bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of First Metatarsal Shortening on Forefoot Loading Pattern: A Finite Element Model Study
Authors: Xiang Geng , Jiaqi Shi , Wenming Chen , Ma Xin , Xu Wang , Chao Zhang , Li Chen 
Published: November 2019

Abstract
Backgrounds There has long been agreement that shortening of the first metatarsal during hallux valgus reconstruction could lead to postoperative transfer metatarsalgia. But appropriate shortening is sometimes beneficial for correcting severe deformities or relieving stiff joints. So this study is to investigate, from the biomechanical perspective, whether and how much shortening of the first metatarsal could be allowed.
Methods A finite element model of the human foot simulating the push-off phase of the gait was established and validated by subject-specific plantar pressure data. Shortening of the first metatarsal for 2mm, 4mm, 6mm, 8mm were sequentially applied to the model, and the corresponding instant forefoot loading pattern during push-off phase, especially the loading ratio at the central rays, was respectively calculated. The effect of depressing the first metatarsal head was also observed at last.
Results With increasing shortening level of first metatarsal, the plantar pressure of the first ray decreased, while the lateral rays continued to rise. When the shortening reaches 6 mm, the load ratio of the central rays exceeds a critical threshold of 55%, which was considered risky. But it could still be manipulated to normal if the distal end of the first metatarsal displaced plantarly by 3 mm.
Conclusions During the first metatarsal osteotomy, a maximum of 6 mm of shortening is considered to be within the safe range. Whenever a higher level of shortening is necessary, pushing down the distal metatarsal segment could be a compensatory procedure to maintain normal plantar force distributions.
An alarming rise of non-albicans Candida species and uncommon yeasts in the clinical samples; a combination of various molecular techniques for identification of etiologic agents
Authors: Taei Mohireh , Chadeganipour Mostafa , Mohammadi Rasoul 
Published: November 2019

Abstract
Objective: Yeasts are unicellular microorganisms may cause systemic infection in immunocompromised patients. The aim of this study was to identify yeast strains isolated from clinical specimens using molecular techniques.
Results: A total of 202 yeast strains isolated from 341 clinical samples between February 2017 and May 2019. All clinical isolates were identified using phenotypic and molecular tests including PCR-RFLP, duplex-PCR, multiplex-PCR, and PCR-sequencing. The most yeast fungal isolates were obtained from urine (66.8%), nail (9.4%), skin lesion (7.9%), bronchoalveolar lavage (5.9%), and blood (3.9%). One hundred and twenty-one Candida species were identified as non-albicans versus 76 Candida albicans. Trichosporon asahii, and Pichia terricola were uncommon non-Candida yeasts isolated from urine samples. For the first time, we isolated P. terricola as etiological agent of urinary tract infection in a pregnant female. Since Candida species show different levels of resistance to antifungal agents, precise identification of clinical isolates is critical for better treatment of infection.
Zerumbone ameliorates behavioral impairments and neuropathology in transgenic APP/PS1 mice by suppressing MAPK signaling
Authors: Li Lei , Wu Xiang-Hui , Zhao Xiao-Jing , Xu Lu , Pan Cai-Long , Zhang Zhi-Yuan 
Published: November 2019

