bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real-World Effectiveness and Safety of Fingolimod in Patients with Multiple Sclerosis in the Czech Republic: Results from Core and Extension Parts of the GOLEMS Study up to 48 Months
Authors: Tichá Veronika , Počíková Zuzana , Vytlačil Josef , Štěpánová Radka 
Published: November 2021

Abstract
Background: Fingolimod, an oral sphingosine 1-phosphate receptor immunomodulator, is approved in Europe for multiple sclerosis (MS) patients with highly active disease despite a full and adequate course of treatment with ≥1 disease-modifying therapy or patients with rapidly evolving severe relapsing–remitting MS. GOLEMS, a 12-month, national, multicenter, non-interventional, single-arm, real-world study showed a favorable benefit–risk profile of fingolimod in patients with MS in the Czech Republic. Here, we evaluated the long-term effectiveness and safety of fingolimod and its impact on disability progression and work capability for up to 48 months in patients with MS.Methods: The endpoints assessed were the incidence and severity of MS relapses in fingolimod-treated patients and the proportion of relapse-free patients up to 48 months of fingolimod treatment, change from baseline in the Expanded Disability Status Scale (EDSS) score, and change from baseline in work capability assessment. Efficacy outcomes were analyzed in the completed and efficacy sets, and safety was evaluated in all the enrolled patients.Results: Of 240 enrolled patients, 237 were included into efficacy set. Patients with a minimum of a 12-month observation period in the core study who continued fingolimod treatment, were eligible to participate in the extension phase. Of 211 patients enrolled in extension study, 155 were evaluated in the completed set. Based on analysis of 48-month period of fingolimod treatment, 95/237 patients (40.1%) in the efficacy set, 54/155 (34.8%) in the completed set were free of relapses. The majority of relapses reported were moderate in intensity. Mean EDSS score remained stable throughout 48-month study period (Baseline, 3.4; Month 48, 3.6). No significant 3 trend was observed in changes in work capability assessment or number of missed days of work. Of 240 enrolled patients, 147 (61.3%) had ≥1 treatment-emergent adverse event (AE) and 20 (8.3%) reported serious AEs. In total, 45 patients (18.8%) permanently discontinued treatment because of AEs related to study drug; two patients reported pregnancy after treatment initiation and subsequently discontinued the treatment; no deaths were reported.Conclusion: GOLEMS study demonstrated the sustained effectiveness and manageable safety profile of fingolimod under real-world conditions over 48 months in patients with MS.Trial registration: Not applicable
Effects of Advance Exposure to an Animated Surgery-Related Picture Book on Preoperative Anxiety and Anesthesia Induction in Preschool Children: A Randomized Controlled Trial
Authors: Yang Yanyan , Zhang Mazhong , Sun Ying , Peng Zhezhe , Zheng Xiaosu , Zheng Jijian 
Published: November 2021

Abstract
Background: Our aim was to investigate whether early surgical preparation by reading an animated picture book about procedure-related events could reduce the preoperative anxiety in preschoolers.Methods: 131 patients, aged 3-6 years and underwent elective minor surgery were randomized either to a control or a picture book group. Both groups received general information about surgery and anesthesia in pre-anesthesia clinic. Patients in study group also received a surgery-depicting picture book for them to read at home a week earlier before surgery. Child anxiety was evaluated with the modified Yale Preoperative Anxiety Scale Short Form in six observing time points before anesthesia induction, and the compliance of anesthesia induction was assessed with the Induction Compliance Checklist (ICC).Results: There were significantly lower anxiety scores in picture book group than in control group at the time of ready for intravenous cannulation in operation room [51.9 (23.6) vs. 67.2 (22.0); P = 0.001] and at the time of pre-anesthesia visit [27.8 (7.6) vs. 33.2 (13.6); P = 0.018]. No significant differences of anxiety levels were found between two groups at other observed time points: in the anesthesia outpatient clinic, in the holding area, at separation from parent to operating room (OR), and on entrance to OR (P = 0.584, 0.335, 0.228, 0.137, respectively). The percentage of children with poor induction compliance (i.e., ICC ≥ 6) was higher in control group compared with that in picture book group (38% vs.21%, P = 0.041).Conclusions: Home-reading an animated picture book to get familiar with the perioperative events earlier prior to surgery could effectively reduce the preoperative anxiety level and increase the compliance during the induction of anesthesia in preschool children.Trial registration: ChiCTR2000033583, 06/06/2020 www.chictr.org.cn.
Self-made Vitreoretinal Surgical Simulator Using Silicone Mold
Authors: Nagamoto Takashi , Kubono Hirohisa , Kawamura Mari , Suzuki Kotaro 
Published: November 2021

