bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors contributing to diagnostic delay of Caroli syndrome: a single-center, retrospective study
Authors: Shi Wen , Huang Xiao-ming , Feng Yun-lu , Wang Feng-dan , Gao Xiao-xing , Jiao Yang 
Published: January 2020

Abstract
Background Caroli syndrome (CS) is a rare congenital disorder without pathognomonic clinical symptoms or laboratory findings. Imaging modalities are first-line diagnostic methods.Methods A retrospective analysis was conducted on CS patients admitted to a single tertiary medical center in Mainland China. The diagnostic timelines of CS patients were reviewed to demonstrate the initial findings at diagnosis of CS, the risk factors associated with diagnostic delay, and potential clues leading to early diagnosis. Results The median diagnostic delay was 1.75 years (range: 1 month to 29 years, interquartile range: 6.2 years) in sixteen enrolled CS patients. Sex, age, and initial symptoms were not associated with diagnostic delay. 87.5% of CS patients were diagnosed by imaging, and the accuracy of ultrasonography, computed tomography (CT), and magnetic resonance cholangiopancreatography was 25%, 69.2%, and 83.3%, respectively. The median diagnostic delays for patients with or without CT performed at the first hospital visited according to physician and radiologist suspicion of the diagnosis were 7.4 months and 6 years, respectively (p=0.021). Hepatic cysts with splenomegaly were found by ultrasound in over half of CS patients.Conclusions The majority of CS patients were not diagnosed until complications of portal hypertension had already developed due to the non-specific clinical presentations, rarity, and therefore low index of suspicion for CS. Some patients had positive autoantibodies, which can lead to misdiagnosis. Recognition and early suspicion of the disease were important factors influencing diagnostic delay of CS. Hepatic cysts plus splenomegaly detected by US, which is almost always the first imaging test, might provide a clinical clue to include CS in the differential diagnosis.
Socioeconomic Inequalities in Tobacco Smoking in Women Aged 15-54 in Iran: A multilevel model
Authors: oradi Ghobad , Goodarzi Elham , Khosravi Ardeshir 
Published: January 2020

Abstract
Background Significant evidence suggests an inverse relationship between socioeconomic status and tobacco smoking, where inequality is visible among different social and economic strata. The aim of this study was to investigate the prevalence and economic and social inequalities in tobacco smoking in women aged 15-54 in Iran.MethodThis study is a cross-sectional study. Sampling in this study was a randomized clustered multistage sampling with equal clusters. A total of 35,305 women aged 15-55 enrolled in the study. Data analysis was in two stages. In the first stage, the social and economic inequalities were investigated using the concentration index and concentration curve method, and in the second method, and multilevel method was used to identify the determinants.ResultsThe prevalence of tobacco smoking in women was 12.24%. The concentration index for smoking was CI = -0.07 [95% CI (-0.09, -0.05)], which represents smoking in people with low socioeconomic status. The results of the multilevel analysis indicated that the marital status of people over the age of 35 and the economic class was related to smoking in women.ConclusionInequality in tobacco smoking in women is to the interest of the well-off group, and this inequality varies in different provinces. Marital status, place of residence, age and socioeconomic status of women are factors influencing the prevalence of tobacco smoking in women, and these issues should be noticed to reduce inequalities.
Recruitment patterns in a large international randomized controlled trial of perioperative care in cancer patients
Authors: Gazendam Aaron , Bozzo Anthony , Schneider Patricia , Giglio Victoria , Wilson David , Ghert Michelle 
Published: January 2020

