bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retrospective comparison of three minimally invasive approaches for adrenal tumors: perioperative outcomes of transperitoneal laparoscopic, retroperitoneal laparoscopic and robot-assisted laparoscopic adrenalectomy
Authors: Ji Changwei , Lu Qun , Chen Wei , Zhang Feifei , Ji Hao , Zhang Shiwei , Zhao Xiaozhi , Li Xiaogong , Zhang Gutian , Guo Hongqian 
Published: June 2020

Abstract
Background
To compare the perioperative outcomes of transperitoneal laparoscopic (TLA), retroperitoneal laparoscopic (RLA), and robot-assisted transperitoneal laparoscopic (RATLA) adrenalectomy for adrenal tumors in our center.

Methods
Between April 2012 and February 2018, 241 minimally invasive adrenalectomies were performed. Cases were categorized based on the minimally invasive adrenalectomy technique. Demographic characteristics, perioperative information and pathological data were retrospectively collected and analyzed.

Results
This study included 37 TLA, 117 RLA, and 87 RATLA procedures. Any two groups had comparable age, ASA score, Charlson Comorbidity Index, and preoperative hemoglobin. The tumor size for RLA patients was 2.7 ± 1.1 cm, which was significantly smaller compared to patients who underwent TLA/RATLA (p = 0.000/0.000). Operative time was similar in any two groups, while estimated blood loss was lower for RATLA group (75.6 ± 95.6 ml) compared with the TLA group (131.1 ± 204.5 ml) (p = 0.041). Conversion to an open procedure occurred in only one (2.7%) patient in the TLA group for significant adhesion and hemorrhage. There were no significant differences between groups in terms of transfusion rate and complication rate. Length of stay was shorter for the RATLA group versus the TLA/RLA group (p = 0.000/0.029). In all groups, adrenocortical adenoma and pheochromocytoma were the most frequent histotypes.

Conclusions
Minimally invasive adrenalectomy is associated with expected excellent outcomes. In our study, the RATLA approach appears to provide the benefits of decreased estimated blood loss and length of stay. Robotic adrenalectomy appears to be a safe and effective alternative to conventional laparoscopic adrenalectomy.
No research for the decisionally-impaired mentally ill: a view from Montenegro
Authors: Dakić Tea 
Published: June 2020

AbstractBackgroundMany of the important elements of a valid informed consent – comprehension, voluntariness, and capacity – can be compromised or unmet in the context of psychiatric research. The inability to protect their own interests puts mentally ill subjects at an increased likelihood of being wronged or harmed and makes them particularly vulnerable in the context of clinical research. Therefore, they are due extra protection. Sometimes, these additional safeguards can significantly limit the possibilities for research involving subjects deemed unable to consent due to their mental illness. Montenegro, a middle-income country in Southern-Eastern Europe, goes so far in their policy to protect these subjects from harms of research, as to ban all biomedical research on mentally ill persons who are unable to provide consent.Main bodyMental health research is often neglected and very low on the list of health research priorities, especially in low- and middle-income countries. Despite the fact that mental health disorders are among leading causes of disability, the need for evidence-based services and interventions for those affected remains unmet.To exclude all members of a certain group of subjects seems extremely restrictive and unnecessary. Such a policy is discriminatory and unethical, because it inflicts further harms and exclusion of those patients from participation in society. This unjust exclusion policy obstructs research of certain psychiatric disorders and implies that new treatments for conditions that directly affect these incapacitated subjects will not be developed.ConclusionsScientific and clinical development must not be precluded by overly restrictive, discriminatory and unjust practices, such as the normative ban on research on decisionally-impaired mentally ill subjects. Rather, there should be a regulative framework that ensures that those who cannot consent for themselves are respected and protected in research, the anticipated benefits maximized, risks minimized, their autonomy recognized and extended. These patient-subjects must be appropriately included unless there is a clear and compelling rationale and justification that inclusion is inappropriate with respect to the health of the participants or the purpose of the research.
“I cannot say no when a pregnant woman needs my support to get to the health centre”: involvement of community health workers in Rwanda’s maternal health
Authors: Tuyisenge Germaine , Hategeka Celestin , Luginaah Isaac , Cechetto David F. , Rulisa Stephen 
Published: June 2020

