bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation of a Ductal Carcinoma In Situ Biomarker Profile for Risk of Recurrence after Breast-Conserving Surgery with and without Radiotherapy
Authors: Weinmann Sheila , Leo Michael C. , Francisco Melanie , Jenkins Charisma L. , Barry Todd , Leesman Glen , Linke Steven P. , Whitworth Pat W. , Patel Rakesh , Pellicane James , Wärnberg Fredrik , Bremer Troy 
Published: April 2020

Abstract

Purpose:
A major challenge in ductal carcinoma in situ (DCIS) treatment is selection of the most appropriate therapeutic approach for individual patients. We conducted an external prospective–retrospective clinical validation of a DCIS biologic risk signature, DCISionRT, in a population-based observational cohort of women diagnosed with DCIS and treated with breast-conserving surgery (BCS).

Experimental Design:
Participants were 455 health plan members of Kaiser Permanente Northwest diagnosed with DCIS and treated with BCS with or without radiotherapy from 1990 to 2007. The biologic signature combined seven protein tumor markers assessed in formalin-fixed, paraffin-embedded tumor tissue with four clinicopathologic factors to provide a DCISionRT test result, termed decision score (DS). Cox regression and Kaplan–Meier analysis were used to measure the association of the DS, continuous (linear) or categorical (DS ≤ 3 vs. DS &gt; 3), and subsequent total ipsilateral breast events and invasive ipsilateral breast events at least 6 months after initial surgery.

Results:
In Cox regression, the continuous and categorical DS variables were positively associated with total and invasive breast event risk after adjustment for radiotherapy. In a subset analysis by treatment group, categorical Kaplan–Meier analyses showed at least 2-fold differences in 10-year risk of total breast events between the elevated-risk and low-risk DS categories.

Conclusions:
In this first external validation study of the DCISionRT test, the DS was prognostic for the risk of later breast events for women diagnosed with DCIS, following BCS.
Limiting Permissible Limitations: How to Preserve the Substance of Religious Freedom
Authors: Bielefeldt Heiner 
Published: April 2020

Abstract
The question of how to draw legitimate limits to the content and exercise of human rights has caused many controversies, not only in academic debates, but also in human rights practice. Governments often invoke limitation clauses linked to human rights provisions as a broad allowance to impose restrictions. However, the main function of those clauses is actually to limit the scope of permissible limitations. This chapter takes freedom of religion or belief as a test case to illustrate the role of limitation clauses. Moreover, from an adequate understanding of limitation clauses, the popular “balancing” semantics deserves serious criticism, since it obfuscates the task to preserve the substance of human rights guarantees even in situations of normative conflict.
Endoscopic Septoplasty Versus Traditional Septoplasty for Treating Deviated Nasal Septum: A Prospective, Randomized Controlled Trial
Authors: Na’ara Shorook , Kaptzan Boris , Gil Ziv , Ostrovsky Dimitry 
Published: April 2020

Importance: This is the first randomized study to compare the quality of life of patients undergoing endoscopic septoplasty compared to traditional trans-nasal trans-speculum (TNTS) septoplasty. Objective: To assess the clinical outcomes and quality of life results of endoscopic versus TNTS septoplasty in patients with septal deviation and nasal obstruction. Design: A prospective, randomized controlled trial comparing 2 approaches of septoplasty: endoscopic and TNTS septoplasty performed in a single institution during the years 2016 to2017. The follow-up time was 3 months. Setting: A single institution study in a tertiary health-care referral center. Participants: Patients who underwent primary surgery for repairing deviated nasal septum due to nasal obstruction, were older than 18 years old, and were eligible for study inclusion. Sixty-five patients were enrolled in this study, 34 in the endoscopic arm and 31 in the TNTS septoplasty arm. The overall follow-up rate was 94% at the first visit (2 weeks) and 92% at the last visit (12 weeks). Thus, the final cohort consisted of 60 patients, 30 in each study arm. The patients ranged in age from 18 to 71 years (mean 27 years) old. Main Outcomes and Measures: The primary outcome was the Sino-Nasal Outcome Test-22 (SNOT-22) score. Secondary outcomes were the Short Form 36 (SF36) QOL score and complication rates. Both questionnaires were administered at 2 weeks and 3 months following surgery. Results: Sixty patients completed this study, 30 in each study arm. Sino-Nasal Outcome Test-22 scores were improved after 3 months, with no difference between the study arms. There were no cases of septal perforation or profound bleeding requiring repeated surgery. Conclusions and Relevance: Endoscopic septoplasty and TNTS show similar results for treatment of nasal septum deviation. Trial Registration: Traditional Septoplasty versus Endoscopic Septoplasty for Treating Deviated Nasal Septum, NCT02653950. https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0005ZOR&selectaction=Edit&uid=U00021YC&ts=2&cx=-2w7hot .
Retrospective analysis of tricuspid valve repair using a novel surgical technique: A 7-year single-surgeon experience
Authors: Abdul Khader Ashiq , Khan Habib , Stowell Catherine , Liu Guiqing , Sameh Mohamed , Punjabi Prakash 
Published: April 2020

