bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metabolic engineering strategy for synthetizing trans-4-hydroxy-l-proline in microorganisms
Authors: Zhang Zhenyu , Liu Pengfu , Su Weike , Zhang Huawei , Xu Wenqian , Chu Xiaohe 
Published: April 2021

AbstractTrans-4-hydroxy-l-proline is an important amino acid that is widely used in medicinal and industrial applications, particularly as a valuable chiral building block for the organic synthesis of pharmaceuticals. Traditionally,trans-4-hydroxy-l-proline is produced by the acidic hydrolysis of collagen, but this process has serious drawbacks, such as low productivity, a complex process and heavy environmental pollution. Presently,trans-4-hydroxy-l-proline is mainly produced via fermentative production by microorganisms. Some recently published advances in metabolic engineering have been used to effectively construct microbial cell factories that have improved thetrans-4-hydroxy-l-proline biosynthetic pathway. To probe the potential of microorganisms fortrans-4-hydroxy-l-proline production, new strategies and tools must be proposed. In this review, we provide a comprehensive understanding oftrans-4-hydroxy-l-proline, including its biosynthetic pathway, proline hydroxylases and production by metabolic engineering, with a focus on improving its production.
Oncological outcomes of laparoscopic versus open nephroureterectomy for the treatment of upper tract urothelial carcinoma: an updated meta-analysis
Authors: Piszczek Radosław , Nowak Łukasz , Krajewski Wojciech , Chorbińska Joanna , Poletajew Sławomir , Moschini Marco , Kaliszewski Krzysztof , Zdrojowy Romuald 
Published: April 2021

Abstract
Background
During the past two decades, laparoscopic radical nephroureterectomy (LRNU) has been proposed as an alternative technique to open radical nephroureterectomy (ORNU) and has become increasingly accepted for the treatment of patients with upper tract urothelial carcinoma (UTUC). Nevertheless, the oncologic efficacy of LRNU remains controversial, especially for the treatment of locally advanced (T3/T4 and/or N+) UTUC. In this meta-analysis, we aimed to cumulatively compare the oncological outcomes of LRNU versus ORNU.

Materials and methods
The present meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A search was conducted of three electronic databases, namely, Medline, Embase, and Cochrane Library. Outcome measurements of cancer-specific survival (CSS), overall survival (OS), intravesical recurrence-free survival (IVRFS), and recurrence-free survival (RFS), including hazard ratios (HRs) and 95% confidence intervals (CIs), were extracted and pooled.

Results
Eighteen articles published from 2007 to 2020 were included in the final quantitative analysis. One study was a randomized controlled trial (RCT), and the remaining articles had a retrospective design. Among a total of 10,730 participants in the selected papers, 5959 (55.5%) and 4771 (44.5%) underwent ORNU and LRNU, respectively. The results of pooled analyses revealed no significant differences in CSS (HR 0.84, 95% CI 0.60–1.19, p = 0.33), OS (HR 0.84, 95% CI 0.62–1.13, p = 0.25), IVRFS (HR 1.08, 95% CI 0.85–1.39, p = 0.52), and RFS (HR 1.09, 95% CI 0.94–1.25, p = 0.26) between LRNU and ORNU groups. Furthermore, the results of subgroup analyses for pT3/T4 and pTany N+ populations did not confirm any statistically significant differences between LRNU and ORNU in terms of any survival parameter.

Conclusions
Our present meta-analysis of current evidence suggests that LRNU and ORNU have comparable oncological outcomes in patients with UTUC, even in those with locally advanced disease. Further multicenter RCTs with large sample sizes and uniform data regarding specific surgical procedures, such as bladder cuff excision, are required to establish definitive conclusions.
Salpingo-oophorectomy versus cystectomy in patients with borderline ovarian tumors: a systemic review and meta-analysis on postoperative recurrence and fertility
Authors: Wang Peng , Fang Lei 
Published: April 2021

Abstract
Background
To compare the postoperative recurrence and fertility in patients with borderline ovarian tumors (BOTs) who underwent different surgical procedures: salpingo-oophorectomy versus cystectomy.

Methods
Potentially relevant literature from inception to Nov. 06, 2020, were retrieved in databases including Cochrane Library, EMBASE (Ovid), and MEDLINE (Pubmed). We applied the keywords “fertility-sparing surgery,” or “conservative surgery,” or “cystectomy,” or “salpingo-oophorectomy,” or “oophorectomy,” or “adnexectomy,” or “borderline ovarian tumor” for literate searching. Systemic reviews and meta-analyses were performed on the postoperative recurrence rates and pregnancy rates between patients receiving the two different surgical methods. Begger’s methods, Egger’s methods, and funnel plot were used to evaluate the publication bias.