Abstract
Background: Alzheimer’s disease (AD) is a major clinical problem, but there is a distinct lack of effective therapeutic drugs for this disease. We investigated the potential therapeutic effects of zerumbone, a subtropical ginger sesquiterpene, in transgenic APP/PS1 mice, rodent models of AD which exhibit cerebral amyloidosis and neuroinflammation. Methods: The N9 microglial cell line and primary microglial cells were cultured to investigate the effects of zerumbone on microglia. APP/PS1 mice were treated with zerumbone, and non-cognitive and cognitive behavioral impairments were assessed and compared between the treatment and control groups. The animals were then sacrificed, and tissues were collected for further analysis. The potential therapeutic mechanism of zerumbone and the signaling pathways involved were also investigated. Results: Zerumbone suppressed the expression of pro-inflammatory cytokines and induced a switch in microglial phenotype from the classic inflammatory phenotype to the alternative anti-inflammatory phenotype by inhibiting the mitogen-activated protein kinase (MAPK)/nuclear factor-kappa B signaling pathway in vitro. After a treatment period of 20 days, zerumbone significantly ameliorated deficits in both non-cognitive and cognitive behaviors in transgenic APP/PS1 mice. Zerumbone significantly reduced β-amyloid deposition and attenuated pro-inflammatory microglial activation in the cortex and hippocampus. Interestingly, zerumbone significantly increased the proportion of anti-inflammatory microglia among all activated microglia, potentially contributing to reduced β-amyloid deposition by enhancing phagocytosis. Meanwhile, zerumbone also reduced the expression of key molecules of the MAPK pathway, such as p38 and extracellular signal-regulated kinase. Conclusions: Overall, zerumbone effectively ameliorated behavioral impairments, attenuated neuroinflammation, and reduced β-amyloid deposition in transgenic APP/PS1 mice. Zerumbone exhibited substantial anti-inflammatory activity in microglial cells and induced a phenotypic switch in microglia from the pro-inflammatory phenotype to the anti-inflammatory phenotype by inhibiting the MAPK signaling pathway, which may play an important role in its neuroprotective effects. Our results suggest that zerumbone is a potential therapeutic agent for human neuroinflammatory and neurodegenerative diseases, in particular AD.
Water, sanitation and hygiene practices associated with improved height-for-age, weight-for-height and weight-for-age z-scores in Nepal.
Authors: Shrestha Som Kumar , Vicendese Don , Erbas Bircan 
Published: November 2019

Abstract
Abstract: Background: Evidence of the influence of water, sanitation and hygiene (WASH) behaviors on childhood nutritional status is inconsistent. Few studies have examined their interactive effects. This study aimed to examine associations and interactions between WASH variables and preschool child undernutrition. Methods: Data from a nationally representative sample of 2352 children assessed during the 2016 Nepal Demographic and Health Survey were analyzed by multi-variable linear regression to obtain β-coefficients representing change in height-for-age (HAZ), weight-for-height (WHZ) and weight-for-age (WAZ) z-scores associated with WASH variables. Interactions between WASH variables, sex and area of residence on childhood nutritional status were also examined. Results: The mean z-score [standard deviation] for children’s WAZ, HAZ and WHZ scores were -1.33 [1.1], -1.52 [1.3] and -0.65 [1.1], respectively. A unit increase in cluster sanitation coverage was associated with an increase of 0.30 (95%CI: 0.12, 0.48) for WAZ and 0.28 (95%CI: 0.001, 0.56) for HAZ scores. Household water purification practice was associated with an increase of 0.24 (95%CI: 0.07, 0.41) in WHZ score. Handwashing practice with water and soap was associated with an increase of 0.15 (95%CI: 0.04, 0.25) in WAZ and 0.13 (95%CI: 0.01, 0.24) in WHZ scores. The effect of water purification practice was higher for rural areas compared to urban settings for HAZ scores (p-value for interaction=0.002). Conclusions: Consistent with findings from other countries in the South Asian region, findings of this study highlight the potential importance of good WASH practices, and therefore the potential of WASH interventions, to contribute to improved nutritional status in rural Nepal.
An observational study of Patho-oncological outcomes of various surgical methods in rectal cancer: a single center analysis
Authors: CHEN YI-TING , HUANG CHING-WEN , MA CHENG-JEN , TSAI HSIANG-LIN , YEH YUNG-SUNG , SU WEI-CHIH , CHAI CHEE-YIN , Wang Jaw Yuan 
Published: November 2019

