bluuebunny/crossref_metadata_2025_split huggingface dataset:
Women's experiences of VBAC in Cyprus: a qualitative study
Authors: Hadjigeorgiou Eleni , Katsie Constantina , Papadopoulou Maria , Christofi Maria Dolores , Christoforou Andri 
Published: November 2021

AbstractBackground and aimIn 21st century, there has been an increasing interest in vaginal birth after previous caesarean section (VBAC) in Cyprus, a country with a very high operative birth rate. Research-based evidence of women’s VBAC experiences in Cyprus is non-existent, despite its significance for the well-being of mothers and families. The aim of this study is to gain insight into the women’s lived experience of VBAC in Cyprus. In this study women’s experiences of VBAC are explored for the first time in Cyprus.MethodThe study is qualitative and exploratory in nature. Data were collected through semi-structured interviews with 10 women, who experienced vaginal birth after a previous caesarean section (VBAC) in Cyprus. A descriptive phenomenological approach was employed for the analysis of data.ResultsAnalysis of data yielded four major themes: (a) medicalization of childbirth, (b) preparing for a VBAC, (c) birth environment, and (d) healing through VBAC. On the whole, the women interviewed described their previous experience of CS as traumatic, in contrast to vaginal childbirth. VBAC was considered an utterly positive experience that made the women feel empowered and proud of themselves.ConclusionThis study offers valuable insight into a newly researched subject in Cyprus, which is necessary for advancing perinatal care in Cyprus. The findings indicate that women need evidence-based information, guidelines on birthing options, good preparation with tailored information and personalized care for a successful vaginal birth after a previous caesarean section. Proper, non-biased, consultations are a main factor that affects women’s choice of mode of birth. The introduction of new, women-friendly perinatal strategies that respect and promote childbirth rights is imperative in the case of Cyprus. All women have the right to exercise informed choice and the choice to alternative birthing options.
Telomerase-positive circulating tumor cells are associated with poor prognosis via a neutrophil-mediated inflammatory immune environment in glioma
Authors: Zhang Wen , Qin Tiancheng , Yang Zhenrong , Yin Liyuan , Zhao Changyun , Feng Lin , Lin Song , Liu Binlei , Cheng Shujun , Zhang Kaitai 
Published: November 2021

Abstract
Background
Gliomas are the most common aggressive cancer in the central nervous system. Considering the difficulty in monitoring glioma response and progression, an approach is needed to evaluate the progression or survival of patients with glioma. We propose an application to facilitate clinical detection and treatment monitoring in glioma patients by using telomerase-positive circulating tumor cells (CTCs) and to further evaluate the relationship between the immune microenvironment and CTCs in glioma patients.

Methods
From October 2014 to June 2017, 106 patients newly diagnosed with glioma were enrolled. We used the telomerase reverse transcriptase CTC detection method to detect and analyze the CTC statuses of glioma patients before and after surgery. FlowSight and FISH confirmed the CTCs detected by the telomerase-based method. To verify the correlation between CTCs and the immune response, peripheral white blood cell RNA sequencing was performed.

Results
CTCs were common in the peripheral blood of glioma patients and were not correlated with the pathological classification or grade of patients. The results showed that the presence of postoperative CTCs but not preoperative CTCs in glioma patients was a poor prognostic factor. The level of postoperative CTCs, which predicts a poor prognosis after surgery, may be associated with neutrophils. RNA sequencing suggested that postoperative CTCs were positively correlated with innate immune responses, especially the activation of neutrophils and the generation of neutrophil extracellular traps, but negatively correlated with the cytotoxic response.

Conclusions
Our results showed that telomerase-positive CTCs can predict a poor prognosis of patients with glioma. Our results also showed a correlation between CTCs and the immune macroenvironment, which provides a new perspective for the treatment of glioma.
Efficient hepatic differentiation and regeneration potential under xeno-free conditions using mass-producible amnion-derived mesenchymal stem cells
Authors: Choi Jiwan , Kang Seoon , Kim Bitnara , So Seongjun , Han Jongsuk , Kim Gyeong-Nam , Lee Mi-Young , Roh Seonae , Lee Ji-Yoon , Oh Soo Jin , Sung Young Hoon , Lee Yeonmi , Kim Sung Hoon , Kang Eunju 
Published: November 2021

Abstract
Background
Amnion-derived mesenchymal stem cells (AM-MSCs) are an attractive source of stem cell therapy for patients with irreversible liver disease. However, there are obstacles to their use due to low efficiency and xeno-contamination for hepatic differentiation.

