bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aflatoxins as a risk factor for liver cirrhosis: a systematic review and meta-analysis
Authors: Mekuria Abraham Nigussie , Routledge Michael N. , Gong Yun Yun , Sisay Mekonnen 
Published: June 2020

Abstract
Background
Liver cirrhosis is characterized by fibrosis and nodule formation in the liver, due to a chronic injury, and subsequent alteration of the normal architecture of the liver. Even though there is a huge effort to elucidate the possible etiologic factors of liver cirrhosis, a significant number of cases are cryptogenic, especially in Sub Saharan Africa, where there is a high burden of aflatoxin exposure. Aflatoxins are known to cause hepatocellular carcinoma, which share similar etiologic factors with liver cirrhosis. This study aimed to assess the association between aflatoxin exposure and the risk of liver cirrhosis.

Methods
Relevant studies were identified through systematic searches conducted in Ovid MEDLINE, PubMed and Google Scholar. Also, by searching the references of retrieved articles. The abstracts and full text were screened for eligibility and the risk of bias was assessed for each study using Joanna Briggs Institute (JBI) critical appraisal checklist for observational studies. The extracted data from included studies using Microsoft Excel were exported to Stata software version 15.0 for analyses. The overall pooled estimation of outcomes was calculated using a random-effects model of DerSimonian–Laird method at a 95% confidence level. The heterogeneity of studies was determined using I2 statistics. The presence of publication bias between studies was evaluated using the Begg’s and Egger’s tests and funnel plot. The protocol of this systematic review and meta-analysis was registered in the Prospero database with reference number ID: CRD42019148481.

Results
A total of 5 studies published between the years 2005 and 2018 that met the pre-defined inclusion and exclusion criteria were included. The meta-analysis showed that a significant increase in the risk of liver cirrhosis is associated with aflatoxin exposure (unadjusted pooled odds ratio (OR) = 3.35, 95% CI: 2.74–4.10, p = 0.000; I2 = 88.3%, p = 0.000; adjusted OR = 2.5, 95% CI: 1.84–3.39, p = 0.000; I2 = 0%, p = 0.429).

Conclusions
The present meta-analysis suggests that aflatoxin exposure is associated with a higher risk of liver cirrhosis.
Analyzing MRI scans to detect glioblastoma tumor using hybrid deep belief networks
Authors: Reddy Annapareddy V. N. , Krishna Ch. Phani , Mallick Pradeep Kumar , Satapathy Sandeep Kumar , Tiwari Prayag , Zymbler Mikhail , Kumar Sachin 
Published: June 2020

AbstractGlioblastoma (GBM) is a stage 4 malignant tumor in which a large portion of tumor cells are reproducing and dividing at any moment. These tumors are life threatening and may result in partial or complete mental and physical disability. In this study, we have proposed a classification model using hybrid deep belief networks (DBN) to classify magnetic resonance imaging (MRI) for GBM tumor. DBN is composed of stacked restricted Boltzmann machines (RBM). DBN often requires a large number of hidden layers that consists of large number of neurons to learn the best features from the raw image data. Hence, computational and space complexity is high and requires a lot of training time. The proposed approach combines DTW with DBN to improve the efficiency of existing DBN model. The results are validated using several statistical parameters. Statistical validation verifies that the combination of DTW and DBN outperformed the other classifiers in terms of training time, space complexity and classification accuracy.
Bigdata analytics identifies metabolic inhibitors and promoters for productivity improvement and optimization of monoclonal antibody (mAb) production process
Authors: Morris Caitlin , Polanco Ashli , Yongky Andrew , Xu Jianlin , Huang Zhuangrong , Zhao Jia , McFarland Kevin S. , Park Seoyoung , Warrack Bethanne , Reily Michael , Borys Michael C. , Li Zhengjian , Yoon Seongkyu 
Published: June 2020

