bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Peer Role-playing to Improve Student Skills for Musculoskeletal Physical Examinations
Authors: Yamauchi Kazuyo , Hagiwara Yoko , Iwakura Nahoko , Kubo Saori , Sato Azusa , Ohtsuru Tadahiko , Okazaki Ken , Okubo Yumiko 
Published: July 2020

Abstract
The traditional curriculum for medical students in Japan does not include sufficient opportunity for the students to develop their skills for musculoskeletal examination and clinical reasoning and diagnosis. So, many residents report a lack of confidence in performing these tasks. Our aim was to assess the effectiveness of peer role-playing to improving these skills among 90 women medical students who were completing their first orthopaedic clinical clerkship. Participants were allocated into two groups. One group participated in role-play (the simulation group) and the other did not participate in role-play because of the clerkship schedule or almanac circumstance (the no-simulation group). This program consisted of two modules: the simulation-based module and the outpatient encounter module. Each module included two sessions. The simulation-based module had two parts: a structured encounter with role-play for musculoskeletal cases, and a structured debriefing with the course supervisor including self-reflection. The students’ performance was observed and assessed using the mini clinical evaluation exercise (mini-CEX) for musculoskeletal cases in the simulation-based module (Day1) and the outpatient encounter module (Day2). The simulation-based module increased the physical examination score on the mini-CEX because of the encounters with real-life patients with musculoskeletal symptoms. This result suggests that role-play as a peer enhancing simulation may help to improve the competency of medical students in performing a musculoskeletal physical examination in a clinical setting.
How joint line orientation affects the amount of bone resection in mechanically aligned TKA: a retrospective clinical-radiographic correlation study
Authors: Wang Zhiwei , Yu Yang , Wen Liang , Ma Desi , Qu Tiebing 
Published: July 2020

Abstract
Background

The discrepancy of bone resections between the medial and the lateral compartment is very common in total knee replacement (TKA) when mechanical alignment (MA) is used. The purpose of this study was to explore whether or how the joint line orientation affects the gross amount of bone resection in mechanically aligned TKA.
Methods

A total of 112 patients (137 knees) diagnosed with osteoarthritis (OA) were included. Simulated bone cuttings were conducted on the coronal view using full-length weight bearing radiographs according to the technical requirement of MA, and the feasibility of simulated osteotomy was verified by intraoperative calipered measurement. Correlation and regression analyses were conducted between the amounts of bone resection and various parameters, including hip-knee-ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), joint line congruency angle (JLCA), and medial proximal tibial angle (MPTA). Moreover, any intraoperative bone resection adjustments if existed, were retrospectively collected using medical records query system.
Results

All knees in current case series can be artificially divided into 4 subgroups: 84 varus knees (61.3%) with valgus femur in subgroup 1, 32 varus knees (23.4%) with varus femur in subgroup 2. 14 valgus knees (10.2%) with varus tibia in subgroup 3, 7 valgus knees (5.1%) with valgus tibia in subgroup 4. The amount of simulated bone resection had high consistency with the intraoperative measurement. MPTA and mLDFA had a positive correlation with the bone resection amount in subgroup 1. The regression equation was Bone resection (mm) = 0.556*mLDFA (deg.) + 0.098*MPTA (deg.) -39.74, R2 = 0.808. Similarly, the intraoperative bone cutting adjustments also showed a certain relationship with mLDFA in subgroup 1.
Conclusions

Deformities of knee OA can be divided into 4 subgroups based on the alignment of extremities and the joint line orientations. When a TKA is performed in varus knee with valgus femur using conventional instrument and mechanical alignment technique, the amount of bone resection on coronal plane is linearly related to the patient’s mLDFA.
Analysis of mRNAs and ncRNAs and Prediction Competing Endogenous RNA Networks in Colorectal Cancer Chemo-Resistance by Whole-Transcriptome Sequencing
Authors: Yao Fei , Zhou Chuanren , Huang Qiyou , Huang Xiaoying , Chen Jie , Zhou Yanling , Wang Qiang , Wu Qingming 
Published: July 2020

