bluuebunny/crossref_metadata_2025_split huggingface dataset:
Kiguchi Method, A Novel Simplified Technique For Pancreaticojejunostomy In Minimally Invasive Pancreaticoduodenectomy, Significantly Reduces Postoperative Pancreatic Fistula Rate In Patients With A Soft Pancreatic Texture&nbsp;
Authors: Kiguchi Gozo , Sugioka Atsushi , Nakauchi Masaya , Kojima Masayuki , Yasuda Akira , Nakajima Sanae , Tanahashi Yoshinao , Suda Koichi , Kato Yutaro , Uyama Ichiro 
Published: September 2020

Abstract
Background: Minimally invasive pancreaticoduodenectomy (MIPD), including laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD), is especially demanding due to pancreaticojejunostomy (PJ). Postoperative pancreatic fistula (POPF) remains the most serious complication in MIPD as well as in open pancreaticoduodenectomy (OPD). Conventional PJ in MIPD did not improve the POPF rate and hospital stay, contrary to expectations. High POPF rates have been attributed to technical issues encountered during MIPD, including motion restriction and insufficient water tightness; therefore, we have developed the Kiguchi method as a novel PJ technique optimized for MIPD. Herein, we describe the technique and assess its impact in patients with a soft pancreatic texture, which has been reported to be significantly related to POPF.Methods: The retrospective study included 188 patients with a soft pancreatic texture. Briefly, 143 patients underwent OPD with conventional PJ (OPD group); 19 patients underwent MIPD with conventional PJ (Old-MIPD group), including 7 and 12 patients undergoing LPD and RPD, respectively; and 26 patients underwent MIPD using the Kiguchi method (New-MIPD group), including 15 and 11 patients undergoing LPD and RPD, respectively. Short-term outcomes were assessed, and POPF risk factors were determined using univariate and multivariate analyses.Results: The grade B/C POPF rate was significantly lower in the New-MIPD group than in the Old-MIPD and OPD groups (3.8% vs. 42.1% and 36.4%, respectively). The median hospital stay was significantly shorter in the New-MIPD group than in the Old-MIPD and OPD groups (23 vs. 33 and 31 days, respectively). By multivariate analysis, the PJ method and male sex were significant POPF risk factors. Among the patients without POPF, the hospital stay was significantly shorter in those undergoing MIPD than in those undergoing OPD, suggesting the advantage of MIPD. Conclusions: The novel Kiguchi method significantly reduced the POPF rate in patients with a soft pancreatic texture.
A Haptic Laparoscopic Trainer Based on Affine Velocity Analysis: Engineering and Preliminary Results
Authors: De Witte Benjamin , Barnouin Charles , Moreau Richard , Leleve Arnaud , Martin Xavier , Collet Christian , Hoyek Nady El 
Published: September 2020

Abstract
Background: General agreement exists upon the importance of acquiring laparoscopic skills outside the operation room. During the past two decades, simulation-based training and simulators have been more extensively used in surgeons’ training. Nevertheless learning through simulation-based systems is hindered by several flaws. High-fidelity simulators are cost-prohibitive which limits training opportunities. Their use also elicits a high cognitive load. Low-fidelity simulators lack in haptic, direct and summative feedback. Our goal is to develop a new low fidelity simulator integrating effective learning features as a new assessment variable while limiting the associated costs. We also aim at assessing its primary validity. Methods: We engineered a low fidelity simulator for teaching basic laparoscopic skills taking into account psychomotor skills, direct and summative feedback and engineering key features (haptic feedback and complementary assessment variables). Afterward, 77 participants with 4 different surgical skill levels (17 experts; 12 intermediates; 28 inexperienced interns and 20 novices) tested the simulator. We checked the content validity using a 10 point Likert scale. We also assessed the simulator discriminative power by comparing the 4 groups’ performance over two sessions. To do so, we used 3 variables: time, number of errors (collisions) and affine velocity. Results: The content validation mean value score was 7.57/10. The statistical analysis yielded performance discrepancies on the selected variables among the groups (p<0.001). Conclusion: We developed an affordable and validated simulator for testing and learning basic laparoscopic skills. The results exhibit three levels of performance on the selected variables. Experts and intermediates outperformed the inexperienced interns who in turn outperformed the novices. Results show that the embedded evaluation variables are complimentary and provide realistic results. The inclusion of a new variable and, meanwhile, haptic, direct and summative feedback is innovative regarding low-fidelity simulators. Limitations and implementation conditions of the simulator in the surgical curricula are discussed.
Molecular Epidemiological Investigation and Analysis of Toxoplasma Gondii Infection in Livestock, Poultry, and Pets in Henan Province, Central China
Authors: Zhang Xiao-Li , Zhu Rong-Hui , Huang Jia-Qi , Qiao Meng-Yuan , Xu xinxin , Bo Peng-Fei , Wang Shuai , Liu Shiguo 
Published: September 2020