AbstractRecent advances in metabolite quantification and identification have enabled new research into the detection and control of titer inhibitors and promoters. This paper presents a bigdata analytics study to identify both inhibitors and promoters using multivariate data analysis of metabolomics data. By applying multi-way partial least squares (PLS) model to metabolite data from four fed-batch bioreactor conditions where feed formulation and selection agent concentrations varied, metabolites which exhibited the most significant impact on titer during cultivation were ranked from highest to lowest. The model outputs were then constrained to reduce the number of statistically relevant inhibitors or promoters to the top ten, which were used to conduct metabolic pathway analysis. Furthermore, a method is presented for identifying amino acids that prevent the accumulation of the inhibitors and/or enhance the formation of promoters during production. Finally, the metabolomics and pathway analysis results were integrated and validated with transcriptomics data to characterize metabolic changes occurring among different growth conditions. From these results, new feeding strategies were implemented which resulted in increased fed-batch production titer. Methodology from this work could be applied to future process optimization strategies for biotherapeutic production.
A case of spontaneous mesenteric hematoma with diagnostic difficulty
Authors: Tanioka Nobuhisa , Maeda Hiromichi , Tsuda Sachi , Iwabu Jun , Namikawa Tsutomu , Iguchi Mitsuko , Hanazaki Kazuhiro 
Published: June 2020

Abstract
Background
Spontaneous mesenteric hematoma (SMH) is a rare condition characterized by intraperitoneal hemorrhage of unknown etiology. SMH without worsening of general status allows conservative management; however, patients showing chronological changes on imaging require surgical intervention to rule out possible malignancy.

Case presentation
A 69-year-old man was referred to our hospital to evaluate an abdominal mass with no associated clinical symptoms. He had a history of chronic hepatitis C and diabetes mellitus. Six months earlier, computed tomography (CT) revealed a 75-mm tumor arising from the jejunum, suspected to be a gastrointestinal stromal tumor (GIST) of the small intestine. Following a further 6 months of observation, the patient was referred to our hospital. Abdominal contrast-enhanced CT revealed a well-defined heterogeneous round tumor with a maximum diameter of 75 mm adjacent to the upper jejunum. The tumor was accompanied by calcification at the periphery, with no evidence of augmentation over the prior 6 months. Diffuse lymphadenopathy was observed around the aorta and splenic artery. Under the diagnosis of GIST arising from small intestine, the patient underwent elective surgery. The resection revealed an elastic soft tumor at the mesentery adjacent to the upper jejunum with severe adhesion between the tumor and jejunum. The tumor origin was unclear; thus, we performed mesenteric excision and partial enterectomy without lymph node dissection.
The tumor was surrounded by fibrous capsular tissue containing massive hemosiderin deposits and cholesterol crystals showing partial calcification, resulting in a diagnosis of spontaneous hematoma of the mesentery.

Conclusions
We report a case of SMH mimicking small intestinal GIST. It is difficult to diagnose long-established SMH because its radiological features change with time, and more case reports are needed to improve the accuracy of diagnosis.
Laparoscopic surgery for urachal remnants in pubescent children: a case series
Authors: Hashizume Naoki , Ohtaki Masahiro , Nihei Kouei , Sakamoto Kaoru , Shirahata Yasuhiro , Shimada Tetsuya , Ohta Eriko , Yamai Daisuke , Takeshi Akihiro , Sato Kaito , Suzuki Satoshi , Yagi Minoru 
Published: June 2020

Abstract
Background
Various techniques are applied in laparoscopic surgery for the treatment of urachal remnants, which are less invasive and associated with lower morbidity. We herein report a case series in which we treated urachal remnants and medial umbilical ligaments using a laparoscopic approach.

Case presentation
From 2015 to 2019, seven patients (male, n = 5; female, n = 2) with a urachal remnant were treated by laparoscopic surgery in our institute. Five boys and two girls with a median age of 11 years (range 10–15 years) were enrolled in this series. The clinical results of laparoscopic treatment, the perioperative records, and the pathologic results were evaluated. The operation was performed with the use of three ports and an EZ access® (Hakko Medical, Nagano, Japan), which is a silicon cap for the wound retractor (Lap Protector®, Hakko Medical, Nagano, Japan). The removal of the urachal remnant and medial umbilical ligaments was completed with a median operative time of 92 min (range 69–128). The median hospital stay after surgery was 4 days (range 2–5). No patients developed intra-postoperative complications or recurrence.