Abstract
Background: Chemo-resistance is a major clinical obstacle to the treatment of colorectal cancer (CRC), mRNAs and non-coding RNAs (ncRNAs) have been reported to modulate the development of chemo-resistance. However, the profiles of mRNAs and ncRNAs as well as competing endogenous RNA (ceRNA) networks in CRC chemo-resistance are still unclear, and whether different drug resistance of CRC have the same mechanisms also needs to be explored. This study aims to uncover the expression of mRNAs and ncRNAs in parental cell lines and different chemo-resistant cell lines, and construct ceRNA regulatory networks by whole-transcriptome sequencing.Methods: The expression of mRNAs and ncRNAs in parental cell lines and drug-resistant cell lines were identified by whole-transcriptome sequencing and bioinformatics methods.Results: A total of 1779 mRNAs, 64 miRNAs, 11 circRNAs and 295 lncRNAs were common differentially expressed in two different chemo-resistant cell lines when compared with the control. In addition, 5,767 lncRNA-miRNA-mRNA relationship pairs and 47 circRNA-miRNA-mRNA pathways were constructed according to ceRNA regulatory rules, in which AC109322.2-hsa-miR-371a-5p-BTNL3 and hsacirc_027876-hsa-miR-582-3p-FREM1 were identified as the most potential ceRNA networks involved in drug resistance to CRC. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis of two ceRNA regulatory networks showed that the TNF signaling pathway may be crucial in the process of CRC drug resistance.Conclusions: A large number of mRNAs and ncRNAs in chemo-resistant cell lines were different expressed, which may play pivotal roles in development of drug resistance through the ceRNA regulatory network. This study may improve our understanding of the underlying mechanisms and provide a promising therapeutic strategy for CRC chemo-resistance.
Effect of aspirin versus cilostazol for inhibition of antiplatelet aggregation in type 2 diabetes mellitus patients (ESCORT-DM Study)
Authors: Hong Sangmo , Lee Woo Je , Park Cheol-Young 
Published: July 2020

Abstract
BackgroundThe role of aspirin in primary prevention of cardiovascular disease in patients with diabetes is controversial. In contrast, some studies have suggested beneficial effects of cilostazol on cardiovascular disease in patients with diabetes. Here we prospectively investigated the antiplatelet effects of cilostazol compared with aspirin in patients with diabetes and cardiovascular risk factors.MethodsWe randomly assigned 116 patients with type 2 diabetes and cardiovascular risk factors but no evident cardiovascular disease to receive aspirin at a dose of 100 mg or cilostazol at a dose of 200 mg daily for 14 days. The primary efficacy outcome was antiplatelet effects of aspirin and cilostazol assessed with the VerifyNow system (aspirin response units; ARU) and PFA-100 (closure time; CT). Secondary outcomes were changes of clinical laboratory data.ResultsThe decrease of ARU (-0.4 ± 7.1% vs. -28.9 ± 9.9%, p < 0.001) and the increase of CT (25.7 ± 54.1% vs. 99.6 ± 63.5%, p < 0.001) were significantly greater in aspirin compared cilostazol. The prevalence of aspirin resistance was 7.5% according to VerifyNow (defined by ARU ≥ 550) and 18.9% according to PFA-100 (CT < 192 s). Compared with aspirin, cilostazol treatment was associated with increased HDL cholesterol (7.1 ± 12.7% vs. 4.2 ± 18.0%, p = 0.006) and decreased triglycerides (-9.4 ± 33.7% vs. 4.4 ± 17.57%, p = 0.016). However, there were no significant changes in total and LDL cholesterol, CRP level, and CD40 ligand between cilostazol and aspirin groups.ConclusionsAspirin showed better antiplatelet effects assessed with VerifyNow and PFA-100 compared with cilostazol. However, there were favorable changes in atherogenic dyslipidemia only in the cilostazol treatment group.Trial registrationNCT02933788, dated october 14, 2016
Interventions for Treating Tennis Elbow: An Overview of Systematic Reviews in the Past Ten Years
Authors: Wang Xue , Xiong Jun , Yang Jun , Yuan Ting 
Published: July 2020