Result
Among the sixteen eligible studies, the risk of recurrence was evaluated in all studies, and eight studies assessed the postoperative pregnancy rates in the BOT patients. A total of 1839 cases with borderline ovarian tumors were included, in which 697 patients (37.9%) received unilateral salpingo-oophorectomy and 1142 patients (62.1%) underwent unilateral/bilateral cystectomy. Meta-analyses showed that BOT patients with unilateral/bilateral cystectomy had significantly higher recurrence risk (OR=2.02, 95% CI: 1.59-2.57) compared with those receiving unilateral salpingo-oophorectomy. Pooled analysis of four studies further confirmed the higher risk of recurrence in patients with cystectomy (HR=2.00, 95% CI: 1.11-3.58). In addition, no significant difference in postoperative pregnancy rate was found between patients with the two different surgical procedures (OR=0.92, 95% CI: 0.60-1.42).

Conclusion
Compared with the unilateral/bilateral cystectomy, the unilateral salpingo-oophorectomy significantly reduces the risk of postoperative recurrence in patients with BOT, and it does not reduce the pregnancy of patients after surgery.

Trial registration
PROSPERO CRD42021238177
The role of parliamentarians in promoting self-care interventions for sexual and reproductive health and rights: applying COVID-19 lens in the Eastern Mediterranean region
Authors: Abou-Taleb Hala , Mohamed Nada , Gholbzouri Karima , Scolaro Elisa , Ezzeddine Inaya , Alouini Souhail , Hagrass Heba , Morshed Magdy , Datta Neil 
Published: April 2021

AbstractInnovative people-centered care modalities including self-care interventions offer an opportunity to ensure continuity of healthcare services during COVID-19 and in post-COVID-19, as well as contribute to the achievement of universal health coverage. Parliamentarians are uniquely positioned to promote self-care interventions for sexual and reproductive health and rights through their legislative, budget allocation, oversight, and advocacy roles. However, existing health systems governance challenges in the Eastern Mediterranean region such as weak institutions setups, fragmentation of health programs, and limitation of resources could impede parliamentarians’ progress. To address these challenges, the following recommended actions should be considered: (1) promote the adaptation of sexual and reproductive health and rights service packages at primary healthcare level to integrate self-care interventions (2) govern innovative people-centered care channels including self-care interventions; and (3) engage in a dialogue with civil society and communities to meet needs, raise public awareness and generate demand.
The role of community pharmacists in increasing access and use of self-care interventions for sexual and reproductive health in the Eastern Mediterranean Region: examples from Egypt, Jordan, Lebanon and Somalia
Authors: El Bizri Luna , Jarrar Laila Ghazi , Ali Wael K. Ali , Omar Abdifatah H. 
Published: April 2021

AbstractBackgroundSelf-care interventions offer a solution to support the achievement of three goals of the World Health Organization (WHO): to improve universal health coverage, reach people in humanitarian situations, and improve health and well-being. In light of implementing WHO consolidated guidelines on self-care interventions to strengthen sexual and reproductive health (SRH) in the Eastern Mediterranean Region (EMR), especially during the COVID-19 pandemic, pharmacists from four different EMR countries discussed the current SRH situation, inequality gaps, barriers to SRH service access and the pharmacist’s crucial role as a first-line responder to patients before, during and after COVID-19.Case presentationSelf-care interventions for SRH allow health care providers to serve a greater number of patients, improve progress toward universal health coverage, and reach people in humanitarian crises. In fact, these interventions can be significantly enhanced by utilizing community pharmacists as first-line health care providers. This review highlights the important role of community pharmacists in promoting self-care interventions and empowering individuals, families and communities. As a result, well-informed individuals will be authoritative in their health decisions. Exploring self-care interventions in the EMR was done through reviewing selected SRH services delivery through community pharmacists before and during the COVID-19 pandemic in Egypt, Jordan, Lebanon and Somalia. Before the COVID-19 pandemic, community pharmacists were found to be excluded from both governmental and nongovernmental SRH programmes. During the pandemic, community pharmacists managed to support patients with self-care interventions, whether voluntarily or through their pharmacy associations. This highlights the need for the health care decision-makers to involve and support community pharmacists in influencing policies and promoting self-care interventions.ConclusionSelf-care interventions can increase individuals’ choice and autonomy over SRH. Supporting community pharmacists will definitely strengthen SRH in the EMR and may help make the health system more efficient and more targeted.
Predictors of failure on second-line antiretroviral therapy with protease inhibitor mutations in Uganda
Authors: Musana Hellen , Ssensamba Jude Thaddeus , Nakafeero Mary , Mugerwa Henry , Kiweewa Flavia Matovu , Serwadda David , Ssali Francis 
Published: April 2021

