bluuebunny/crossref_metadata_2025_split huggingface dataset:
Blameless Aegisthus Revisited
Authors: Xian Ruobing 
Published: May 2020

Abstract
In this article I offer a new interpretation of the puzzling phrase ἀµύµονος Αἰγίσθοιο at Od. 1.29 by focusing on the context of Od. 1.29-31. A closer analysis of the passage within the narrative logic of the proem strongly suggests that Zeus, after the departure of Poseidon, should think of Odysseus. While Zeus’ opening speech is to be understood as a covert signal to Athena, Homer’s audience is invited to recognize the speech’s direct relevance to Odysseus: the narrator deliberately utilizes the apparent incongruity of the phrase ‘blameless Aegisthus’ to alert the audience to its significance. Not only is the epithet ἀµύµων most frequently attributed to Odysseus in the Odyssean tradition, but also the formulaic combination between Zeus (ἴστω νῦν Ζεύς) and ‘blameless Odysseus’ (Ὀδυσῆος ἀµύµονος) helps the audience to reflect upon the epic hero’s fate and deeds.
Development of the “POP” scoring system for predicting obstetric and gynecological diseases in the emergency department: a retrospective cohort study
Authors: Okada Asami , Okada Yohei , Fujita Hiroyuki , Iiduka Ryoji 
Published: May 2020

Abstract
Background
Obstetric and gynecological (OBGY) diseases are among the most important differential diagnoses for young women with acute abdominal pain. However, there are few established clinical prediction rules for screening OBGY diseases in emergency departments (EDs). This study aimed to develop a prediction model for diagnosing OBGY diseases in the ED.

Methods
This single-center retrospective cohort study included female patients with acute abdominal pain who presented to our ED. We developed a logistic regression model for predicting OBGY diseases and assessed its diagnostic ability. This study included young female patients aged between 16 and 49 years who had abdominal pain and were examined at the ED between April 2017 and March 2018. Trauma patients and patients who were referred from other hospitals or from the OBGY department of our hospital were excluded.

Results
Out of 27,991 patients, 740 were included. Sixty-five patients were diagnosed with OBGY diseases (8.8%). The “POP” scoring system (past history of OBGY diseases + 1, no other symptoms + 1, and peritoneal irritation signs + 1) was developed. Cut-off values set between 0 and 1 points, sensitivity at 0.97, specificity at 0.39, and negative likelihood ratio (LR-) of 0.1 (95% CI: 0.02–0.31) were considered to rule-out, while cut-off values set between 2 and 3 points, sensitivity at 0.23 (95% CI 0.13–0.33), specificity at 0.99 (95% CI 0.98–1.00), and positive likelihood ratio (LR+) of 17.30 (95% CI: 7.88–37.99) were considered to rule-in.

Conclusions
Our “POP” scoring system may be useful for screening OBGY diseases in the ED. Further research is necessary to assess the predictive performance and external validity of different data sets.
Association between NAFLD and risk of prevalent chronic kidney disease: why there is a difference between east and west?
Authors: Zhang Min , Lin Su , Wang Ming-fang , Huang Jiao-feng , Liu Shi-ying , Wu Su-mei , Zhang Hao-yang , Wu Zi-mu , Liu Wen-Yue , Zhang Dong-Chu , Hao Chuan-ming , Zhu Yue-yong , Zheng Ming-Hua , Wang Xiao-zhong 
Published: May 2020

Abstract
Backgrounds
There is a discrepancy between west and east on the relationship between non-alcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD). This study aimed to find out the possible reason for this and to clarify the association between NAFLD and CKD by analyzing two population-based datasets from the US and China.

Methods
Two health examination datasets from China and the US were used. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2 or and/or abnormal albuminuria and/or overt proteinuria. Binary logistic regression was used to examine the association between NAFLD and CKD.

Results
A total of 60,965 participants were analyzed, including 11,844 from the US and 51,229 from China. The prevalence of NAFLD was 27.12% in the Chinese population and 36.08% in the US population (p < 0.001). The proportions of CKD and late stage CKD (stages 3–5) were higher in the US population than the Chinese one. NAFLD was independently associated with an increased risk of CKD in Chinese population, whereas in the US population, the NAFLD was not an independent risk factor of CKD. In subgroup analyses which excluded late stages CKD (stages 3–5), the risks of mild renal function decline became consistent: NAFLD was associated with early stages of CKD but not the late stages of CKD in both populations.