Methods
We established an efficient protocol for differentiating AM-MSCs into hepatic progenitor cells (HPCs) by analyzing transcriptome-sequencing data. Furthermore, to generate the xeno-free conditioned differentiation protocol, we replaced fetal bovine serum (FBS) with polyvinyl alcohol (PVA). We investigated the hepatocyte functions with the expression of mRNA and protein, secretion of albumin, and activity of CYP3A4. Finally, to test the transplantable potential of HPCs, we transferred AM-MSCs along with hepatic progenitors after differentiated days 11, 12, and 13 based on the expression of hepatocyte-related genes and mitochondrial function. Further, we established a mouse model of acute liver failure using a thioacetamide (TAA) and cyclophosphamide monohydrate (CTX) and transplanted AM-HPCs in the mouse model through splenic injection.

Results
We analyzed gene expression from RNA sequencing data in AM-MSCs and detected downregulation of hepatic development-associated genes including GATA6, KIT, AFP, c-MET, FGF2, EGF, and c-JUN, and upregulation of GSK3. Based on this result, we established an efficient hepatic differentiation protocol using the GSK3 inhibitor, CHIR99021. Replacing FBS with PVA resulted in improved differentiation ability, such as upregulation of hepatic maturation markers. The differentiated hepatocyte-like cells (HLCs) not only synthesized and secreted albumin, but also metabolized drugs by the CYP3A4 enzyme. The best time for translation of AM-HPCs was 12 days from the start of differentiation. When the AM-HPCs were transplanted into the liver failure mouse model, they settled in the damaged livers and differentiated into hepatocytes.

Conclusion
This study offers an efficient and xeno-free conditioned hepatic differentiation protocol and shows that AM-HPCs could be used as transplantable therapeutic materials. Thus, we suggest that AM-MSC-derived HPCs are promising cells for treating liver disease.
Evaluation of cerebroprotective effect of Ricinus communis leaves against ischemia reperfusion injury in rats
Authors: Ahmad Nesar , Mishra Anuradha , Ahsan Farogh , Khan Zafar 
Published: November 2021

Abstract
Background
Ricinus communis (RC) has been used for a long time as natural origin medicine in the treatment of central nervous system ailments. This present study was designed to identify the possible role of Ricinus communis leaves extract against ischemia-reperfusion induced-neurobehavioral changes, oxidative stress, histopathological and cellular modifications in the brain.

Methods
Sprague Dawley (SD) rats (200–250 g) were induced to bilateral common carotid artery occlusion (BCCAO) for around 30 min later subjected to reperfusion for 24 h to induce cerebral injury by reperfusion. Ricinus communis leaves extract (250 and 500 mg/kg, p.o) was administered continuously for 14 days and on the 15th-day animals were subjected to ischemia-reperfusion injury. Different behavioral tests and biochemical parameters were assessed subsequently.

Results
Fourteen days Ricinus communis leaves extract (250 and 500 mg/kg, p.o.) treatment very significantly improved neurobehavioral alterations when compared to control ischemia-reperfusion. Ricinus communis leaves extract (250 and 500 mg/kg, p.o.) kg, i.p. treatment significantly attenuated oxidative damage when compared to ischemia-reperfusion (I/R) group animals. In addition, Ricinus communis leaves extract treatment was well supported histopathologically when compared to the ischemia-reperfusion (I/R) group.

Conclusion
The data from this study recommend that treatment with Ricinus communis leaves extract increases the antioxidant protection against BCCAO-induced global cerebral ischemia and demonstrates neuroprotective activity.
Characterization of simulation centers and programs in Latin America according to the ASPIRE and SSH quality criteria
Authors: Armijo-Rivera Soledad , Machuca-Contreras Felipe , Raul Norma , de Oliveira Saionara Nunes , Mendoza Ismael Ballesteros , Miyasato Héctor Shibao , Díaz-Guio Diego Andrés 
Published: November 2021

Abstract
Background
Latin American clinical simulation has had an important development; there are no studies that characterize simulation centers and programs in the entire region. The aims of this work are to characterize the current state of simulation-based education in the health sciences, to determine the structure of Latin American simulation centers in terms of teaching, research, and continuing medical education (CME), as well as to determine the perception of quality based on international standards of simulation practices for the directors of Latin American centers.

