bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of amino acid infusion during cesarean delivery on newborn temperature: a randomized controlled trial
Authors: Pokharel Krishna , Subedi Asish , Tripathi Mukesh , Biswas Binay Kumar 
Published: March 2021

Abstract
Background
The effect of maternal amino acid (AA) infusion before and during cesarean delivery on neonatal temperature remains unknown. We hypothesized that thermogenic effects of AA metabolism would help maintain body temperature of newborn babies and their mothers.

Methods
Seventy-six parturients scheduled for elective singleton term cesarean delivery were equally randomized to receive intravenous 200 ml of AA or placebo approximately 1 h before subarachnoid block (infusion rate:100 ml/h). The primary outcome was the newborn rectal temperature at 0, 5 and 10 min after birth. The secondary outcomes included the maternal rectal temperature at six time-points: T0 = before starting study solution infusion, T1 = 30 min after starting infusion, T2 = one hour after starting infusion, T3 = during spinal block, T4 = half an hour after spinal block, T5 = at the time of birth and T6 = at the end of infusion, as well as maternal thermal discomfort and shivering episodes.

Results
There were no differences in newborn temperature between the two groups at any of the time-points (intervention-time-interaction effect, P = 0.206). The newborn temperature (mean [95%CI] °C) at birth was 37.5 [37.43–37.66] in the AA and 37.4 [37.34–37.55] in the placebo group. It showed a significant (P < 0.001) downward trend at 5 and 10 min after birth (time effect) in both groups. One neonate in the AA and five in the placebo group were hypothermic (temperature < 36.5 °C) (P = 0.20). There was a significant difference in the maternal temperature at all time points between the two groups (Intervention-time interaction effect, P < 0.001). However, after adjustment for multiplicity, the difference was significant only at T6 (P = 0.001). The mean difference [95%CI] in temperature decline from baseline (T0) till the end of infusion (T6) between the two groups was − 0.39 [− 0.55;− 0.22] °C (P < 0.0001). Six mothers receiving placebo and none receiving AA developed hypothermia (temperature < 36 °C) (P = 0.025). Maternal thermal discomfort and shivering episodes were unaffected by AA therapy.

Conclusions
Under the conditions of this study, maternal AA infusion before and during spinal anesthesia for cesarean delivery did not influence the neonatal temperature within 10 min after birth. In addition, the maternal temperature was only maintained at two hours of AA infusion.

Trial registration
ClinicalTrials.government, Identifier NCT02575170. Registered on 10th April, 2015 - Retrospectively registered.
A nomogram for screening esophageal squamous cell carcinoma based on environmental risk factors in a high-incidence area of China: a population-based case-control study
Authors: Yang Xiaorong , Suo Chen , Zhang Tongchao , Yin Xiaolin , Man Jinyu , Yuan Ziyu , Chen Hui , Yu Jingru , Jin Li , Chen Xingdong , Lu Ming , Ye Weimin 
Published: March 2021

Abstract
Background
Selection of high-risk subjects for endoscopic screening of esophageal squamous cell carcinoma (ESCC) lacks individual predictive tools based on environmental risk factors.

Methods
We performed a large population-based case-control study of 1418 ESCC cases and 1992 controls in a high-risk area of China. Information on potential risk factors was collected via face-to-face interview using an electronic structured questionnaire. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression models, and predictive nomograms were established accordingly. A weighted analysis was further conducted to introduce age into predictive nomograms due to frequency matching study design.

Results
Most cases were usually exposed to 4 to 6 risk factors, but most controls were usually exposed to 3 to 5 risk factors. The AUCs of male and female predictive nomograms were 0.75 (95%CI: 0.72, 0.77) and 0.76 (95%CI: 0.73, 0.79), respectively. The weighted analysis adding age in the predictive model improved the AUC in both men and women (0.81 (95%CI: 0.79, 0.84) and 0.88 (95%CI: 0.85, 0.90), respectively).