Abstract
Background:Toxoplasma gondii (T.gondii ) is a protozoan parasite spread around the world and is concerned as one of the most important foodborne zoonotic parasites in the global world. This study aimed to determine the prevalence of T.gondii in foodborne animals in Henan Province, China.Methods:During 2012 to 2015, a total of 1879 samples of foodborne animal tissues or peripheral blood were collected from 12 slaughterhouses, eight pastures and 434 farmers in different areas of Henan province using systematic random sampling method. The genomic DNA was extracted by the phenol-chloroform method. Moreover, then a One-tube nested polymerase chain reaction (PCR) assay was performed to amplify the 529bp repetitive sequence of T.gondii in these samples.T.gondii infections in diverse animals is different in the study.Results:Of the 1879 samples,cat had the highest T.gondii infection(51.9%,28/54),followed by goose(24.3%,44/181), chicken(19.7%,91/462), cattle(12.6%,23/182), sheep(11.5%,22/191), duck(11.3%,24/212), dog(10.5%,13/124), pigeon(5.4%,16/297) and pig(4.6%,8/176). The total infection of T. gondii in these animals was 269/1879, and the positive rate was 14.3%.Conclusions:The results revealed that all the livestock, poultry, and pets in close contact with humans had toxoplasma infection, which suggest that the consumption of meat products in Henan may pose a potential threat to human health. Therefore, to strengthen the prevention and control of T.gondii infection in animals is an important measure to develop animal husbandry, support food safety, and protect human health.
Inhibition of Kpn β 1 Mediated Nuclear Import Enhances Cisplatin Chemosensitivity in Cervical Cancer.
Authors: Chi Ru-pin Alicia , Watt Pauline van der , Wei Wei , Birrer Michael , Leaner Virna 
Published: September 2020

Abstract
Background: Inhibition of nuclear import via Karyopherin beta 1 (Kpnβ1) shows potential as an anti-cancer approach. This study investigated the use of nuclear import inhibitor, INI-43, in combination with cisplatin. Methods: Cervical cancer cells were pre-treated with INI-43 before treatment with cisplatin, and MTT cell viability and apoptosis assays performed. Activity and localisation of p53 and NFκB was determined after co-treatment of cells.Results: Pre-treatment of cervical cancer cells with INI-43 at sublethal concentrations enhanced cisplatin sensitivity, evident through decreased cell viability and enhanced apoptosis. Kpnβ1 knock-down cells similarly displayed increased sensitivity to cisplatin. Combination index determination using the Chou-Talalay method revealed that INI-43 and cisplatin engaged in synergistic interactions. p53 was found to be involved in the cell death response to combination treatment as its inhibition abolished the enhanced cell death observed. INI-43 pre-treatment resulted in moderately stabilized p53 and induced p53 reporter activity, which translated to increased p21 and decreased Mcl-1 upon cisplatin combination treatment. Furthermore, cisplatin treatment led to nuclear import of NFκB, which was diminished upon pre-treatment with INI-43. NFκB reporter activity and expression of NFκB transcriptional targets, cyclin D1, c-Myc and XIAP, showed decreased levels after combination treatment compared to single cisplatin treatment and this associated with enhanced DNA damage. Conclusions: Taken together, this study shows that INI-43 pre-treatment significantly enhances cisplatin sensitivity in cervical cancer cells, mediated through stabilization of p53 and decreased nuclear import of NFκB. Hence this study suggests the possible synergistic use of nuclear import inhibition and cisplatin to treat cervical cancer.
Incorporating Support Vector Machine With Sequential Minimal Optimization to Identify Anticancer Peptides
Authors: Wan Yu , Wang Zhuo , Lee Tzong-Yi 
Published: September 2020