Abstract
Introduction: The Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) randomized controlled trial (RCT) was the first study to prospectively enroll and randomize orthopaedic oncology patients in multiple centers internationally. The objective of this study was to describe recruitment patterns, examine the differences in enrollment across different PARITY sites, and to identify variables associated with differing levels of recruitment.Methods: Data from this study was obtained from the PARITY trial Methods Center and records of correspondence between the Methods Center and recruiting sites. We performed descriptive statistics to report the recruitment patterns over time. We compared recruitment, time to set up, and time to enroll the first patient between North American and international sites, private and public health care models, and the presence or absence of research personnel. Two-tailed non-paired t-tests were performed to test average monthly recruitment rates between groups. Results: A total of 602 patients from 36 North American and 12 international sites were recruited from 2013 to 2019. Average monthly enrollment increased each year of the study. North American sites were able to start up significantly faster than international sites (19.5 vs. 27.0 months p=0.04). However, international sites had a significantly higher recruitment rate once active (0.2 participants/month vs. 0.59 participants/month, p=0.023). Sites with research personnel were able to reach ‘enrolment ready’ status significantly faster than sites without research personnel (19.3 vs. 30.3 months, p=0.032), but there was no difference in recruitment once active (0.28 participants/month vs. 0.2 participants/month). Publicly funded sites were to recruit significantly more patients compared to private institutions (0.4/month vs. 0.17/month, p=0.03).Conclusions: As a collaborative group, the PARITY investigators increased the pace of recruitment throughout the trial, likely by increasing the number of active sites. The longer time to start-up at international sites may be due to the complex governing regulations of pharmaceutical trials. Nevertheless, international sites should be considered essential as they recruited significantly more patients per month once active. The absence of research support personnel may lead to delays in time to start up. The results of the current study will provide guidance for choosing which sites to recruit for participation in future collaborative clinical trials in orthopaedic oncology and other surgical specialties.
Breast milk Vitamin B12 Concentration and Incidence of Diarrhea and Respiratory Infections among Infants in Urban Tanzania: a prospective cohort study
Authors: Lweno Omar Ndano , Sudfeld Christopher R , Hertzmark Ellen , Manji Karim P , Darling Anne Marie , Fawzi Wafaie W 
Published: January 2020

Abstract
Trials of vitamin B12 supplementation in children 6-30 months have shown an increased risk of diarrhea and respiratory infections among participants. These results are not consistent with studies in adults that showed improvement of the immune response following treatment with vitamin B12. We sought to determine how the adequacy of vitamin B12 concentrations in breast milk could act as immune modulator and protect against the incidence of diarrhea and respiratory infections of children up to 18 months in urban Tanzania. A prospective cohort study was undertaken to determine the association of milk vitamin B12 concentration with the incidence of acute respiratory infection and diarrhea among infants in urban Tanzania. A random sample of 491 women enrolled in a trial of multivitamins provided milk for B12 analysis at or around 6 weeks postpartum. Of 491 women, 345 had vitamin B12 concentrations less than the value used to define adequate intake (<310 pmol/L) in breast milk. Using generalized estimating equations, we found no overall association of milk vitamin B12 concentration with incident diarrhea and ARI in infants. Prospective studies that perform longitudinal evaluations of milk B12 concentration over time are needed to clarify the role of milk vitamin B12 in childhood infections.
Combined ANN/ EVOP Factorial Design Approach for Media Screening for Cost-effective Production of Alkaline Proteases from Rhizopus oryzae (SN5) / NCIM-1447 under SSF
Authors: Negi Sangeeta , Vibha Kumari 
Published: January 2020

Abstract
In order to achieve high yield of fungal protease in a very cost effective way and to meet its increased market demand, current study deals with the screening of various agro-wastes as carbon source for the production of protease from Rhizopus oryzae (SN5) / NCIM-1447 under solid state fermentation. Substrates and culture parameters such as wheat bran, soybean meal, black-gram husk, rice husk, mixture of wheat bran, soybean meal, nitrogen sources, pH, temperature and incubation time were first optimized with one factor at time strategy and then EVOP factorial and yield of alkaline protease was achieved 412.8 U/gds at 28oC and pH=6 after 72 hours of fermentation taking wheat bran and soybean as a substrate in 4:1 ratio. Further Artificial Neural Networks (ANN), was trained with data of EVOP and yield of protease was enhanced up to 422.6 U/gds with wheat bran: soyabean in ratio of 70:30, pH 6.2 at 30°C. The evolved process and Rhizopus oryzae (SN5)/NCIM-1447 strain would be promising for protease production at industrial scale at low cost.
TSGA10 Expression Status in Breast Cancer: The Role of Microenvironmental Changes
Authors: Marzbany Marzieh , Norooznezhad Amir Hossein , Hoseinkhani Zohreh , Mahnam Azadeh , Eslampia Kiumaras , Jahani Mozhgan , Mansouri kamran 
Published: January 2020

