bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of sagittal profile and radiographic parameters in symptomatic thoracolumbar disc herniation patients
Authors: Gao Ang , Yu Miao , Wang Yongqiang , Liu Xiaoguang 
Published: October 2020

Abstract
Background Few studies describe thoracolumbar disc herniation (TLDH) as an isolated category, it is frequently classified as the lower thoracic spine or upper lumbar spine. Thus, less is known about the morphology and aetiology of TLDH compared to lumbar disc herniation (LDH). The aim of study is to investigate sagittal alignment in TLDH and analyze sagittal profile with radiographic parameters.Methods Data from 70 patients diagnosed with TLDH were retrospectively reviewed. The thoracic-lumbar alignment was depicted by description of curvatures (the apex of lumbar curvature, the apex of thoracic curvature, and inflexion point of the two curvatures) and radiographic parameters from complete standing long-cassette spine radiographs. The rank sum test was utilised to compare radiographic parameter values in each subtype. Results We found two subtypes differentiated by the apex of thoracic kyphotic curves. The apex of the thoracic kyphotic curve located in the middle thoracic spine in type I, and the apex of the thoracic kyphotic curve located in the thoracolumbar region in type II patients. Thirty-six patients were classified as type I, and 34 patients were classified as type II. The mean sagittal vertical axis, T1 pelvic angle and L1 pelvic angle were 27.9±24.8°, 8.2±7.3° and 6.2±4.9°, respectively. There was significant difference (p<0.001) of thoracolumbar angle between type I (14.9±7.9°) and type II patients (29.1±13.7°).Conclusions We presented two distinctive sagittal profiles in TLDH patients, and a regional kyphotic deformity with a balanced spine was validated in both subtypes. In view of the different curvatures, different aetiologies were discovered in each subtype. Mismatch between shape and sacral slope value was observed, and better agreement was found in Type II patients.
Computer-Assisted femoral head reduction osteotomies: An approach for anatomic reconstruction of severely deformed Legg-Calvé-Perthes hips. A pilot study of six patients
Authors: Fürnstahl Philipp , Casari Fabio A. , Ackermann Joëlle , Marcon Magda , Leunig Michael , Ganz Reinhold 
Published: October 2020

Abstract
Background Legg–Calvé–Perthes (LCP) is a common orthopedic childhood disease that causes a deformity of the femoral head and to an adaptive deformity of the acetabulum. The altered joint biomechanics can result in early joint degeneration that requires total hip arthroplasty. In 2002, Ganz et al. introduced the femoral head reduction osteotomy (FHRO) as a direct joint-preserving treatment. The procedure remains one of the most challenging in hip surgery. Computer-based 3D preoperative planning and patient-specific navigation instruments have been successfully used to reduce technical complexity in other anatomies. The purpose of this study was to report the first results in the treatment of 6 patients to investigate whether our approach is feasible and safe.Methods In this retrospective pilot study, 6 LCP patients were treated with FHRO in multiple centers between May 2017 and June 2019. Based on patient-specific 3D-models of the hips, the surgeries were simulated in a step-wise fashion. Patient-specific instruments tailored for FHRO were designed, 3D-printed and used in the surgeries for navigating the osteotomies. The results were assessed radiographically [diameter index, sphericity index, Stulberg classification, extrusion index, LCE-, Tönnis-, CCD-angle and Shenton line] and the time and costs were recorded. Radiologic values were tested for normal distribution using the Shapiro–Wilk test and for significance using Wilcoxon signed-rank test.Results The sphericity index improved postoperatively by 20% (p = 0.028). The postoperative diameter of the femoral head differed by only 1.8% (p = 0.043) from the contralateral side and Stulberg grading improved from poor coxarthrosis outcome to good outcome (p = 0.026). All patients underwent acetabular reorientation by periacetabular osteotomy. The average time (in minutes) for preliminary analysis, computer simulation and patient-specific instrument design was 63 (±48), 156 (±64) and 105 (±68.5), respectively.Conclusion The clinical feasibility of our approach to FHRO has been demonstrated. The results showed significant improvement compared to the preoperative situation. All operations were performed by experienced surgeons; nevertheless, three complications occurred, showing that FHRO remains one of the most complex hip surgeries even with computer assistance. However, none of the complications were directly related to the simulation or the navigation technique.
Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy for uterus weighing ≥ 1kg
Authors: Wang Xiaojuan , LI Junwei , Hua Keqin , Chen Yisong 
Published: October 2020