Abstract
Background
In Rwanda, maternal community health workers (M-CHWs) are involved in the country’s overall health system. In maternal health, their role includes the provision of preventive and promotional health services at the community level. They provide services such as health education on maternal health wellbeing, advice and information on access and timely utilization of health facilities for prenatal, delivery and postpartum care. The contribution of M-CHWs in the health sector combined with other government initiatives led the country to achieving the fifth Millennium Development Goal (MDG) - target 5A- that aimed to improve maternal health through the reduction of maternal mortality ratio by 75% between 1990 and 2015). The objective of this study was to explore M-CHWs’ perceptions and experiences on access and provision of maternal health services.

Methods
We used a case study methodology, a qualitative research approach to explore M-CHWs’ experiences and perceptions on access and provision of maternal health services at the community level in Rwanda. For the period of June–August 2014, in-depth interviews were conducted with sixteen M-CHWs who had been providing maternal health services in the Eastern Province of Rwanda. Participants shared their experiences and perceptions on access and provision of maternal health service in their communities.

Results
The results of this research highlight the role of M-CHWs in promoting the use of health facilities for prenatal care and delivery and the ways they use to reach out to women. Several challenges prohibit M-CHWs to deliver adequate maternal health services and these are related to the poor resources settings in which they operate.

Conclusion
The results of this study highlight the experiences and perceptions of M-CHWs on the provision and access to maternal health services in their communities. The fact that M-CHWs are volunteers operating in limited resources settings with no formal training in maternal health and with considerable workloads translates into challenges regarding the quality and quantity of services they provide in their communities. Such challenges create an impact on M-CHWs service provision, satisfaction and retention. The voices of M-CHWs and the communities they serve are needed to explore areas that are specific to each community context that would contribute to making the M-CHW program sustainable to achieve equitable access to maternal health services.
The replication machinery of LUCA: common origin of DNA replication and transcription
Authors: Koonin Eugene V. , Krupovic Mart , Ishino Sonoko , Ishino Yoshizumi 
Published: June 2020

AbstractOrigin of DNA replication is an enigma because the replicative DNA polymerases (DNAPs) are not homologous among the three domains of life, Bacteria, Archaea, and Eukarya. The homology between the archaeal replicative DNAP (PolD) and the large subunits of the universal RNA polymerase (RNAP) responsible for transcription suggests a parsimonious evolutionary scenario. Under this model, RNAPs and replicative DNAPs evolved from a common ancestor that functioned as an RNA-dependent RNA polymerase in the RNA-protein world that predated the advent of DNA replication. The replicative DNAP of the Last Universal Cellular Ancestor (LUCA) would be the ancestor of the archaeal PolD.
Spatial and temporal distribution of foot and mouth disease outbreaks in Amhara region of Ethiopia in the period 1999 to 2016
Authors: Aman Endris , Molla Wassie , Gebreegizabher Zeleke , Jemberu Wudu Temesgen 
Published: June 2020

Abstract
Background
Foot and mouth disease (FMD) is an economically important trans-boundary viral disease of cloven-hoofed animals. It is caused by FMD virus, which belongs to the genus Aphthovirus and family Picornaviridae. FMD is a well-established endemic disease in Ethiopia since it was first detected in 1957. This retrospective study was carried out to identify the spatial and temporal distribution of FMD outbreaks in Amhara region of Ethiopia using 18 years (January 1999–December 2016) reported outbreak data.

Results
A total of 636 FMD outbreaks were reported in Amhara region of Ethiopia between 1999 and 2016 with an average and median of 35 and 13 outbreaks per year respectively. In this period, FMD was reported at least once in 58.5% of the districts (n = 79) and in all administrative zones of the region (n = 10). The average district level incidence of FMD outbreaks was 4.68 per 18 years (0.26 per district year). It recurs in a district as epidemic, on average in 5.86 years period. The incidence differed between administrative zones, being the lowest in East Gojjam and highest in North Shewa. The occurrence of FMD outbreaks was found to be seasonal with peak outbreaks in March and a low in August. The long-term trend of FMD outbreaks indicates a slight, but statistically significant (p < 0.001) decrease over the study period.

