bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Instruction on Preventing Delayed Bleeding After Colorectal Polypectomy and Endoscopic Mucosal Resection
Authors: Okugawa Takuya , Oshima Tadayuki , Nakai Keisuke , Eda Hirotsugu , Tamura Akio , Hara Ken , Ogawa Tomohiro , Kono Tomoaki , Kondo Takashi , Tozawa Katsuyuki , Fukushima Masashi , Tomita Toshihiko , Fukui Hirokazu , Watari Jiro , Miwa Hiroto 
Published: October 2020

Abstract
Background: The frequency of delayed bleeding after colorectal polypectomy has been reported as 0.6 – 2.8%. With the increasing performance of polypectomy under continuous use of antithrombotic agents, care is required regarding delayed post-polypectomy bleeding. Better instruction to educate endoscopists is therefore needed. We aimed to evaluate the effect of instruction and factors associated with delayed bleeding after endoscopic colorectal polyp resection.Methods: This single-center, retrospective study was performed to assess instruction in checking complete hemostasis and risk factors for onset of delayed post-polypectomy bleeding. The incidence of delayed bleeding, comorbidities, and medications were evaluated from medical records. Characteristics of patients before and after instruction were compared. Univariate analysis and forward stepwise logistic regression analysis were performed to test the influence of factors in association with delayed post-polypectomy bleeding.Results: A total of 3318 polyps in 1002 patients were evaluated. The before-instruction group comprised 1479 polyps in 458 patients and the after-instruction group comprised 1839 polyps in 544 patients. Polyp size, pedunculated type, polyp location, and rate of cold snare polypectomy did not differ between before and after instruction. Clip placement was significantly more common after instruction (22.6%, 416/1839) than before (9.7%, 144/1479, P < 0.01). Delayed post-polypectomy bleeding occurred in 1.1% of cases before instruction, and 0.4% after instruction. Instruction significantly decreased delayed bleeding, particularly in cases with antithrombotic agents. Multivariate logistic regression analysis showed that hot polypectomy, clip placement, and use of antithrombotic agents were significant independent risk factors for delayed post-polypectomy bleeding even after instruction.Conclusion: The rate of delayed bleeding significantly decreased after instruction to check for complete hemostasis. Even after instruction, delayed bleeding can still occur in cases with antithrombotic agents or hot polypectomy.
P2Y12 Inhibitor Utilization for Acute Coronary Syndrome in the Elderly: A Provincial Analysis From 2008 to 2018
Authors: Gupta Saurabh , Belley-Cote Emilie P , Eqbal Adam , McEwen Charlotte , Basha Ameen , Wu Nicole , Cerasuolo Joshua , Mehta Shamir , Schwalm Jon-David , Whitlock Richard P 
Published: October 2020

Abstract
Background Guidelines recommend acetylsalicylic acid (ASA) and ticagrelor following acute coronary syndrome (ACS), but appropriate prescription practices lag. We analyzed the impact of government medication approval, national guideline updates, and publicly funded drug coverage plans on P2Y12 inhibitor utilization.Methods Accessing provincial databases, we obtained data for elderly ACS patients in Ontario, Canada between 2008 and 2018. Using an interrupted-time series, we evaluated types of P2Y12 inhibitors prescribed at discharge, and changes to their utilization following ticagrelor’s national approval by Health Canada, national antiplatelet therapy guidelines (by the Canadian Cardiovascular Society (CCS)), and ticagrelor's coverage by a publicly funded medication plan.Results We included 114,142 patients (49.4%-PCI and 7.7%-CABG). Proportion of PCI patients utilizing P2Y12 inhibitors increased from 73.4% to 86.9% (p<0.001) and 11.4% to 46.5% (p<0.001) for CABG patients. Among PCI patients, clopidogrel utilization declined monthly after 2010 national guidelines were published (0.7%; p<0.0001) and within the first month after ticagrelor’s national approval by Health Canada (5.3%; p=0.03). Among PCI patients, ticagrelor utilization increased within the first month (24.5%; p<0.0001) and continued increasing monthly (0.4%; p<0.0001) after its coverage by a publicly funded medication plan. Among CABG patients, ticagrelor’s coverage was associated with a monthly increase in its utilization (0.2%; p<0.0001). Among PCI patients, clopidogrel utilization declined within the first month (6.1%; p=0.003) and ticagrelor utilization increased monthly (0.3%; p=0.05) after 2012 CCS guidelines.Conclusion National guideline updates and drug coverage by a publicly funded medication plan significantly improved P2Y12 inhibitor utilization. Barriers to appropriate antiplatelet therapy in the surgical population must be explored.
The Effectiveness of Two Implementation Strategies for Improving Teachers’ Delivery of an Evidenced-based HIV Prevention Program
Authors: Wang Bo , Deveaux Lynette , Cottrell Lesley , Li Xiaoming , Adderley Richard , Dorsett Barbara , Firpo-Triplett Regina , Koci Veronica , Marshall Sharon , Forbes Nikkiah , Stanton Bonita 
Published: October 2020