Abstract
Background: The transvaginal natural orifice transluminal endoscopic surgery (vNOTES) applied in gynecology has been developed recent years and been evolving. In this study, we aimed to evaluate the feasibility and effect of the vNOTES hysterectomy for uterus ≥ 1 kilogram (kg).Methods: From January 2019 to March 2020, patients with benign indications in cases of uterus weighing ≥ 1kg, underwent vNOTES hysterectomy were studied retrospectively. The patients’ demographics, indications for surgery, operation outcomes and follow-up details were recorded. Results: 39 patients were performed vNOTES hysterectomy for large uterus (mean weight 1141.8 gram, range from 1000 to 1720), indications for surgery included bulky uterine myomas or adenomysosis. The mean age was 48 years (range 42-66) and mean BMI was 24 kg/m2 (range 18.4-38). Mean operating time was 123.3 minutes (rang 40-400) and the mean estimated blood loss was 206.7 milliliters (range 10-1300). The mean pain assessment was 2.1 (range 0-5). The mean length of stay was 2.4 nights (1-11). 1 patient experienced ureteral injury and was performed ureteral anastomosis. 3 patients were converted to vaginal-assisted trans-umbilicus single-port laparoscopy. The learning curve was analyzed to show that 20 cases were needed to achieve proficiency in vNOTES hysterectomy for large uterus ≥ 1 kg.Conclusion: Our preliminary experience suggested that vNOTES hysterectomy for large uterus weighing ≥ 1kg was feasible and safe, meanwhile this procedure had the advantages of all the minimal invasive approach such as fast recovery and aesthetic advantage.
A Tripartite Analysis of Online Healthcare Platforms: Evidence from Spring Rain Doctor in China
Authors: Cao Xia , Zhang Lanting , Lv Dan , Li Weijia , Xing Zeyu 
Published: October 2020

Abstract
Background: Online healthcare platform (OHP) is a new form of medical treatment, which solves the problems of unbalanced distribution of medical resources and expensive medical treatment in China. Especially under the epidemic of COVID-19, OHP has greatly reduced the medical pressure of the hospital and the risk of cross infection. Methods: This paper uses evolutionary game theory to analyze behavioral strategies and their dynamic evolution in the promotion of OHP, and then numerical simulations are carried out with the help of program compilation. Results: The results demonstrate that: (1) both the stricter qualification inspection of doctors and the more investment in information protection promote the participation of doctors and the use of patients; (2) with a higher initial probability of doctors joining, the possibility for patients in using OHP and platforms to provide standardized online healthcare services becomes higher; (3) if the initial probability of patients using is higher, the possibility for doctors to join OHP and platforms to provide standardized online healthcare services raises; (4) the trend of doctors joining the platform is affected by factors, such as registration cost, time cost, reputation loss ; (5) the tendency of patients in using online healthcare is mainly decided by the cost.Conclusions: Based on theoretical analysis, this article takes the Spring Rain Doctor OHP as an example to verify the game results. Therefore, OHP should attach importance to the inspection of doctors and the protection of privacy information, and strengthen the publicity in remote places. At the same time OHP can promote the active participation of grassroots doctors, and set a reasonable evaluation mechanism, so as to popularize online medical treatment among patients further.
The impact of individual creativity, psychological capital, and leadership autonomy support on hospital employees’ innovative behaviour
Authors: Slåtten Terje , Mutonyi Barbara Rebecca , Lien Gudbrand 
Published: October 2020

