bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction of mortality in metastatic colorectal cancer in a real-life population: a multicenter explorative analysis
Authors: Rumpold Holger , Niedersüß-Beke Dora , Heiler Cordula , Falch David , Wundsam Helwig Valenting , Metz-Gercek Sigrid , Piringer Gudrun , Thaler Josef 
Published: November 2020

Abstract
Background
Metastatic colorectal cancer (mCRC) remains a lethal disease. Survival, however, is increasing due to a growing number of treatment options. Yet due to the number of prognostic factors and their interactions, prediction of mortality is difficult. The aim of this study is to provide a clinical model supporting prognostication of mCRC mortality in daily practice.

Methods
Data from 1104 patients with mCRC in three prospective cancer datasets were used to construct and validate Cox models. Input factors for stepwise backward method variable selection were sex, RAS/BRAF-status, microsatellite status, treatment type (no treatment, systemic treatment with or without resection of metastasis), tumor load, location of primary tumor, metastatic patterns and synchronous or metachronous disease. The final prognostic model for prediction of survival at two and 3 years was validated via bootstrapping to obtain calibration and discrimination C-indices and dynamic time dependent AUC.

Results
Age, sidedness, number of organs with metastases, lung as only site of metastasis, BRAF mutation status and treatment type were selected for the model. Treatment type had the most prominent influence on survival (resection of metastasis HR 0.26, CI 0.21–0.32; any treatment vs no treatment HR 0.31, CI 0.21–0.32), followed by BRAF mutational status (HR 2.58, CI 1.19–1.59). Validation showed high accuracy with C-indices of 72.2 and 71.4%, and dynamic time dependent AUC’s of 76.7 ± 1.53% (both at 2 or 3 years), respectively.

Conclusion
The mCRC mortality prediction model is well calibrated and internally valid. It has the potential to support both, clinical prognostication for treatment decisions and patient communication.
Prevalence and associated risk factors for childhood strabismus in Lhasa, Tibet, China: a cross-sectional, school-based study
Authors: He Hailong , Fu Jing , Meng Zhaojun , Chen Weiwei , Li Lei , Zhao Xinyu 
Published: November 2020

AbstractBackgroundTo estimate the prevalence of strabismus and associated risk factors among grade one school children in Lhasa, Tibet, China.MethodsThe Lhasa Childhood Eye Study (LCES) was a cross-sectional, school-based childhood study conducted in Grade one students from primary schools in Lhasa, Tibet, China. Comprehensive ophthalmic examinations and basic systemic examinations were evaluated. A questionnaire survey containing information about children, as well as parents’ information, was sent to the corresponding parents of eligible children. The prevalence of strabismus and its 95% confidence interval was estimated. Univariate and multivariate logistic regression analyses were conducted to determine the associated risk factors.ResultsA total of 1942 eligible grade one students were enrolled, of which 1856 participants completed all examinations. The average age was 6.83 ± 0.46 years, 53% of participants were boys and 1762 were the Tibetan Minority. Over all, the prevalence of strabismus was 68/1856 (3.7%) (95%CI: 2.81,4.52), with no difference between the ages, genders, ethnicities and body mass index, while tilting one’s head when writing may be a risk factor for strabismus (P = 0.004). Strabismus students had mean best corrected visual acuity of 0.16 ± 0.28(LogMAR), over 50% patients with esotropia were hyperopic, and participants who had stereopsis impairments showed a significant difference between esotropia and exotropia (P = 0.026).ConclusionsThe prevalence of strabismus in LCES was 3.7%, which is higher than previous reports from Chinese childhood epidemiology studies. Strabismus is a common contributing factor to amblyopia. Tilting one’s head when writing may be a risk factor. Esotropia is more likely to affect stereopsis and be associated with the refractive state of hyperopia.Trial registrationThe study has finished the clinical registration on Chinese Clinical Trial Registry. (http://www.chictr.org.cn,ChiCTR1900026693).
Advancing universal health coverage in China and Vietnam: lessons for other countries
Authors: Mao Wenhui , Tang Yuchen , Tran Tra , Pender Michelle , Khanh Phuong Nguyen , Tang Shenglan 
Published: November 2020

Abstract
Background
China and Vietnam have made impressive progress towards universal health coverage (UHC) through government-led health insurance reforms. We compared the different pathways used to achieve UHC, to identify the lessons other countries can learn from China and Vietnam.

Methods
This was a mixed method study which included a literature review, in-depth interviews and secondary data analysis. We conducted a literature search in English and Chinese databases, and reviewed policy documents from internal contacts. We conducted semi-structured interviews with 16 policy makers, government bureaucrats, health insurance scholars in China and Vietnam. Secondary data was collected from National Health Statistics Reports, Health Insurance Statistical Reports and National Health Household Surveys carried out in both countries. We used population insurance coverage, insurance policies, reimbursement rates, number of households experiencing catastrophic heath expenditure (CHE) and incidence of impoverishment due to health expenditure (IHE) to measure the World Health Organization’s three dimensions of UHC: population coverage, service coverage, and financial coverage.