Abstract
BackgroundCancer is a major cause of death worldwide. To treat cancer, the use of anticancer peptides (ACPs) has received increasing attention in recent years. ACPs are a unique group of small molecules that can target and kill cancer cells fast and directly. However, identifying ACPs by wet-lab experiments is time-consuming and labor-intensive. Therefore, it is significant to develop computational tools for ACPs prediction.ResultsThis study chose amino acid composition (AAC), N5C5, k-space, position-specific scoring matrix (PSSM) as features, and analyzed them by machine learning methods, including support vector machine (SVM) and sequential minimal optimization (SMO) to build a model (model 2) distinguishing ACPs from non-ACPs. Since a growing number of studies have shown that some antimicrobial peptides (AMPs) exhibit anticancer function, a model (model 1) to distinguish ACPs from AMPs is also been developed. Comparing to previous models, models developed in this research show better performance (accuracy: 82.5% for model 1 and 93.5% for model 2).ConclusionsThis work utilizes a new feature, PSSM, which contributes to better performance than other features. In addition to SVM, SMO is used in this research for optimizing SVM and the SMO-models show better performance than unoptimized models. Last but not least, this work provides two different functions, including distinguishing ACPs from AMPs and distinguishing ACPs from all peptides. The second SMO-optimized model, which utilizes PSSM as feature, performs better than all other existing tools.
Effect of Duration of Symptoms on the Clinical and Functional Outcomes of Lumbar Microdiscectomy: A Randomized Controlled Trial
Authors: Hamawandi Sherwan 
Published: September 2020

Abstract
Background Microdiscectomy is the gold standard surgical procedure for symptomatic lumbar disc herniation. The aim of this study is to determine whether the preoperative duration of symptoms can affect the postoperative clinical and functional outcomes after microdiscectomy for symptomatic lumbar disc herniation. Method A single blind, randomized controlled trial was performed by single spine surgeon on patients with symptomatic lumbar disc herniation. 122 patients, who had eligibility criteria, were divided randomly by computer system into 3 groups (A, B and C) who were operated at six weeks, three months and six months from the onset of symptoms respectively. 97 patients were analyzed at the end of this study for outcome measures. Primary outcome measures are Oswestry disability index, Roland-Morris Questionnaire and Visual analogue scale for back pain and leg pain. Secondary outcome measures are post-operative complications, length of hospital stay and time of return to daily activities.Results Better results among study’s groups were in sequence of group A, group B then group C. There was significant difference in Oswestry disability index score until three years of follow up (P-value <0.001). Improvement in Roland-Morris Questionnaire among the groups was significant at three months post-operatively (P-value <0.001). Visual analogue scale for back pain was better significantly at 2 weeks post-operatively (P-value=0.002) while Visual analogue scale for leg pain was better significantly at 3 months postoperatively (P-value=0.003). There was no significant difference among study’s groups regarding other outcome measures.Conclusion Preoperative duration of symptoms in patients with lumbar disc herniation can affect the clinical and functional outcomes after microdiscectomy. The shorter duration of symptoms the better postoperative outcomes are. This effect of duration of symptoms on postoperative outcomes is more significant in early postoperative period.Trial registration NCT, NCT04538027. Registered 1 September 2020 -Retrospectively registered, https://www.clinicaltrials.gov/NCT04538027
Atezolizumab Plus Chemotherapy Vs Chemotherapy Alone for Non-small Cell Lung Cancer: A Meta-analysis of Different PD-L1-expression Levels
Authors: Hong Zhang , Xiaoyu Zhong , Zhaowei Liu , Feifei Miao , Changgeng Zhang 
Published: September 2020