Objectives: Tricuspid annuloplasty is the optimal surgical repair technique for tricuspid regurgitation which improves mortality and morbidity. Ring annuloplasties is the techniques of choice. Here, we evaluate the efficacy and durability of a new method of interrupted pledgeted suture annuloplasty. Methods: Between 2011 and 2018, 39 eligible patients underwent tricuspid valve repair using this novel technique. Indication for repair was a grade of regurgitation at moderate or greater, or an annular diameter >40 mm. Patients were assessed both preoperatively and postoperatively by echocardiogram. Follow-up results were split into the first postoperative echocardiogram and most recent postoperative echocardiogram undertaken. Results: There were two in-hospital mortalities and two patients required permanent pacemaker implantation following surgery. At the time of the first postoperative echocardiogram undertaken (median 3 months postoperatively), freedom from moderate-severe regurgitation was 92.3%. At the time of the most recent postoperative echocardiogram undertaken (median 11 months postoperatively); none or mild regurgitation was detected in 24 patients (61.5%), mild-moderate in 11 (28.2%) and moderate-severe in 4 (10.3%) patients. Freedom from moderate-severe regurgitation was 89.7%. Postoperative grade of regurgitation was significantly reduced from preoperative grades (p < 0.001). Conclusion: Initial and midterm results of our technique show a good durability of repair. We have demonstrated recurrence rates of regurgitation equal and superior to current forms of suture annuloplasty published in the literature. This novel method of suture annuloplasty can be considered in the surgical repertoire of tricuspid valve repair techniques.
In utero Δ9-tetrahydrocannabinol exposure confers vulnerability towards cognitive impairments and alcohol drinking in the adolescent offspring: Is there a role for neuropeptide Y?
Authors: Brancato Anna , Castelli Valentina , Lavanco Gianluca , Marino Rosa Anna Maria , Cannizzaro Carla 
Published: April 2020

Background: Cannabinoid consumption during pregnancy has been increasing on the wave of the broad-based legalisation of cannabis in Western countries, raising concern about the putative detrimental outcomes on foetal neurodevelopment. Indeed, since the endocannabinoid system regulates synaptic plasticity, emotional and cognitive processes from early stages of life interfering with it and other excitability endogenous modulators, such as neuropeptide Y (NPY), might contribute to the occurrence of a vulnerable phenotype later in life. Aims: This research investigated whether in utero exposure to Δ9-tetrahydrocannabinol (THC) may induce deficits in emotional/cognitive processes and alcohol vulnerability in adolescent offspring. NPY and excitatory postsynaptic density (PSD) machinery were measured as markers of neurobiological vulnerability. Methods: Following in utero THC exposure (2 mg/kg delivered subcutaneously), preadolescent male rat offspring were assessed for: behavioural reactivity in the open field test, neutral declarative memory and aversive limbic memory in the Novel Object and Emotional Object Recognition tests, immunofluorescence for NPY neurons and the PSD proteins Homer-1, 1b/c and 2 in the prefrontal cortex, amygdala and nucleus accumbens at adolescence (cohort 1); and instrumental learning, alcohol taking, relapse and conflict behaviour in the operant chamber throughout adolescence until early adulthood (cohort 2). Results: In utero THC-exposed adolescent rats showed: (a) increased locomotor activity; (b) no alteration in neutral declarative memory; (c) impaired aversive limbic memory; (d) decreased NPY-positive neurons in limbic regions; (e) region-specific variations in Homer-1, 1b/c and 2 immunoreactivity; (f) decreased instrumental learning and increased alcohol drinking, relapse and conflict behaviour in the operant chamber. Conclusion: Gestational THC impaired the formation of memory traces when integration between environmental encoding and emotional/motivational processing was required and promoted the development of alcohol-addictive behaviours. The abnormalities in NPY signalling and PSD make-up may represent the common neurobiological background, suggesting new targets for future research.
The validity of grayscale and color Doppler ultrasound in assessment of scrotal swellings: a retrospective study in a large case series
Authors: Almassry Hosam Nabil , Basha Mohammad Abd Alkhalik , Zaitoun Mohamed MA , Abdelazim Mohamed , Harb Ola A , Aly Sameh Abdelaziz 
Published: April 2020

