bluuebunny/crossref_metadata_2025_split huggingface dataset:
Value of peri-operative chemotherapy in patients with CINSARC high-risk localized grade 1 or 2 soft tissue sarcoma: study protocol of the target selection phase III CHIC-STS trial
Authors: Filleron Thomas , Le Guellec Sophie , Chevreau Christine , Cabarrou Bastien , Lesluyes Tom , Lodin Sabrina , Massoubre Angélique , Mounier Muriel , Poublanc Muriel , Chibon Frédéric , Valentin Thibaud 
Published: July 2020

Abstract
Background
The value of chemotherapy in soft tissue sarcoma (STS) remains controversial. Several expert teams consider that chemotherapy provides a survival advantage and should be proposed in high-risk (HR) patients. However, the lack of accuracy in identifying HR patients with conventional risk factors (large, deep, FNCLCC grade 3, extremity STS) is an issue that cannot be neglected. For example, while the FNCLCC grading system is a powerful tool, it has several limitations. CINSARC, a 67-gene signature, has proved to be an additional independent factor for predicting metastatic spread and outperforms histological grade. Regardless of FNCLCC grade, CINSARC stratifies patients into two separate prognostic groups: one with an excellent prognosis (low-risk (LR) CINSARC) and the other with a worse outcome (HR-CINSARC) in terms of metastatic relapse. Here we evaluate the role of chemotherapy in grade 1–2 STS patients with HR-CINSARC and assess the prognostic value of CINSARC in patients treated with standard of care.

Methods
CHIC is a parallel, randomized, open-label, multicenter study evaluating the effect on metastasis-free survival of adding perioperative chemotherapy to standard of care in patients with grade ½ STS sarcoma defined as HR by CINSARC. In this target selection design, 600 patients will be screened with CINSARC to randomize 250 HR-CINSARC patients between standard of care and standard of care plus chemotherapy (4 cycles of 3 weeks of intravenous chemotherapy with doxorubicin in combination with dacarbazine or ifosfamide according to histologic subtype). LR-CINSARC patients will be treated by standard of care according to the investigator. The primary endpoint is metastasis-free survival. Secondary endpoints include overall survival, disease-free survival and safety. Furthermore, the prognostic value of CINSARC will be evaluated by comparing LR-CINSARC patients to HR-CINSARC patients randomized in standard of care.

Discussion
CHIC is a prospective randomized phase III trial designed to comprehensively evaluate the benefit of chemotherapy in HR-CINSARC patients and to prospectively validate the prognostic value of CINSARC in grade ½ STS sarcoma patients.

Trial registration
ClinicalTrials.gov identifier: NCT04307277 Date of registration: 13 March 2020
Transient ocular surface non-perfusion during cataract phacoemulsification surgery
Authors: Hu Yijun , Qi Wei , Liu Baoyi , Yu Honghua 
Published: July 2020

Abstract
Background
Complete non-perfusion of the anterior segment vasculature during cataract phacoemulsification surgery is rarely reported.

Case presentation
We present two cases of transient ocular surface non-perfusion (TOSN) during cataract phacoemulsification surgery. The TOSN happened during intraocular lens (IOL) implantation with complete vanish of blood flow in the conjunctival, episcleral and limbal vessels. Reperfusion started within 30 s and part of the blood supply of the conjunctiva and episclera was restored within 2 min. However, the blood flow in the limbal vessels was not restored until 5 min later. The postoperative examination of both eyes was normal. These two rare cases are the TOSN during cataract surgery. We speculated that the significantly increased intraocular pressure during IOL implantation might be the cause of this rare phenomenon.