Abstract
purpose: Tennis elbow is a common orthopedic disease, and there are many ways to treat it. This overview aimed to summarize the evidence of different treatments for tennis elbows, so as to provide the best guidance for clinical treatment.Methods: Use computer to search CNKI, WanFang database, WeiPu database, CBM database, PubMed, Cochrane Library and Embase from the time of establishment to May 31, 2019.Te Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and latest Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklists were used to assess reporting characteristics and methodological quality, respectively.Results: A total of 37 references were included. Methodological quality and reporting quality were unsatisfactory. Methodological quality was generally low and many key items were not reported. Some research reports are of high quality, but there is no trial registration and protocol written in advance, which may lead to some bias in the research process. The most frequent problems included non-registration of study protocol, absence of a list of excluded studies, and unclear acknowledgment of conflicts of interests. The different types of interventions included have been shown to relieve pain, improve quality of life, and restore elbow function, but there has been a lack of comparative studies.Conclusion: The reporting and methodological quality of systematic reviews and meta-analysis studies were sub-optimal, which demands further improvement. Comparative studies of different types of interventions are needed to determine unclear.PROSPERO registration number: CRD42015017071
A Four-quadrant Mobility Model-based Routing Protocol for Post-earthquake Emergency Communication Network
Authors: Wang Xiaoming , Guo Chang , Li Ping 
Published: July 2020

Abstract
Emergency communication network (ECN) is essential for both disaster victims and rescuers since the pre-deployed network infrastructure may be completely destroyed after the earthquake.Traditional protocols cannot satisfy the requirements of ECN as they neither consider mobility model nor seismic intensity. In this paper, a four-quadrantmobility model (FQMM) based on seismic intensity is proposed for rescuers. Then a FQMM-based protocol (FQMMBP) forECN is designed, which aims to improve the performance of ECN. Simulation results show that the proposed protocol performs better than other three compared routing protocols (AODV, DSDV and DSR) in package delivery rate (PDR) and end-to-end delay. Although the performance of FQMMBP in overhead is not as good as the other three protocols, it is worthwhile for the emergency rescue.
Serum CA242: a biomarker for diagnosis, progression, and metastasis in multiple tumors
Authors: Shen Kaicheng , Qin Xiangquan , Su Xingxing , Yang Yishi , Wang Hongqian , Dai Haisu , Jiang Yan , Bai Jie , Chen Zhiyu 
Published: July 2020

Abstract
Background

CA242 is a classic biomarker used for diagnosing digestive tract tumors, especially pancreatic cancer. However, CA242 serum levels in some tumor patients and what might influence these levels remain unknown or uncertain. This study aimed to reveal the pancancer landscape of serum CA242 levels and identify some influencing factors.
Methods

In the current study, serum CA242 levels and clinical information, including clinical stage and metastatic status, were collected from 37,493 patients with 35 different types of neoplastic disease, and CA242 values were also obtained for 880 healthy controls.
Results

Serum CA242 levels in patients with one of 21 different cancers were significantly higher than those in healthy controls and had diagnostic value in 9 tumors (AUC > 0.7, P < 0.05); serum CA242 levels were increased across all malignant digestive tract tumors. Compared to patients without metastasis, cancer patients with one of 15 kinds of cancer with lymph node metastasis and distant metastasis showed elevated CA242 levels. Moreover, CA242 was helpful in distinguishing the clinical stage and metastatic status in 6 cancers. In addition, the presence of multiple metastases and liver metastasis might result in increased CA242 levels.
Conclusions

Overall, CA242 can not only serve as a diagnostic biomarker for malignant tumors in the digestive system but also predict the progression, stage, and metastasis of many other tumors that have not received clinical attention.
Clinical characteristics of confirmed cases of COVID-19 admitted at Al-Nahdha hospital, Oman: a cross-sectional descriptive study
Authors: Harthi Saud Al , AlOsali Magdi , Ismaili Ruwaida Al , Lawati Sultan Al , Kamble Bina , Shaaibi Mustafa Al , kindi Nasser Al , Qasabi Salim Al , Hinai Mohamed Al , Harthi Hamad Al , Ghafri Thamra Al 
Published: July 2020