Conclusion
FMD occurred in all zones of the region and showed statistically significant decrease in the long-term trend. Numbers of outbreaks were relatively higher during dry season. The spatial and temporal distribution identified in this study should be considered in controlling the disease. As unregulated and frequent animal movements are the likely causes of high outbreak occurrence during the dry season, animal movement regulations should be considered for the long-term control of FMD.
The origin and underlying driving forces of the SARS-CoV-2 outbreak
Authors: Chaw Shu-Miaw , Tai Jui-Hung , Chen Shi-Lun , Hsieh Chia-Hung , Chang Sui-Yuan , Yeh Shiou-Hwei , Yang Wei-Shiung , Chen Pei-Jer , Wang Hurng-Yi 
Published: June 2020

AbstractBackgroundSARS-CoV-2 began spreading in December 2019 and has since become a pandemic that has impacted many aspects of human society. Several issues concerning the origin, time of introduction to humans, evolutionary patterns, and underlying force driving the SARS-CoV-2 outbreak remain unclear.MethodGenetic variation in 137 SARS-CoV-2 genomes and related coronaviruses as of 2/23/2020 was analyzed.ResultAfter correcting for mutational bias, the excess of low frequency mutations on both synonymous and nonsynonymous sites was revealed which is consistent with the recent outbreak of the virus. In contrast to adaptive evolution previously reported for SARS-CoV during its brief epidemic in 2003, our analysis of SARS-CoV-2 genomes shows signs of relaxation. The sequence similarity in the spike receptor binding domain between SARS-CoV-2 and a sequence from pangolin is probably due to an ancient intergenomic introgression that occurred approximately 40 years ago. The current outbreak of SARS-CoV-2 was estimated to have originated on 12/11/2019 (95% HPD 11/13/2019–12/23/2019). The effective population size of the virus showed an approximately 20-fold increase from the onset of the outbreak to the lockdown of Wuhan (1/23/2020) and ceased to increase afterwards, demonstrating the effectiveness of social distancing in preventing its spread. Two mutations, 84S in orf8 protein and 251 V in orf3 protein, occurred coincidentally with human intervention. The former first appeared on 1/5/2020 and plateaued around 1/23/2020. The latter rapidly increased in frequency after 1/23/2020. Thus, the roles of these mutations on infectivity need to be elucidated. Genetic diversity of SARS-CoV-2 collected from China is two times higher than those derived from the rest of the world. A network analysis found that haplotypes collected from Wuhan were interior and had more mutational connections, both of which are consistent with the observation that the SARS-CoV-2 outbreak originated in China.ConclusionSARS-CoV-2 might have cryptically circulated within humans for years before being discovered. Data from the early outbreak and hospital archives are needed to trace its evolutionary path and determine the critical steps required for effective spreading.
Prognostic value of the systemic immune-inflammation index in patients with breast cancer: a meta-analysis
Authors: Zhang Yantao , Sun Yong , Zhang Qiwen 
Published: June 2020

Abstract
Background
Although previous studies have evaluated the prognostic role of the systemic immune-inflammation index (SII) in patients with breast cancer, the results were inconsistent. Therefore, in this context, we aimed to identify the prognostic and clinicopathological value of the SII in patients with breast cancer by performing a meta-analysis.

Methods
A literature search was using PubMed, Web of Science, EMBASE, and Cochrane Library databases for relevant articles, from their inception to May 12, 2020. The prognostic value of the SII in breast cancer was assessed by pooling the hazard ratios (HRs) with 95% confidence intervals (CIs). The clinical outcomes included the overall survival (OS), disease-free survival (DFS), recurrence-free survival (RFS), and distant metastasis-free survival (DMFS). The methodological quality of all the included studies was evaluated using the Newcastle–Ottawa quality assessment scale. The odds ratios (ORs) with 95% CIs were combined to evaluate the correlation between the SII and clinicopathological characteristics of patients with breast cancer. Publication bias was evaluated using the Begg funnel plot and the Egger linear regression test. All statistical analyses were performed using Stata software, version 12.0 (Stata Corporation, College Station, TX, USA). A p value of < 0.05 was considered statistically significant.