Abstract
There is no consensus on an appropriate and sustainable practice method in vitreoretinal surgery. We found a self-made vitreoretinal surgical simulator using a silicone mold that can offer various operative maneuvers and can become a solution for such a problem. We obtained a spherical silicone mold, a mannequin head, and spray material on the net market and combined them with expired surgical instruments to complete the simulator. Simulated vitrectomy was performed by vitreoretinal experts, and the practicality was verified. They reviewed that the simulated eyeball had size and rigidity very similar to the eyeball and that the intraocular practice swing seemed to be useful for the prevention of complications. The silicone material's semitransparency and open-sky structure offered them plenty of visibility. The membrane simulated by spray glue provided them with an excellent peeling sensation. These findings suggested that this simulator is suitable for practicing the basic procedures of vitreoretinal surgery. The simple shape seems to have many possibilities, and further verification at many facilities is desirable.
A Study of Dose Painting Radiotherapy Guided by Three-Dimensional Arterial Spin labeling Perfusion Magnetic Resonance Imaging for Non-Enhancing Low-Grade Gliomas
Authors: Zhu Zihong , Gong Guanzhong , Wang Lizhen , Su Ya , Qin Xiaohang , Chen Mingming , Lu Jie , Yin Yong 
Published: November 2021

Abstract
Background: The purpose of this study was to investigate the feasibility and dosimetric characteristics of dose painting for non-enhancing low-grade gliomas (NE-LGGs) guided by three-dimensional arterial spin labeling (3D-ASL) perfusion magnetic resonance imaging.Methods: Eighteen patients with NE-LGGs were enrolled. 3D-ASL, T2 fluid attenuated inversion recovery (T2 FLAIR) and contrast-enhanced T1-weight magnetic resonance images were obtained. The gross tumor volume (GTV) was delineated on the T2 FLAIR. The hyper-perfusion region of the GTV (GTV-ASL) was determined by 3D-ASL, and the GTV-SUB was obtained by subtracting the GTV-ASL from the GTV. The planning target volume (PTV), PTV-ASL and PTV-SUB were developed by expanding the external margins of the GTV, GTV-ASL and GTV-SUB, respectively. Three plans were established for each patient: in plan 1, the traditional homogeneous prescription dose to the PTV was 45-60 Gy; in plan 2 and plan 3, the dose to the PTV-ASL increased by 10-20% based on plan 1, without the maximum dose constraint to the PTV-ASL in plan 3. The dosimetric differences among the three plans were compared.Results: Compared with plan 1, the dose to 2% (D2%), 98% (D98%) and 50% (Dmean) of PTV-ASL volumes increased by 14.67%, 16.17% and 14.31% in plan 2 and 19.84%, 15.52% and 14.27% in plan 3, respectively (P < 0.05); the D2% of the PTV, PTV-SUB increased by 11.89% and 8.34% in plan 2, 15.89% and 8.49% in plan 3, respectively (P< 0.05). The PTV coverages were comparable among the three plans (P > 0.05). In Plan 2 and plan 3, the conformity indexs decreased by 18.60% and 12.79%; while the homogeneity indexs increased by 1.43 and 2 times (P<0.05). Compared with plan 1, the D0.1cc of brain stem and Dmax of optic chiasma slightly increased in plan 2 and plan 3, but the absolute doses met the dose constraint. The other organs at risk were similar among the three plans (P > 0.05).Conclusions: The sub-volume with hyper-perfusion for NE-LGG radiotherapy can be segmented based on the perfusion difference guided by 3D-ASL. And the radiation dose to the hyper-perfusion area increased safely by 10-20% through dose painting.
Factors Related to Nurses and Physicians’ Knowledge of and Attitudes Towards Palliative Care
Authors: Ashrafizadeh Hadis , Khanali-Mojen Leila , Barasteh Salman , Beiranvand Samira , Farahani Azam Shirinabadi , Eshaghian-dorcheh Azam , Karami Maryam , Khademi Fatemeh , Khoshnazar Tahereh Alsadat Khoubbin , Krakauer Eric , Rassouli Maryam 
Published: November 2021