Conclusions
Although our data are preliminary, complete laparoscopic removal of symptomatic urachal remnants and medial umbilical ligaments was a safe and effective minimally invasive approach, with better cosmetic outcomes.
Chyle leakage after axillary node sampling in a patient with breast cancer: a case report
Authors: Kohno Norio , Kimoto Takeo , Okamoto Akiko , Tanino Hirokazu 
Published: June 2020

Abstract
Background
Chyle leakage is a well-known complication after thoracic surgery, such as esophagectomy, cardiac surgery, mediastinal lymph node dissection, and neck surgery. However, chyle leakage is a rare complication after dissections of the lateral or subclavian axillary nodes for breast surgery. It is particularly unusual for chyle leakage to occur after minimally invasive dissection of the axillary nodes. Most cases of chyle leakage subside with conservative management, but some cases require surgery.

Case report
An 80-year-old woman had invasive lobular cancer of the left breast (cT1 [1.7 cm], cN0, M0) for which she underwent breast-conservative surgery and biopsy of an axillary sentinel lymph node. Because two of the three sentinel lymph nodes tested positive for cancer, seven lateral axillary lymph nodes (level I) were subsequently removed for the additional sampling. On postoperative day 11, the patient visited our outpatient clinic because of swelling in her left axillary region and breast. Centesis of the axilla yielded 670 mL of milky fluid, which suggested chyle leakage. We commenced the conservative management at first; however, the persistent leakage made us perform the surgical management. The operation was not only ligating the opening of the chyle duct but needed total mastectomy because the postoperative pathology report showed invasive lobular carcinoma; the nipple and the caudal surgical margin of the lumpectomy were positive for cancer. The patient agreed to our recommendation of total mastectomy and surgical management of the chyle leakage. Ligation of the opening completely resolved the chylous discharge.

Conclusion
We here report a case of large-volume leakage of chyle after sampling dissection of the lateral axillary lymph nodes for left breast cancer; the leakage persisted despite the standard conservative therapy but was resolved after surgical treatment. Chyle leakage can occur even after minimally invasive dissection of the axillary nodes.
Stent graft treatment for ruptured pseudoaneurysms of the splanchnic arteries after pancreaticoduodenectomy: a case report
Authors: Nemoto Masaru , Koyama Ken , Enokido Midori , Kudo Shohei , Yoshimi Fuyo 
Published: June 2020

Abstract
Background
Hemorrhage due to a ruptured splanchnic pseudoaneurysm followed by the formation of a postoperative pancreatic fistula is the most severe complication of a pancreatectomy, sometimes leading to a fatal outcome. Stent graft placement to control the hemorrhage due to the pseudoaneurysm is a validated treatment option, but once the stent graft is infected, infection control is complicated. We report a case of a ruptured pseudoaneurysm of the splanchnic artery after pancreaticoduodenectomy to evaluate the stent graft treatment.

Case presentation
A 77-year-old man underwent pylorus-preserving pancreaticoduodenectomy for suspected distal bile duct cancer. Hemorrhage from a pseudoaneurysm of the common hepatic artery due to the formation of the pancreatic fistula was detected on postoperative day 9, and a stent graft was successfully placed with the preservation of hepatic arterial blood flow. On postoperative day 12, new-onset hemorrhage from a pseudoaneurysm of the right hepatic artery developed, and a stent graft was similarly placed, but immediately occluded. Refractory pancreatic and biliary fistulas developed and required continuous drainage. On postoperative day 85, computed tomography revealed the presence of air within the latter stent graft, which indicated infection of the stent graft. The patient died due to sepsis caused by the graft infection.