Conclusion
NAFLD increased the risk of early stages of CKD in both Chinese and the US population. The conflicting results reported by previous studies might result from the different proportion of late stages of CKD.
Metastatic rectal cancer to papillary thyroid carcinoma: a case report and review of literature
Authors: Luo Min , Huang Yu , Li Yongqiang , Zhang Yumei 
Published: May 2020

AbstractBackgroundTumor-to-tumor metastasis is a rare event. Rectal cancer to primary thyroid neoplasm metastasis is extremely rare. Herein, we reported a case of metastatic rectal adenocarcinoma to a papillary thyroid carcinoma. The incidence and clinicopathological characteristics of metastatic colorectal cancer to a thyroid gland neoplasm were described, and the pertinent literature was reviewed.Case presentationA 34-year-old female patient had curative treatment of initial rectal adenocarcinoma in 2012, and was found to have lung metastases by follow-up CT scan 3 years later. In 2018, she was found to have thyroid metastasis by imaging due to left neck pain and hoarseness. A fine-needle aspiration biopsy (FNAB) result suggested suspicious papillary thyroid carcinoma (PTC). The patient underwent a total thyroidectomy and bilateral cervical lymph nodes dissection. The histopathology of thyroidectomy specimen revealed a rectal adenocarcinoma metastatic to the thyroid concomitant with the papillary carcinoma in metastatic adenocarcinoma. The patient received levothyroxine supplementation therapy and palliative chemotherapy with irinotecan and anti-angiogenesis for the metastatic rectal adenocarcinoma. After 1 year of thyroidectomy, no newly developed lesion evidence of recurrent PTC was observed. The patient remains still alive.ConclusionThe possibility of metastases should be considered in patients with a history of rectal cancer and with a thyroid lesion, particularly in those with ageing, hereditary nonpolyposis colorectal cancer (HNPCC) or long-term survival. The diagnosis should be histologically confirmed for the presence of both primary thyroid lesions and secondary thyroid neoplasms. Thyroidectomy may be a feasible treatment for symptomatic thyroid metastasis or thyroid cancer. we need to gain more available evidence from large or multi-center clinical data to help clinicians to diagnose rectal cancer to thyroid neoplasm metastases and evaluate treatment.
Comparison of three dimensional reconstruction and conventional computer tomography angiography in patients undergoing zero-ischemia laparoscopic partial nephrectomy
Authors: Wu Xiaorong , Jiang Chen , Wu Guangyu , Shen Chao , Fu Qibo , Chen Yonghui , Liu Dongming , Xue Wei 
Published: May 2020

Abstract
Background
With the development of three dimensional (3D) reconstruction and printing technology, it has been widely using in the field of urology. However, there have been few studies reporting the role of 3D reconstruction in zero-ischemia partial nephrectomy (PN). The aim of this study was to assess the role of 3D reconstruction and conventional computer tomography angiography (CTA) in zero-ischemia laparoscopic partial nephrectomy (LPN).

Methods
A total of 60 consecutive patients undergoing zero-ischemia LPN between October 2017 and March 2018 who underwent CTA (CTA group including 30 patients) and 3D reconstruction (3D group including the remaining 30 patients) preoperatively were included. 3D reconstruction and CTA images were prepared which were used to demonstrate the number and spatial interrelationships of the location of renal tumors and tumor feeding arteries. These radiological findings were directly correlated with intraoperative surgical findings at laparoscopy. Baseline, perioperative variables and the rate of accurate tumor feeding artery orientation were compared between groups.

Results
All LPNs were completed without conversion to renal hilar clamping or open surgery. Preoperative 3D reconstruction identified that 15 patients had only one tumor feeding artery, 12 had two, and another 3 had three, while the conventional CTA revealed that 22 patients had one tumor feeding artery, 8 had two (P > 0.05). The mean operation time was shorter and estimated blood loss was less in the 3D group (P < 0.05) and the rate of accurate tumor feeding artery dissection was higher in the 3D group (91.7%) in comparison with the CTA group (84.2%). The baseline characteristics and renal function outcomes had no statistical differences between groups.