Background Scrotal swellings have a non-specific clinical picture, so their clinical diagnosis is challenging. Scrotal grayscale and color Doppler ultrasound are non-invasive methods used in both adult and childhood groups and act as accurate screening and diagnostic modalities. Purpose To evaluate the diagnostic validity of grayscale and color Doppler ultrasound in the assessment of scrotal swelling to reach accurate diagnosis. Material and Methods A retrospective study included 181 patients (mean age = 35.5 ± 7.3, age range = 1–71 years) with scrotal swelling. Examinations were performed by an experienced radiologist using grayscale and color Doppler ultrasound. The diagnostic validity of grayscale and color Doppler ultrasound for diagnosing scrotal swelling were estimated using surgical findings, histopathological results, and imaging and clinical follow-up as reference standards. Results Overall, 202 scrotal swellings were detected. The final diagnoses were 13 (6.4%) malignant and 189 (93.6%) benign alterations. Varicocele was the most common scrotal swelling (26%), followed by hydrocele (23.8%). Matched to the reference standards, grayscale and color Doppler ultrasound represented a sensitivity of 84.6% (95% confidence interval [CI] = 54.6–98.1), a specificity of 76.2% (95% CI = 69.5–82.1), a positive predictive value of 19.6% (95% CI = 10.2–32.4), and a negative predictive value of 98.6% (95% CI = 95.1–99.8) for diagnosing scrotal tumors. Conclusion Scrotal grayscale and color Doppler ultrasound provide high diagnostic validity for assessment of scrotal swellings.
Three different computed tomography obesity indices, two standard methods, and one novel measurement, and their association with outcomes after colorectal cancer surgery
Authors: Frostberg Erik , Pedersen Malene RV , Manhoobi Yavar , Rahr Hans B , Rafaelsen Søren R 
Published: April 2020

Background Obesity can be measured by different indices, either as body mass index (BMI) or by more intuitive radiological measurements, and obesity has been shown to have an impact on outcome after colorectal cancer (CRC) surgery. Purpose To investigate whether the thickness of the subcutaneous adipose tissue (SAT) in the abdominal wall can be used as a surrogate for the visceral fat area (VFA)—both measured on computed tomography (CT)—in prediction of short- and long-term outcomes after elective CRC surgery. Material and Methods Preoperative CT scans of all patients having elective CRC surgery (stages I–III), in two consecutive years at a single-center institution, were used to measure the SAT (mm) and VFA (cm2). BMI was calculated for each patient. The three different obesity indices were used in different analyses in order to predict postoperative complications and overall survival. Results A BMI >30 kg/m2 was an independent prognostic factor in postoperative complications (odds ratio 3.2, 95% confidence interval [CI] 1.43–7.03). SAT and VFA were not able to predict complications. Patients considered visceral obese according to a high VFA (>130 cm2) had poorer survival (hazard ratio 1.53, 95% CI 1.00–2.36) compared to non-obese patients, but in the adjusted model, VFA lost its predictive power. BMI and SAT were not able to predict mortality. Conclusion The novel measurement of the thickness of SAT in a preoperative setting before elective CRC surgery cannot predict either postoperative complications or overall survival; the other obesity indices had better predictive features.
Long noncoding RNA MACC1-AS1 promotes the stemness of hepatocellular carcinoma cells by antagonizing miR-145
Authors: Guo Yuling , Zhong Jiuhong , Wu Fang , Zhan Zhengyu 
Published: April 2020