Abstract
Background Atezolizumab was effective and well tolerated in pretreated non-small-cell lung cancer (NSCLC). This meta-analysis assessed that the efficacy and safety of atezolizumab plus chemotherapy combination, compared to chemotherapy alone.Methods This meta-analysis included double-blind randomized controlled trials (RCTs) comparing atezolizumab plus chemotherapy combination with chemotherapy alone for NSCLC. The subgroups were the high expression of PD-L1（PD-L1-high）, the low expression of PD-L1 （PD-L1-low） and the negative expression of PD-L1 (PD-L1-negative). The hazard ratios (HRs) and odds ratios (ORs) with 95% confidence interval (CI) were calculated. The outcome parameters were overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and adverse events Grade 3-5（AEs G3-5）.Results A total of 6 articles were included in this meta-analysis. The results indicated that atezolizumab plus chemotherapy combination had better efficacy than chemotherapy alone for PFS (HR=0.64, 95% CI=0.60 to 0.70,P<0.001), PFS（PD-L1-high）(HR=0.41, 95% CI=0.34 to 0.51,P<0.001), PFS（PD-L1-low）(HR=0.63,95% CI 0.55 to 0.72,P<0.001) and PFS（PD-L1-negative）(HR=0.71, 95% CI=0.61 to 0.83,P<0.001). There were statistically significant improvements in terms of OS (HR = 0.79, 95% CI = 0.73 to 0.86,P<0.001) 、OS (PD-L1-high) (HR = 0.65, 95% CI = 0.48 to 0.88,P<0.01) and OS (PD-L1-negative) (HR = 0.84, 95% CI = 0.72 to 0.98,P<0.05). Significant benefits were observed in ORR (OR=1.81,95% CI=1.58 to 2.08, P<0.001), ORR（PD-L1-high）(OR=2.24,95% CI=1.24 to 4.06,P<0.01), ORR（PD-L1-low）(OR=1.51,95% CI=1.03 to 2.21,P<0.05) and ORR（PD-L1-negative）(OR=1.54,95% CI=1.05 to 2.27,P<0.05). Meanwhile, atezolizumab was well tolerated and the incidence of AEs G3-5 (OR = 1.32, 95% CI = 1.06 to 1.64,P=0.01). Conclusion The atezolizumab plus chemotherapy combination had excellent efficacy and great safety than chemotherapy alone for NSCLC. Furthermore, these benefits had nothing to do with the state of PD-L1 expression.
Predicting COVID-19 in very large countries: the case of Brazil
Authors: Parro Vanderlei , Lafetá Marcelo , Ipolito Felipe , Toporcov Tatiana 
Published: September 2020

Abstract
The existence of asymptomatic individuals with mild symptoms represents an additional challenge for the control of the coronavirus disease 2019 (COVID-19) pandemic. This challenge puts pressure on public management officials involved in the design of infrastructure for service provision as well as isolation procedures. The challenge is even greater in a country such as Brazil, which has large physical dimensions with the assumption of free movement. Considering this scenario, this work presents a new proposal for estimating health system use for COVID-19 cases, as well as a methodology for using the model in the real world. The estimate was obtained by modifying the dynamic model known as Susceptible, Infected, Removed and Dead (SIRD), including a parameter to model not all cases but only the health system dynamics. The model was tuned from the data available for each state and updated day-by-day, establishing a figure of merit to assess the quality of the model and determining the free parameters that best fit the model to the data. The proposed model and the respective tuned parameters were validated considering the data available for the 26 Brazilian states, demonstrating strong adherence in most cases and allowing the estimation of an epidemic model for the whole of Brazil, which was obtained via the linear combination of the models for each state. In addition to the effective use of the health system, the incidence rate and removal rate were analysed, as was the reproduction rate: baseline R0 and effective Rt. In the specific case of Brazil, the states that make up the federation have autonomy in decision making, which increases the complexity of the analysis of the evolution of the pandemic. With the proposed global model, the method used to tune the parameters and the available results, there was heterogeneity in the dynamics observed for each state, which is compatible with some characteristics of the real-world scenario.
Perceived Consequences of Healthcare Service Decentralization on Access, Affordability and Quality of Care in Khartoum Locality, Sudan
Authors: Noory Bandar , Hassanein Sara , Edwards Jeffrey , Lindskog Benedikte Victoria 
Published: September 2020