Abstract
Total mesorectal excision (TME) with or without neoadjuvant concurrent chemoradiotherapy (CCRT) is the treatment for rectal cancer (RC). Recently, the use of conventional laparoscopic surgery (LS) or robotic-assisted surgery (RS) has been on a steady increase cases. However, various oncological outcomes from different surgical approaches are still under investigation.Materials and methods This is a retrospective observational study comprising 300 consecutive RC patients who underwent various techniques of TME (RS, n = 88; LS, n = 37; Open surgery, n = 175) at a single center of real world data to compare the pathological and oncological outcomes, with a median follow-up of 48 months.Results Upon multivariate analysis, histologic grade ( P =0.048), tumor depth ( P =0.003), and pre-operative CCRT ( P =0.038) were the independent factors of circumferential resection margin (CRM) involvement. The Kaplan-Meier survival analysis determined RS, early pathologic stage, negative CRM involvement, and pathologic complete response to be significantly associated with better overall survival (OS) and disease-free survival (DFS) (all P <0.05). Multivariable analyses observed the surgical method ( P =0.037), histologic grade ( P =0.006), and CRM involvement ( P =0.043) were the independent factors of DFS, whereas histologic grade ( P =0.011) and pathologic stage ( P =0.022) were the independent prognostic variables of OS.Conclusions This study determined that RS TME is feasible because it has less CRM involvement and better oncological outcomes than the alternatives have. The significant factors influencing CRM and prognosis depended on the histologic grade, tumor depth, and pre-operative CCRT. RS might be an acceptable option owing to the favorable oncological outcomes for patients with RC undergoing TME.
Evaluation of the safety and efficacy of suction-tip forceps, a new tool for laparoscopic surgery, in patients with gastric cancer: Preliminary results from a prospective trial
Authors: Sakurazawa Nobuyuki , Harada Jun-ichiro , Ando Fumihiko , Arai Hiroki , Kuge Komei , Matsumoto Satoshi , Kawano Youichi , Matsuda Akihisa , Suzuki Hideyuki , Yoshida Hiroshi 
Published: November 2019

Abstract
Background
Laparoscopic surgery is widely accepted as minimally invasive surgery; however, obstacles to its functional optimization remain. One such challenge is that each surgical port can accommodate only one instrument at a time. Complex manipulations are therefore necessary to exchange one laparoscopic tool with another during surgery (e.g., removal of forceps and placement of a suction tube), which increases operation times and risk to patients. We developed a new laparoscopic instrument that functions as both forceps and a suction tube, which renders intraoperative tool exchange unnecessary. This prospective pilot study was undertaken to evaluate the safety and efficacy of this novel dual-function device in laparoscopic surgery for gastric cancer.
Methods
This single-center prospective pilot study was undertaken with 15 patients who required laparoscopic distal gastrectomy for gastric cancer. To assess patient safety, intraoperative video was used to document any tissue damage associated with the new instrument. To evaluate instrument efficacy, we measured the time interval between the start of bleeding and the start of aspiration (“suction access time”) and compared this time with that of a conventional surgical setup.
Results
All procedures were successful, and no excess tissue damage occurred during surgery with the suction-tip forceps. Bleeding occurred 158 times. Suction access time was significantly shorter in cases of bleeding when the suction-tip forceps were used (2.01 seconds) than when an ordinary suction tube was used for aspiration (12.5 seconds; P < 0.01).
Conclusion
These findings suggest that our new suction-tip forceps are a useful, safe, and efficacious operative tool. This surgical innovation may considerably simplify gastric laparoscopic surgery. This pilot study was registered with Japan Clinical Trial Registration on June 22, 2017 (registration number: UMIN000027879).
Sleep disordered breathing, insomnia, and excessive daytime sleepiness among Japanese pregnant women without gestational complications do not negatively impact delivery outcomes
Authors: Kondo Hideaki , Umeno Shiho , Eto Hiromi , Kato Chiho , Nagaura Yuki 
Published: November 2019

Abstract
Frequently observed sleep/wake problems among pregnant women need comprehensive evaluation. This study was conducted to clarify the sleep/wake problems among pregnant women without gestational complications at the second and third trimester and the effects of sleep/wake problems on delivery outcomes. Methods: A total of 88 Japanese pregnant women participated in this study. At the second and third trimester, subjective sleep quality, insomnia severity, excessive daytime sleepiness (EDS), and restless legs syndrome/Willis-Ekbom disease (RLS/WED) were assessed using questionnaires; also, sleep disordered breathing (SDB) was screened using a pulse oximeter. Results: From the second to third trimester, an increasing tendency of sleep/wake problems was observed. At the third trimester, the percentage of women experiencing decreased subjective sleep quality, difficulty maintaining sleep (DMS), EDS, RLS/WED, and 3% oxygen desaturation index (ODI) values ≥ 5/h were 62.5%, 45.5%, 48.9%, 9.1%, and 29.5%, respectively. In a logistic regression analysis for EDS at the third trimester, the adjusted odds ratio (95% confidence interval) of total sleep time < 6 hours, moderate to severe DMS, and 3% ODI ≥ 5/h were 3.25 (1.16–9.10), 4.74 (1.60–14.00), and 0.90 (0.28–2.89), respectively. Decreased subjective sleep quality, insomnia severity, EDS, and SDB did not affect the delivery outcome or infant’s condition. Conclusions: Sleep/wake problems were frequent during pregnancy, especially at the third trimester. EDS among pregnant women was associated with shorter sleep time and DMS, rather than SDB. However, there were no significant effects of sleep/wake problems on the delivery outcomes or infant’s conditions.
The Influence of Experiential Knowledge and Societal Perceptions on Decision-Making Regarding Non-Invasive Prenatal Testing (NIPT)
Authors: Montgomery Sophie , Thayer Zaneta M. 
Published: November 2019