Conclusions
3D reconstruction can provide comprehensive information for the preoperative evaluation and intraoperative orientation about tumor feeding arteries that may facilitate tumor resection during zero-ischemia LPN for renal tumors.
The association between serum chloride levels and chronic kidney disease progression: a cohort study
Authors: Khatri Minesh , Zitovsky Joshua , Lee Dale , Nayyar Kamal , Fazzari Melissa , Grant Candace 
Published: May 2020

Abstract
Background
Limited data suggest serum chloride levels associate with mortality in heart failure, chronic kidney disease (CKD), and pulmonary arterial hypertension. Randomized trials have also shown that administration of crystalloid intravenous fluids with lower chloride concentration may have better renal outcomes. However, chloride has not been studied longitudinally for CKD progression.

Methods
We used a prospective cohort of subjects with stage 3 and 4 CKD recruited from a nephrology clinic at a single medical center. Linear regression, linear regression with generalized estimating equations, and Cox proportional hazards models were created for outcomes of overall change in estimated glomerular filtration rate (eGFR), longitudinal changes in eGFR, and time to > 30% decline in eGFR, respectively. Baseline chloride was modeled continuously and categorically, and models were adjusted for potential confounders.

Results
Median follow-up was 1.7 years. Baseline median age was 72 years and median eGFR was 35.7 mL/min/1.73m2. In multivariable analysis, higher serum chloride associated with worsened eGFR decline. Every 1 mEq/L increase in chloride associated with an overall eGFR decline of 0.32 mL/min/1.73m2 (p = 0.003), while the difference in eGFR decline in the highest quartile of chloride was 3.4 mL/min/1.73m2 compared to the lowest quartile (p = 0.004). No association between serum chloride and time to 30% decline in eGFR was observed in multivariable analysis (hazard ratio 1.05 per 1 mEq/L increase in serum chloride, p = 0.103).

Conclusions
In CKD patients, higher serum chloride associated with a modestly steeper rate of eGFR decline, and may be a useful biomarker to predict CKD progression. Further studies are needed to determine causality.
Obstetric triage systems: a systematic review of measurement properties (Clinimetric)
Authors: Moudi Asieh , Iravani Mina , Najafian Mahin , Zareiyan Armin , Forouzan Arash , Mirghafourvand Mojgan 
Published: May 2020

Abstract
Background
Since labor and delivery units often serve as emergency units for pregnant women, the use of obstetric triage systems with poor or inadequate quality can lead to unintended consequences such as over and under-triage and so a waste of humans and financial resources. Therefore, this systematic review was conducted to evaluate the measurement properties of obstetric triage tools.

Methods
PubMed, EMBASE, and Medline were searched to identify studies in October 2018 and were updated in May 2019. The risk of bias COSMIN checklist was used to evaluate the quality of the studies. The quality of every measurement property was appraised by the update criteria of COSMIN. Evidence quality was judged using the modified GRADE approach.

Results
A total of 444 studies were retrieved in initial search. Six studies evaluating 4 tools were included in this study. All the included studies reported only content validity and reliability. The quality of evidence varied from very low to moderate. The quality of content validity and reliability of the included tools was sufficient except for the reliability of the maternal-fetal triage index. The obstetric triage acuity scale (OTAS) was found to have higher reliability than other tools.

Conclusions
Due to insufficient evidence, the conclusions about the quality of measurement properties of each obstetric triage tool may be uncertain. This review emphasizes the necessity for further studies with robust methodological quality on the measurement properties of obstetric triage tools.
Impact of the comprehensive geriatric assessment on treatment decision in geriatric oncology
Authors: Sourdet Sandrine , Brechemier Delphine , Steinmeyer Zara , Gerard Stephane , Balardy Laurent 
Published: May 2020

Abstract
Background
The comprehensive geriatric assessment (CGA) is the gold standard in geriatric oncology to identify patients at high risk of adverse outcomes and optimize cancer and overall management. Many studies have demonstrated that CGA could modify oncologic treatment decision. However, there is little knowledge on which domains of the CGA are associated with this change. Moreover, the impact of frailty and physical performance on change in cancer treatment plan has been rarely assessed.

Methods
This is a cross-sectional study of older patients with solid or hematologic cancer referred by oncologists for a geriatric evaluation before cancer treatment. A comprehensive geriatric assessment was performed by a multidisciplinary team to provide guidance for treatment decision. We performed a multivariate analysis to identify CGA domains associated with change in cancer treatment plan.

