bluuebunny/crossref_metadata_2025_split huggingface dataset:
Consensus Analysis for the Panel Responses and the Psychometrics Properties in Script Concordance Testing
Authors: Ganesan Sivaraman , Bhandary Shital , Thulasingam Mahalakshmy , Chacko Thomas , Rajan Zayapragassa , Ravichandran Surya , Raja Kalaiarasi , Ramasamy Karthikeyan , Alexander Arun , Saxena Sunil Kumar 
Published: January 2021

Abstract
Background: Clinical reasoning is an essential attribute in the teaching, learning, and assessment part of medical education for undergraduates. In using the Script Concordance Test (SCT) to foster clinical reasoning, expert panel members’ responses are initially created. There is no agreement in optimizing the panel members’ responses. Our study aimed to develop and validate an SCT and test the utility of the consensus index and panel response pattern. Methods: The methodology was an evolving pattern of constructing SCTs, administering them to the panel members, optimizing the panel with response pattern and consensus index. The SCT’s final items were chosen to be administered to the students. Item-total correlation and Cronbach’s alpha were calculated from the students’ scores. Results: Our study developed an SCT with 98 items and was administered to 20-panel members. The mean score of the panel members for these 98 items was 79.5 (+/- 4.4 SD). On optimizing with the panel responses, 14 items had a uniform response pattern, and 2 had bimodal response patterns. The consensus index calculated for the 98 item SCT ranged from 25.81 to 100. When the 16 items of bimodal and uniform response pattern were eliminated, the consensus index ranged from 58.65 to 100. We administered this 82 items SCT to 30 undergraduate and ten postgraduate students. The mean score of undergraduate students was 61.1 (+/-7.5 SD), and that of postgraduate students was 67.7 (+/- 6.3 SD), which was statistically significant using an independent t-test. Cronbach’s alpha for this 82 item SCT was 0.74. On analysing the item-total correlation, 22 items had a correlation of less than 0.05. Excluding these 22 poor items, the final SCT instrument of 60 items had a Cronbach’s alpha of 0.82. Conclusion: The consensus index can also be used to optimize the items for panel responses in SCT. Our study revealed that a consensus index of above 60 had a good item-total correlation with good internal consistency. Our study also revealed that the panel response clustering pattern could also be used to categorize the items though bimodal and uniform distribution patterns need further differentiation.
Is Unilateral Transverse Process-Pedicle Percutaneous Kyphoplasty A Better Choice for Osteoporotic Thoracolumbar Fractures in the Old Patients
Authors: Wu Tao , Qin Hu , Nicolas Yap , Xu Nuo , Huang Daoyu , Jin Zhen , Sun Jinpeng , Liu Jun 
Published: January 2021

Abstract
Background: A few reports have shown that unilateral transverse process-pedicle percutaneous kyphoplasty is a good choice for patients with osteoporotic vertebral compression fracture (OVCF). However, this issue remains controversial and the related comprehensive research was lacked.Methods: A retrospective study was conducted on patients receiving PKP surgery for OVCF. Patients were divided into three groups according to surgical approach. Symptom and radiographical evaluation were performed preoperatively, one-month postoperatively, one-year postoperatively and follow-ups. And follow-ups were repeated every year. Visual Analogue Scale Score (VAS), Oswestry Disability Index (ODI) scores, anterior vertebral height, coronal Cobb angle and sagittal Cobb angle was determined and compared among three groups.Results: Totally four hundred and forty-seven patients were included with an average age of 76.6±7.2 years old. UTP showed significantly shorter surgical duration (p<0.001), lower cement volume (p<0.001) but higher cement leakage proportion (p=0.044). No significant statistical difference was found in terms of improvement rates among three groups. Besides, it was notable that the a significantly higher coronal Cobb angle was observed in UTP group, and a about 4°coronal correction was found after UTP PKP.Conclusion: UTTP PKP could achieve similar symptoms relief and kyphosis correction as UTP and BTP PKP. However, it had shorter surgical time and less radio exposure than BTP PKP, lower risk of cement leakage and higher proportion of bilaterally cement distribution than UTP PKP. It seemed to be a better choice for patients with OVCF. In addition, we found that UTP PKP was especially fit for OVCF patients with asymmetrical vertebral compression.
Vitexin as a Potential Inhibitor for the Activation of Microglial Cells: Insights from Molecular Docking and Molecular Dynamics
Authors: YAHAYA MUHAMAD AFIQ FAISAL , BAKAR AMIRUL RIDZUAN ABU , STANSLAS JOHNSON , NORDIN NORSHARIZA , ZAINOL MURIZAL , MEHAT MUHAMMAD ZULFADLI 
Published: January 2021