Abstract
Non-invasive prenatal testing (NIPT) allows women to access genetic information about their fetuses without the physical risk inherent to prior testing methods. The advent of NIPT technology has yielded concerns among bioethicists regarding the quality and process of informed consent, as the routinization of this technology could degrade the intentionality of women choosing whether to undergo testing. Prior studies evaluating the NIPT decision-making process have focused on the clinical encounter as the primary environment for acquisition of biomedical information and decision formation. While important, this conceptualization fails to consider how additional sources of knowledge, including both embodied and empathetic experiential knowledge, shape perceptions of risk and the societal use of NIPT.
In order to address this issue, qualitative, semi-structured interviews with 25 women who had been offered NIPT were performed. Women were categorized by NIPT use/non-use, as well as whether their described decision-making process was routinized. Qualitative analysis of the data using a phenomenological approach was used to explore themes in the data, develop a framework of NIPT decision-making, and compare the perceptions of women with differential decision-making processes and outcomes.
A framework for decision-making regarding NIPT was developed based on three emergent factors: perceptions of the societal use of NIPT, expected emotional impact of genetic information, and perceived utility of genetic information. Qualitative analysis revealed that perceptions of widespread use of NIPT, pervasive societal narratives of NIPT use as progressive and “forward-thinking,” and a perception of more information as anxiety-relieving contributed to routinized uptake of NIPT. In contrast, women who displayed a lack of routinization expressed fewer stereotypes regarding the audience for NIPT and relied on communication with their social networks in-person and online to consider how they might use the information provided by NIPT.
The findings of this study reveal the societal narratives and perceptions that shape differential decision-making regarding NIPT. Understanding and addressing these perceptions that influence NIPT decision-making, especially routinized uptake of NIPT, is important as the use and scope of this technology increases.
Chemotherapy for breast cancer during pregnancy induces vascular alterations and impaired development of placental villi: a preliminary histopathological study.
Authors: Gobbo Alessandro Del , Scarfone Giovanna , Peccatori Fedro Alessandro , Villa Antonella , Ossola Wally , Ercoli Giulia , Bosari Silvano , Ferrero Stefano , Boggio Francesca Laura , Grossi Elena , Cribiù Fulvia Milena 
Published: November 2019

Abstract
Breast cancer is diagnosed in approximately 1/3000 pregnant women. Chemotherapy may be administered after the first trimester, with improved maternal outcome and relatively few pregnancy and offspring complications. Nonetheless, no information about the effects of different chemotherapy regimens on placenta architecture and vasculature are available. Methods To evaluate histological alterations in placentas of women affected by breast cancer and treated with chemotherapy during pregnancy, we retrospectively analyzed 23 placentas of patients affected by breast cancer and treated with chemotherapy during pregnancy and 23 control placentas of women without breast cancer and with physiological pregnancies of the same gestational age. Results All the patients had breast ductal infiltrating carcinoma, 19 of 23 cases had a G3 cancer. All patients were treated with 2-6 cycles of chemotherapy starting after 16 weeks of gestation, with different protocols. No hypertensive complications and no pre-eclampsia episodes were observed; birth weight was consistent with gestational age in all babies in both group with no uneventful outcomes and no perinatal mortality or fetal malformations. Twenty out of 23 cases (86%) showed hypoxia-induced villous alterations, including increased syncytial knotting (Tenney-Parker changes), perivillar fibrin deposits, distal villous hypoplasia or accelerated maturation and focal villous chorangiosis. These alterations were found in 19 out of 23 controls (83%), with no statistically significant difference between the two groups. Conclusions These results shows that chemotherapy in the second and third trimester of pregnancy may lead to non-specific alterations in placental vasculature and morphology.
High manganese exposure decreased the risk of high triglycerides in male workers: a cross-sectional study
Authors: luo xiaoyu , liu zhenfang , ge xiaoting , huang sifang , zhou yanting , li defu , li longman , chen xiang , huang lulu , hou qingzhi , cheng hong , xiao lili , liu chaoqun , zou yunfeng , Yang Xiaobo 
Published: November 2019