Conclusion
Non-perfusion of the ocular structures may occur if the IOP peak during IOL injection exceeds the perfusion pressure of the anterior vasculature.
The correlation between vitamin a status and refractory Mycoplasma Pneumoniae pneumonia (RMPP) incidence in children
Authors: Li Yuanyuan , Guo Ziyao , Zhang Guangli , Tian Xiaoyin , Li Qinyuan , Chen Dapeng , Luo Zhengxiu 
Published: July 2020

AbstractBackgroundVitamin A plays a pivotal role in respiratory infection, accurate estimation of vitamin A status was recommended in planning and implementing interventions. As infections affect serum vitamin A productions, the real status need to be adjusted by acute phase protein (APP).Mycoplasma pneumoniaeis an important cause of respiratory infection in children, the association between vitamin A concentrations and refractoryMycoplasma pneumoniaepneumonia (RMPP) remains unclear.Methods181 MPP patients were enrolled in this retrospective study, adjusted vitamin A concentrations and other parameters were compared between RMPP and general-MPP (GMPP) patients. Multivariate logistic regression test was performed to evaluate the association between vitamin A levels and RMPP incidence, linear correlation tests were applied to evaluate correlation between vitamin A concentrations and fever duration, length of stay (LOS).ResultsVitamin A concentrations in RMPP group were significantly lower than those in GMPP patients (P < 0.05), vitamin A (OR = 0.795, 95% C. I 0.669–0.946) and CRP (OR = 1.050, 95% C. I 1.014–1.087) were independently associated with RMPP incidence. Linear correlation tests found vitamin A concentrations were negatively correlated with fever duration and LOS (P < 0.001).ConclusionsSerum vitamin A concentrations were independently associated with RMPP incidence, which may correlate with reduced incidence of RMPP.
Medication management in the context of mental illness: an exploratory study of young people living in Australia
Authors: McMillan Sara S. , Stewart Victoria , Wheeler Amanda J. , Kelly Fiona , Stapleton Helen 
Published: July 2020

Abstract
Background
Young people face significant challenges when managing a mental illness, such as acquiring treatment autonomy, being inexperienced users of the healthcare system and associated peer-related stigma. While medication use can be challenging in its own right, there is comparatively little information about the associated experiences and needs of young people with mental illness, particularly in the Australian context. This exploratory study will provide valuable insight into how this group is currently supported in relation to medication use.

Methods
Young people (aged 14–25 years) who had used a prescription medication for any mental illness for a minimum of 2 months were eligible to participate in this qualitative exploratory study. Semi-structured interviews were conducted between October 2017–September 2018 in consultation rooms at two youth-focused mental health support organisations in Brisbane, Queensland. Interview questions explored how participants managed their medication and related experiences. Interviews were transcribed verbatim and descriptively analysed using thematic analysis.

Results
Eighteen young people discussed their lived experience during interviews averaging 50 min in duration. Finding the right medication that reduced symptom severity with minimal side-effects was identified as a complex experience for many, particularly when there was a lack of information, support or reduced financial capacity. Young people described a range of strategies to manage medication side-effects, changes and to support routine medication use.

Conclusions
Young people persevered with taking medication to manage a mental illness within a healthcare system that does not adequately support this vulnerable population. There remains a clear directive for healthcare professionals to provide credible information that proactively engages young people as healthcare participants, and for policy makers to consider financial burden for this population with limited financial capacity.
Public engagement in the development of the National Health Insurance: a study involving patients from a central hospital in South Africa
Authors: Tandwa Lizeka Amanda , Dhai Ames 
Published: July 2020

Abstract
Background
The National Health Insurance (NHI) is a proposed health policy in South Africa that aims to change the structure of the current health system. Public involvement in policy making is important and it is a constitutional requirement in the legislation development process in South Africa. Patients are key stakeholders and should be engaged in NHI policy process. Before patients can be engaged, they need to be provided with sufficient information about the NHI. Therefore, the aim of this exploratory study was to examine the levels of patient awareness of the NHI, which is a requisite for meaningful engagement.

Methods
This was a cross sectional study of 244 patients from the follow-up clinics at the Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital in the Gauteng Province, South Africa. The patients were interviewed using a structured interview process and a questionnaire. Descriptive statistics and logistic regression analyses were conducted.