Abstract
Background: Decentralization of healthcare services have been widely utilized, especially in developing countries, to improve the performance of healthcare systems by increasing the access and efficiency of service delivery. Experiences have been variable secondary to disparities in financial and human resources, system capacity and community engagement. Sudan is no exception and understanding the perceived effect of decentralization on access, affordability, and quality of care among stakeholders is crucial.Methods: This was a mixed method, cross-sectional, explorative study that involved 418 household members among catchment areas and 40 healthcare providers of Ibrahim Malik Hospital (IBMH) and Khartoum Teaching Hospital (KTH). Data were collected through a structured survey and in-depth interviews from July-December 2015.Results: Access, affordability and quality of healthcare services were all perceived as worse, compared to before decentralization was implemented. Reported affordability was found to be 53% and 55% before decentralization compared to 24% to 16% after decentralization, within KTH and IBMH catchment areas respectively, (p= 0.01). The quality of healthcare services were reported to have declined from 47% and 38% before decentralization to 38% and 28% after, in KTH and IBMH respectively (p=0.02). Accessibility was found to be more limited, with services being accessible before decentralization approximately 59% and 52% of the time, compared to 41% and 30% after, in KTH and IBMH catchment areas respectively, (p=0.01).Accessibility to healthcare was reported to have decreased secondary to facility closures, reverse transference of services, and low capacity of devolved facilities. Lastly, privatized services were reported as strengthened in response to this decentralization of healthcare. Conclusions: The deterioration of access, affordability and quality of health services was experienced as the predominant perception among stakeholders after decentralization implementation. Our study results suggest there is an urgent need for a review of the current healthcare policies, structure and management within Sudan in order to provide evidence and insights regarding the impact of decentralization.
Forming an “Impossible” 85 solar mass Black Hole
Authors: Vink Jorick , Higgins Erin , Sander Andreas , Sabhahit Gautham 
Published: September 2020

Abstract
At the end of its life, a very massive star is expected to collapse into a black hole. The masses of these black holes are pivotal for our understanding of the evolution and fate of these stars, as well as for galaxy evolution and the build-up of black hole masses through Cosmic time. The recent detection of an 85 solar mass black hole from the gravitational wave event GW 190521 appears to present a fundamental problem as to how such heavy black holes exist above the approximately 50 solar mass pair-instability limit where stars are expected to be blown to pieces with no remnant left. Here we show that for stellar models at reduced heavy element content, 90-100 solar mass stars can produce core masses sufficiently small to remain below the fundamental pair-instability limit, yet at the same time lose an amount of mass small enough to end up in an 85 solar mass black hole. A key point is that the amount of mass-loss scales with the host galaxy heavy element fraction, and not with the total amount of element enrichment that occurs naturally during the life of massive stars. Our study shows how our Universe is capable of producing heavy black holes, which are important seeds for the production of supermassive black holes that regulate the evolution of galaxies. Our evolutionary channel to the formation of an 85 solar mass black hole is of fundamental relevance for the manner in which metals are released in the outflows and explosions of the most massive stars, which is shown to be a strong function of Cosmic time.
Clinical Outcome and Pathologic Correlation of Stereotactic Body Radiation Therapy as a Bridge to Transplantation for Advanced Hepatocellular Carcinoma
Authors: Wang Ying-Fu , Dai Yang-Hong , Lin Chun-Shu , Chang Hao-Chih , Shen Po-Chien , Yang Jen-Fu , Hsiang Chih-Weim , Lo Cheng-Hsiang , Huang Wen-Yen 
Published: September 2020

Abstract
Background: Stereotactic body radiotherapy (SBRT) is an emerging modality for hepatocellular carcinoma (HCC). However, there is scant information about its safety and effectiveness in the neoadjuvant setting prior to liver transplantation (LT). We present the clinical outcome and pathologic assessment of SBRT followed by LT for patients with advanced HCC.Methods: This retrospective study included HCC patients treated with neoadjuvant SBRT prior to LT between 2009 and 2018. Radiographic response and adverse effects, including radiation-induced liver disease (RILD), were evaluated. Pathologic response was assessed by the percentage of tumor necrosis relative to the total tumor volume. Overall survival (OS) and recurrence-free survival (RFS) were calculated using the Kaplan–Meier method.Results: Fourteen patients underwent SBRT for a total of 25 HCC lesions, followed by LT. The median tumor size was 4.45 cm in diameter, and the median prescribed dose was 45 Gy in 5 fractions. SBRT provided significant AFP reduction, 100% infield control, and a 62.5% response rate. The maximum detected toxicity included grade 3 thrombocytopenia and two grade 3–4 hyperbilirubinemia. One patient developed non-classic RILD. Patients were bridged to LT with a median time of 8.4 months after SBRT, and 23.1% of them achieved a complete pathologic response. The median OS and RFS were 37.8 and 18.3 months from the time of LT, respectively.Conclusions: SBRT provides favorable tumor control and acceptable adverse effects for patients awaiting LT. Further prospective studies to test SBRT as a bridging therapy for LT are feasible.