Abstract
Background: Overly-activated microglia are known to be the culprit in chronic neuroinflammation in the presence of excessive lipopolysaccharide (LPS). Hence, abundance of pro-inflammatory cytokines are produced which later cause toxic and death to neurons. Tolllike receptor 4 (TLR4)/MD-2 complex found on the cell surface of microglia is responsible for the attachment of LPS and activation of nuclear factor-κB (NF-κB) downstream signalling pathway. Albeit vitexin has been shown to possess anti-inflammatory property, however, little is known on its ability to bind at the TLR4/MD-2 complex of microglia as well as to be an antagonist for LPS. Results: The molecular docking result shows that both vitexin and donepezil are able to bind at the close proximity of LPS binding site located at the TLR4/MD-2 complex with the binding energy of -4.35 and -9.14 kcal/mol, respectively. During molecular dynamic simulations, both vitexin and donepezil formed stable complex with TLR4/MD-2 throughout the 20 ns time length with the RMSD values of 1.9Å and 2.0Å, respectively. As for the RMSF, both compounds have the RMSF values of <1.2Å. Conclusions: Taken together, our results suggest that vitexin can be a potential antineuroinflammatory drug candidate by acting as an antagonist for LPS at the TLR4/MD-2 complex.
Identification of 4-Genes Model in Papillary Renal Cell Tumor Microenvironment Based on Comprehensive Analysis
Authors: Luo Liang , Zhou Haiyi , Su Hao 
Published: January 2021

Abstract
Background: The tumor microenvironment acts a pivotal part in the occurrence and development of tumor. However, there are few studies on the microenvironment of papillary renal cell carcinoma (PRCC). Our study aims to explore prognostic genes related to tumor microenvironment in PRCC. Methods: PRCC expression profiles and clinical data were extracted from The Cancer Gene Atlas (TCGA) database. Immune/stromal scores were performed utilizing the ESTIMATE algorithm. 323 samples were split into two groups on the basis of median immune/stromal score, and comparison of gene expression were conducted. Cross genes were obtained by Venn diagrams. Hub genes were selected through protein-protein interaction (PPI) network construction, and relevant functional analysis was conducted by DAVID. We used Kaplan–Meier analysis to identify the correlations between genes and overall survival (OS). Finally, univariate and multivariate cox regression analysis were employed to construct survival model and predict prognosis. Results: We found immune/stromal score was correlated with T pathological grade and PRCC subtypes. 989 differentially expressed genes (DEGs) and 1169 DEGs were identified respectively on the basis of immune and stromal score. Venn diagrams indicated that 763 co-upregulated genes and 4 co-downregulated genes were identified. Kaplan-Meier analysis revealed that 120 genes were involved in tumor prognosis. Then PPI network analysis identified 22 hub genes, and four of which were significantly related to OS in patients with PRCC confirmed by cox regression analysis. Conclusions: Four tumor microenvironment-related genes (CD79A, CXCL13, IL6 and CCL19) were identified as biomarkers for PRCC prognosis.
The Place of 3D Printing Preoperative Planning in Upper Thoracic Fractures
Authors: Kaya Ismail , Cingoz Ilker , Sahin Meryem , Bozoglan Emirhan , Sayin Murat , Yuceer Nurullah 
Published: January 2021

Abstract
Background: This study aims to compare the clinical results of patients with upper thoracic vertebral fractures treated with pedicle screw and posterior spinal fusion with preoperative surgical planning and 3-dimensional (3D) modeling and patients treated with freehand screws.Methods: Thirty patients who underwent pedicle screw placement with a diagnosis of upper thoracic fracture between June 2018 and October 2020 were included in our study. Pedicle screws were used in 15 patients (group 1) after the planning was completed with the help of 3D preoperative printing and modeling. Pedicle screws were applied in 15 patients in the control group (group 2) using the freehand technique. Intraoperative bleeding amount, pedicle screw insertion time, and correct screw placement data in both groups were recorded. The time of insertion of each pedicle screw was recorded.Results: The operation time was 134 ± 22 minutes for group 1 and 152 ± 38 minutes for group 2. The difference in operation times was found to be statistically significant (p <0.05). Based on axial and sagittal reconstruction images, the accuracy rate of pedicle screw placement (grade 0 and 1) in group I was 96.5% compared to 84.2% in group II. Analyzing axial reconstruction images alone, the overall perforation rate was 10.3% in group I compared to 26.3% in group II. The minor perforation rate (Grade 1, <2 mm) was 7.0% in group I compared to 12.2% in group II. The moderate perforation rate (grade 2, 2-4 mm) was 3.4% in group I compared to 14% in group II. The severe perforation rate (grade 3, > 4 mm) was 1.7% in group II. The difference in overall accuracy rates between the two groups was significant (p<0.05).Conclusions: For 3D models of upper thoracic pedicle screw insertion, guide plates can be produced inexpensively and individually. It provides a new method for the accurate placement of upper thoracic pedicle screws with high accuracy and secure use in screw insertion.
Neuregulin-1 Promotes Myocardial Angiogenesis in Acute Myocardial Infarction Through Regulating&nbsp;PI3K-AKT-eNOS and VEGF/VEGFR2 Signal Pathways
Authors: Ma Xiao , Wu Chengqiang , Li Lang , Zeng Zhiyu , Gui Chun 
Published: January 2021