Results
China has increased population coverage through strong political commitment and extensive government financial subsidies to expand coverage. Vietnam expanded population coverage gradually, by prioritizing the poor and the near-poor in an incremental way. In China, insurance service packages varied across regions and schemes and were greatly determined by financial contributions, resulting in limited service coverage in less developed areas. Vietnam focused on providing a comprehensive and universal service packages for all enrollees thereby approaching UHC in a more equitable manner. CHE rate decreased in Vietnam but increased in China between 2003 and 2008. While Vietnam has decreased the CHE gap between urban and rural populations, China suffers from persistent disparities among population income levels and geographic location. CHE and CHE rates were still high in lower income groups.

Conclusion
Political commitment, sustainable financial sources and administrative capacity are strong driving factors in achieving UHC through health insurance reform. Health insurance schemes need to consider covering essential health services for all beneficiaries and providing government subsidies for vulnerable populations’ in order to help achieve health for all.
A phase Ib/IIa, randomised, double-blind, multicentre trial to assess the safety and efficacy of expanded Cx611 allogeneic adipose-derived stem cells (eASCs) for the treatment of patients with community-acquired bacterial pneumonia admitted to the intensive care unit
Authors: Laterre Pierre-François , Sánchez-García Miguel , van der Poll Tom , de la Rosa Olga , Cadogan Kathy-Ann , Lombardo Eleuterio , François Bruno 
Published: November 2020

Abstract
Background
Community-acquired bacterial pneumonia (CABP) can lead to sepsis and is associated with high mortality rates in patients presenting with shock and/or respiratory failure and who require mechanical ventilation and admission to intensive care units, thus reflecting the limited effectiveness of current therapy. Preclinical studies support the efficacy of expanded allogeneic adipose-derived mesenchymal stem cells (eASCs) in the treatment of sepsis. In this study, we aim to test the safety, tolerability and efficacy of eASCs as adjunctive therapy in patients with severe CABP (sCABP).

Methods
In addition to standard of care according to local guidelines, we will administer eASCs (Cx611) or placebo intravenously as adjunctive therapy to patients with sCABP. Enrolment is planned for approximately 180 patients who will be randomised to treatment groups in a 1:1 ratio according to a pre-defined randomization list. An equal number of patients is planned for allocation to each group. Cx611 will be administered on Day 1 and on Day 3 at a dose of 160 million cells (2 million cells / mL, total volume 80 mL) through a 20–30 min (240 mL/hr) intravenous (IV) central line infusion after dilution with Ringer Lactate solution. Placebo (Ringer Lactate) will also be administered through a 20–30 min (240 mL/hr) IV central line infusion at the same quantity (total volume of 80 mL) and following the same schedule as the active treatment. The study was initiated in January 2017 and approved by competent authorities and ethics committees in Belgium, Spain, Lithuania, Italy, Norway and France; monitoring will be performed at regular intervals. Funding is from the European Union’s Horizon 2020 Research and Innovation Program.

Discussion
SEPCELL is the first trial to assess the effects of eASCs in sCABP. The data generated will advance understanding of the mode of action of Cx611 and will provide evidence on the safety, tolerability and efficacy of Cx611 in patients with sCABP. These data will be critical for the design of future confirmatory clinical investigations and will assist in defining endpoints, key biomarkers of interest and sample size determination.

Trial registration
NCT03158727, retrospectively registered on 9 May 2017.
CircRNA0001859, a new diagnostic and prognostic biomarkers for COPD and AECOPD
Authors: Chen Shuifang , Yao Yinan , Lu Shan , Chen Junjun , Yang Guangdie , Tu Lingfang , Chen Lina 
Published: November 2020

Abstract
Background
Dysregulation of circRNAs has been reported to be functionally associated with chronic obstructive pulmonary disease (COPD). The present investigation elucidated the potential role of CircRNA0001859 in regulating chronic obstructive pulmonary disease acute (COPD) and Acute Exacerbation of COPD (AECOPD).

Methods
Mice model of COPD was established to screen and verify the dysregulated expression of CircRNA0001859. Fluorescence in situ hybridization (FISH) and quantitative real-time PCR (qRT-PCR) were carried out to detect the expression of CircRNA0001859. 38 stable COPD patients, 24 AECOPD patients, 57 COPD with lung cancer patients and 28 healthy person with age and sex matched to total patients were used for the present investigation.