Conclusions
An easy-to-use preclinical predictive tool is provided to select candidate population with high ESCC risk for endoscopic screening. Its usefulness needs to be further evaluated in future screening practice.
High vimentin expression with E-cadherin expression loss predicts a poor prognosis after resection of grade 1 and 2 pancreatic neuroendocrine tumors
Authors: Zhou Bo , Xiang Jie , Jin Ming , Zheng Xiang , Li Guogang , Yan Sheng 
Published: March 2021

Abstract
Background
Pancreatic neuroendocrine tumors (pNETs) are a heterogeneous group of neoplasms with malignant behaviors that can develop from inert slow growth or low malignancy to aggressive metastasis during follow-up. Recently, vimentin and E-cadherin were shown to be prognostic markers in some malignant tumors but were not evaluated in pNETs. The aim of this study was to evaluate the expression and prognostic significance of vimentin and E-cadherin in grade 1 and 2 pNETs.

Methods
A retrospective review of 227 patients with grade 1 and 2 pNETs undergoing surgical resection was conducted. Tumor specimens were immunohistochemically stained for vimentin and E-cadherin. Correlations between vimentin and E-cadherin expression and other clinicopathological features were then analyzed. Furthermore, overall survival (OS) and disease-free survival (DFS) were evaluated using Kaplan-Meier and univariate and multivariate Cox regression methods.

Results
Among 227 patients, 55 (24.2%) harbored tumors with high vimentin expression, while 117 (51.5%) harbored tumors with loss of E-cadherin expression. Patients with high vimentin expression and loss of E-cadherin expression had significantly elevated risks of lymph node metastasis, distant metastasis, perineural invasion and an advanced American Joint Committee on Cancer (AJCC) stage compared with those with low vimentin expression and preserved E-cadherin expression, high vimentin expression and preserved E-cadherin expression, or low vimentin expression and loss of E-cadherin expression. Furthermore, multivariate analysis showed that high vimentin expression with loss of E-cadherin expression was an independent predictor of OS and DFS in patients with grade 1 and 2 pNETs who underwent resection (both P < 0.001).

Conclusions
The current study demonstrated that high vimentin expression with loss of E-cadherin expression was correlated with lymph node metastasis, distant metastasis, disease progression and a poor prognosis in patients with grade 1 and 2 pNETs who underwent resection.
Randomized and dose-escalation trials of recombinant human serum albumin /granulocyte colony-stimulating factor in patients with breast cancer receiving anthracycline-containing chemotherapy
Authors: Chen Shanshan , Han Yiqun , Ouyang Quchang , Lu Jianguo , Zhang Qingyuan , Yang Shun’e , Wang Jingfen , Huang Haixin , Liu Hong , Shao Zhimin , Li Hui , Chen Zhendong , Sun Sanyuan , Geng Cuizhi , Lu Junguo , Sun Jianwei , Wang Jiayu , Xu Binghe 
Published: March 2021

Abstract
Background
To evaluate the efficacy and safety of recombinant human serum albumin /granulocyte colony-stimulating factor (rHSA/G-CSF) in breast cancer following receipt of cytotoxic agents.

Methods
The phase 1b trial assessed the pharmacokinetics, pharmacodynamics, and safety of dose-escalation, ranging from rHSA/G-CSF 1800 μg, 2100 μg, and 2400 μg. Randomized controlled phase 2b trial was further conducted to ensure the comparative efficacy and safety of rHSA/G-CSF 2400 μg and rhG-CSF 5 μg/kg. In multicenter, randomized, open-label, parallel, phase 2 study, participants treated with anthracycline-containing chemotherapy were assigned in a ratio 1:1:1 to receive double delivery of rHSA/G-CSF 1200 μg, 1500 μg, and continuous rhG-CSF 5 μg/kg.

Results
Between December 16, 2014, to July 23, 2018, a total of 320 patients were enrolled, including 25 individuals in phase 1b trial, 80 patients in phase 2b trial, and 215 participants in phase 2 study. The mean duration of agranulocytosis during the first chemotherapeutic intermission was observed as 1.14 ± 1.35 days in rHSA/G-CSF 1500 μg, which was comparable with that of 1.07 ± 0.97 days obtained in rhG-CSF control (P = 0.71). Safety profiles were assessed to be acceptable ranging from rHSA/G-CSF 1800 μg to 2400 μg, while the double delivery of HSA/G-CSF 2400 μg failed to meet the noninferiority in comparison with rhG-CSF.

