bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barrel-shaped design of the forearm free flap for lower lip reconstruction: a pilot case-control study
Authors: Lin Nan-Chin , Lin Shih-Lung , Tsai Kuo-Yang 
Published: June 2020

Abstract
Background
Radial free forearm flaps is indicated patients with total or near-total defects in their lower lip. The purpose of our study was to evaluate a simple and effective barrel-shaped design of the radial free forearm flap for lower lip reconstruction and to compare its clinical outcomes with those of a conventional rectangular shaped free forearm flap.

Methods
Twenty-two patients with a lower lip carcinoma who underwent radial forearm free flap reconstructive surgery were enrolled in this study between January 1, 2012, and December 31, 2017. A barrel-shaped design of radial forearm free flap for reconstruction was used in 8 patients (case group), and a rectangular design was used in 14 patients (control group). The patients’ quality of life was evaluated preoperatively and postoperatively in all the patients using the European Organization for Research and Treatment of Cancer Quality of Life (EORTC-HN35) questionnaire. We analyzed the differences in the EORTC QLQ-HN35 scores pre- and postoperatively between the case and control group.

Results
The patients in the case group had better outcomes in swallowing, speech, social eating, social contact, and dry mouth than the control group at 1-year follow-up (P < 0.05).

Conclusions
The use of a barrel-shaped design free forearm flap for lower lip reconstruction is an effective procedure and can achieve better results than the use of rectangular free forearm flap.
Treatment outcomes of Kugel repair for obturator hernias: a retrospective study
Authors: Hosoi Yoshie , Asano Hiroshi , Fukano Hiroyuki , Shinozuka Nozomi 
Published: June 2020

Abstract
Background
We examined the validity and applicability of the Kugel repair approach for obturator hernias, whereby we placed a Kugel patch through the preperitoneal space after placing a short 5-cm skin incision just medial to the anterior iliac spine and 2 cm cranial to the expected origin of the internal inguinal ring.

Methods
We studied patients who underwent surgical Kugel repair for obturator hernias at the Department of General Surgery, Saitama Medical University between 2007 and 2017. We examined the operating time, length of hospital stay, postoperative complications, and mortality rate.

Results
Fifty-eight patients with obturator hernias presented with symptoms of small bowel obstruction. A Kugel approach was used in 53 patients and a midline approach was used in 5 patients with preoperative peritonitis. Of the 53 patients managed using the Kugel approach, 39 did not require intestinal resection; a mesh was used in all these patients. In the remaining 14 patients, intestinal resection was required and performed using the same approach; subsequently, a mesh was used successfully in 6 of these 14 patients. The overall median operating time was 47 min; the corresponding values for procedures with and without intestinal resection were 39 and 68 min, respectively. In terms of postoperative complications, operative mortality was not noted among patients without intestinal perforation; however, superficial surgical site infection developed in 2 patients. Among the 5 patients with preoperative peritonitis who underwent exploratory laparotomy via a midline incision, intestinal perforation was detected during surgery, and all patients required intestinal resection; none of the patients had received a mesh, and 2 patients died after surgery.

Conclusions
The Kugel repair approach was possible even in patients with obturator hernia requiring intestinal resection. However, for patients with perforations, open surgery should be performed after securing the surgical field through a midline incision.
Prevalence of monarch (Danaus plexippus) and queen (Danaus gilippus) butterflies in West Texas during the fall of 2018
Authors: Brym Matthew Z. , Henry Cassandra , Lukashow-Moore Shannon P. , Henry Brett J. , van Gestel Natasja , Kendall Ronald J. 
Published: June 2020

Abstract
Background
The monarch butterfly (Danaus plexippus) is a conspicuous insect that has experienced a drastic population decline over the past two decades. While there are several factors contributing to dwindling monarch populations, habitat loss is considered the most significant threat to monarchs. In the United States, loss of milkweed, particularly in the Midwest, has greatly reduced the available breeding habitat of monarchs. This has led to extensive efforts to conserve and restore milkweed resources throughout the Midwest. Recently, these research and conservation efforts have been expanded to include other important areas along the monarch’s migratory path.