Objectives This work aimed to investigate the roles of long noncoding (lnc)RNA MACC1-AS1 (MACC1 antisense RNA 1) in progression of hepatocellular carcinoma (HCC). Methods Real-time quantitative PCR, western blot, spheroid formation, aldehyde dehydrogenase isoform 1 (ALDH1) activity analysis, luciferase reporter assay, and RNA pull-down analysis were used to examine MACC1-AS1–mediated effects on HCC cell stemness. Results MACC1-AS1 was highly expressed in HCC tissues and cells. MACC1-AS1 positively regulated the expression of stemness master regulators and inhibited spheroid-forming ability and ALDH1 activity. Furthermore, MACC1-AS1 promoted the stemness of HCC cells by antagonizing microRNA (miR)-145 activity. Overexpression of miR-145 also attenuated HCC cell stemness. Conclusions This work revealed a novel MACC1-AS1/miR-145 axis that regulates the stemness of HCC cells.
Diaphragmatic muscle thickness and diaphragmatic function are reduced in patients with systemic lupus erythematosus compared to those with primary Sjögren’s syndrome
Authors: Satış Hasan , Cindil Emetullah , Salman Reyhan B , Yapar Dilek , Temel Esra , Demir Nur B , Babaoğlu Hakan , Gündoğdu Onur , Ataş Nuh , Şendur Halit , Avanoğlu Güler Aslıhan , Karadeniz Hazan , Tufan Abdurrahman , Öztürk Mehmet A , Haznedaroğlu Şeminur , Göker Berna 
Published: April 2020

Introduction Systemic lupus erythematosus (SLE) is associated with an increased risk of pulmonary infections, as well as a rare condition known as shrinking lung syndrome (SLS). The diaphragm has an important role to play in lung physiology and might also play a role in these adverse events. Here, we aimed to investigate whether SLE patients have impairment in their diaphragmatic muscle thickness and function with respect to another connective-tissue disease: primary Sjögren’s syndrome (pSS). Method Patients diagnosed with SLE who were in remission or who had minimal disease activity and had at least one year of follow-up were included in this study. Patients with known lung pathology and smokers were excluded. Patients with pSS constituted the second experimental group. Ultrasonographic evaluation of the diaphragmatic muscle was conducted by an experienced independent sonographer at three time points, diaphragmatic thickness during deep and quiet inspiration and maximum expiration being measured. Diaphragmatic muscle function was evaluated with maximum expiratory pressure (MEP) and maximum inspiratory pressure (MIP). Results A total of 115 patients were studied ( n = 39 SLE; n = 76 pSS). The mean ±  standard deviation ( SD) thickness of the diaphragmatic muscles during quiet inspiration was significantly reduced in patients with SLE compared to patients with pSS (2.32 mm vs. 2.81 mm; p < 0.05). Similarly, the thickness during deep inspiration and at maximum deep expiration were significantly lower in SLE patients (2.88 mm vs. 3.29 mm and 1.92 mm vs. 2.33 mm, respectively; p < 0.01). MIPs and MEPs, defined as the percentages of expected values, were significantly lower in patients with SLE compared to those with pSS (80% vs. 92% and 76% vs. 120%, respectively; p < 0.05). Diaphragmatic muscle thickness during deep inspiration demonstrated a moderate correlation with MIP ( r = 0.434; p = 0.001). Conclusion SLE patients had reduced diaphragmatic muscle thickness compared to those with pSS, which was associated with impaired functional tests. Further prospective studies are needed to investigate whether structural and functional impairments in diaphragmatic muscle play a role in an increased risk of pulmonary infections and SLS in patients with SLE.
Exploring Employee Engagement Using Grounded Theory: Experiences from the Best Firms in India
Authors: Shrotryia Vijay Kumar , Dhanda Upasana 
Published: April 2020

