secondary endpoints were time until pregnancy, reasons for ulipristal acetate treatment, number of treatment courses completed, hemorrhagic control achievement, hemoglobin levels, fibroid FIGO classification, largest fibroid diameter, and type of myomectomy (if any). Results: Fifty-five pregnancies were registered in 53 patients following ulipristal acetate therapy (43 live births, 9 miscarriages, and 3 ongoing pregnancies). Half of the patients became pregnant without interval surgery. Bleeding control was achieved in 96% of the cases. A significant increase (p < 0.001) in hemoglobin levels and a reduction (p < 0.001) in uterine fibroid size was observed after treatment. No malformations were reported among newborns after ulipristal acetate therapy. Conclusion: So far, this is the largest case series reporting both pregnancy and birth outcomes following ulipristal acetate therapy for uterine fibroids. Our data support favorable outcomes after therapy for this population subset.