Conclusion
The prospective randomized controlled trials demonstrated that rHSA/G-CSF was efficacious and well-tolerated with an approachable frequency and expense of application for prophylactic management of agranulocytosis. The double delivery of rHSA/G-CSF 1500 μg in comparisons with paralleling G-CSF preparations is warranted in the phase 3 trial.

Trial registration
ClinicalTrials.gov identifiers: NCT02465801 (11/17/2014), NCT03246009 (08/08/2017), NCT03251768 (08/07/2017).
Panretinal photocoagulation after or prior to intravitreal conbercept injection for diabetic macular edema: a retrospective study
Authors: Zhang Wei , Zhao Guiyang , Fan Weijie , Zhao Taihong 
Published: March 2021

AbstractBackgroundPanretinal photocoagulation treatment (PRP) have been known as a standard treatment for proliferative diabetic retinopathy (PDR) or severe nonproliferative diabetic retinopathy (sNPDR). However, there is no consensus on when PRP should be administrated if anti-VEGF treatment is needed for the concurrent diabetic macular edema (DME). This study is to evaluate the difference between two groups of PRP prior to, or after intravitreal conbercept (IVC) for patients with PDR or sNPDR combined with DME.MethodsThis was a retrospective study. Fifty-eight eyes with DME secondary to PDR or sNPDR were divided into two groups; the PRP after (PRP-aftergroup), or prior to (PRP-priorgroup), IVC. Changes in number of IVC injections, best corrected visual acuity (BCVA), and central subfield macular thickness (CSMT) were compared after 4 weeks, 12 weeks, 1 year, and 2 years from the first IVC injection.ResultsThe mean number of injections in PRP-aftergroup was 4.8 (1 year) and 6.4 (2 year), lower than 6.4 (1 year) and 8.5 (2 year) in PRP-priorgroup (bothp = 0.002). There was no significant difference in change in BCVA and CSMT between two groups after each follow-up.ConclusionPRP after IVC requires less injections but also yields similar visual and anatomic outcome comparing with PRP prior to IVC in patients with diabetic retinopathy combined with DME.
A qualitative exploration of roles and expectations of male partners from PMTCT services in rural Malawi
Authors: M’baya Kansinjiro Beatrice , Nyondo-Mipando Alinane Linda 
Published: March 2021

Abstract
Background
Prevention of mother-to-child transmission of HIV (PMTCT) is effective in curbing rates of HIV infection in children because its interventions reduce the rates of transmission during pregnancy, in labour, and in breastfeeding. Male involvement (MI) greatly influences uptake and adherence to PMTCT services. Lack of clarity on the roles and expectations of men in PMTCT is one of the main barriers to MI. The main aim of the study was to explore the roles and expectations of male partners from PMTCT services in Malawi.

Methods
This was a descriptive qualitative study that involved men whose partners were either pregnant or breastfeeding a child, health care workers working in PMTCT services for over six months, and traditional leaders. We conducted 9 in-depth interviews and 12 key informant interviews from January to March 2018. All interviews were audio-recorded, transcribed, and translated. Thematic analysis was employed to analyze data.

Results
The subjective and community norms and attitudes of men towards PMTCT provide the context in which male partners define the specific roles they render and the services they expect from PMTCT services. The roles of men in PMTCT service were contextualized in what is socially acceptable and normalized in the setting and include supportive roles expressed as accompanying the wife to attend; antenatal care services, Dry blood sample collection (DBS) when its due, keeping appointments when is due to take the ARVs, providing financial support; HIV prevention behavior change and decision-making roles. The desired services within PMTCT include health assessment such as checking their weight; blood pressure; blood sugar and promotion activities such as education sessions that are provided in a male-friendly manner that is in tandem with existing socio-cultural norms and attitudes of men towards such services.