Results
Four hundred eighteen patients, mean age 82.8 ± 5.5, were included between October 2011 and January 2016, and 384 of them were referred with an initial cancer treatment plan. This initial cancer treatment plan was changed in 64 patients (16.7%). In multivariate analysis, CGA domains associated with change in cancer treatment plan were cognitive impairment according to the MMSE score (p = 0.020), malnutrition according to the MNA score (p = 0.023), and low physical performance according to the Short Physical Performance Battery (p = 0.010).

Conclusion
Cognition, malnutrition and low physical performance are significantly associated with change in cancer treatment plan in older adults with cancer. More studies are needed to evaluate their association with survival, treatment toxicity and quality of life. The role of physical performance should be specifically explored.
Psychosocial, education, economic factors, decision-making ability, and caries status of mothers of children younger than 6 years in suburban Nigeria
Authors: Folayan Morenike Oluwatoyin , El Tantawi Maha , Oginni Ayodeji , Adeniyi Abiola , Alade Michael , Finlayson Tracy L. 
Published: May 2020

Abstract
Background
Little information is available on the relationship between mothers’ psychosocial profile and caries status, and less information is available on the oral health status and psychosocial status of mothers of young children in Africa. This study examined the association between the psychosocial profile of mothers in Nigeria and their prevalence of caries.

Methods
The prevalence of caries and severe caries (DMFT > 3) in mothers with children 71 months old and younger recruited through a household survey in Ile-Ife, Nigeria, was estimated through clinical examination. The explanatory variables were maternal education, income, decision-making status, and psychosocial status (dental anxiety, general anxiety, depressive symptoms, parenting stress, executive dysfunction, sense of coherence, fatalism and social support). The risk indicators for maternal caries were analyzed with logistic regression.

Results
The prevalence of caries was 3.3%. Twenty (39.2%) of the 51 women with caries had DMFT > 3. Most study participants were 25–34 years old (59.3%), had secondary level education (63.1%), earned N18,000 ($49)-N30000 ($84) per month (42.9%), and can make autonomous decisions about their health care, household purchases, or visits to family/relatives (68.8%). Most women had normal general anxiety (79.9%), low dental anxiety (90.4%), and normal stress (76.4%) levels. Most also had high fatalism (56.6%), perceived moderate social support (81.6%), had normal depressive symptoms (75.9%), low executive dysfunction (55.9%), and high sense of coherence (53.8%). Mothers who had clinically significant levels of stress were twice more likely to have caries than were those whose level of stress was normal (AOR: 2.26; 95%CI: 1.04–4.89; P = 0.039). Also, mothers who had high fatalism were less likely to have caries than were those with low fatalism (AOR: 0.40; 95%CI: 0.21–0.75; P = 0.004).

Conclusion
High levels of parenting stress was a risk indicator for caries while high fatalism was protective from caries in mothers of children younger than 6-years. Maternal education, income and decision-making ability were not associated with maternal caries. Though the caries prevalence for women with young children was low, the prevalence of severe caries was high and this because of the possible negative effect on their health and wellbeing.
Frequency, risk factors, and complications of induced abortion in ten districts of Madagascar: results from a cross-sectional household survey
Authors: Ratovoson Rila , Kunkel Amber , Rakotovao Jean Pierre , Pourette Dolores , Mattern Chiarella , Andriamiadana Jocelyne , Harimanana Aina , Piola Patrice 
Published: May 2020