Results
circRNA0001859 was downregulated in the lung tissue of mice after the three kinds of treatments (Cigarette smoke (CS)/NK alone or CS + NNK) for inducing COPD. FISH assay verified the downregulation of circRNA0001859 both in the mice lung and human bronchial epithelial cell of COPD model. Furthermore,, the level of circRNA0001859 was also downregulated in the peripheral blood of COPD and lung cancer patients. CircRNA0001859 might act as a diagnostic and prognostic biomarker for the treatment of in COPD and AECOPD with Are under the receiver operating characteristic curve (ROC curve) (AUC) of 0.7433 and 0.8717, respectively.

Conclusion
We explored a novel circRNA0001859, which might act as a potential therapeutic biomarker for the treatment of COPD and AECOPD.
Neck subcutaneous nodule as first metastasis from broad ligament leiomyosarcoma: a case report and review of literature
Authors: Cazzato Fiorella , D’Ercole Angela , De Luca Graziano , Aiello Francesca B. , Croce Adelchi 
Published: November 2020

Abstract
Background
Leiomyosarcoma usually develops in the myometrium and is characterized by a high recurrence rate, frequent hematogenous dissemination, and poor prognosis. Metastasis is usually to lungs, liver, and bone, and occasionally to the brain, but seldom to the head and neck region. Primary leiomyosarcoma very rarely arises in the broad ligament.

Case presentation
A 54-year old woman presented to the otolaryngology department with a mass in the right posterior region of the neck 4 years after surgery for a primary leiomyosarcoma of the right broad ligament. The neck mass was removed and found to be a metastatic leiomyosarcoma. Leiomyosarcoma localizations in lungs and liver were absent. Morphological examination showed both the primary and the secondary leiomyosarcomas to have features of low-grade tumors. One year after excision of the neck mass, the patient presented with tachycardia. Echocardiography detected two intracardiac nodules suggestive of metastatic tumors. Chemotherapy was administered; the disease has been stable since then.

Conclusions
We report the first case of broad ligament leiomyosarcoma with the neck subcutaneous region being the first site of secondary involvement. We speculate that the Batson venous plexus might have been the pathway of dissemination.
A novel nomogram for predicting liver metastasis in patients with gastrointestinal stromal tumor: a SEER-based study
Authors: Zhou Guowei , Xiao Keshuai , Gong Guanwen , Wu Jiabao , Zhang Ya , Liu Xinxin , Jiang Zhiwei , Ma Chaoqun 
Published: November 2020

Abstract
Background
Liver metastasis (LIM) of gastrointestinal stromal tumor (GIST) is associated with poor prognosis. The present study aimed at developing and validating nomogram to predict LIM in patients with GIST, thus helping clinical diagnosis and treatment.

Methods
The data of GIST patients derived from Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2016, which were then screened by univariate and multivariate logistic regression for the construction of LIM nomogram. The model discrimination of LIM nomogram was evaluated by concordance index (C-index) and calibration plots, while the predictive accuracy and clinical values were measured by decision curve analysis (DCA) and clinical impact plot. Furthermore, we validated predictive nomogram in the internal testing set.

Results
A total of 3797 patients were enrolled and divided randomly into training and validating groups in a 3-to-1 ratio. After logistic regression, the significant variables were sex, tumor location, tumor size, N stage and mitotic rate. The calibration curves showed the perfect agreement between nomogram predictions and actual observations, while the DCA and clinical impact plot showed the clinical utility of LIM nomogram. C-index of the nomogram was 0.812. What’s more, receiver operating characteristic curves (ROC) also showed good discrimination and calibration in the training set (AUC = 0.794, 95% CI 0.778–0.808) and the testing set (AUC = 0.775, 95% CI 0.748–0.802).

Conclusion
The nomogram for patients with GIST can effectively predict the individualized risk of liver metastasis and provide insightful information to clinicians to optimize therapeutic regimens.
The role of antibody expression and their association with bladder cancer recurrence: a single-centre prospective clinical-pilot study in 35 patients
Authors: Ella-Tongwiis Peter , Lamb Rebecca May , Makanga Alexander , Shergill Iqbal , Hughes Stephen Fôn 
Published: November 2020

Abstract
Background
Bladder cancer (BC) is the 10th most common cancer in the UK, with about 10,000 new cases annually. About 75–85% of BC are non-muscle invasive (NMIBC), which is associated with high recurrence and progression rates (50–60% within 7–10 years). There are no routine biomarkers currently available for identifying BC patients at increased risk of developing recurrence. The focus of this research study was to evaluate antibody expression in BC patients and their association with cancer recurrence.

Methods
35 patients scheduled for TURBT were recruited after written informed consent. Ethical approval for the project was granted via IRAS (REC4: 14/WA/0033). Following surgical procedure, tissues were preserved in 10% buffered formalin and processed within 24 h in FFPE blocks. 7 sections (4 µm each) were cut from each block and stained for CD31, Human epidermal growth factor receptor-2 (HER-2), S100P, Cyclooxygenase-2 (COX-2), VEGFR-3 thrombomodulin and CEACAM-1 using immunohistochemistry. Clinical outcome measures (obtained via cystoscopy) were monitored for up to 6 months following surgical procedure.