Abstract
Background: There is growing interest in and focus on healthcare services research to identify factors associated with innovation in healthcare organizations. However, previous innovation research has concentrated primarily on the organizational level. In contrast, this study focuses on innovation by individual employees. The specific aim is to examine factors with potential impact on individual employee innovation in hospital organizations. Thus, the study significantly deepens and broadens previous research on innovation in the domain of health services.Methods: A conceptual model was developed and tested on a sample of hospital employees (n=1008). Partial least-squares structural equation modelling (PLS-SEM) was used to analyse the data with SmartPLS 3 software in two steps involving a measurement model and a structural model. Mediation analysis was used to test the proposed indirect effects.Results: Hospital employees’ individual innovative behaviour is directly and positively associated with individual creativity (b = 0.440), psychological capital (b = 0.34) and leadership autonomy support (b = 0.07). The relationships between leadership autonomy support, psychological capital and individual innovative behaviour are all mediated by employees’ creativity. Psychological capital mediates the relationship between leadership autonomy support and individual innovative behaviour. Overall, the proposed model explains 50% of the variance in hospital employees’ innovative behaviour.Conclusions: This study reveals a complex pattern of links between innovative behaviour and leadership autonomy support, employees’ creativity and employees’ psychological capital. However, the findings indicate that leadership autonomy support has an influential and multifaceted impact on hospital employees’ innovative behaviour.
A novel modification of the Endorectal Advancement Flap for complex anal fistulas: surgical technique and outcomes
Authors: Al-Turaihi Hassan , Elizabeth Blears , Kavin Sugumar , Ganesh Deshmukh 
Published: October 2020

Abstract
Background:Fistula-in-ano is a common problem encountered by surgeons which can be classified as either simple or complex. Complex fistulas (CF) cause higher morbidity and are much more challenging to treat. Although numerous treatment options are available for CF, none are proven to be 100% effective. The endorectal advancement flap (EAF) procedure was developed as an alternative to conventional surgical treatments for CF. Herein, we describe a novel modification of the EAF procedure along with surgical outcomes in terms of recurrence, fecal incontinence and factors associated with flap failure. Methods:A retrospective review of patients with CF who underwent EAF between 2004-2019 was done. The conventional EAF procedure was modified by performing transverse imbrication of the internal sphincter over the internal fistula opening. The incidence of post-operative recurrence and fecal incontinence were calculated from chart documentation at the last available date of follow-up. Also, the association between various clinical and demographic factors and post-operative flap failure were calculated using statistical significance at alpha of 0.05. Results: With a median follow-up of 6.6 months (range: 3.3-24 months), 99 patients with CFs underwent a modified EAF. Of these, 93% (92/99) had a successful procedure, 7% (7/99) experienced recurrence and 1% (1/99) experienced new-onset fecal incontinence. Systemic steroid or immunomodulatory therapy use (p=0.001) and patients with diagnosed inflammatory bowel disease (p<0.0001) were associated with increased rate of recurrence.Conclusion:EAF with transverse imbrication of the internal opening using interrupted, absorbable suture is an effective technique to treat complex or recurrent anal fistulas. It is associated with a low risk of recurrence (7%) and fecal incontinence (1%) and a valid treatment option for CFs.
CD4 T-cell immune stimulation of HER2+ breast cancer cells alters response to trastuzumab in vitro
Authors: Song Patrick , Mansur Amer , Dugger Kari J. , Davis Tessa R. , Howard Grant , Yankeelov Thomas E. , Sorace Anna G. 
Published: October 2020