Methods
A quantitative, descriptive, cross-sectional study with a demographic questionnaire and a Likert-type survey was conducted to the directors of the simulation centers found in Latin America.

Results
Four hundred eight simulation centers were documented, the survey was answered by 240 directors, and the data from 149 were complete responses on the 42 quality self-perception scale and considered valid on further analyses related to the quality of the programs. Most of the centers that responded correspond to Chile, Brazil, and Mexico (37.5%, 18.1%, 12.7%). 84% of the centers are university-based, and 71% of the centers are medium-sized, with less than 10 instructors (54%). The directors are mostly women (61.7%), medical doctors (50%), and nurses (40%), with clinical specialization (37%), master’s degree (53%), and doctorate (13%). 75% have completed a simulation instructor course, and 6% have developed a fellowship. Most consider the maintenance of international quality standards to be relevant in their centers, mainly in reflective training techniques, ethical aspects, and adequate learning environments.

Conclusions
Simulation-based education in health sciences has had an increasing development in Latin America, within a university environment, in an important academic specialization process that seeks to adhere to high-quality standards to improve training and development of clinical skills, human factors, and critical thinking. We recommend starting accreditation processes in Latin America and studies that measure the quality of simulation-based education in our region, based on objective observations more than in self-reporting.
3D printed customised external cranial plate in a patient with syndrome of trephined: ‘a case report’
Authors: H. Mee , S. Greasley , G. Whiting , C. Harkin , G. Oliver , D. Marsden , R. Andrews , S. Sireau , RD. Price , F. Anwar , IS. Timofeev , PJ. Hutchinson , PA. White , A. Helmy 
Published: November 2021

Abstract
Background
Syndrome of the trephined is a well-recognised phenomenon that occurs in patients following a craniectomy. It is associated with several symptoms, including headaches, motor impairments, cognitive disorders and reduced consciousness. Treatment for the syndrome usually involves replacing the skull defect.

Case Study
A 71-year-old male underwent a left-sided craniectomy after being diagnosed with biopsy-confirmed invasive squamous cell carcinoma with associated skull erosion. Subsequently, he developed a severe case of syndrome of the trephined (SoT,) resulting in having to lie flat to prevent the motor component of the Glasgow Coma Score (GCS) falling from M5/6 (E3/4 Vt M5/6) to M1 (E3/4 Vt M1) on sitting to 30 degrees. Unfortunately, due to ongoing chest sepsis and physical frailty, he was unable to undergo a cranioplasty. Therefore, to aid in clinical stabilisation, the treating physicians and clinical engineering teams designed and manufactured a prosthesis on-site, allowing rapid patient treatment. The prosthesis led to the patient being able to sit up to 30 degrees without the motor component of the GCS falling from M6 to M1 (E4 VT M6).

Conclusion
Clinical improvements were demonstrated with definitive neurological improvement after applying the external cranial plate in clinical outcome measures and radiographically. Furthermore, we have shown that rapid prototyping technology provides a flexible solution to synthesise bespoke medical prostheses with the correct expertise and regulatory framework.
The value of quantitative diffusion tensor imaging indices of spinal cord disorders
Authors: Omar Mohammad Koriem Mahmoud , Abd Allah Abd El-Karem Hasan , Maghrabi Mona Gouda , Mohamed Mohamed Zidan 
Published: November 2021

Abstract
Background
Different lesions affecting the spinal cord can lead to myelopathy. Diffusion tensor imaging (DTI) is widely used to predict the degree of spinal cord microstructure affection and to assess axonal integrity and diffusion directionality. We hypothesized that not all DTI parameters have the same affection with different spinal cord pathologies. The purpose of this study is to assess the value of the quantitative diffusion tensor imaging indices in different spinal cord lesions.

Results
There is highly statistically significant difference of the fractional anisotropy (FA), relative anisotropy (RA), volume ratio (VR) and secondary eigenvector values (E2 and E3) between various studied cord lesions and control levels. There is no statistically significant difference of the apparent diffusion coefficient (ADC) and the primary eigenvector value (E1) (ANOVA test). The ROC curve analysis showed the higher sensitivity and accuracy were ‘88% and 62.5%, respectively,’ with FA cutoff value about 0.380.