Abstract
Background
With the increase of the elderly population, the need for palliative care has increased, which is one of the requirements of effective palliative care services, sufficient knowledge and positive attitude of nurses and physicians towards this care approach. The aim of this study was to determine the factors related to the knowledge and attitudes of nurses and physicians about palliative care.
Methods
This descriptive correlational study was performed in 2021 on 277 nurses and physicians working in selected teaching hospitals in Iran who were selected by convenience sampling method. The data collection tool was an online and researcher-made questionnaire consisting of three sections: demographics and occupation, knowledge (30 items) and attitude (37 items) that were designed and validated in the present study. To analyze the data, spss-v24 software was used for descriptive statistics tests (means and frequency tables) and inferential tests (correlation and univariate regression).
Results
The mean scores of knowledge and attitude of care providers were 19.36 ± 2.73 and 140.90 11 11.56, respectively. There was a positive relationship between knowledge and attitude variables (P-value = 0.000, r = 0.378). Meaning of relationship between the mean score of attitude and knowledge with age ranges of 31-60 and 60-51 years, level of education, workplace, work experience in palliative care, need for formal education in palliative care and need to pass palliative care course there was.
Conclusion
Based on the results of this study, the level of knowledge and attitude of palliative care providers was moderate. Therefore, in order to further promote the knowledge and attitude of nurses and physicians, it is recommended to hold theoretical and practical training courses in the form of skill and retraining courses, reviewing the curricula of general medicine and bachelor's degree in nursing.
Respiratory Syncytial Virus and Metapneumovirus Infection Have Different Clinical Presentation in Children
Authors: Montero Jonathan Illan , Berger Alice , Levy Jack , Busson Laurent , Hainaut Marc , Goetghebuer Tessa 
Published: November 2021

Abstract
Respiratory syncytial virus (RSV) and Human metapneumovirus (hMPV), members of Pneumoviridae family are common causes of acute respiratory tract infections (ARTI) among children. Study material includes routine nasopharyngeal samples obtained during 8-year period for hMPV and one single season for RSV in children aged 0 to 15 years at the Centre Hospitalier Universitaire (CHU) Saint Pierre in Brussels. Positive samples for RSV or hMPV identified by viral culture, lateral flow chromatography test for RSV or direct fluorescent assay for hMPV were selected retrospectively. The medical charts of these patients were reviewed. Hospitalization rate was 37% (219/591) and 39% (187/476) for hMPV and RSV respectively. Children hospitalized for RSV infection were significantly younger and more dyspneic, requiring more respiratory support, longer hospital stay and transfers in Pediatric intensive Care Units (PICU) than those hospitalized for hMPV infection. Pneumonia diagnostic and antibiotics therapies were more significantly associated with hMPV infections.In conclusion, despite their genetic similarities, RSV and hMPV present epidemiological and clinical differences in pediatric infections.
Evaluation of adrenal reserve in patients with differential thyroid cancer receiving thyroid hormone suppression therapy- case-control comparative study
Authors: Bilginer Muhammet Cuneyt , Tam Abbas Ali , Faki Sevgul , Bestepe Nagihan , Dellal Fatma Dilek , Ozdemir Didem , Topaloglu Oya , Ersoy Reyhan , Cakir Bekir 
Published: November 2021

Abstract
Background

Patients with differentiated thyroid cancer (DTC) are exposed to subclinical exogenous hyperthyroidism for the suppression of thyroid-stimulating hormone (TSH). In this study, we aimed to evaluate the adrenal reserve in DTC patients receiving suppression therapy.
Materials and Methods

The study included 55 DTC patients on suppression therapy and 32 healthy volunteers. Basal serum cortisol of all participants and adrenocorticotropic hormone (ACTH) of the patient group were measured. A standard-dose ACTH test (0.25 mg) was performed in patients with a basal cortisol < 14.5 mcg/dL.
Results

In the patient group, TSH was lower, free thyroxine (fT4) was higher, and free triiodothyronine (fT3) was similar to those of the control group (p < 0.01, p < 0.01, p = 0.140, respectively). The serum cortisol of the patient group was significantly lower than the control group (12.14 ± 5.12 mcg/dL vs 18.00 ± 5.56 mcg/dL, p < 0.001). 34 (61.8%) patients with DTC had a basal cortisol < 14.5 mcg/dL. Prolonged TSH suppression (≥ 5 years vs < 5 years) was associated with lower basal cortisol (7.46 ± 2.63 mcg/dL vs 9.48 ± 2.65 mcg/dL, p = 0.022). The ACTH stimulation test showed that 2 (5.8%) patients had a cortisol response < 18 mcg/dL. The rate of adrenal insufficiency was 3.6% in DTC patients. A moderate negative correlation was found between ACTH and fT3 of patients with low basal cortisol (r = − 0.358, p = 0.038)
Conclusion