Abstract
Background: Testis-specific gene antigen (TSGA10) mainly involves in spermatogenesis and embryogenesis. In the new defined roles, being a tumor suppressor agent or a cancer/testis antigen (CTA) is still unclear for this protein. The current study aimed to examine exact role of TSGA10 as a tumor suppressor or CTA in breast cancer and evaluate the role of microenvironment on its expression. Methods: This study evaluated the expression of TSGA10 and hypoxia-inducible factor 1α (HIF-1α) in two different breast cancer cell lines (MCF-7 and MDA-MB23) as well as their control (MCF10A) using real-time PCR. Moreover, expression of the mentioned genes evaluated in samples obtained from tumoral tissues with two types of controls: paired (tumor-free margin) and unpaired (healthy individuals). Also, in order to asses TSGA10 levels in the tumoral tissues, western blotting was performed. Furthermore, to evaluate the role epigenetic changes on TSGA10 expression, breast cancer cell lines were treated with a histone deacetylase inhibitor (HDACI) as well as H2O2 for oxidative stress induction. Results: The current study evaluated 36 patients diagnosed with breast cancer as well as 10 healthy controls. According to the results, it was shown that 35 (97.7%) and 1 (2.8%) of patients were diagnosed with ductal and lobular carcinomas respectively. The TSGA10 levels in the tumoral samples showed 1.38±0.014-fold decrease and 1.41±0.127-fold increase compared with their paired (P<0.001) and unpaired (P<0.001) controls respectively. Moreover, results of blotting in tumoral tissues expressed significant decrease in TSGA10 levels in comparison to the paired controls (P<0.01). Among the cell lines, TSGA10 expression in MCF-7 and MDA-MB23 cells had 4.9±0.283 and 4.21±0.163 folds of decrease in normoxic and 4.7±.0.283 and 7.1±0.141 folds of expression reduction in hypoxic condition respectively (all P<0.0001). Furthermore, the results showed that HIF-1α expression was up-regulated in both normoxic (P<0.01) and hypoxic (P<0.01) conditions. Also, TSGA10 expression increased up to 7.39±0.156 folds in MCF-7 cells after HDACI treatment (all P<0.01). However, MDA-MB23 cells firstly experienced a decrease and then a notable increase in TSGA10 expression (all P<0.01). Conclusion: Results of current study showed that TSGA10 seems to be tumor suppressor, however, further studies are necessary.
High UBE2T mRNA expression and its prognostic significance in Ovarian cancer: a study based on data mining
Authors: Cai Fu-Cheng 
Published: January 2020

Abstract
Background Ovarian cancer (OC) affects about 22 000 women annually in the US and ranks 5th in cancer deaths, largely due to diagnosed with advanced stage. Epithelial ovarian cancer (EOC) accounts for approximately 90% of all ovarian cancer cases. Our study was to assess the prognostic meaningful of UBE2T expression in OC dependent on data acquired from TCGA and so as to increase further knowledge into the biological pathways involved in OC pathogenesis related to UBE2T. Methods Information on gene expression and comparing clinical data were recognized and downloaded from TCGA. Gene set enrichment analysis (GSEA) created an arranged list of all genes s indicated by their connection with UBE2T expression. Results The scatter plot showed the difference of UBE2T expression between normal and tumor samples ( P <0.01). So as to decide the biological interaction network of UBE2T in OC, we used to tab Network in cBioPortal and the 50 most as often altered neighbor genes of UBE2T were demonstrated utilizing Network and the most frequent alterations were HES1. The GSEA results showed that cell cycle, DNA replication, RNA degradation, some cancers, spliceosome, Huntington’s disease, oxidative phosphorylation are differentially enriched in UBE2T high expression phenotype. Cumulative survive showed that dendritic cell of immune infiltrates statistically significant ( P <0.05) of UBE2T in OC suggesting that dendritic cell significantly affecting the prognosis, it is worth more research and exploration. Conclusion Our study found that the expression of UBE2T was significantly increased in OC patients and associated with several clinical features. UBE2T may be a potentially useful prognostic molecular biomarker of bad survival in OC, while further experimental ought to be performed to demonstrate the biologic effect of UBE2T.
A comparison of medical student competency, attitudes and knowledge of abortion care after a structured clinical curriculum
Authors: Gardner Hallie , Zimmerman Marguerite , Flanigan Moira , Baldwin Maureen K 
Published: January 2020