Conclusion
The resulted quantitative DTI indices ‘fractional anisotropy, relative anisotropy, volume ratio and secondary eigenvalues’ work as a numerical in vivo marker of overall tissue injury in different pathologies affecting the spinal cord.
Constructing the resistivity-to-sediment-type transform for the interpretation of airborne electromagnetic data
Authors: Dewar Noah , Knight Rosemary 
Published: November 2021

A novel Markov chain Monte Carlo (MCMC)-based methodology was developed for the transformation of resistivity, derived from airborne electromagnetic (AEM) data, into sediment type. This methodology was developed and tested using AEM data and well sediment type and resistivity logs from Butte and Glenn Counties in the California Central Valley. Our methodology accounts for the spatially varying sensitivity of the AEM method by constructing different transforms separated based on the sensitivity of the AEM method. The large spatial separation that typically exists between the AEM data and the wells with sediment type logs was avoided by planning the acquisition of AEM data so as to fly as close as possible to the well locations. We had 55 locations with sediment type logs and AEM data separated by 100 m, determined to be the maximum acceptable separation distance. Differences in vertical resolution between the AEM method and the sediment type logs were addressed by modeling the physics of the AEM measurement, allowing for a comparison of field and AEM data generated during the MCMC process. The influence of saturation state was captured by creating one set of transforms for the region above the top of the saturated zone and another for below. Using the set of transforms developed at the 55 locations, an inverse distance weighting scheme that included a well quality ranking was used to construct a set of 12 (six sensitivity bins, and two saturation states) resistivity-to-sediment-type transforms at every AEM data location. These represent a set of transforms that accommodate the variation in AEM sensitivity and are independent of the inversion used to retrieve the resistivity model. Thus, these transforms avoid two of the significant limitations common to resistivity-to-sediment-type transforms used to interpret AEM data.
Role of Optical Coherence Tomography Angiography to differentiate Intraretinal microvascular abnormalities and retinal neovascularization in Diabetic Retinopathy
Authors: Memon Abdul Sami , Memon Nasir Ahmed , Mahar Pir Salim 
Published: November 2021

Objective: To assess proliferative diabetic retinopathy (PDR) and to describe the difference in angiographic representation of new vessels (NVs) and Intra retinal microvascular abnormalities (IRMA) on optical coherence tomography angiography (OCTA).
Methods: A cross-sectional observational study was performed at ISRA Postgraduate Institute of Ophthalmology, Karachi, from March 2018 to September 2018. Forty-two eyes of 21 patients with history of diabetes mellitus (DM) were examined. Twenty-eight eyes with a clinical diagnosis of severe non proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) according to early treatment diabetic retinopathy study (ETDRS) were included and evaluated using Swept source optical coherence tomography angiography (SS-OCTA). Then face wide ﬁeld SS-OCTA images and co registered structural optical coherence tomography (OCT) with ﬂow overlay were used to distinguish the features of IRMA and retinal NVs.
Results: Forty-two eyes (21 patients) were examined clinically. Fourteen eyes had moderate NPDR, 15 had severe NPDR and 13 eyes had changes consistent with PDR. After clinical diagnosis, we included 28 eyes in our study based on inclusion criteria. These 28 eyes went through SS-OCTA evaluation and we observed 15 cases with PDR and 13 with severe NPDR changes. The OCTA and clinical diagnosis were similar except in 2 eyes, which is critical but not statically significant showing the importance of this noninvasive technology.
Conclusions: Widefield OCTA can work as an alternative to fundus fluorescein angiography (FFA) in the diagnosis of diabetic retinopathy (DR). As it is a non-invasive and depth encoded technique so can be used frequently to monitor the retinal changes and their progression.
doi: https://doi.org/10.12669/pjms.38.1.3891
How to cite this:Memon AS, Memon NA, Mahar PS. Role of Optical Coherence Tomography Angiography to differentiate Intraretinal microvascular abnormalities and retinal neovascularization in Diabetic Retinopathy. Pak J Med Sci. 2022;38(1):57-61. doi: https://doi.org/10.12669/pjms.38.1.3891
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Pre-morbidity and COVID-19 disease outcomes in Pakistani population: A cross-sectional study
Authors: Toori Kaleem Ullah , Qureshi Muhammad Arsalan , Chaudhry Asma 
Published: November 2021