Abstract
Introduction: The HER2+ tumor immune microenvironment is composed of macrophages, natural killer cells, and tumor infiltrating lymphocytes, which produce pro-inflammatory cytokines. Determining the effect of T-cells on HER2+ cancer cells during therapy could guide immunogenic therapies that trigger antibody-dependent cellular cytotoxicity. This study utilized longitudinal in vitro time-resolved microscopy to measure T-cell influence on trastuzumab in HER2+ breast cancer.Methods: Fluorescently-labeled breast cancer cells (BT474, SKBR3, MDA-MB-453, and MDA-MB-231) were co-cultured with CD4+ T-cells (Jurkat cell line) and longitudinally imaged to quantify cancer cell viability when treated with or without trastuzumab (10, 25, 50 and 100 mg/mL). The presence and timing of T-cell co-culturing was manipulated to determine immune stimulation of trastuzumab-treated HER2+ breast cancer. HER2 and TNF-a expression were evaluated with western blot and ELISA, respectively. Significance was calculated using a two-tailed parametric t-test.Results: The viability of HER2+ cancer cells significantly decreased when exposed to 25 mg/mL trastuzumab and T-cells, compared to cancer cells exposed to trastuzumab without T-cells (p = 0.01). The presence of T-cells significantly increased TNF-a expression in trastuzumab-treated cancer cells (p = 0.02). Conversely, cancer cells treated with TNF-a and trastuzumab had a similar decrease in viability as trastuzumab-treated cancer cells co-cultured with T-cells (p = 0.32).Conclusions: The presence of T-cells significantly increases the efficacy of targeted therapies and suggests trastuzumab may trigger immune mediated cytotoxicity. Increased TNF-a receptor expression suggest cytokines may interact with trastuzumab to create a state of enhanced response to therapy in HER2+ breast cancer, which has potential to reducing tumor burden.
Patterns of informal family care during acute hospitalization of older adults from different ethno-cultural groups in Israel.
Authors: Shulyaev Ksenya , Gur-Yaish Nurit , Shadmi Efrat , Zisberg Anna 
Published: October 2020

Abstract
Introduction Informal caregiving during hospitalization of older adults is significantly related to hospital processes and patient outcomes. Studies in home settings demonstrate that ethno-cultural background is related to various aspects of informal caregiving; however, this association in the hospital setting is insufficiently researched.Objectives Our study explore potential differences between ethno-cultural groups in the amount and kind of informal support they provide for older adults during hospitalization.Methods This research is a secondary data analysis of two cohort studies conducted in Israeli hospitals. Hospitalized older adults are divided into three groups: Israeli-born and veteran immigrant Jews, Arabs, and Jewish immigrants from the Former Soviet Union (FSU). Duration of caregiver visit, presence in hospital during night hours, type of support (using the Informal Caregiving for Hospitalized Older Adults scale) are assessed during hospitalization. Results are controlled by background parameters including functional Modified Barthel Index (MBI) and cognitive Short Portable Mental Status Questionnaire (SPMSQ) status, chronic morbidity (Charlson), and demographic characteristics.Results Informal caregivers of “FSU immigrants” stay fewer hours during the day in both cohorts, and provide less supervision of medical care in Study 2, than caregivers in the two other groups. Findings from Study 1 also suggest that informal caregivers of “Arab” older adults are more likely to stay during the night than caregivers in the two other groups.Conclusions Ethno-cultural groups differ in their patterns of caregiving of older adults during hospitalization. Health care professionals should be aware of these patterns and the cultural norms that are related to caregiving practices for better cooperation between informal and formal caregivers of older adults.
The implications of clinical risk factors, CAR index, and compositional changes of immune cells on hyperprogressive disease in non-small cell lung cancer patients receiving immunotherapy
Authors: Kim Seo Ree , Chun Sang hoon , Kim Joo ri , Kim Sang-Yeob , Seo Jun young , Jung Chan Kwon , Gil Bo-Mi , Kim Jeong-Oh , Ko Yoon Ho , Woo In Sook , Shim Byoung Yong , Hong Sook-Hee , Kang Jin-Hyoung 
Published: October 2020