Abstract
Introduction
Failure on second-line antiretroviral therapy (ART) with protease inhibitor (PI) mutations (VF-M) is on the rise. However, there is a paucity of information on the factors associated with this observation in low-income countries. Knowledge of underlying factors is critical if we are to minimize the number of PLHIV switched to costly third-line ART. Our study investigated the factors associated with VF-M.

Methods
We conducted a matched case–control analysis of patients' records kept at the Joint Clinical Research Center, starting from January 2008 to May 2018. We matched records of patients who failed the second-line ART with major PI mutations (cases) with records of patients who were virologically suppressed (controls) by a ratio of 1:3. Data analysis was conducted using STATA Version 14. Categorical variables were compared with the outcomes
failure on second-line ART with PI mutations using the Chi-square and Fisher's exact tests where appropriate. Conditional logistic regression for paired data was used to assess the association between the outcome and exposure variables, employing the backward model building procedure.

Results
Of the 340 reviewed patients' records, 53% were women, and 6.2% had previous tuberculosis treatment. Males (aOR = 2.58, [CI 1.42–4.69]), and patients concurrently on tuberculosis treatment while on second-line ART (aOR = 5.65, [CI 1.76–18.09]) had higher odds of VF-M. ART initiation between 2001 and 2015 had lower odds of VF-M relative to initiation before the year 2001.

Conclusion
Males and patients concomitantly on tuberculosis treatment while on second-line ART are at a higher risk of VF-M. HIV/AIDS response programs should give special attention to this group of people if we are to minimize the need for expensive third-line ART. We recommend more extensive, explorative studies to ascertain underlying factors.
Propagation of desert moss Syntrichia caninervis in peat pellet: a method for rapidly obtaining large numbers of cloned gametophytes
Authors: Liu Xiujin , Zhou Ping , Li Xiaoshuang , Zhang Daoyuan 
Published: April 2021

Abstract
Background
Syntrichia caninervis is a typical desiccation tolerant moss that is a dominant species forming biological soil crusts in the Gurbantunggut Desert. This study investigated the effect of different explants on regeneration potential by propagating them on peat pellet.

Result
Juvenile and green leaves can regenerate secondary protonema within one week and shoots in one-half month in peat pellet. Rhizoids have a great ability to regenerate, and similar to leaf regeneration, secondary protonema is the dominant type of regenerant. The process of stem regeneration is similar to that of whole gametophytes. Stems are the most important integral body part during propagation. The whole gametophyte is the best materials for rapidly propagating gametophyte on peat pellet.

Conclusion
This article improves the state of our current knowledge of desiccation tolerant moss cultivation, highlighting efforts to effectively obtain a large number of gametophytes through different explant parts. This work provides a useful resource for the study of S. caninervis as well as biocrust restoration.
Impact of provincial and national implementation strategies on P2Y12 inhibitor utilization for acute coronary syndrome in the elderly: an interrupted time series analysis from 2008 to 2018
Authors: Gupta Saurabh , Belley-Cote Emilie P. , Eqbal Adam , McEwen Charlotte , Basha Ameen , Wu Nicole , Cerasuolo Joshua O. , Mehta Shamir , Schwalm Jon-David , Whitlock Richard P. 
Published: April 2021

Abstract
Background
Guidelines recommend both acetylsalicylic acid 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 interrupted-time series with descriptive statistics and segmented regression analysis, we evaluated types of P2Y12 inhibitors prescribed at discharge and changes to their utilization in patients managed with percutaneous intervention (PCI), coronary artery bypass grafting (CABG) or medically, following national antiplatelet therapy guidelines (by the Canadian Cardiovascular Society), ticagrelor’s national approval by Health Canada, and ticagrelor’s coverage by a publicly funded medication plan.