Abstract
Background: Abortion care is a core educational objective according to the Association of Professors of Gynecology and Obstetrics (APGO), but clinical exposure is variable in medical education. The authors sought to compare professional competency, attitudes, and knowledge regarding abortion between students who attended a structured clinical experience in abortion care to those who chose a less-structured family planning clinical environment. Methods: All medical students participating in the Obstetrics & Gynecology clerkship from 2014-2015 were invited to complete a pre- and post-clerkship survey and grouped based on their attendance to a structured clinical abortion experience at Planned Parenthood (PPCW) versus an alternative Family Planning Clinic (FPC) experience. Competency and attitudes about abortion were assessed using a 100-mm visual analog scale (VAS). Authors assessed knowledge about abortion with multiple-choice questions. Results: A total of 89 students completed the surveys (PPCW: 74; FPC: 15). Students attending PPCW were more likely to observe counseling about abortion and ultrasound prior to abortion (PPCW: 67/74, 91%; FPC: 4/15, 27%, p=<0.01). More PPWC students observed a surgical abortion (91% versus 7% of FPC students). Competency scores improved with composite mean difference in VAS for PPCW of 42.2 mm and FPC of 27.3 mm (p=0.02). Attitude scores were unchanged in those with initial VAS <80 mm. Knowledge improved overall, with greater changes among the PPCW group. Conclusions: A structured clinical abortion experience met APGO educational objectives more than an alternative experience. Future physicians should universally be exposed to clinical abortion care in order to ensure evidence-based education about abortion.
Engaging Stakeholders in the Adaptation of the Connect for Health Pediatric Weight Management Program for National Implementation
Authors: Simione Meg , Frost Holly M. , Cournoyer Rachel , Mini Fernanda Neri , Cassidy Jackie , Craddock Cassie , Moreland Jennifer , Wallace Jessica , Metlay Joshua , Kistin Caroline J. , Sease Kerry , Hambidge Simon J. , Taveras Elsie M. 
Published: January 2020

Abstract
Background: Connect for Health is an evidence-based weight management program with clinical- and family-facing components for delivery in pediatric primary care for families of children ages 2 to 12 years. We used the Consolidated Framework for Implementation Research (CFIR) to guide formative work prior to national implementation. The purpose of this study was to describe the process and results of stakeholder engagement and program adaptation. Methods: We used mixed qualitative and quantitative methods to iteratively adapt and optimize the program by assessing needs and perspectives of clinicians and parents, as well as contextual barriers, facilitators and organizational readiness for the uptake of the proposed program tools and implementation strategies. We conducted interviews with primary care clinicians from four health care organizations in Boston, MA, Denver, CO, and Greenville, SC and used principles of immersion-crystallization for qualitative analyses. We also conducted surveys of parents of children with a body mass index ≥ 85th percentile.Results: We reached thematic saturation after 52 clinician interviews. Emergent themes representing the CFIR domains of intervention characteristics, outer and inner setting, and process included: (1) importance of evidence-based clinical decision support tools that integrate into the workflow and do not extend visit time; (2) developing resources that respond to family’s needs; (3) using multimodal delivery options for family resources; (4) addressing childhood obesity while balancing competing demands; (5) emphasizing patient care rather than documentation and establishing sustainability plans; and (6) offering multiple training methods that incorporate performance feedback. Of the parents surveyed (n=400), approximately 50% were Spanish-speaking and over 75% reported an annual income < $50,000. Parents affirmed the importance of addressing weight management during well-child visits, being provided with referrals and resources, and offering multiple methods for resource delivery. Decisions about program modifications were made at the program and healthcare-system level and based on stakeholder engagement findings. Modifications included cultural, geographic, and target audience adaptations, as well as varied resource delivery options. Conclusions: To ensure the fit between the Connect for Health program and national implementation settings, adaptations were systematically made through engagement of clinician and parent stakeholders to support adoption, sustainability, and health outcomes.
Explaining the mixed findings of a randomised trial of telehealth with centralised remote support for heart failure: qualitative evaluation
Authors: Papoutsi Chrysanthi , A'Court Christine , Wherton Joseph , Shaw Sara , Greenhalgh Trisha 
Published: January 2020