Abstract
Background: Effective implementation strategies are needed to enhance the success of evidence-based prevention programs. The current study evaluates the effects of two implementation strategies on teachers’ implementation of an evidenced-based HIV intervention.Methods: Using our 7-item Pre-Implementation School Screening tool, we identified teachers who were at-risk for not implementing the Focus on Youth HIV-risk reduction intervention curriculum which targets middle and high school youth. After completing a two-day curriculum workshop, 84 low- and moderate-performing teachers were randomly assigned to one of four experimental conditions and were asked to teach the intervention curriculum for nearly two months. This optimization trial examines the impact of two implementation strategies including biweekly monitoring/feedbacks (BMF) and site-based assistance/mentorship (SAM). The primary outcome is implementation fidelity defined as number of core activities taught. General linear model was used to examine the association of the implementation strategies with implementation fidelity.Results: BMF and SAM were significantly associated with teachers’ implementation fidelity. Teachers who received both BFM and SAM taught the greatest numbers of core activities, followed by teachers who received either BMF or SAM. Teachers who did not receive BMF or SAM taught the lowest numbers of core activities (15.0 vs. 7.9 vs. 6.9 vs. 4.1, p< 0.001). Teachers’ confidence in implementing five core activities, attitudes towards sex education in schools, and perceived principal support were significantly related to increased self-efficacy, which in turn was related to teachers’ fidelity of implementation. Teacher full attendance at the training workshop and teachers’ sustained implementation of FOYC in the prior school year were related to increased implementation fidelity. Conclusion: BMF and SAM are effective in promoting teachers’ implementation of youth evidence-based interventions. Researchers and future program implementers should consider teacher training, teachers’ attitudes towards sex education, perceived principal support and self-efficacy when attempting to maintain the effects of teacher-delivered interventions in schools.
Hemagglutinin Stalk-based Monoclonal Antibody Elicits Broadly Reactivity Against Group 1 Influenza A Virus
Authors: Huang Jingjin , Huang Nan , Fan Menglu , Zhao Lingcai , Luo Yan , Ding Pingyun , Tian Miao , Liu Qingzheng , Guo Yanna , Zhao Jinhua , Zheng Yiqing , Zhang Haitao , Ping Jihui 
Published: October 2020

Abstract
Background: Influenza virus remains a continuous and serious threat to public health worldwide, and its prevention and treatment have always been a major international issue. Because of its ability to evade immune surveillance through rapid antigenic drift and antigenic shift, broad-spectrum vaccines seem increasingly important. Methods: A mAb named 3C12 from an immortalized hybrid cell was generated via immunizing mice with HA2 protein from A/chicken/Anhui/BRI99/2016 (AH/BRI99/16, H9N2) generated by prokaryotic expression. Then, its broad-spectrum activity was analyzed by WB and IFA. Next, the minimal linear epitope was identified via analyzing the reaction of a series of HA truncations with 3C12. Finally, the protective effects of 3C12 were evaluated in vitro and in vivo infection experiments.Results: The mAb could react with the viruses of subtypes H1, H2, H5, H8, H9, H12, H13, H16, and HA protein of H18 in group 1, but failed to react with viruses in group 2. The minimal linear epitope targeted by the mAb was 433NAELLVL439 in full length of HA and localized in the C-helix region of HA2 (residue 95-101, HA2 numbering). What’s more, the mAb 3C12 inhibited H1, H2, H5, H8, H9, H12, H13 and H16 virus-replication in vitro and also has shown effectiveness in preventing and treating disease in mice challenged with lethal dose of AH/BRI99/16 (H9N2) virus in vivo. These results suggested that the broadly reactive anti-HA stem mAb 3C12 exhibited prophylactic and therapeutic efficacy.Conclusions: Here, we have demonstrated that the linear epitope identified in this study could be a novel target for developing broad-spectrum influenza diagnostics or vaccine design, and the HA2-based monoclonal antibody is indeed a promising strategy for broad-spectrum protection against seasonal and pandemic influenza viruses.
Promoting Respectful Maternity Care using a Behavioral Design Approach in Zambia: Results from a Mixed-Methods Evaluation
Authors: Smith Jana , Schachter Allison , Banay Rachel , Zimmerman Emily , Sellman Abigail , Kamanga Ameck 
Published: October 2020