Results
We included 114,142 patients (49.4%-PCI; mean age 75.71±6.94 and 62.3% male and 7.7%-CABG; mean age 74.11±5.63 and 73.5% male).
Among PCI patients, clopidogrel utilization declined monthly after 2010 national guidelines were published (p<0.0001) and within the first month after ticagrelor’s national approval by Health Canada (p=0.03). Among PCI patients, ticagrelor utilization increased within the first month (p<0.0001) and continued increasing monthly (p<0.0001) after its coverage by a publicly funded medication plan. Among PCI patients, clopidogrel utilization declined within the first month (p=0.003) and ticagrelor utilization increased monthly (p=0.05) after 2012 CCS guidelines.
Among CABG patients, ticagrelor’s coverage was associated with a monthly increase in its utilization (p<0.0001).

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.
Optimal stereotactic body radiotherapy dosage for hepatocellular carcinoma: a multicenter study
Authors: Su Ting-Shi , Liu Qiu-Hua , Zhu Xiao-Fei , Liang Ping , Liang Shi-Xiong , Lai Lin , Zhou Ying , Huang Yong , Cheng Tao , Li Le-Qun 
Published: April 2021

Abstract
Background
The optimal dose and fractionation scheme of stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC) remains unclear due to different tolerated liver volumes and degrees of cirrhosis. In this study, we aimed to verify the dose-survival relationship to optimize dose selection for treatment of HCC.

Methods
This multicenter retrospective study included 602 patients with HCC, treated with SBRT between January 2011 and March 2017. The SBRT dosage was classified into high dose, moderate dose, and low dose levels: SaRT (BED10 ≥ 100 Gy), SbRT (EQD2 > 74 Gy to BED10 < 100 Gy), and ScRT (EQD2 < 74 Gy). Overall survival (OS), progression-free survival (PFS), local control (LC), and intrahepatic control (IC) were evaluated in univariable and multivariable analyses.

Results
The median tumor size was 5.6 cm (interquartile range [IQR] 1.1–21.0 cm). The median follow-up time was 50.0 months (IQR 6–100 months). High radiotherapy dose correlated with better outcomes. After classifying into the SaRT, SbRT, and ScRT groups, three notably different curves were obtained for long-term post-SBRT survival and intrahepatic control. On multivariate analysis, higher radiation dose was associated with improved OS, PFS, and intrahepatic control.

Conclusions
If tolerated by normal tissue, we recommend SaRT (BED10 ≥ 100 Gy) as a first-line ablative dose or SbRT (EQD2 ≥ 74 Gy) as a second-line radical dose. Otherwise, ScRT (EQD2 < 74 Gy) is recommended as palliative irradiation.
Improvement of surgical complications using single-lumen endotracheal tube intubation and artificial carbon dioxide pneumothorax in esophagectomy: a meta-analysis
Authors: Chuang Kai-Hao , Lai Hsing-Hua , Chen Yu , Chen Li-Chun , Lu Hung-I , Chen Yen-Hao , Li Shau-Hsuan , Lo Chien-Ming 
Published: April 2021

Abstract
Background
Esophageal cancer has a poor prognosis. Surgery is the main treatment but involves a high risk of complications. Some surgical strategies have tried to eliminate complications. Our meta-analysis tried to find the benefits of single-lumen endotracheal tube intubation with carbon dioxide (CO2) inflation.

Methods
A systematic search of studies on esophagectomy and CO2 inflation was conducted using PubMed, Medline, and Scopus. The odds ratio of post-operative pulmonary complications and anastomosis leakage were the primary outcomes. The standardized mean difference (SMD) in post-operative hospitalization duration was the secondary outcome.

Results
The meta-analysis included four case-control studies with a total of 1503 patients. The analysis showed a lower odds ratio of pulmonary complications in the single-lumen endotracheal tube intubation in the CO2 inflation group (odds ratio: 0.756 [95% confidence interval, CI: 0.518 to 1.103]) compared to that in the double-lumen endotracheal tube intubation group, but anastomosis leakage did not improve (odds ratio: 1.056 [95% CI: 0.769 to 1.45])). The SMD in hospitalization duration did not show significant improvement. (SMD: -0.141[95% CI: − 0.248 to − 0.034]).