Abstract
BackgroundCentralised specialist remote support, in which a clinician responds promptly to biomarker changes, could potentially improve outcomes in heart failure. The SUPPORT-HF2 trial compared telehealth technology alone with the same technology combined with centralised remote support. The intervention was implemented differently in different sites; no significant impact was found overall. We sought to explain these findings in a qualitative evaluation. Methods51 people (25 patients, 3 carers, 18 clinicians and 4 additional research staff) were interviewed and observed in 7 SUPPORT-HF sites across UK between 2016 and 2018. We also collected 110 pages of documents. Analysis was informed by sociotechnical theory. ResultsPatients’ experiences of the technology were largely positive; staff engaged with the intervention to a variable degree. Existing services, staffing levels, technical capacity and previous experience with telehealth all influenced how the complex intervention of ‘telehealth technology plus centralised specialist remote support’ was interpreted and the extent to which it was adopted and used to its full potential. In some settings, the intervention was quickly mobilised to fill significant gaps in service provision. In others, it was seen as usefully extending the existing care model for selected patients. However, in some settings, the new care model was actively resisted and the technology little used. In one setting, centralised provision of specialist advice aligned awkwardly with an existing community-based heart failure support service. ConclusionsThe introduction of a telehealth programme rests not only on the technological intervention but also on the individuals involved and numerous subtle aspects of local service design. An iterative approach that attends to patients’ illness experiences, clinicians’ professional values, work practices and care pathways could lead to more effective telehealth support for patients with heart failure.
An intelligent decision-making support system for the detection and staging of prostate cancer in developing countries
Authors: Zhang Jun , Chen Zhigang , Wu Jia , Liu Kanghuai 
Published: January 2020

Abstract
Background Most developing countries face great problems in the medical, and the threat posed by large populations, scarce medical resources and inadequate medical personnel will affect the development and stability of the society. Therefore, for most developing countries, the development of intelligent medical systems can greatly alleviate the social contradictions arising from this problem. Intelligent Medical System is a system to assist doctors to make decisions. Through effective input, the system makes corresponding decisions and provides doctors with corresponding auxiliary diagnosis and relevant treatment plans. Methods The experimental team collected and compiled about 2,156,528 data items based on the hospitalization information of more than 8,000 prostate patients in three hospitals of Xiangya. The ratio of experimental data to test data was about 7: 3. Combining prostate cancer images and physical indicators to assist diagnosis and make decisions, from the extraction of corresponding image feature data to the final diagnosis decision, a new intelligent system for prostate cancer data decision-making based on Perceptron neural network is proposed. In the comprehensive decision-making, the final decision is made by using the rule-reasoning model. Through data collection, medical data analysis and integration, image processing and analysis, and disease detection and decision-making processes, patients are assisted in diagnosis and treatment to solve the problems and social contradictions facing most developing countries. Results Through the study of hospitalization information of more than 8,000 prostate patients in three hospitals, about 2,156,528 data items were collected and compiled for experiment purposes. Experimental data shows that when the patient base increases from 200 to 8,000, the accuracy of the machine-assisted diagnostic system will increase from 61% to 87%, and the doctor's diagnosis rate will be reduced to 81%. Conclusions From the study, it is concluded that when the patient base reaches a certain number, the diagnostic accuracy of the machine-assisted diagnosis system will exceed the doctor's expertise. So the smart medical system can help doctors and Medical experts make suggest more effective treatments.