Results
The majority (79.51%) of the participants were not aware of the proposed National Health Insurance (NHI) in South Africa even though the NHI policy process commenced in 2011. Of the participants who were aware of the NHI, 86% responded that they had not been provided with an opportunity to be involved in the policy making process of the NHI. The odds of awareness were higher for male (OR: 2.08, 95% CI: 1.11–3.9, p value: 0.02) than female participants; White (OR: 2.36, 95% CI: 1.06–5.26, p value: 0.04) and Indian (OR: 2.76, 95% CI: 0.10–7.60, p value: 0.05) participants when compared to Black participants; and retired (OR: 3.13, 95% CI: 1.35–7.25, p value: 0.008) than unemployed participants.

Conclusion
The levels of awareness of the NHI were low among the participants from Department of Internal Medicine, CMJAH. Without the awareness and information about the NHI, patients are not equipped to be involved in the NHI policy process in a meaningful way. Public patients are the intended beneficiaries of universal health coverage, therefore they should be prioritized in the NHI community engagement process to ensure that the NHI is community and patient centred.
Factors associated with unsafe work behaviours in an Iranian petrochemical company: perspectives of workers, supervisors, and safety managers
Authors: Zahiri Harsini Azita , Ghofranipour Fazlollah , Sanaeinasab Hormoz , Amin Shokravi Farkhondeh , Bohle Philip , Matthews Lynda R. 
Published: July 2020

Abstract
Background
The petrochemical industry is hazardous, in part because of the inherently dangerous nature of the work conducted, and incidents frequently result in significant financial and social losses. The most common immediate cause of incidents and injuries in this industry is unsafe worker behaviour. Identifying the factors encouraging unsafe work behaviours is the first step in taking action to discourage them. The aim of this study was to (a) explore workers’, supervisors’ and safety managers’ attitudes and perceptions of safety in a petrochemical company in Iran, and (b) identify the factors that discourage safe work behaviours.

Methods
A qualitative study was conducted by applying the steps described by Graneheim and Lundman (2004). Twenty participants were recruited from an Iranian petrochemical company using a multi-stage approach, with initial purposive sampling followed by snowball sampling to enhance recruitment. Individual face-to-face and semi-structured interviews were conducted to gain an in-depth understanding of factors acting as barriers to safe behaviour. The interviews were recorded and transcribed in Persian and then translated into English. Conventional content analysis was performed.

Results
The main themes emerging from the interviews were: (i) poor direct safety management and supervision; (ii) unsafe workplace conditions; (iii) workers’ perceptions, skills and training; and (iv) broader organisational factors.

Conclusions
The findings give insights into practical organisational measures that can be implemented by management to promote workers’ commitment to safety and engage in safe behaviours in their workplace.

Trial registration
Iranian Registry of Clinical Trials: IRCT20170515033981N2. Retrospectively registered 19 June 2018.
Clinical outcomes of Ti-Ni shape-memory patella concentrator combined with cannulated compression screws in the treatment of C2 and C3 patella fracture: a retrospective study of 54 cases
Authors: Yao Chen , Sun Jie , Wu Jiancheng , Zhou Zhenyu , Liu Fan , Tao Ran , Zhang Yafeng 
Published: July 2020

Abstract
Background
Ti-Ni shape-memory patella concentrator (TNSMPC) has been designed as an alternative approach for fixation of patella fracture, which has some advantages like higher hardness, higher tenacity, better wearing resistance, excellent corrosion resistance and desired histocompatibility. The present study was to investigate the efficiency of TNSMPC combined with cannulated compression screws in the treatment of comminuted patella fractures.

Methods
Between January 2014 and December 2017, 54 patients of C2 and C3 patella fractures underwent open reduction and internal fixation with TNSMPC combined with cannulated compression screws. All the patients got standard postoperative rehabilitation programs and were regularly followed up for at least 12 months after the operation. X-rays, knee functions and life quality were evaluated during the follow-up.