Conclusion
Stent graft placement for the treatment of hemorrhage of a pseudoaneurysm secondary to a postoperative pancreatic fistula, following pancreaticoduodenectomy, is an effective treatment option as it achieves immediate hemostasis and maintains end-organ perfusion. However, stent graft infection is the most detrimental complication.
Gaining favorable identities of Iranian EFL teachers: a single case study of transition from elementary schools to universities
Authors: Rostami Farzad , Yousefi Mohammad Hosssein , Amini Davoud 
Published: June 2020

AbstractAdopting the self-concept framework as a lens and interpretative case study as a methodological tool, the present study set out to examine how the professional identity of an elementary school teacher is socially (re) constructed while his transition from teaching at elementary schools to teach at universities. The design of the study was the intrinsic case study. The focal participant was an assistant professor of TEFL who has been teaching in elementary, middle, and high schools prior to starting his academic work 10 years ago. For the purpose of the data collection, in-depth interview was conducted. Another source of the data was the participant’s stories, as well as the diaries he had kept over the years. For the data analysis, thematic analysis was employed. Results indicate that the transition was seen to be in parallel with the transition from lower identity perception to higher identity perception. The transition can be best expressed in terms of identity promotion. The results indicate that the transitions were two main and noticeable ones. The data analyses also indicate that three themes, including personal-self, social self, and learners were the driving forces for the case’s professional identity development. The study has a number of implications for teacher education, policymakers, and teachers.
Lessons learned from participatory research to enhance client participation in long-term care research: a multiple case study
Authors: Scheffelaar Aukelien , Bos Nanne , de Jong Marjan , Triemstra Mattanja , van Dulmen Sandra , Luijkx Katrien 
Published: June 2020

Abstract
Background
Although participatory research is known to have advantages, it is unclear how participatory research can best be performed. This study aims to report on lessons learned in collaboration with service users involved as co-researchers in three participatory teams in long-term care.

Methods
A multiple case study design was chosen to explore the collaboration in three teams, each covering one specific client group receiving long-term care: physically or mentally frail elderly people, people with mental health problems or people with intellectual disabilities.

Results
A good working environment and a good collaboration were found to be crucial requirements for participatory research. A good working environment was developed by discussing reasons for engagement and wishes, formulating basic rules, organizing training sessions, offering financial appreciation, and the availability of the researcher to give travel support. The actual collaboration was established by developing a bond and equal positioning, deciding on the role division, holding on to transparency and a clear structure, and have sufficient time for the collaboration. Moreover, the motivations and unique contributions of the co-researchers and differences between the teams were reported. The motivations of co-researchers ranged from individual goals – such as personal development, creating a new social identity and belonging to a social group – to more external goals, such as being valuable for other service users and increasing the quality of care. An inclusive collaboration required valuing the individual contributions of co-researchers and adjustment to team differences.

Conclusions
The results showed the importance of developing a good working environment and establishing a good collaboration for participatory research. Furthermore, the study shows that individual and team differences should be taken into account. These results can be used by researchers for designing and shaping future research projects in long-term care in collaboration with co-researchers.
Development of a dynamic Chest Wall and operating table simulator to enhance congenital heart surgery simulation
Authors: Peel Brandon , Voyer-Nguyen Pascal , Honjo Osami , Yoo Shi-Joon , Hussein Nabil 
Published: June 2020

Abstract
Background
The Hands-On Surgical Training in Congenital Heart Surgery (HOST-CHS) program using 3D printed heart models has received positive feedback from attendees. However, improvements were necessary in the simulator set up to replicate the ergonomics experienced in the operating room. This paper illustrates the development of a dynamic chest wall and operating table simulator to enhance the simulation experience.

Methods
The simulator was designed to address the limitations with the existing set up. This included a suboptimal operating position, unrealistic surgical exposure and limitations in illuminating the operative field and recording procedures. A combination of computer-aided design and various 3D-printing techniques were used to build the components. The simulator’s usefulness was evaluated by surgeons who attended the 5th annual HOST course via a questionnaire.

Results
The simulator consists of three components; an operating table simulator which allows height adjustment and pitch-and-roll motion; a suture retraction disc, which holds sutures under tension to improve exposure; and a pediatric chest wall cavity to replicate a surgeon’s access experience during surgery. Nineteen surgeons completed the questionnaire. All surgeons agreed that the addition of the simulator was acceptable for surgical simulation and that it helped replicate the ergonomics experienced in the operating room.