Patients with DTC receiving TSH suppression therapy are at risk for adrenal insufficiency. The duration and severity of suppression might increase this possibility. Dynamic testing with synthetic ACTH can be used to reveal insufficient cortisol response in case of clinical suspicion.
Anastomotic Leakage Following Resection of the Esophagus – Introduction of an Endoscopic Scoring System
Authors: Bachmann Jeannine , Feith Marcus , Schlag Christoph , Abdelhafez Mohamed , Martignoni Marc , Friess Helmut 
Published: November 2021

Abstract
Background Malignant tumors of the esophagus are the sixth leading cause of cancer-related deaths worldwide. Postoperative leakage of the esophago-gastrostomy leads to mediastinal sepsis, which is still associated with a high morbidity and mortality rate. The aim of this study was to describe the endoscopic view of the different severity grades of an anastomotic leakage. MethodsPatients Between June 2016 and September 2018, 144 patients were operated upon in the Department of Surgery, University of Munich, Germany. Among these patients, 34 (23.6%) presented with a leakage of the anastomosis. EndoscopyIn this retrospective analysis the focus is to describe different patterns of leakage of the anastomosis.Results We studied 34 patients in whom post-esophagectomy leakage of the anastomosis was detected and treated with an endoluminal vacuum sponge system. The leakage healed in 26 of 29 patients (success rate 89.7%). With increasing severity of leakage, the treatment time and the in-hospital mortality correspondingly increased. Furthermore, the incidence of development of a fistula to the tracheobronchial system increased with higher grades of leakage.ConclusionsExact descriptions of leakage are necessary to compare the cases and to prove post-treatment improvement. This is, to our knowledge, the first publication to present a leakage grading score in patients after esophagectomy including reconstruction with a gastric tube. This new grading system needs to be tested in further analyses, with special focus on prospective analysis.
Role of Gasdermins in the Biogenesis of Apoptotic Cell–Derived Exosomes
Authors: Hur Jaehark , Kim Yeon Ji , Choi Da Ae , Kang Dae Wook , Kim Jaeyoung , Yoo Hyo Soon , Shahriyar Sk , Mustajab Tamanna , Kim Junho , Kim Dong Young , Chwae Yong-Joon 
Published: November 2021

Abstract
The gasdermins are a family of pore-forming proteins that has recently been suggested to play a central role in the pyroptosis and the release of inflammatory cytokines. Here, we describe the novel roles of gasdermins in the biogenesis of apoptotic cell–derived exosomes. In apoptotic cells, GADMA, GSDMC, GSDMD, and GSDME increased the release of ApoExos, and both their full-length and cleaved forms were localized in the exosomal membrane. GSDMB and DFNB59, on the other hand, negatively affected the release of ApoExos. The caspase-mediated cleavage of gasdermins, especially GSDME, is suggested to increase Ca2+ influx to cytosol through endosomal pores and thus increase the biogenesis of ApoExos. In addition, the GSDME-mediated biogenesis of ApoExos depended on the ESCRT-III complex and endosomal recruitment of Ca2+-dependent proteins: annexins A2 and A7, the PEF domain family proteins sorcin and grancalcin, and the Bro1 domain protein HD-PTP. Therefore, we propose that the biogenesis of ApoExos begins when gasdermin-mediated endosomal pores increase cytosolic Ca2+, continues through the recruitment of annexin-sorcin/grancalcin-HD-PTP, and is completed when the ESCRT-III complex synthesizes intraluminal vesicles in the multivesicular bodies of dying cells. Finally, we found that GSDME-bearing tumors released ApoExos to induce inflammatory responses in the in vivo 4T1 orthotropic model of breast cancer. The data presented in this study indicate that the switch from apoptosis to pyroptosis could drive the transfer of mass signals to nearby or distant living cells and tissues by way of extracellular vesicles, and that gasdermins play critical roles in that process.
Health-Related Quality of Life in Multiple System Atrophy using EQ-5D-5L: A Large Cross-Sectional Study in China
Authors: Xiao Yi , Zhang Lingyu , Wei Qianqian , Ou Ruwei , Hou Yanbing , Liu Kuncheng , Lin Junyu , Yang Tianmi , Shang HuiFang 
Published: November 2021