Results
All the patients achieved bone healing and recovery of knee function with low incidence of complications according to outcomes of X-rays and questionnaires. The average operation time and blood loss during surgery were 77.5 ± 25.12 min and 24.25 ± 4.70 ml respectively. The Knee Outcome Survey Activities of Daily Living Scale, the range of motion and the 36-item short-form heath survey after the operation were all improved. According to the Bostman’s criteria, the excellent to good rate was 92.6%.

Conclusion
TNSMPC combined with cannulated compression screws is an effective internal fixation method for C2 and C3 patella fracture with excellent clinical outcomes. In addition, the operation does not increase extra technique difficulty or tissue damage relatively, which is worth promotion.
The ethics of DNR-decisions in oncology and hematology care: a qualitative study
Authors: Pettersson Mona , Hedström Mariann , Höglund Anna T. 
Published: July 2020

AbstractBackgroundIn cancer care, do not resuscitate (DNR) orders are common in the terminal phase of the illness, which implies that the responsible physician in advance decides that in case of a cardiac arrest neither basic nor advanced Coronary Pulmonary Rescue should be performed. Swedish regulations prescribe that DNR decisions should be made by the responsible physician, preferably in co-operation with members of the team. If possible, the patient should consent, and significant others should be informed of the decision. Previous studies have shown that physicians and nurses can experience ethical dilemmas in relation to DNR decisions, but knowledge about what ethical reasoning they perform is lacking. Therefore, the aim was to describe and explore what ethical reasoning physicians and nurses apply in relation to DNR-decisions in oncology and hematology care.MethodsA qualitative, descriptive and explorative design was used, based on 287 free-text comments in a study-specific questionnaire, answered by 216 physicians and nurses working in 16 oncology and hematology wards in Sweden. Comments were given by 89 participants.ResultsThe participants applied a situation-based ethical reasoning in relation to DNR-decisions. The reasons given for this were both deontological and utilitarian in kind. Also, expressions of care ethics were found in the material. Universal rules or guidelines were seen as problematic. Concerning the importance of the subject, nurses to a higher extent underlined the importance of discussing DNR-situations, while physicians described DNR-decisions as over-investigated and not such a big issue in their daily work.ConclusionThe study revealed that DNR-decisions in oncology and hematology care gave rise to ethical considerations. Important ethical values described by the participants were to avoid doing harm and to secure a peaceful and “natural” death with dignity for their dying patients. A preference for the expression “allow for natural death” instead of the traditional term “do not resuscitate” was found in the material.
Preventing overuse of laboratory diagnostics: a case study into diagnosing anaemia in Dutch general practice
Authors: Kip Michelle M. A. , Oonk Martijn L. J. , Levin Mark-David , Schop Annemarie , Bindels Patrick J. E. , Kusters Ron , Koffijberg Hendrik 
Published: July 2020

Abstract
Background
More information is often thought to improve medical decision-making, which may lead to test overuse. This study assesses which out of 15 laboratory tests contribute to diagnosing the underlying cause of anaemia by general practitioners (GPs) and determines a potentially more efficient subset of tests for setting the correct diagnosis.

Methods
Logistic regression was performed to determine the impact of individual tests on the (correct) diagnosis. The statistically optimal test subset for diagnosing a (correct) underlying cause of anaemia by GPs was determined using data from a previous survey including cases of real-world anaemia patients.

Results
Only 9 (60%) of the laboratory tests, and patient age, contributed significantly to the GPs’ ability to diagnose an underlying cause of anaemia (CRP, ESR, ferritin, folic acid, haemoglobin, leukocytes, eGFR/MDRD, reticulocytes and serum iron). Diagnosing the correct underlying cause may require just five (33%) tests (CRP, ferritin, folic acid, MCV and transferrin), and patient age.