Abstract
Background: Respectful maternity care (RMC) has been elevated in the global discourse, however, instances of disrespect and abuse remain prevalent. While several studies have highlighted promising approaches to promote RMC, this body of literature is still limited and few approaches have been scaled outside the initial study sites. Building on formative research conducted through a behavioral science lens, we sought to develop and test evidence-based, low-cost solutions to promote RMC which would be well-positioned for scale-up. Our study highlights the effectiveness of the solution package on provider provision of better care and client satisfaction, as well as intermediary outcomes and behavioral mechanisms. Methods: A quasi-experimental evaluation, informed by the behavioral design approach, was completed to test the effectiveness of a 5-component solution package in Chipata, Zambia. Quantitative surveys were collected from health facility providers and postpartum clients at baseline and endline in intervention and comparison facilities. Additional qualitative interviews were conducted with health facility providers and postpartum clients at endline. We also conducted interviews with health facility in-charges and observed labor and delivery practices at intervention facilities over the course of implementation. Results: Evidence suggested that at endline, clients at implementation facilities were less likely to experience disrespect and abuse compared to clients at comparison facilities (ß= -0.15 p=.01). Clients at intervention facilities were more likely to request pain management compared to clients at comparison facilities (ß=.33, p=.003). The solutions were simple for providers to implement and were easily integrated into existing services by providers during labor and delivery. Providers at intervention facilities also described the pain management toolkit as helpful in expanding the types of pain management techniques used during labor.Conclusions: The results of this small-scale study act as a proof of concept, demonstrating that the behavioral design approach can lead to solutions that show potential for impact. In other settings where providers face similar barriers to providing RMC, an adaptation of this solution package might lead to similarly positive results. Given the global scale of disrespectful care, these low-cost solutions hold promise for improving the quality of care women receive during labor and delivery.
Diagnostic and Prognostic Impact of Cytokeratin 18 Expression in Human Tumors: A Tissue Microarray Study on 11,952 Tumors
Authors: Menz Anne , Weitbrecht Timo , Büscheck Franziska , Luebke Andreas M , Kluth Martina , Hube-Magg Claudia , Hinsch Andrea , Höflmayer Doris , Weidemann Sören , Fraune Christoph , Möller Katharina , Bernreuther Christian , Lebok Patrick , Clauditz Till , Sauter Guido , Uhlig Ria , Wilczak Waldemar , Steurer Stefan , Minner Sarah , Burandt Eike , Krech Rainer , Dum David , Krech Till , Marx Andreas , Simon Ronald 
Published: October 2020