Results
During the fall of 2018, we conducted surveys of monarch eggs and larvae through West Texas. We documented monarch and queen butterfly (Danaus gilippus) reproduction throughout the region and used the proportion of monarch and queen larva to estimate the number of monarch eggs. Peak egg densities for monarchs were as high as 0.78 per milkweed ramet after correction for the presence of queens. Despite our observations encompassing only a limited sample across one season, the peak monarch egg densities we observed exceeded published reports from when monarch populations were higher.

Conclusions
To our knowledge, this is the first study to correct for the presence of queens when calculating the density of monarch eggs. This research also provides insight into monarch utilization of less well-known regions, such as West Texas, and highlights the need to expand the scope of monarch monitoring and conservation initiatives. While the importance of monarch research and conservation in the Midwest is unquestionable, more comprehensive efforts may identify new priorities in monarch conservation and lead to a more robust and effective overall strategy, particularly given the dynamic and rapidly changing global environment.
Evaluating the effect of healthcare providers on the clinical path of heart failure patients through a semi-Markov, multi-state model
Authors: Gasperoni Francesca , Ieva Francesca , Paganoni Anna Maria , Jackson Christopher H , Sharples Linda 
Published: June 2020

AbstractBackgroundInvestigating similarities and differences among healthcare providers, on the basis of patient healthcare experience, is of interest for policy making. Availability of high quality, routine health databases allows a more detailed analysis of performance across multiple outcomes, but requires appropriate statistical methodology.MethodsMotivated by analysis of a clinical administrative database of 42,871 Heart Failure patients, we develop a semi-Markov, illness-death, multi-state model of repeated admissions to hospital, subsequent discharge and death. Transition times between these health states each have a flexible baseline hazard, with proportional hazards for patient characteristics (case-mix adjustment) and a discrete distribution for frailty terms representing clusters of providers. Models were estimated using an Expectation-Maximization algorithm and the number of clusters was based on the Bayesian Information Criterion.ResultsWe are able to identify clusters of providers for each transition, via the inclusion of a nonparametric discrete frailty. Specifically, we detect 5 latent populations (clusters of providers) for the discharge transition, 3 for the in-hospital to death transition and 4 for the readmission transition. Out of hospital death rates are similar across all providers in this dataset. Adjusting for case-mix, we could detect those providers that show extreme behaviour patterns across different transitions (readmission, discharge and death).ConclusionsThe proposed statistical method incorporates both multiple time-to-event outcomes and identification of clusters of providers with extreme behaviour simultaneously. In this way, the whole patient pathway can be considered, which should help healthcare managers to make a more comprehensive assessment of performance.
Examining racial and ethnic trends and differences in annual healthcare expenditures among a nationally representative sample of adults with arthritis from 2008 to 2016
Authors: Spector Antoinette L. , Nagavally Sneha , Dawson Aprill Z. , Walker Rebekah J. , Egede Leonard E. 
Published: June 2020

Abstract
Background
Disparities in health care utilization and outcomes for racial and ethnic minorities with arthritis are well-established. However, there is a paucity of research on racial and ethnic differences in healthcare expenditures and if this relationship has changed over time. Our objectives were to: 1) examine trends in annual healthcare expenditures for adults with arthritis by race and ethnicity, and 2) determine if racial and ethnic differences in annual healthcare expenditures were independent of other factors such as healthcare access and functional disability.

Methods
We used the Medical Expenditures Panel Survey (2008–2016) to examine trends in annual healthcare expenditures within and between racial and ethnic groups with arthritis (n = 227,663). A two-part model was used to estimate the marginal differences in expenditures by race and ethnicity after adjusting for relevant covariates, including the impact of healthcare access.

Results
Between 2008 and 2016, there were no significant changes in unadjusted healthcare expenditures within any of the racial and ethnic groups, but the trend among non-Hispanic whites did differ significantly from Hispanics and Other. In fully adjusted analysis, mean annual expenditures for non-Hispanic whites was $946, $939, and $1178 more than non-Hispanic blacks, Hispanics, and Other, respectively (p < .001). Healthcare access also independently explained expenditure differences in this population with adults who delayed care spending significantly more ($2629) versus those who went without care spending significantly less (−$1591).