Results
Eight studies involving 2642 patients were included in the current meta-analysis. The combined data showed that patients with a high SII had worse OS (HR = 1.79, 95% CI 1.33–2.42, p < 0.001), poorer DFS/RFS (HR = 1.79, 95% CI 1.31–2.46, p < 0.001), and inferior DMFS (HR = 1.64, 95% CI 1.32–2.03, p < 0.001) than patients with a low SII. In addition, a high SII was correlated with the presence of lymph node metastasis (OR = 1.38, 95% CI 1.12–1.69, p = 0.002), higher T stage (OR = 1.49, 95% CI 1.17–1.89, p < 0.001), advanced TNM stage (OR = 1.37, 95% CI 1.07–1.77, p = 0.014), and higher histological grade (OR = 3.71, 95% CI 1.00–13.73, p = 0.049). However, there was no significant association between the SII and the pathological type (OR = 0.82, 95% CI 0.55–1.23, p = 0.345) or lymphatic invasion (OR = 1.30, 95% CI 0.82–2.08, p = 0.266).

Conclusions
The results of our meta-analysis suggest that an elevated SII predicts poor survival outcomes and is associated with clinicopathological features that indicate tumor progression of breast cancer.
Validation of the Arabic version of the breastfeeding behavior questionnaire among Lebanese women
Authors: Charafeddine Lama , Masri Saadieh , Shamsedine Lama , Ghandour Lilian , Tamim Hani , El Khoury Nathalie , Hachem Zahraa , Nabulsi Mona 
Published: June 2020

Abstract
Background
The Breastfeeding Behavior Questionnaire (BBQ) assesses women’s perceptions of their breastfeeding behavior. It was adapted to several languages and used in different settings, but has not been validated in Arabic-speaking populations. None of the previous studies that used the BBQ in other cultures examined its ability to predict the actual breastfeeding behaviors of mothers postpartum. This study validated the BBQ in a cohort of Lebanese pregnant women between December 2013 and January 2016, and examined whether it can predict exclusive breastfeeding at one, three and six months.

Methods
The internal consistency reliability and construct validity of the Arabic BBQ (BBQ-A) were tested on 354 pregnant women. Its predictive ability was assessed by correlating the women’s BBQ-A scores with their breastfeeding outcomes at one, three and six months post-delivery.

Results
The BBQ-A had a good internal consistency reliability (Cronbach’s alpha = 0.78). Exploratory factor analysis revealed that it is unidimensional. Inter-item correlations ranged between − 0.016 and 0.934, with corrected-item total correlations ranging from 0.273 to 0.678. Perceived positive breastfeeding behavior correlated with positive breastfeeding attitudes, good breastfeeding knowledge and stronger breastfeeding intention supporting its external validity. However, in binomial multivariate logistic regression analysis, the BBQ-A did not predict exclusive breastfeeding at one, three or six months.

Conclusions
The BBQ-A is a reliable and valid instrument to assess women’s perceptions of their breastfeeding behavior in an Arab context. Availability of this instrument is important for investigators conducting breastfeeding research in the Arab world. However, the BBQ-A does not predict exclusive breastfeeding at one, three or six months. Further research on the Breastfeeding Behavior Questionnaire is needed to examine its predictive validity in other cultures.
Chimney grafts in renal arteries: a clinical model for coronary perfusion in future transcatheter aortic root repair techniques
Authors: Ferrari Enrico , Wang Changtian , Berdajs Denis , von Segesser Ludwig Karl 
Published: June 2020

Abstract
Objectives
Given the similarities between coronary ostia and renal arteries, chimney grafts (CG) for kidney perfusion during abdominal endovascular aneurysm repair (EVAR) can be considered for coronary perfusion in future transcatheter aortic root repair (TARR) techniques. We analysed the results of renal CG and compared anatomic and technical details with root and coronary anthropometric data.

Methods
Current status of kidney perfusion with CG was reviewed from literature. Anatomic details, technical data, CG performance and clinical outcome were collected and analysed. Anatomic details of aortic landing zone and renal arteries were compared with human anthropometric data of aortic root, ascending aorta and coronary ostia.