Results
There was significantly increased expression of CD31 (p < 0.001), HER-2 (p = 0.032), S100P (p < 0.001), COX-2 (p < 0.001), VEGFR-3 (p < 0.001) and decreased expression of thrombomodulin (p = 0.010) and CEACAM-1 (p < 0.001) in bladder tumours compared to normal bladder tissues. HER-2 expression was also significantly associated with cancer grade (p = 0.003), especially between grade 1 and grade 2 (p = 0.002) and between grade 1 and grade 3 (p = 0.004). There was also a significant association between cancer stage and HER-2 expression (p < 0.001). Although recurrence was significantly associated with cancer grade, there was no association with antibody expression.

Conclusion
Findings from the present study may indicate an alternative approach in the monitoring and management of patients with BC. It is proposed that by allowing urological surgeons access to laboratory markers such as HER-2, Thrombomodulin and CD31 (biomarker profile), potentially, in the future, these biomarkers may be used in addition to, or in combination with, currently used scoring systems to predict cancer recurrence. However, verification and validation of these biomarkers are needed using larger cohorts.
Barriers and facilitators to dental care access among asylum seekers and refugees in highly developed countries: a systematic review
Authors: Paisi Martha , Baines Rebecca , Burns Lorna , Plessas Anastasios , Radford Philip , Shawe Jill , Witton Robert 
Published: November 2020

Abstract
Background
Dental diseases are prevalent among asylum seekers and refugees (ASRs). Despite significant treatment needs, access to dental care in host countries is often limited. The aim of this systematic review was to identify the barriers and enablers to dental care access for ASRs in host countries of very high development.

Methods
Five health and social care databases and eight grey literature sources of information were searched. The Critical Appraisal Skills Programme tool was used to critically appraise included studies. Thematic analysis was undertaken to identify common themes. These were then deductively organised according to Penchansky and Thomas’s modified access model. All review stages were conducted by two independent reviewers.

Results
Nine papers were included in the review. ASRs encounter significant challenges to accessing dental care in their host countries. These include affordability, communication difficulties, insufficient interpretation, limited knowledge of the healthcare systems and healthcare rights, and negative encounters with healthcare teams. The views and experiences of dental care teams providing care to ASRs were explored in only one study.

Conclusions
Both population and healthcare characteristics influence access to dental care for ASRs. Affordability, awareness and accommodation are most frequently described as barriers to dental access for this population. The diverse needs of this population need to be recognised by policy makers, commissioners and practitioners alike. Cultural competence needs to be incorporated into dental services and any interventions to improve access to dental care for this population.
Registration
PROSPERO- International prospective register of systematic reviews (CRD42019145570).
Using interviews and observations in clinical practice to enhance authenticity in virtual patients for interprofessional education
Authors: Wiegleb Edström Desiree , Karlsson Niklas , Edelbring Samuel 
Published: November 2020

Abstract
Background
Interprofessional collaboration is increasingly important in healthcare, but interprofessional education (IPE) faces challenges, such as different study programmes with varied schedules and campuses. These challenges can be met, in part, by using web-based virtual patients (VPs) as a tool in IPE. However, demands for relevant patient presentations and clinical practice increase when VPs are used by students from different programmes. The aim of this study was to improve the presentation of professional perspectives regarding nurses and physicians and their collaboration in order to increase the clinical authenticity of existing VPs.

Methods
Clinical observations were conducted to gain familiarity with the context. Semi-structured interviews were performed with individual nurses and physicians with experience of patients with leg ulcers. The interviews were recorded, transcribed and analysed using thematic analysis.

Results
The clinical observations exposed a lack of interprofessional collaboration in practice with regard to patients with leg ulcers. The interview analysis resulted in two themes: Clinical care and Organizational structure. The theme Clinical care included nursing with a holistic approach to the patient and awareness of the patient’s well-being, including nutrition and home situation. The theme Organizational structure revealed a lack of teamwork in primary care. The interviewees stressed learning together and sharing responsibility, and they emphasised the importance of implementing interprofessional learning in the education of nurses and physicians in order to stimulate future teamwork. The VP should offer a broad medical history so that healthcare students are made aware of how a disease can affect the patient’s social situation, and thereby illustrate the importance of interprofessional collaboration. The information should also be comprehensive and clear, leading to a diagnosis, so the student can gain clinical knowledge and build a foundation for discussion of treatment.

Conclusions
Interviews and observations in clinical practice can be used to enhance authenticity in VPs for interprofessional learning. A thorough look at authentic clinical environments can enrich and improve educational settings using VPs, and it can highlight the challenges students can encounter in clinical care of the patient and in an organisation with regard to interprofessional collaboration.