Conclusion
The roles of male partners in PMTCT services are underpinned by subjective norms and what is socially acceptable within a specific context. The services that men require from PMTCT services are influenced by their attitudes and beliefs towards PMTCT interventions. Services should be male-tailored provided in an atmosphere that allows and accepts male partners to exercise their roles in PMTCT services.
Combination of conditional cash transfer program and environmental health interventions reduces child mortality: an ecological study of Brazilian municipalities
Authors: de Souza Anelise Andrade , Mingoti Sueli Aparecida , Paes-Sousa Rômulo , Heller Leo 
Published: March 2021

AbstractBackgroundThis study aims to assess the interactive effects of Brazilian public interventions, environmental health programs (access to water, sanitation and solid waste collection) and a Conditional Cash Transfer Program (PBF), on the mortality reduction due to diarrhea and malnutrition among children under 5 years old.MethodsThe study design is ecological, with longitudinal analysis in a balanced panel. The period covered is 2006 to 2016, including 3467 municipalities from all regions of the country, which resulted in 38,137 observations. The generalized linear models were adjusted considering the Negative Binomial (NB) distribution for the number of deaths due to malnutrition and diarrhea, with fixed effects. NB models with and without zero-inflation were assessed. Subsequent interaction models were applied to assess the combined effects of the two public policies.ResultsIn relation to the decline of mortality rates due to diarrhea in the municipalities, positive effect modification were observed in the presence of: high coverage of the target population by the PBF and access to water, 0.54 (0.28–1.04) / 0.55 (0.29–1.04); high coverage by the total population by the PBF and access to water, 0.97 (0.95–1.00) and high coverage by the total population by the PBF and access to sanitation, 0.98 (0.97–1.00). Decline on diarrhea mortality was also observed in the joint presence of high coverage of solid waste collection and access to water, categories 1 (> 60% ≤85%): 0.98 (0.96–1.00), 0.98 (0.97–1, 00) and 2 (> 85% ≤ 100%): 0.97 (0.95–0.98), 0.97 (0.95–0.99). Negative effect modification were observed for mortality due to malnutrition in the presence of simultaneous high coverage of the total population by the PBF and access to sanitation categories 1 (≥ 20 < 50%): 1.0061 (0.9991–1.0132) and 2 (≥ 50 < 100%): 1.0073 (1.0002–1.0145) and high coverage of the total population by the PBF and solid waste collection, 1.0004 (1.0002–1.0005), resulting in malnutrition mortality rates increase.ConclusionImplementation of environmental health services and the coverage expansion by the PBF may enhance the prevention of early deaths in children under 5 years old due to diarrhea, a poverty related disease.
Response to pembrolizumab in a patient with primary lung adenocarcinoma originated from indium lung
Authors: Sekine Yasuharu , Ichimura Hideo , Ueda Sho , Kobayashi Keisuke , Nawa Takeshi , Amata Atsuko , Chonan Tatsuya , Sakata Akiko , Komatsu Yoji , Sato Yukio 
Published: March 2021

Abstract
Background
Indium is a metal used as a compound called indium-tin oxide for liquid crystal display. Its inhalation causes lung toxicity, resulting in a new occupational lung disease called indium lung. Although the carcinogenicity of indium has been reported in an animal model, its carcinogenicity in humans is unknown.

Case presentation
This is the first reported case of a primary lung cancer originating from indium lung. In this report, we describe a 46-year-old man with interstitial pneumonia-type indium lung diagnosed 16 years ago. The initial symptom was left chest pain, and computed tomography showed a mass adjacent to the aorta with left pleural effusion. Specimens collected using video-assisted thoracoscopy revealed an adenocarcinoma with a high expression of programmed cell death-ligand 1 (cT4N0M1a stage IVA). Although the lesions showed a remarkable aggressive nature, the patient benefited from pembrolizumab, a monoclonal antibody against programmed cell death 1, which was used as second-line therapy for 2 years.

Conclusions
It is important for clinicians to be aware of lung cancer development in indium-exposed workers or in patients with indium lung, as this could have an aggressive behavior. Treatment with immune checkpoint inhibitors is an option even in patients with interstitial pneumonia-type indium lung.
Phytochemical analysis, in-vitro anti-proliferative, anti-oxidant, anti-diabetic, and anti-obesity activities of Rumex rothschildianus Aarons. extracts
Authors: Jaradat Nidal , Hawash Mohammed , Dass Gada 
Published: March 2021

Abstract
Background
Rumex rothschildianus is the sole member of a unique section of the genus Rumex, in the family Polygonaceae. This species is a very rare small dioecious annual, endemic to Palestine that is traditionally used as food and for the treatment of various diseases. Therefore, the current investigation aimed to screen the chemical constituents, antioxidants, anti-α-amylase, anti-α-glucosidase, antilipase, and cytotoxic effects of four solvents fractions of R. rothschildianus leaves.