Abstract
BackgroundCytokeratin 18 (CK18) is an intermediate filament protein of the cytokeratin acidic type I group and is primarily expressed in single-layered or “simple” epithelial tissues and carcinomas of different origin. MethodsTo systematically determine CK18 expression in normal and cancerous tissues, 11,952 tumor samples from 115 different tumor types and subtypes (including carcinomas, mesenchymal and biphasic tumors) as well as 608 samples of 76 different normal tissue types were analyzed by immunohistochemistry in a tissue microarray format. ResultsCK18 was expressed in normal epithelial cells of most organs but absent in normal squamous epithelium. At least an occasional weak CK18 positivity was seen in 90 of 115 (78.3%) tumor types. Wide-spread CK18 positivity was seen in 37 (31.9%) of tumor entities, including adenocarcinomas of the lung, prostate, colon and pancreas as well as ovarian cancer. Tumor categories with variable CK18 immunostaining included cancer types arising from CK18 positive precursor cells but show CK18 downregulation in a fraction of cases, tumor types arising from CK18 negative precursor cells occasionally exhibiting CK18 neo-expression, tumors derived from normal tissues with variable CK18 expression, and tumors with a mixed differentiation. CK18 downregulation was for example seen in renal cell cancers and breast cancers, whereas CK18 neo-expression was found in squamous cell carcinomas of various origins. Down-regulation of CK18 in invasive breast carcinomas of no special type and clear cell renal cell carcinomas (ccRCC) was related to adverse tumor features in both tumors (p≤0.001) and poor patient prognosis in ccRCC (p=0.0088). Up-regulation of CK18 in squamous cell carcinomas was linked to high grade and lymph node metastasis (p<0.05). In summary, CK18 is consistently expressed in various epithelial cancers, especially adenocarcinomas. ConclusionsDown-regulation or loss of CK18 expression in cancers arising from CK18 positive tissues as well as CK18 neo-expression in cancers originating from CK18 negative tissues is linked to cancer progression and may reflect tumor dedifferentiation.
Cloning and Expression of the EsxA Gene and Analysis of the Growth-Promoting&nbsp;Effects of the Encoded Protein on Rice Seedlings
Authors: Yu Wen Qing , Wang Xin , Tang Yi Cong , Yan Feng Chao , Liu Wen Zhi , Zheng Gui Ping , Yin Dong Mei 
Published: October 2020

Abstract
An EsxA-encoding gene was previously identified in the genome of the plant growth-promoting rhizobacterium Paenibacillus terrae strain NK3-4. The EsxA gene was cloned and expressed in Pichia pastoris , after which the effects of the EsxA protein on rice seedling growth were analyzed to determine whether EsxA contributes to the plant growth-promoting activity of strain NK3-4. The EsxA gene was successfully cloned from the NK3-4 genome and ligated to the eukaryotic expression vector pPICZαA. The resulting pPICZαA- EsxA recombinant plasmid was inserted into P. pastoris cells, and EsxA gene expression in the yeast cells was confirmed. The treatment of seed- buds with the EsxA protein increased the root length by 1.35-times, but decreased the bud length. Additionally, in rice seedlings treated with EsxA, the root and shoot lengths increased by 2.6- and 1.7-times, respectively. These findings imply that EsxA is important for the promotion of rice plant growth by P. terrae strain NK3-4. Furthermore, the construction of the EsxA gene expression vector and the engineered strain may be useful for future investigations of the mechanism underlying the plant growth-promoting effects of EsxA, with implications for the application of EsxA for regulating plant growth.
Data Sharing Across Osteoarthritis Research Groups and Disciplines: Opportunities and Challenges
Authors: Evans Jill , Biggs Paul , Elliott Mark 
Published: October 2020

Abstract
Background: Osteoarthritis is a heterogeneous condition characterised by a wide variety of factors and represents a worldwide healthcare challenge. There are multiple clinical and research specialisms involved in the diagnosis, prognosis and treatment of osteoarthritis, and there may be opportunities to share or pool data which are currently not being utilised. However, there are challenges to doing so which require carefully structured solutions and partnership working.Methods: Interviews were conducted with nine experts from various fields within osteoarthritis research. A semi-structured approach was used, and thematic analysis applied to the results.Results: Generally, osteoarthritis researchers were supportive of data sharing, provided it is done responsibly and without impacting data integrity. Benefits identified included increasing typically low-powered data, the potential for machine learning opportunities, and the potential for improved patient outcomes. However, a number of challenges were identified, in particular related to; data security, data harmonisation, storage costs, ethical considerations and governance.Conclusions: There is clear support for increased data sharing and partnership working in osteoarthritis research. Further investigation will be required to navigate the complex issues identified; however, it is clear that collaborative opportunities should be better facilitated and there may be innovative ways to do this. It is also clear that nomenclature within different disciplines could be better streamlined, to improve existing opportunities to harmonise data.
TGF-β and CCL18 as Indicators for Predicting and Monitoring the Development of Pulmonary Fibrosis in Patients with COVID-19
Authors: Zong Ming , Zheng Liang , Zhou Huan , Lu Liu , He Long , Wu Xiaodong , Chen Nianzhen , Wang Lan , Yuan Jiayi , Jiang Erpeng , Shi Yan , Li Qiang , Fan lieying , Liu Zhongmin 
Published: October 2020