Conclusions
The inclusion of the HOST-CHS simulator adds value to simulation in congenital heart surgery (CHS) as it replicates the view and exposure a surgeon experiences. Improvements like these will help develop high-fidelity simulation programs in CHS, which could be utilized to train surgeons globally.
Diffusion tensor magnetic resonance imaging of optic pathway in cases of suprasellar masses
Authors: El-Hady Nada Ashraf Abd , Alashwah Mohammad Mahmoud Alhousini , Emam Haitham Haroun , Rahil Ashraf Mohamed Farid 
Published: June 2020

Abstract
Background
Diffusion tensor imaging (DTI) is a novel MRI technique which can provide information of the compressed tissue’s microstructural properties. The evaluation of visual function is important for the clinical management of patients with suprasellar mass lesion. Compression of the optic nerve and chiasm due to pituitary mass lesions often leads to impaired visual function. The evaluation and prognosis of visual function are important for patient management. The aim of this work is to evaluate the feasibility of DTI in the evaluation of the optic pathway in patients with suprasellar masses. Fifty patients were included in the study, 24 cases with suprasellar masses and 26 cases without suprasellar masses as a control group. All patients underwent detailed history taking, MRI of the sella with coronal and sagittal T1, and coronal T2 sequences and DTI. The region of interests (ROIs) were set on the optic chiasm as well as the anterior and posterior optic tracts. For each ROI, axial diffusivity (AD), radial diffusivity (RD), fractional anisotropy (FA), and apparent diffusion coefficient (ADC) values were calculated. DTI parameters of cases group were compared with normal control group parameters.

Results
The result of this study showed that in cases with suprasellar masses, there were significantly lower mean AD and ADC values and higher mean FA value than control group with no masses.

Conclusion
The DTI is a useful technique in the assessment of optic pathway compression degree by suprasellar masses. This will provide the clinicians and surgeons with precise information about the degree of the visual field compromise in correlation with the clinical data.
Undetermined and accidental mortality rates as possible sources of underreported suicides: population-based study comparing Islamic countries and traditionally religious Western countries
Authors: Pritchard Colin , Iqbal Wajid , Dray Rosslyn 
Published: June 2020

BackgroundFour Western countries (Greece, Ireland, Italy and Portugal) with strong Orthodox and Catholic traditions have been associated with the underreporting of death by suicide, and underreported suicides are sometimes found among deaths recorded as ‘undetermined’ or ‘accidental’.AimsThis population-based study tests whether there are any significant difference in patterns of suicides, undetermined deaths and accidental deaths between these four Western countries and 21 predominately Islamic countries.MethodWorld Health Organization age-standardised death rates per million population were used to compare suicide rates with combined undetermined death and accidental death (UnD+AccD) rates, from which odds ratios were calculated. Substantial odds ratios (OR > 2.0) were taken as indicative of likely underreporting of suicides. The Islamic countries come from four different historico-cultural regions, described as: less-traditional Islamic countries; former USSR countries; Gulf Arab states; and Middle Eastern and North African countries. χ2-tests were used to determine any significant differences between the Western comparator countries and the Islamic regions.ResultsFor the Western comparator countries, the average suicide rate was 66 per million population, the average undetermined death rate 56 per million and the average accidental death rate 58 per million, yielding a suicide:UnD+AccD odds ratio (OR) of 1.73. The average values for the other three groups were as follows. Less-traditional Islamic countries: suicide rate, 31 per million; UnD+AccD rate, 101 per million; suicide:UnD+AccD OR = 3.3. Former USSR countries: suicide rate, 61 per million; UnD+AccD rate, 221 per million; suicide:UnD+AccD OR = 3.6. Gulf Arab states: suicide rate, 10 per million; UnD+AccD rate, 76 per million; suicide:UnD+AccD OR = 8.6. Middle Eastern and North African countries: suicide rate, 6 per million; UnD+AccD rate, 151 per million; suicide:UnD+AccD OR = 25.2. The patterns of these mortalities in the Islamic countries was significantly different from Western comparator countries.ConclusionsThe results indicate underreporting of suicides in Islamic countries. This might inadvertently lead to reduced access to mental health preventive services in both Western and Islamic countries.