Conclusions
In diagnosing the underlying cause of anaemia a subset of five tests has most added value. The real-world impact of using only this subset should be further investigated. As illustrated in this case study, a statistical approach to assessing the added value of tests may reduce test overuse.
A newly identified lncRNA H1FX-AS1 targets DACT1 to inhibit cervical cancer via sponging miR-324-3p
Authors: Shi Xinghua , Huo Jinzhi , Gao Xingping , Cai Hua , Zhu Weipei 
Published: July 2020

Abstract
Background
Cervical cancer (CC) is the 4th most common cancer-related death in gynecological cancer worldwide. It has been reported that many lncRNAs contribute to oncogenesis although the fundamental mechanisms are basically unknown. Here, we aimed to identify a novel lncRNA H1FX-AS1 and explore a ceRNA network in CC oncogenesis and progression.

Methods
The expression level and the association with the prognosis of H1FX-AS1 in CC patients were analyzed based on Cancer Genome Atlas (TCGA) datasets, and further verified in 50 CC patients. The biological role of H1FX-AS1 was investigated in vitro and in vivo by over-expression of H1FX-AS1 in CC cells; the potential binding sites between H1FX-AS1 and miRNA, between miR-324-3p and DACT1 were predicted by LncBASE and Targetscan respectively, which were further verified by dual-luciferase reporter assay, RNA pull-down and point mutation; the relationship between genes was analyzed by Pearson correlation; the rescue experiments were used to further explore the involved molecular mechanism.

Results
Lower H1FX-AS1 expression in CC tissues was found to be associated with the poor prognosis of CC patients. Over-expression of H1FX-AS1 inhibited CC cell proliferation, migration and invasion, while induced apoptosis by sponging miR-324-3p to up-regulate the DACT1 expression level.

Conclusion
A novel lncRNA H1FX-AS1 was identified, which acted as a competing endogenous RNA (ceRNA) of miR-324-3p to inhibit DACT1 mediated CC progression. Therefore, H1FX-AS1 is a new prognostic predictor and targeting the factors in the H1FX-AS1/miR-324-3p/DACT1 axis is the novel potential therapeutic strategy for CC.
Gut microbiota-associated metabolite trimethylamine N-Oxide and the risk of stroke: a systematic review and dose–response meta-analysis
Authors: Farhangi Mahdieh Abbasalizad , Vajdi Mahdi , Asghari-Jafarabadi Mohammad 
Published: July 2020

AbstractAimsSeveral epidemiological studies have examined the association between trimethylamineN-Oxide (TMAO) and stroke risk; however, the results are still inconclusive. The purpose of this meta-analysis was to evaluate the relationship between TMAO concentrations and stroke risk.MethodsPubMed, Scopus, Cochrane and ProQuest search engines were systematically searched up to 18 June 2019. All of the studies that evaluated the relationship between TMAO and stroke were included in the systematic review and eligible studies were included into the meta-analysis. Meta-regression and subgroup analysis were also employed to find the source of heterogeneity.ResultsEight studies (two cross-sectional studies, two cohort studies, three case-control studies and one nested case-control study) with a total of 6150 participants were included in the meta-analysis. The overall result showed that being in the highest category of TMAO increased the odds of stroke by 68% (OR: 1.675; CI: 0.866–3.243;P = 0.047) and mean TMAO concentrations was 2.201 μmol/L higher in patients with stroke rather than non-stroke controls (weighted mean difference (WMD): 2.20; CI: 1.213–3.188;P < 0.001). Furthermore, we observed revealed a non-linear association between increased TMAO levels and increased odds of stroke (P- for nonlinearity < 0.001). In addition, visual inspection of the funnel plot revealed a significant asymmetry among studies examining the differences in TMAO in patients with stroke versus control group.ConclusionThis is the first meta-analysis to show positive dose-dependent relations between circulating TMAO concentration and stroke risk. However, further interventional studies and long-term studies are needed to better explain causality.