Abstract
Background: Immune checkpoint blockades (ICBs) are characterized by a durable clinical response and better tolerability in patients with a variety of advanced solid tumors. However, we not infrequently encounter patients with hyperprogressive disease (HPD) exhibiting paradoxically accelerated tumor growth with poor clinical outcomes. This study aimed to investigate implications of clinical factors and immune cell composition on different tumor responses to immunotherapy in patients with non-small cell lung cancer (NSCLC).Methods: This study evaluated 231 NSCLC patients receiving ICBs between January 2014 and May 2018. HPD was defined as a >2-fold tumor growth kinetics ratio during ICB therapy and time-to-treatment failure of ≤ 2 months. We analyzed clinical data, imaging studies, periodic serologic indexes, and immune cell compositions in tumors and stromata using multiplex immunohistochemistry.Results: Of 231 NSCLC patients, PR/CR and SD were observed in 50 (21.6%) and 79 (34.2%) patients, respectively and 26 (11.3%) patients met the criteria for HPD. Median overall survival in poor response groups (HPD and non-HPD PD) was extremely shorter than region disease-controlled group (SD and PR/CR) (5.5 and 6.1 months vs. 16.2 and 18.3 months, respectively, P= 0.000). In multivariate analysis, HPD were significantly associated with heavy smoker (p=0.0072), PD-L1 expression ≤1% (0.0355), and number of metastatic site ≥3 (0.0297). Among the serologic indexes including NLR, PLR, CAR, and LDH, only CAR had constantly significant correlations with HPD at the beginning of prior treatment, immunotherapy, and at the 1st tumor assessment. The number of CD4+ effector T cells and CD8+ cytotoxic T cells, and CD8+/PD-1+ tumor-infiltrating lymphocytes (TIL) tended to be smaller, especially in stromata of HPD group. More M2-type macrophages expressing CD14, CD68 and CD163 in the stromal area and markedly fewer CD56+ NK cells in the intratumoral area were observed in HPD group.Conclusions: Our study suggests that not only clinical factors including heavy smoker, very low PD-L1 expression, multiple metastases, and CAR index, but also fewer CD8+/PD-1+ TIL and more M2 macrophages in the tumor microenvironment are significantly associated with the occurrence of HPD in the patients with advanced/metastatic NSCLC receiving immunotherapy.
Adverse events of video capsule endoscopy over the past two decades: a systematic review and proportion meta-analysis
Authors: Wang Yuan-Chen , Pan Jun , Liu Ya-Wei , Sun Feng-Yuan , Qian Yang-Yang , Jiang Xi , Zou Wen-Bin , Xia Ji , Jiang Bin , Ru Nan , Zhu Jia-Hui , Linghu En-Qiang , Li Zhao-Shen , Liao Zhuan 
Published: October 2020

Abstract
Backgrounds and Aims: A full spectrum of video capsule endoscopy (VCE) adverse events over the past two decades has not been evaluated. We aimed to determine pooled rates, predictors and temporal-trend of VCE adverse events over the past two decades. Methods: Systematic search of PubMed and EMBASE for English-language publications reporting VCE adverse events (January 1, 2000 to March 31, 2019). Data were extracted independently by two investigators. Pooled VCE adverse event rates were calculated using the random or fixed model as appropriate. Predictors and temporal-trend of each adverse event were performed by meta-regression analyses. Results: In total, 402 studies were identified, including 108,079 VCE procedures. Rate of retention, swallow disorder, aspiration, technical failure, and procedural adverse events were 0.73% (95% confidence interval [CI], 0.59%-0.89%), 0.75% (95% CI, 0.43%-1.13%), 0.00% (95% CI, 0.00%-0.00%), 0.94% (95% CI, 0.65%-1.28%), 0.67% (95% CI, 0.32%-1.10%), respectively; incomplete examination rate of esophagus, stomach, small bowel, and colon were 9.05%, 7.69%, 12.08%, 19.19%, respectively. Patency capsule reduced retention rate by 5.04%, whereas known inflammatory bowel disease increased retention rate by 4.29%. Elder was the risk and protective factor for small bowel incomplete examination (0.30%) and swallow disorder (-0.72%), respectively. Rates of retention and small bowel incomplete examination significantly declined over time ( P = .0006 and P < .0001). Conclusions: VCE adverse event rates were generally low, and retention and small bowel incomplete examination rates declined over the past two decades. Patients with known inflammatory bowel disease or elder should be alerted to high risk of retention or small bowel incomplete examination (PROSPERO: CRD42019139595).