Conclusions
Race and ethnicity are independent drivers of healthcare expenditures among adults with arthritis independent of healthcare access and functional disability. This underscores the need for ongoing research on the factors that influence persistent racial and ethnic differences in this population.
Inhibiting autophagy potentiates the antitumor efficacy of Euphorbia royleana for canine mammary gland tumors
Authors: Huang Yu-Ya , Chen Chia-Hung , Hsu Chia-Hui , Kuo Tsun-Yung , Liu Cheng-Chi , Liao Albert Tai-Ching , Lin Chen-Si 
Published: June 2020

Abstract
Background
Canine mammary gland tumors (cMGTs) are the most common neoplasms in intact female canines and viewed as a suitable model for studying human breast cancers. Euphorbia royleana has been reported to have a variety of antitumor efficacies. We have prepared the crude extracts of E. royleana in ethanol and hexane solvents to evaluate the anti-tumor effects for cMGT in vitro and in vivo.

Results
The results showed that E. royleana could inhibit cell proliferation and colony formation in cMGT cells. The suppression of tumor cell growth resulted from necrosis and cell cycle arrest. Moreover, autophagy appears to play a critical role in E. royleana-mediated cell death by triggering cell apoptosis. The in vivo results also revealed that E. royleana treatment could reduce the size of solid tumors while exhibiting low toxicity in cMGT-bearing nude mice.

Conclusions
The anti-tumor mechanisms of E. royleana were firstly verified to show it would cause autophagic cell death, apoptosis, and cell cycle arrest in canine mammary tumor cells. The in vitro and in vivo findings in the present study revealed E. royleana has potential anticancer effects for the treatment of canine mammary gland tumors.
A computational paradigm for real-time MEG neurofeedback for dynamic allocation of spatial attention
Authors: Rana Kunjan D. , Khan Sheraz , Hämäläinen Matti S. , Vaina Lucia M. 
Published: June 2020

AbstractBackgroundNeurofeedback aids volitional control of one’s own brain activity using non-invasive recordings of brain activity. The applications of neurofeedback include improvement of cognitive performance and treatment of various psychiatric and neurological disorders. During real-time magnetoencephalography (rt-MEG), sensor-level or source-localized brain activity is measured and transformed into a visual feedback cue to the subject. Recent real-time fMRI (rt-fMRI) neurofeedback studies have used pattern recognition techniques to decode and train a brain state to link brain activities and cognitive behaviors. Here, we utilize the real-time decoding technique similar to ones employed in rt-fMRI to analyze time-varying rt-MEG signals.ResultsWe developed a novel rt-MEG method, state-based neurofeedback (sb-NFB), to decode a time-varying brain state, a state signal, from which timings are extracted for neurofeedback training. The approach is entirely data-driven: it uses sensor-level oscillatory activity to find relevant features that best separate the targeted brain states. In a psychophysical task of spatial attention switching, we trained five young, healthy subjects using the sb-NFB method to decrease the time necessary for switch spatial attention from one visual hemifield to the other (referred to as switch time). Training resulted in a decrease in switch time with training. We saw that the activity targeted by the training involved proportional changes in alpha and beta-band oscillations, in sensors at the occipital and parietal regions. We also found that the state signal that encodes whether subjects attend to the left or right visual field effectively switches consistently with the task.ConclusionWe demonstrated the use of the sb-NFB method when the subject learns to increase the speed of shifting covert spatial attention from one visual field to the other. The sb-NFB method can target timing features that would otherwise also include extraneous features such as visual detection and motor response in a simple reaction time task.
Complete genome analysis of hepatitis B virus in Qinghai-Tibet plateau: the geographical distribution, genetic diversity, and co-existence of HBsAg and anti-HBs antibodies
Authors: Liu He , Shen Liping , Zhang Shuang , Wang Feng , Zhang Guomin , Yin Zundong , Qiu Feng , Liang Xiaofeng , Wang Fuzhen , Bi Shengli 
Published: June 2020

Abstract
Background
The genetic variation and origin of Hepatitis B Virus (HBV) in Qinghai-Tibet Plateau were poorly studied. The coexistence of HBsAg and anti-HBs has been described as a puzzle and has never been reported in the indigenous population or in recombinant HBV sequences. This study aimed to report geographical distribution, genetic variability and seroepidemiology of HBV in southwest China.