Abstract
Manganese (Mn) is to be involved in lipids metabolism. However, few epidemiological studies have investigated the association between elevated exposure to Mn and the risk of dyslipidemia. Methods: This was a cross-sectional study based on follow-up of the manganese-exposed workers healthy cohort (MEWHC) in 2017. A total of 803 Mn-exposed workers were divided into the low-exposure, and high-exposure group according to Mn-Time Weighted Average (Mn-TWA) ≤0.15mg/m3 or >0.15mg/m3. And we evaluated the associations between Mn-TWA levels and dyslipidemia, and assessed the interaction between Mn-TWA levels and each of the potential interacting factors. Results: After adjustment for potential confounders, we observed mainly significant negative association between high triglycerides (TG) risk and Mn-TWA levels in male (OR = 0.60; 95% CI: 0.39, 0.94; p <0.01). In interaction analyses of male, we did not observe a significant interaction between Mn-TWA levels and pack-years on high TG risk (relative excess risk for the interaction (RERI) = -1.30, 95% CI: -3.29, 0.70, RERI = -1.62, 95% CI: -3.92, 0.67). Similarly, analysis of smoking status, drinking status, high-fat diets frequency, and BMI were nonsignificant interaction with Mn-TWA levels on high TG risk as well. Conclusions: Our study indicated that high Mn exposure was significantly associated with low risk of hyper TG in male workers.Keywords: Manganese; Occupation; Dyslipidemia; Triglycerides
Does Xpert MTB/RIF Assay Give Rifampicin Resistance Results Without Identified Mutation? Review of Cases from Addis Ababa, Ethiopia.
Authors: Alemu Ayinalem , Tadesse Mengistu , Seid Getachew , Mollalign Helina , Eshetu Kirubel , Sinshaw Waganeh , Abebaw Yeshiwork , Amare Misikir , Dagne Biniyam , Diriba Getu , Yenew Bazezew , Getu Melak , Zerihun Betselot 
Published: November 2019

Abstract
Background: Xpert MTB/RIF Assay is currently used in Ethiopia for the rapid diagnosis of Mycobacterium tuberculosis (MTB) and mutations that confer Rifampicin resistance. Rifampicin resistance is determined based on any mutation in the 81 bp of rpoB gene using five overlapping probes represented as Probe A (codons 507–511), Probe B (codons 512–518), Probe C (codons 518–523), Probe D (codons 523–529) and Probe E (codons 529–533). In this review, we assessed the frequency of missed probe types for Rifampicin Resistance results. Methods: Data were reviewed from specimens received and tested using Xpert® MTB/RIF Assay at Ethiopian National Tuberculosis Reference Laboratory, in Addis Ababa from 15 July 2016 to 31 December 2018 retrospectively. All archived data were reviewed carefully to describe missed probe types and quantity of DNA in the sample. Results: A total of 100 specimens were reported as MTB Detected Rifampicin Resistance Detected by Xpert MTB/RIF assay. More than half (55%) of these results were reported from male patients. The median age was 28.0 years (5 months to 88 years). Majorities (62%) of the cases were detected from sputum. Among the total of 38 extra pulmonary samples, lymph node aspirates were accounted 50% (19/38). The most common mutations (81.0%) were found in Probe E region followed by Probe D (10.0%), and Probe B (3.0%). Mutations in Probe A and Probe C regions were not observed. However six (6.0%) Rifampicin resistance cases were found without any missed probe type. The delta Ct max is ≥4.3. No specimen yielded Rifampicin resistance associated with more than one probe failure or mutation combinations. Conclusion: Mutations associated with Probe E (codons 529–533) region were identified as the commonest rpoB gene mutations. The Rifampicin resistance results found without any identified missing probe needs a further study. Lower DNA amount was observed in extrapulmonary specimens compared with sputum. Keywords: Rifampicin-resistance, Molecular Beacon, DNA probes, Xpert MTB/RIF Assay