A highly engaged workforce is being looked at as the means for attaining a sustainable competitive advantage in the dynamic business world. Research has shown that both the academicians and practitioners tout employee engagement to improve organizational and financial performance. However, numerous overlapping yet inconsistent definitions have created a conceptual chaos. Delineation between the academic and industrial view on employee engagement creates difficulty in operationalization of the construct. This paper explores the construct of employee engagement by conducting structured interviews of HR heads of 15 best companies to work for in India. The data obtained were subjected to thematic analysis using Grounded Theory Methodology by Charmaz (2006). The emergent themes around the notion of employee engagement led to the development of a theoretical framework comprising three dimensions (Alignment, Affectiveness and Action-orientation) of employee engagement. Various drivers of employee engagement and the challenges in engaging employees were exemplified with narratives from practitioners in the Indian context. An attempt has been made to bridge the gap between the academic and industrial view by exploring variables of the construct after taking inputs from the HR practitioners. It attempts to bring a conceptual clarity on construct which may help the organizations to develop effective engagement strategies and interventions for fostering higher engagement levels among employees.
A change in practice after the introduction of a state-wide service plan: standardisation of the provision of care to patients with an eating disorder in a regional hospital including support from a new Eating Disorders Outreach Service
Authors: Yaseen Faisal , Bertram Michelle , Vickery Meg , Murphy Michael 
Published: April 2020

Objective: A state-wide service plan was introduced to guide local practice of the inpatient management of patients with an eating disorder. There was significant change in our management of such patients in our regional hospital. Our aim is to describe the changes and characterise our current practice. Method: We undertook a retrospective review of the characteristics of nine consecutive inpatients and a descriptive qualitative study to examine the care provided to the patients and to identify the resultant care provisions a year after the introduction of the service plan. Results: Patient demographics and clinical characteristics were within the expected range. By the end of the year, the following changes were identified: (i) a team of local champions emerged; (ii) a case conference and template became routine; (iii) high utilisation of the new Eating Disorder Outreach Service (EDOS); (iv) common treatment challenges and methods to address them. Conclusions: Standardisation of care and a systematic team approach are helpful in allowing small regional non-specialist centres to successfully manage complex patients. Funding of a local coordinator and assistance from EDOS was paramount to facilitate change. Other regional services may wish to adopt some of the practices described.
Effect of drug-coated balloons versus bare-metal stents on endothelial function in patients with severe lower limb peripheral artery disease
Authors: Shafe Omid , Moosavi Jamal , Shishehbor Mehdi H , Sedigh Hamid , Bakhshandeh Hooman , Mahboubian Farzane , Alilou Sanam , Rafatnia Shirin , Sadeghipour Parham 
Published: April 2020

Background Research shows impaired endothelial function in patients with vascular diseases and improved endothelial function following revascularization and medical treatment. There is, however, a dearth of data on the effects of different endovascular therapeutic strategies on endothelial function. We sought to compare the effects of two endovascular strategies of drug-coated balloons versus stenting on endothelial function. Methods The reactive hyperemia index, the ankle-brachial index, and the toe-brachial index were measured in patients undergoing endovascular revascularization preprocedurally and on the 90th postprocedural day. After adjusting for baseline line characteristics, reactive hyperemia index were compared between the two groups at baseline and at 90 days. Results Between January 2018 and March 2019, 86 patients were prospectively included in a non-randomized manner. Drug-coated ballooning alone was carried out on 46 patients, and bailout stenting after plain balloon angioplasty was performed on the remaining 40 patients The post-revascularization reactive hyperemia index exhibited a significant rise in both groups (1.58 ± 0.21 vs. 1.43 ± 0.20; P =  0.0001). There was no difference in the postprocedural reactive hyperemia index between the two treatment groups. Additionally, the follow-up reactive hyperemia index showed no significant change compared with the postprocedural reactive hyperemia index (1.58 ± 0.23 vs. 1.57 ± 0.22). The results of subgroup analysis between a group of clinically high-risk patients and a group of patients with complex lesions were similar to the aforementioned results. Conclusions The reactive hyperemia index was significantly improved by endovascular therapy in our study population. However, no difference was observed between drug-coated ballooning and bare-metal stenting, which highlights the effects of vessel patency on endothelial function.