Methods
During 2014–2017, 1263 HBsAg positive serum were identified and 183 complete genome sequences were obtained. Serum samples were collected from community-based populations by a multistage random sampling method. Polymerase chain reaction (PCR) was used to amplify the HBV complete genome sequences. Then recombination, genetic variability, and serological analysis were performed.

Results
(1) Of the 1263 HBsAg positive serum samples, there were significant differences between the distribution of seromarkers in Tibet and Qinghai. (2) Of 183 complete genome sequences, there were 130 HBV/CD1 (71.0%), 49 HBV/CD2 (26.8%) and four HBV/C2 isolates (2.2%). Serotype ayw2 (96.1%) was the main serological subtype. (3) Several nucleotide mutations were dramatically different in CD1 and CD2 sequences. Clinical prognosis-related genetic variations such as nucleotide mutation T1762/A1764 (27.93%), A2189C (12.85%), G1613A (8.94%), T1753C (8.38%), T53C (4.47%) T3098C (1.68%) and PreS deletion (2.23%) were detected in CD recombinants. (4) From the inner land of China to the northeast boundary of India, different geographical distributions between CD1 and CD2 were identified. (5) Twenty-seven (2.14%) HBsAg/HBsAb coexistence serum samples were identified. S protein amino acid mutation and PreS deletion were with significant differences between HBsAg/HBsAb coexistence group and control group.

Conclusions
HBV/CD may have a mixed China and South Asia origin. Based on genetic variations, the clinical prognosis of CD recombinant seems more temperate than genotype C strains in China. The HBsAg/HBsAb coexistence is a result of both PreS deletion and aa variation in S protein. Several unique mutations were frequently detected in HBV/CD isolates, which could potentially influence the clinical prognosis.
Cardiovascular health outcomes of mobbing at work: results of the population-based, five-year follow-up of the Gutenberg health study
Authors: Romero Starke Karla , Hegewald Janice , Schulz Andreas , Garthus-Niegel Susan , Nübling Matthias , Wild Philipp S. , Arnold Natalie , Latza Ute , Jankowiak Sylvia , Liebers Falk , Rossnagel Karin , Riechmann-Wolf Merle , Letzel Stephan , Beutel Manfred , Pfeiffer Norbert , Lackner Karl , Münzel Thomas , Seidler Andreas 
Published: June 2020

Abstract
Background
The aim of this study was to determine if there is an increased risk of incident cardiovascular disease (CVD) resulting from workplace mobbing measured with two mobbing instruments in the Gutenberg Health Study.

Methods
In this prospective study, we examined working persons younger than 65 years for the presence of mobbing at baseline and at a 5-year follow-up using a single-item and a 5-item instrument. We used multivariate models to investigate the association between mobbing and incident CVD, hypertension, and change in arterial stiffness and further stratified the models by sex.

Results
After adjustment for confounders, mobbed workers appeared to have a higher risk of incident CVD than those not mobbed (single-item HR = 1.28, 95% CI 0.73–2.24; 5-item HR = 1.57, 95% CI 0.96–2.54). With the 5-item instrument, men who reported mobbing had a higher risk of incident CVD (HR = 1.77, 95% CI 1.01–3.09), while no association was observed for women (HR = 1.05, 95% CI 0.38–2.91). There was no difference in risks between men and women with the single-item instrument. No association between mobbing and incident hypertension and arterial stiffness was seen.

Conclusions
Our results show an indication of an increased risk of incident CVD for those mobbed at baseline when using the whole study population. Differences in risks between men and women when using the five-item instrument may be due to the instrument itself. Still, it is essential to detect or prevent workplace mobbing, and if present, to apply an intervention to halt it in order to minimize its adverse effects on CVD.
Clinical implication in the use of the AAA algorithm versus the AXB in nasopharyngeal carcinomas by comparison of TCP and NTCP values
Authors: Bufacchi Antonella , Caspiani Orietta , Rambaldi Giulia , Marmiroli Luca , Giovinazzo Giuseppe , Polsoni Mattia 
Published: June 2020

Abstract
Purpose
Retrospective analysis of volumetric modulated arc therapy treatment plans to investigate qualitative, possible, clinical consequences of the use of AAA versus AXB in nasopharyngeal cancer (NPC) cases.