Abstract
Background: With the coronavirus disease 19 (COVID-19) pervading the world, little has been published regarding the hospitalized cases of COVID-19 (confirmed) in the Arabian Gulf countries. This paper describes the socio-demographic, clinical, laboratory, and radiological characteristics, treatment and clinical outcomes of these cases in Al-Nahdha hospital, Oman. Additionally, factors associated with requiring critical care were identified.Methods: Data of all the positive cases in Al-Nahdha hospital were retrieved from the electronic health information system retrospectively from 3rd of March to 9th May 2020. Required information was recorded in a bespoke sheet and exported to SPSS for further analysis. The primary outcome was defined as requiring vs not requiring critical care.Results:Out of 102 total admissions, 19 cases required critical care (18.6%). Compared to the non-critical cases, majority of the severe cases requiring critical care were older [54.1(13.4) years vs 48.9(14.9) years], males [89.5% vs 74.7%] and non-nationals [63.2 vs 55.4%]. Significant factors associated with requiring critical care were symptoms of shortness of breath (89.5% vs 65.1%, P=0.03), diabetes (68.4% vs 32.5%, OR=1.5, P=0.004), chronic artery disease (15.8% vs 3.6%, OR=1.7, P=0.04), diagnosis of ARDS (63.2% vs 6.0%, P<0.001). Additionally, the mean ferritin levels was significantly higher in cases requiring critical care compared to their counter cases (2350.4(423.8) vs 795.7(554.3), P=0.005). Depending on disease severity, treatment included anti-bacterial, anti-viral, heparin and steroids. The utilization of steroids was significantly higher in the cases requiring critical care (63.2% vs 26.5%, P=0.001). Out of cases who required critical care (n=19), nine died (death rate= 47.4%). Conclusions:Results from this study provides fundamental information about the non-clinical and clinical characteristics of confirmed COVID-19 cases in Oman. The information obtained can be utilized to follow up the clinical progress of hospitalized patients with COVID-19 in the Arabic speaking countries where such reports are limited.
Examining geographical disparities in the incubation period of the COVID-19 infected cases in Shenzhen and Hefei, China
Authors: Zuopeng Xiao , Guo Wenbo , Zhiqiang Luo , Jianxiang Liao , Feiqiu Wen , Yaoyu Lin 
Published: July 2020

Abstract
Aim Current studies on the COVID-19 depicted a general incubation period distribution and did not examine whether the incubation period distribution varies across patients living in different geographical locations with varying environmental attributes. Profiling the incubation distributions geographically help to determine the appropriate quarantine duration for different regions.Subject and Methods This retrospective study mainly used publicly-accessible clinical report data for patients (n=543) confirmed as infected in Shenzhen and Heifei, China. Based on 217 patients on whom the incubation period could be identified by the epidemiological survey. Statistical and econometric methods were used to investigate how the incubation distributions varied between infected cases reported in Shenzhen and Hefei. Results The median of incubation periods of the COVID-19 for all 217 infected patients was 8 days (95% CI 7 to 9), while median values were 9 days in Shenzhen and 4 days in Heifei. The incubation period probably has an inverse U-shaped association with the meteorological temperature. The warmer condition in the winter of Shenzhen, average environmental temperature between 10℃ to 15℃, may decrease viral virulence and result in more extended incubation periods.Conclusion Case studies of the COVID-19 outbreak in Shenzhen and Hefei indicated that the incubation period of COVID-19 had exhibited evident geographical disparities, although the pathological causality between meteorological conditions and incubation period deserves further investigation.
Extracellular Vesicles from the Apoplastic Fungal Wheat Pathogen Zymoseptoria Tritici
Authors: Hill Erin H , Solomon Peter 
Published: July 2020