Methods
Dried powder of R. rothschildianus leaves was extracted in four solvents with different polarities. Several qualitative and quantitative phytochemical tests were performed to determine the components of the extracts. The colorimetric analysis was used for the quantitative determination of phenols, flavonoids, and tannins. In-vitro assays were performed to evaluate the extracts for antioxidant, anti-α-amylase, anti-α-glucosidase, and antilipase inhibitory activities, as well as cytotoxicity by MTS assay against cervical carcinoma cells line (HeLa) and breast cancer cell line (MCF7).

Results
The acetone fraction of R. rothschildianus leaves showed the most significant antioxidant activity, due to having the highest content of flavonoids and phenolics, with an IC50 value of 6.3 ± 0.4 μg/ml, compared to 3.1 ± 0.9 μg/ml for Trolox, and regarding lipase inhibition activity the acetone fraction showed the most potent activity with an IC50 value of 26.3 ± 0.6 μg/ml, in comparison with orlistat positive control IC50 12.3 μg/ml. The same extract was the most potent inhibitor of α-amylase and α-glucosidase, with IC50 values of 19.1 ± 0.7 μg/ml and 54.9 ± 0.3 μg/ml, respectively, compared to 28.8, 37.1 ± 0.3 μg/ml of acarbose, respectively. The hexane fraction showed 99.9% inhibition of HeLa cells and 97.4% inhibition for MCF7 cells.

Conclusion
The acetone fraction of R. rothschildianus leaves might provide a source of bioactive compounds for the treatment of oxidative stress. Similarly, the hexane fraction indicates the promising antitumor potential of R. rothschildianus. Clearly, these initial indications need further purification of potentially active compounds, and ultimately, in-vivo studies to determine their effectiveness.
Predicting unplanned medical visits among patients with diabetes: translation from machine learning to clinical implementation
Authors: Selya Arielle , Anshutz Drake , Griese Emily , Weber Tess L. , Hsu Benson , Ward Cheryl 
Published: March 2021

Abstract
Background
Diabetes is a medical and economic burden in the United States. In this study, a machine learning predictive model was developed to predict unplanned medical visits among patients with diabetes, and findings were used to design a clinical intervention in the sponsoring healthcare organization. This study presents a case study of how predictive analytics can inform clinical actions, and describes practical factors that must be incorporated in order to translate research into clinical practice.

Methods
Data were drawn from electronic medical records (EMRs) from a large healthcare organization in the Northern Plains region of the US, from adult (≥ 18 years old) patients with type 1 or type 2 diabetes who received care at least once during the 3-year period. A variety of machine-learning classification models were run using standard EMR variables as predictors (age, body mass index (BMI), systolic blood pressure (BP), diastolic BP, low-density lipoprotein, high-density lipoprotein (HDL), glycohemoglobin (A1C), smoking status, number of diagnoses and number of prescriptions). The best-performing model after cross-validation testing was analyzed to identify strongest predictors.

Results
The best-performing model was a linear-basis support vector machine, which achieved a balanced accuracy (average of sensitivity and specificity) of 65.7%. This model outperformed a conventional logistic regression by 0.4 percentage points. A sensitivity analysis identified BP and HDL as the strongest predictors, such that disrupting these variables with random noise decreased the model’s overall balanced accuracy by 1.3 and 1.4 percentage points, respectively. These recommendations, along with stakeholder engagement, behavioral economics strategies, and implementation science principles helped to inform the design of a clinical intervention targeting behavioral changes.

Conclusion
Our machine-learning predictive model more accurately predicted unplanned medical visits among patients with diabetes, relative to conventional models. Post-hoc analysis of the model was used for hypothesis generation, namely that HDL and BP are the strongest contributors to unplanned medical visits among patients with diabetes. These findings were translated into a clinical intervention now being piloted at the sponsoring healthcare organization. In this way, this predictive model can be used in moving from prediction to implementation and improved diabetes care management in clinical settings.