Methods
The dose distribution of 26 treatment plans, produced using RapidArc technique and AAA algorithm, were recalculated using AXB and the same number of monitor units provided by AAA and clinically delivered to each patient. The potential clinical effect of dosimetric differences in the planning target volume (PTV) and in organs at risk (OAR) were evaluated by comparing TCP and NTCP values. The Wilcoxon Signed Rank test was used for statistical comparison of all results obtained from the use of the two algorithms.

Results
The poorer coverage of the PTV, with higher prescribed dose, was reflected in the TCP, which was significantly lower when AXB was used, the median value was 81.55% (range: 74.90, 88.60%) and 84.10% (range: 77.70, 89.90%) for AAA (p < 0.001). OAR mean dose was lower in the AXB recalculated plan than the AAA plan and the difference was statistically significant for all the structures. The NTCP for developing mandible necrosis showed the largest median percentage difference between AAA and AXB (56.6%), the NTCP of risk for larynx edema of Grade ≥ 2 followed with 12.2%.

Conclusions
Differences in dose distribution of NPC treatment plans recalculated with AXB are of clinical significance in those situations where the PTV and OAR involve air or bone, media in which AXB has been shown to more accurately represent the true dose distribution. The availability of AXB algorithm could improve patient dose estimation, increasing the data consistency of clinical trials.
CD155 immunoregulation as a target for natural killer cell immunotherapy in glioblastoma
Authors: Lupo Kyle B. , Matosevic Sandro 
Published: June 2020

AbstractNatural killer (NK) cells are powerful immune effectors, modulating their anti-tumor function through a balance activating and inhibitor ligands on their cell surface. Though still emerging, cancer immunotherapies utilizing NK cells are proving promising as a modality for the treatment of a number of solid tumors, including glioblastoma (GBM) and other gliomas, but are often limited due to complex immunosuppression associated with the GBM tumor microenvironment which includes overexpression of inhibitory receptors on GBM cells. CD155, or poliovirus receptor (PVR), has recently emerged as a pro-tumorigenic antigen, overexpressed on GBM and contributing to increased GBM migration and aggressiveness. CD155 has also been established as an immunomodulatory receptor, able to both activate NK cells through interactions with CD226 (DNAM-1) and CD96 and inhibit them through interaction with TIGIT. However, NK cell TIGIT expression has been shown to be upregulated in cancer, establishing CD155 as a predominantly inhibitory receptor within the context of GBM and other solid tumors, and rendering it of interest as a potential target for antigen-specific NK cell-based immunotherapy. This review will explore the function of CD155 within GBM as it relates to tumor migration and NK cell immunoregulation, as well as pre-clinical and clinical targeting of CD155/TIGIT and the potential that this pathway holds for the development of emerging NK cell-based immunotherapies.
A valuable and affordable handheld ultrasound in combating COVID-19
Authors: Qian Feng , Zhou Xueqin , Zhou Jianqiao , Liu Zhenhua , Nie Qian 
Published: June 2020

AbstractThe handheld ultrasound demonstrates clinical and economic value in combating COVID-19 based on interviews with frontline ultrasound physician and cardiologist as well as a national expert in medical ultrasound.
A feasibility study of a WhatsApp-delivered Transtheoretical Model-based intervention to promote healthy eating habits for firefighters in Hong Kong: a cluster randomized controlled trial
Authors: Ng Wing Man , Cheung Kin 
Published: June 2020

Abstract
Background
Firefighters’ health is often affected by a high prevalence of obesity and cardiovascular diseases, which are common risk factors for sudden cardiac death. The aim of this study is to investigate the feasibility of enhancing healthy eating habits in firefighters through an education programme.

Methods
This will be a cluster randomized control trial study. The participants will be assigned randomly into either control (health promotion pamphlet) or intervention (health promotion pamphlet and education materials through WhatsApp) groups. Changes in healthy eating habits will be assessed by a self-administered questionnaire and anthropometric measurements at three different time points.

Discussion
More education is required in order to improve firefighters’ eating habits.

Trial registration
ISRCTN registry identifier: Registered on 8 April 2019 ISRCTN95472464.