Conclusions
Single-lumen endotracheal tube intubation with CO2 inflation improved pulmonary complications and shortened the hospitalization duration. However, no benefit in anastomosis leakage was observed.
The application analysis of 8F ultrafine chest drainage tube for thoracoscopic lobectomy of lung cancer
Authors: Song Yongbin , Zheng Chong , Zhou Shaohui , Cui Hongshang , Wang Jincong , Wang Jianxun , Wang Wenhao , Liu Lijun , Liu Junfeng 
Published: April 2021

AbstractBackgroundCurrently, thoracoscopic lobectomy is widely used in clinical practice, and postoperative placement of ultrafine drainage tube has advantages of reducing postoperative pain and accelerating postoperative recovery in patients. This study aimed to investigate the feasibility and safety of placement of 8F ultrafine chest drainage tube after thoracoscopic lobectomy and its superiority over traditional 24F chest drainage tube.MethodsA retrospective data analysis was conducted in 169 patients who underwent placement of 8F ultrafine chest drainage tube or 24F chest drainage tube with thoracoscopic lobectomy for lung cancer from January 2018 to December 2019. Propensity score matching (PSM) was used to reduce bias between the experimental group and the control group. After PSM, 134 patients (67 per group) were enrolled. The drainage time, the total drainage volume, postoperative hospital stay, postoperative pain score and postoperative complication of both groups were analyzed and compared.ResultsCompared to group B, group A had lower pain scores on postoperative days 1, 2 and 3 (3.72 ± 0.65point vs 3.94 ± 0.67point,P= 0.027; 2.72 ± 0.93point vs 3.13 ± 1.04point,P= 0.016; and 1.87 ± 0.65point vs 2.39 ± 1.22point,P= 0.005), shorter drainage time (4.25 ± 1.79d vs 6.04 ± 1.96d,P= 0.000), fewer drainage volume (1100.42 ± 701.57 ml vs 1369.39 ± 624.25 ml,P= 0.021); and shorter postoperative hospital stay (8.46 ± 2.48d vs 9.37 ± 1.70d,P= 0.014). Postoperative complications such as subcutaneous emphysema, pulmonary infection, atelectasis, chest tube reinsertion and intrathoracic hemorrhage showed no differences between both groups (P> 0.05).ConclusionCompared with 24F chest drainage tube, the application of an 8F ultrafine chest drainage tube after thoracoscopic lobectomy has significantly shortened the drainage time, reduced the total drainage volume, reduced the postoperative pain degree, shortened the hospital day, and effectively detected postoperative intrathoracic hemorrhage. So, it is considered as an effective, safe and reliable drainage method.
Low suction on digital drainage devices promptly improves post-operative air leaks following lung resection operations: a retrospective study
Authors: Mitsui Suguru , Tauchi Shunsuke , Uchida Takahiro , Ohnishi Hisashi , Shimokawa Toshio , Tobe Satoshi 
Published: April 2021

Abstract
Background
We investigated the most effective suction pressure for preventing or promptly improving postoperative air leaks on digital drainage devices after lung resection.

Methods
We retrospectively analyzed the postoperative data of 242 patients who were monitored with a digital drainage system after pulmonary resection in our institution between December 2017 and June 2020. We divided the patients into three groups according to the suction pressure used: A (low-pressure suction group: − 5 cm H2O), B (intermediate-pressure group: − 10 cm H2O), and C (high-pressure suction group: − 20 cm H2O). We evaluated the duration of air leaks, timing of chest tube replacement, the amount of postoperative air leak, volume of fluid drained before chest tube removal, and the total number of air leaks during drainage.

Results
In total, 217 patients were included in this study. The duration of air leaks gradually decreased with significant difference between the groups, the highest decrease in A, the lowest decrease in C (P = 0.019). Timing of chest tube replacement, on the other hand, did not significantly differ between the three groups (P = 0.126). The number of postoperative air leaks just after surgery did not significantly differ between the three groups (P = 0.175), but the number of air leaks on postoperative day 1 were fewest in group A, then B, and greatest in group C (P = 0.033). The maximum amount of air leaks during drainage was lowest in A, then B, and highest in C (P = 0.036). Volume of fluid drained before chest tube removal did not significantly differ between the three groups (P = 0.986).

Conclusion
Low-pressure suction after pulmonary resection seems to avoid or promptly improve postoperative air leaks in digital drainage devices after lung resection.

Trial registration
This is a single-institution, retrospective analysis-based study of data from an electronic database. Study protocol was approved by the Akashi Medical Center Institutional Research Ethics Board (approval number: 2020–9).