Abstract
Background: The fungal pathogen Zymoseptoria tritici is a significant constraint to wheat production in temperate cropping regions around the world. Despite its agronomic impacts, the mechanisms allowing the pathogen to asymptomatically invade and grow in the apoplast of wheat leaves before causing extensive host cell death remain elusive. Given recent evidence of extracellular vesicles (EVs) – secreted, membrane-bound nanoparticles containing molecular cargo – being implicated in extracellular communication between plants and fungal pathogen, we have initiated an in vitro investigation of EVs from this apoplastic fungal wheat pathogen. We aimed to isolate EVs from Z. tritici broth cultures and examine their protein composition in relation to the soluble protein in the culture filtrate and to existing fungal EV proteomes. Results: Zymoseptoria tritici EVs were isolated from broth culture filtrates using differential ultracentrifugation (DUC) and examined with transmission electron microscopy (TEM) and nanoparticle tracking analysis (NTA). Z. tritici EVs were observed as a heterogeneous population of particles, with most between 50 – 100 nm. These particles were found in abundance in the culture filtrates of viable Z. tritici cultures, but not heat-killed cultures incubated for an equivalent time and of comparable biomass. Bottom-up proteomic analysis using LC-MS/MS, followed by stringent filtering revealed 240 Z. tritici EV proteins. These proteins were distinct from soluble proteins identified in Z. tritici culture filtrates, but were similar to proteins identified in EVs from other fungi, based on sequence similarity analyses. Notably, a putative marker protein recently identified in Candida albicans EVs was also consistently detected in Z. tritici EVs. Conclusion: We have shown EVs can be isolated from the devastating fungal wheat pathogen Z. tritici and are similar to protein composition to previously characterised fungal EVs. EVs from human pathogenic fungi are implicated in virulence, but the role of EVs in the interaction of phytopathogenic fungi and their hosts is unknown. These in vitro analyses provide a basis for expanding investigations of Z. tritici EVs in planta, to examine their involvement in the infection process of this apoplastic wheat pathogen and more broadly, advance understanding of noncanonical secretion in filamentous plant pathogens.
Poor Outcomes in Patients with Cirrhosis and COVID-19
Authors: Shalimar  , Elhence Anshuman , Vaishnav Manas , Kumar Ramesh , Pathak Piyush , Soni Kapil Dev , Aggarwal Richa , Soneja Manish , Jorwal Pankaj , Kumar Arvind , Khanna Puneet , Singh Akhil Kant , Biswas Ashutosh , Nischal Neeraj , Dhar Lalit , Choudhary Aashish , Rangarajan Krithika , Mohan Anant , Acharya Pragyan , Nayak Baibaswata , Gunjan Deepak , Saraya Anoop , Mahapatra Soumya , Makharia Govind , Trikha Anjan , Garg Pramod 
Published: July 2020

Abstract
Background and AimThere is a paucity of data on the clinical presentations and outcomes of Coronavirus disease 2019(COVID-19) in patients with underlying liver disease. We aimed to summarize the presentations and outcomes of COVID-19 positive patients and compare with historical controls.MethodsPatients with known chronic liver disease who presented with superimposed COVID- 19(n=28) between 22nd April and 22nd June 2020 were studied. Seventy-eight cirrhotic patients from historical controls were taken as comparison group.ResultsA total of 28 COVID patients- two without cirrhosis, one with compensated cirrhosis, sixteen with acute decompensation (AD), and nine with acute-on-chronic liver failure(ACLF) were included. The etiology of cirrhosis was alcohol(n=9), non-alcoholic fatty liver disease(n=2), viral(n=5), autoimmune hepatitis(n=4), and cryptogenic cirrhosis(n=6). The clinical presentations included complications of cirrhosis in 12(46.2%), respiratory symptoms in 3(11.5%) and combined complications of cirrhosis and respiratory symptoms in 11(42.3%) patients. The median hospital stay was 8(7-12) days. The mortality rate in COVID-19 patients was 42.3%(11/26), as compared to 23.1%(18/78) in the historical controls(p=0.077). All COVID-19 patients with ACLF(9/9) died compared to 53.3%(16/30) in ACLF of historical controls(p=0.015). Mortality rate was higher in COVID patients with compensated cirrhosis and AD as compared to historical controls 2/17(11.8%) vs 2/48(4.2%), though not statistically significant (p=0.278). Requirement of mechanical ventilation independently predicted mortality (hazard ratio, 13.68). Both non-cirrhotic patients presented with respiratory symptoms and recovered uneventfully.ConclusionCOVID-19 is associated with poor outcomes in patients with cirrhosis, with worst survival rates in ACLF. Mechanical ventilation is associated with a poor outcome.