Objectives: To identify association of underlying pre-morbidities with disease severity and mortality in hospitalized patients with Corona virus disease 2019.
Methods: Total 884 COVID RT-PCR positive patients admitted to KRL Hospital Islamabad from April 2020 to August 2020 were included in this cross-sectional study. Pre-morbidities recorded were hypertension, diabetes mellitus, ischemic heart disease, chronic respiratory disease, chronic kidney disease, chronic liver disease, chronic neuro-psychiatric conditions (stroke and depression) and malignancy. Oxygen requirement, requirement of invasive ventilation, and outcome (recovered versus died) was documented. WHO categories for disease severity were used. Demographic profile and symptoms were also noted. SPSS 22 was used for data analysis. Pearson’s Chi square test was used to see association between pre-morbidities and disease severity categories, oxygen requirement, invasive ventilation and outcome. Pearson’s correlation was applied to analyze the correlation between individual pre-morbidities and disease severity categories. P-value < 0.05 was considered statistically significant.
Results: The mean age was 40 ± 12.21 years with 98.5% being males. Majority patients (74.8%) were asymptomatic. Fever was the most common symptom. Diabetes mellitus and hypertension were the most commonly recorded co-morbidity. Significant correlation (p-value < 0.05) was found between the presence of underlying pre-morbidities and disease severity as well as oxygen requirement, requirement of invasive ventilation and mortality.
Conclusion: Results are compatible with worldwide studies and underlying pre-morbidities are convincing risk factors for disease severity and mortality.
doi: https://doi.org/10.12669/pjms.38.1.4235
How to cite this:Toori KU, Qureshi MA, Chaudhry A. Pre-morbidity and COVID-19 disease outcomes in Pakistani population: A cross-sectional study. Pak J Med Sci. 2022;38(1):287-292. doi: https://doi.org/10.12669/pjms.38.1.4235
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Immunohistochemical Expression of MMP-9 and E-Cadherin in subtypes of Ameloblastoma
Authors: Farhan Farah , Niazi Zainab , Masood Sana , Abbas Beenish 
Published: November 2021

Background & Objective: Ameloblastomas have been analyzed histologically for diagnostics and its sub-classification; however, the analysis carried out so far does not provide any authentic evidence regarding prognosis of Ameloblastoma. Subject categorization is still a topic of debate. The purpose of this study was to determine the immuno-expression of markers such as MMP-9 and E-Cadherin in different sub-types of ameloblastoma and establish their correlation with histological variants.
Methods: Analytical study of 71 cases of ameloblastoma was conducted in AFIP Rawalpindi, between January to June, 2019. Samples were taken from different intraoral sites including the patients with tumor of ameloblast. The tumor was sub classified histologically on the basis of WHO classification. ‘Chi Square’ Test was applied to find the association of MMP-9 and E-Cadherin with histological variants of ameloblastoma. P-value ≤ 0.05 were found statistically significant.
Results: On histopathological sub-classification, 52.1% were diagnosed as follicular type, 23.9% were plexiform type, 14.1% were Acanthomatous type and 9.9% were of unicystic ameloblastoma. 80% of the total Acanthomatous type and 59% of the total plexiform had strong immuno-expression, which was significantly different from follicular type MMP-9 (p ≤ 0.05). All cases of unicystic ameloblastoma and 67.6% of follicular type showed strong immuno-expression significantly different from 20% of Acanthomatous type and 59% of plexiform type E-Cadherin (p ≥ 0.05). On the other hand, when statistical analysis was carried out, an inverse relation between MMP-9 and E-cadherin was observed.
Conclusion: The effect of MMP-9 and E-cadherin in ameloblastoma is aggressive in nature and effectiveness was seen in subtypes of ameloblastoma.
doi: https://doi.org/10.12669/pjms.38.1.4465
How to cite this:Farhan F, Niazi Z, Masood S, Abbas B. Immunohistochemical Expression of MMP-9 and E-Cadherin in subtypes of Ameloblastoma. Pak J Med Sci. 2022;38(1):207-213. doi: https://doi.org/10.12669/pjms.38.1.4465
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.