Abstract
Background Multiple system atrophy (MSA) is a rare neurodegenerative disease, featuring autonomic failure plus parkinsonism and/or cerebellar ataxia. These symptoms impact the health-related quality of life (HRQoL) of MSA. Objective We aimed to evaluate the HRQoL of MSA with a preference-based instrument, the five-level EuroQol five-dimensions questionnaire (EQ-5D-5L), for the first time.Methods EQ-5D-5L was used to evaluate the HRQoL. The result of HRQoL was displayed as heath utility index and visual analog scale (EQ-VAS) score. Specific scales were used to measure the disease severity, cognition, frontal lobe function, anxiety, depression, fatigue, and sleep disorders. The forward logistic model was used to explore the determinants of HRQoL in MSA.Results A total of 205 patients with cerebellar variant (MSA-C, 53.9%) and 175 patients with parkinsonian variant (MSA-P, 46.1%) patients were included in the study. The mean scores of the health utility index and EQ-VAS were 0.558 and 59.5, respectively. Mobility was reported by the largest proportion (92.1%) of MSA patients, followed by usual activities (88.7%), self-care (81.3%), anxiety/depression (72.1%), and pain/discomfort (53.9%). The determinants of the lower health utility index in MSA were female sex, greater total Unified Multiple System Atrophy Rating Scale (UMSARS) scores, fatigue, and Parkinson's disease-related sleep problems (PD-SP). Lower EQ-VAS score was associated with greater total UMSARS scores, fatigue, PD-SP, and anxiety symptom. MSA-P patients reported more frequent problems in pain/discomfort than MSA-C patients, while MSA-C patients reported more problems in mobility than MSA-P patients. Conclusion Patients with MSA had poor HRQoL evaluated by EQ-5D-5L. The most frequent affected problem is mobility in the Chinese MSA population. Besides the severity of MSA, fatigue, PD-SP and anxiety were determinants for poor HRQoL. Our research provides important information to improve the health status of patients with MSA.
Quantifying End User Computing Device Use Phase Greenhouse Gas Emissions Using Analytics Software
Authors: Sutton-Parker Justin 
Published: November 2021

Abstract
1.1 Purpose The purpose of this research is to answer the question, ‘can end user computing (EUC) use phase electricity (UPE) consumption data be captured using analytics software regardless of location?’ In doing so, the field experiment tests a proposed methodology that both addresses current barriers such as mobility and scale (Greenblatt et al., 2013) that limit the availability of EUC UPE field data (Karpagam & Yung, 2017) and challenges current methodologies that cause concomitant greenhouse gas (GHG) emissions quantification to be inaccurate by -48% to +107% (Sutton-Parker, 2020). 1.2 MethodsThis is achieved by using a distributed node based analytics software to capture both asset and use profile data sets from one hundred and eleven computer users operating in a subject organisation for 30-days. The values are then used to populate the current and popularised UPE consumption calculation data flow (Kawamoto et al, 2001; Roth eta al. 2002) in order to examine for omissions. To test for accuracy, the EUC UPE consumption of one control subject is measured using both a watt-metre and the analytics software. The rationale being that the watt-metre data is extensively proven to be accurate (Energy Star, 2017) and will therefore expose errors produced by the software in relation to power draw, on-time and resulting kilo-watt hours (kWh) values.1.3 Results and discussionFurther to the data capture period, the findings are mixed. Positively, the new method reduces complexity via the ability to compile both data sets with one tool rather than a combination of two, such as asset management and watt-metre measurement. Specifically, scale and mobility issues are overcome, also allowing for location to be deduced and therefore national electricity conversion factors to be applied when calculating scope 2 emissions. Additionally, the current methodology error range is reduced from 155% (Sutton-Parker, 2020) to 48%. Negatively, data omissions are experienced although surmountable, with the exception of monitors being excluded from the capture process. This is due to the node requiring an operating system to collect data. 1.4 ConclusionWhilst the research question is answered, the identification of energy consumption over reporting causes the analytics methodology to be arguably in need of further development. The rationale being that UPE consumption quantification is key to lifecycle assessment (LCA) and GHG accounting protocol and both require accuracy (WBCSD and WRI, 2004). It is therefore recommended that further research be undertaken to specifically address omissions and to reduce the over reporting aspect identified as caused by algorithms in the software used to calculate hardware power draw.