AbstractBackgroundMadagascar has restrictive abortion laws with no explicit exception to preserve the woman’s life. This study aimed to estimate the incidence of abortion in the country and examine the methods, consequences, and risk factors of these abortions.MethodsWe interviewed 3179 women between September 2015 and April 2016. Women were selected from rural and urban areas of ten districts via a multistage, stratified cluster sampling survey and asked about any induced abortions within the previous 10 years. Analyses used survey weighted estimation procedures. Quasi-Poisson regression was used to estimate the incidence rate of abortions. Logistic regression models with random effects to account for the clustered sampling design were used to estimate the risk of abortion complications by abortion method, provider, and month of pregnancy, and to describe risk factors of induced abortion.ResultsFor 2005–2016, we estimated an incidence rate of 18.2 abortions (95% CI 14.4–23.0) per 1000 person-years among sexually active women (aged 18–49 at the time of interview). Applying a multiplier of two as used by the World Health Organization for abortion surveys suggests a true rate of 36.4 per 1000 person-year of exposure. The majority of abortions involved invasive methods such as manual or sharp curettage or insertion of objects into the genital tract. Signs of potential infection followed 29.1% (21.8–37.7%) of abortions. However, the odds of potential infection and of seeking care after abortion did not differ significantly between women who used misoprostol alone and those who used other methods. The odds of experiencing abortion were significantly higher among women who had ever used contraceptive methods compared to those who had not. However, the proportion of women with a history of abortion was significantly lower in rural districts where contraception was available from community health workers than where it was not.ConclusionsIncidence estimates from Madagascar are lower than those from other African settings, but similar to continent-wide estimates when accounting for underreporting. The finding that the majority of abortions involved invasive procedures suggests a need for strengthening information, education and communications programs on preventing or managing unintended pregnancies.
Hsa_circ_0068307 mediates bladder cancer stem cell-like properties via miR-147/c-Myc axis regulation
Authors: Chen Qi , Yin Qiuping , Mao Yemeng , Zhang Zheyu , Wu Siqi , Cheng Zhang , Chen Xinan , Xu Hanren , Jin Shengming , Jiang Haowen , Yang Chen 
Published: May 2020

Abstract
Background
Circular RNAs (circRNAs) play an essential role in the regulation of gene expression. However, the underlying mechanisms remain unknown. This study aimed to evaluate the role of hsa_circ_0068307 in bladder cancer (BCa).

Methods
Rt-qPCR was used to detect hsa_circ_0068307 expression in BCa cell lines. The CCK8, colony formation, and Transwell assays were used to evaluate the effect of hsa_circ_0068307 on BCa cell migration and proliferation. Bioinformatics and luciferase reporter experiments were used to study the regulatory mechanism. Nude mouse xenografts were generated to examine the effect of hsa_circ_0068307 on tumor growth.

Results
The results showed that hsa_circ_0068307 was upregulated in BCa cell lines. Downregulation of hsa_circ_0068307 suppressed cell migration and proliferation in T24 and UMUC3 cells. Hsa_circ_0068307 silencing suppressed cancer stem cell differentiation by upregulating miR-147 expression. Upregulation of miR-147 suppressed c-Myc expression, which is involved in cancer stem cell differentiation. Luciferase reporter assays confirmed that hsa_circ_0068307 upregulated c-Myc expression by targeting miR-147. In vivo studies showed that hsa_circ_0068307 knockdown suppressed T24 tumor growth.

Conclusions
These data indicate that downregulation of hsa_circ_0068307 reversed the stem cell-like properties of human bladder cancer through the regulation of the miR-147/c-Myc axis.
Electromagnetic hypersensitivity: a critical review of explanatory hypotheses
Authors: Dieudonné Maël 
Published: May 2020

AbstractBackgroundElectromagnetic hypersensitivity (EHS) is a condition defined by the attribution of non-specific symptoms to electromagnetic fields (EMF) of anthropogenic origin. Despite its repercussions on the lives of its sufferers, and its potential to become a significant public health issue, it remains of a contested nature. Different hypotheses have been proposed to explain the origin of symptoms experienced by self-declared EHS persons, which this article aims to review.MethodsAs EHS is a multi-dimensional problem, and its explanatory hypotheses have far-reaching implications, a broad view was adopted, not restricted to EHS literature but encompassing all relevant bodies of research on related topics. This could only be achieved through a narrative approach. Two strategies were used to identify pertinent references. Concerning EHS, a complete bibliography was extracted from a 2018 report from the French Agency for Food, Environmental and Occupational Health & Safety and updated with more recent studies. Concerning related topics, the appropriate databases were searched. Systematic reviews and expert reports were favored when available.FindingsThree main explanatory hypotheses appear in the literature: (1) the electromagnetic hypothesis, attributing EHS to EMF exposure; (2) the cognitive hypothesis, assuming that EHS results from false beliefs in EMF harmfulness, promoting nocebo responses to perceived EMF exposure; (3) the attributive hypothesis, conceiving EHS as a coping strategy for pre-existing conditions. These hypotheses are successively assessed, considering both their strengths and limitations, by comparing their theoretical, experimental, and ecological value.ConclusionNo hypothesis proves totally satisfying. Avenues of research are suggested to help decide between them and reach a better understanding of EHS.