Abstract
BackgroundMany COVID-19 patients have been discharged, but lung injury, including pulmonary fibrosis, might lead to long-term impairment. This study aimed to evaluate predictors and monitors of pulmonary fibrosis in patients with COVID-19.MethodsThirty-five convalescent patients with severe COVID-19, after appropriate medical treatments, were recruited. According to evidence of fibrosis on initial computed tomography (CT), the patients were divided into mild-to-moderate and severe groups. Levels of transforming growth factor beta (TGF-β), chemokine ligand 18 (CCL18), type III procollagen peptide (PⅢP), hyaluronic acid (HA), laminin (LN), and type IV collagen (CⅣ) were determined. Laboratory tests, clinical data, and CT features at different stages were collected and analyzed, and the prognostic performance of these parameters was evaluated.ResultsSevere fibrosis was found in 76.29% (26/35) of patients. However, most baseline laboratory characteristics were normal. Fibrosis indicators (TGF-β: 66.67±158.57 vs 55.84±126.43 pg/mL, P=0.006; CCL18: 364.27±167.70 vs 84.47±60.67 ng/mL, P=0.000; PⅢP: 54.12±55.34 vs 17.15±2.48 ng/mL, P=0.000; HA: 122.47±78.84 vs 59.74±18.01 ng/mL, p=0.000; LN: 55.43±46.44 vs 24.25±7.79 ng/mL, P=0.000; CⅣ: 24.77±14.97 vs 15.32±1.15 ng/mL, P=0.001) were elevated in patients compared with controls. Over 90 days’ follow-up, HRCT scores gradually decreased from 22.48±16.13 to 10.33±11.11 (P<0.001), and mMRC scores decreased from 3.27±0.32 to 1.48±0.33, and all fibrosis indicators, except for PⅢP, gradually declined with the improvement of pulmonary fibrosis. Moreover, TGF-β and CCL18 levels were lower in the mild-to-moderate than severe fibrosis group (88.16±97.45 vs 205.93±170.57 pg/mL, P=0.024; 241.84±125.37 vs 366.64±161.06 ng/mL, P=0.038), and patients with elevated baseline levels of serum TGF-β and CCL18 had longer rehabilitation times.ConclusionsTGF-β and CCL18 may be promising biomarkers for predicting and monitoring the development of pulmonary fibrosis in patients with COVID-19.
MIEF2 over-expression promotes tumor growth and metastasis through reprogramming of glucose metabolism in ovarian cancer
Authors: Zhao Shuhua , Shi Yuan , Zhang Xiaohong , Cheng Lu , Song Tingting , Wu Bing , Li Jia , Yang Hong 
Published: October 2020

Abstract
Background: Increasing evidence has revealed the close link between mitochondrial dynamic dysfunction and cancer. MIEF2 (mitochondrial elongation factor 2) is mitochondrial outer membrane protein that functions in the regulation of mitochondrial fission. However, the expression, clinical significance and biological functions of MIEF2 are still largely unclear in human cancers, especially in ovarian cancer (OC). Methods: The expression and clinical significance of MIEF2 were determined by qRT-PCR, western blot and immunohistochemistry analyses in tissues and cell lines of OC. The biological functions of MIEF2 in OC were determined by in vitro and in vivo cell growth and metastasis assays. Furthermore, the effect of MIEF2 on metabolic reprogramming of OC was determined by metabolomics and glucose metabolism analyses. Results: MIEF2 expression was significantly increased in OC mainly due to the down-regulation of miR-424-5p, which predictes poor survival for patients with OC. Knockdown of MIEF2 significantly suppressed OC cell growth and metastasis both in vitro and in vivo by inhibiting G1-S cell transition, epithelial-to -mesenchymal transition (EMT) and inducing cell apoptosis, while forced expression of MIEF2 had the opposite effects. Mechanistically, mitochondrial fragmentation-suppressed cristae formation and thus glucose metabolism switch from oxidative phosphorylation to glycolysis was found to be involved in the promotion of growth and metastasis by MIEF2 in OC cells. Conclusions: MIEF2 play a critical role in the promotion of OC progression and may serve as a valuable prognostic biomarker and therapeutic target in treatment of this malignancy.