Results
Seventeen articles reported 430 patients (mean age:74.5 ± 2.9 years) treated with renal CG. Mean length and diameter of proximal landing zone were 2.0 ± 2.0 mm and 26.4 ± 4.3 mm, respectively (anthropometric correspondence: ascending aorta diameter of 29.3 mm). Aortic endograft mean diameter was 26.4 ± 7.3 mm with reported oversize of 19.5 ± 6.0%. In total, 590 renal arteries were treated (left:325; right:265; bilateral:139 cases). Mean left and right renal artery diameters were 5.7 ± 0.6 mm and 5.8 ± 0.7 mm, respectively (anthropometric correspondence: coronary ostia diameters of 4.8 mm (left) and 3.7 mm (right)) with reported CG oversize of 19.75 ± 6% (left) and 18.1 ± 5.1% (right). Mean follow-up time was 16.5 ± 8.5 months, CG occlusion rate was 3.2% and endoleak I or II was reported in 83 patients (19.3%), requiring 7 procedures.

Conclusions
CG provides satisfactory results in patients with suitable renal artery diameter. Based on aortic root and coronary anthropometric data, CG can be considered in future TARR technologies for coronary perfusion but further tests for flow evaluations are mandatory.
Sex-dependent calcium hyperactivity due to lysosomal-related dysfunction in astrocytes from APOE4 versus APOE3 gene targeted replacement mice
Authors: Larramona-Arcas Raquel , González-Arias Candela , Perea Gertrudis , Gutiérrez Antonia , Vitorica Javier , García-Barrera Tamara , Gómez-Ariza José Luis , Pascua-Maestro Raquel , Ganfornina María Dolores , Kara Eleanna , Hudry Eloise , Martinez-Vicente Marta , Vila Miquel , Galea Elena , Masgrau Roser 
Published: June 2020

Abstract
Background
The apolipoprotein E (APOE) gene exists in three isoforms in humans: APOE2, APOE3 and APOE4. APOE4 causes structural and functional alterations in normal brains, and is the strongest genetic risk factor of the sporadic form of Alzheimer’s disease (LOAD). Research on APOE4 has mainly focused on the neuronal damage caused by defective cholesterol transport and exacerbated amyloid-β and Tau pathology. The impact of APOE4 on non-neuronal cell functions has been overlooked. Astrocytes, the main producers of ApoE in the healthy brain, are building blocks of neural circuits, and Ca2+ signaling is the basis of their excitability. Because APOE4 modifies membrane-lipid composition, and lipids regulate Ca2+ channels, we determined whether APOE4 dysregulates Ca2+signaling in astrocytes.

Methods
Ca2+ signals were recorded in astrocytes in hippocampal slices from APOE3 and APOE4 gene targeted replacement male and female mice using Ca2+ imaging. Mechanistic analyses were performed in immortalized astrocytes. Ca2+ fluxes were examined with pharmacological tools and Ca2+ probes. APOE3 and APOE4 expression was manipulated with GFP-APOE vectors and APOE siRNA. Lipidomics of lysosomal and whole-membranes were also performed.

Results
We found potentiation of ATP-elicited Ca2+responses in APOE4 versus APOE3 astrocytes in male, but not female, mice. The immortalized astrocytes modeled the male response, and showed that Ca2+ hyperactivity associated with APOE4 is caused by dysregulation of Ca2+ handling in lysosomal-enriched acidic stores, and is reversed by the expression of APOE3, but not of APOE4, pointing to loss of function due to APOE4 malfunction. Moreover, immortalized APOE4 astrocytes are refractory to control of Ca2+ fluxes by extracellular lipids, and present distinct lipid composition in lysosomal and plasma membranes.

Conclusions
Immortalized APOE4 versus APOE3 astrocytes present: increased Ca2+ excitability due to lysosome dysregulation, altered membrane lipidomes and intracellular cholesterol distribution, and impaired modulation of Ca2+ responses upon changes in extracellular lipids. Ca2+ hyperactivity associated with APOE4 is found in astrocytes from male, but not female, targeted replacement mice. The study suggests that, independently of Aβ and Tau pathologies, altered astrocyte excitability might contribute to neural-circuit hyperactivity depending on APOE allele, sex and lipids, and supports lysosome-targeted therapies to rescue APOE4 phenotypes in LOAD.