Abstract
Background: Myocardial angiogenesis is central to the recovery of acute myocardial infarction (AMI). Neuregulin-1 (NRG-1) plays a critical role in cardiac function, although its role in myocardial angiogenesis is still unclear. The aim of this study was to investigate the effects of NRG-1 in myocardial angiogenesis in a rat model of AMI, and elucidate the underlying mechanisms. Methods: AMI was induced by a single ligation of left anterior descending coronary artery, followed by intravenous injection of recombinant human NRG-1 or normal saline for 8 consecutive days. The cardiac function indices were measured using the catheter MPA cardiac function analysis system. Histo-pathological changes were observed by HE. Microvessel density (MVD) was measured by CD31 and α-SMA immunostaining. The expression levels of other proteins were assessed by Western blotting. Results: NRG-1 improved cardiac function and alleviated myocardial damage induced by AMI. Compared to the sham-operated group, the capillary density and arteriole density increased after AMI (P<0.05), and were augmented by NRG-1 which also significantly increased the left ventricular function (P<0.05). Furthermore, Compared with sham group, PI3K-AKT-eNOS signaling was decreased significantly (P<0.05) whereas VEGF/ VEGFR2 signaling was significantly increased（P<0.05）in AMI group and both of therm were further upregulated by NRG-1 (P > 0.05).Conclusion: NRG-1 improved cardiac function and promoted myocardial angiogenesis post AMI by up-regulating VEGF and activating the PI3K-Akt-eNOS pathway.
The Myth of Diagnosis as Classification: Examining the Effect of Explanation on Patient Satisfaction and Trust in AI Diagnostic Systems
Authors: Alam Lamia , Mueller Shane 
Published: January 2021

Abstract
Background: Artificial Intelligence has the potential to revolutionize healthcare, and it is increasingly being deployed to support and assist medical diagnosis. One potential application of AI is as the first point of contact for patients, replacing initial diagnoses prior to sending a patient to a specialist, allowing health care professionals to focus on more challenging and critical aspects of treatment. But for AI systems to succeed in this role, it will not be enough for them to merely provide accurate diagnoses and predictions. In addition, it will need to provide explanations (both to physicians and patients) about why the diagnoses are made. Without this, accurate and correct diagnoses and treatments might otherwise be ignored or rejected. Method: It is important to evaluate the effectiveness of these explanations and understand the relative effectiveness of different kinds of explanations. In this paper, we examine this problem across two simulation experiments. For the first experiment, we tested a re-diagnosis scenario to understand the effect of local and global explanations. In a second simulation experiment, we implemented different forms of explanation in a similar diagnosis scenario. Results: Results show that explanation helps improve satisfaction measures during the critical re-diagnosis period but had little effect before re-diagnosis (when initial treatment was taking place) or after (when an alternate diagnosis resolved the case successfully). Furthermore, initial “global” explanations about the process had no impact on immediate satisfaction but improved later judgments of understanding about the AI. Results of the second experiment show that visual and example-based explanation integrated with rationales had a significantly better impact on patient satisfaction and trust than no explanations, or with text-based rationales alone. As in Experiment 1, these explanations had their effect primarily on immediate measures of satisfaction during the re-diagnosis crisis, with little advantage prior to re-diagnosis or once the diagnosis was successfully resolved. Conclusion: These two studies help us to draw several conclusions about how patient-facing explanatory diagnostic systems may succeed or fail. Based on these studies and the review of the literature, we will provide some design recommendations for the explanations offered for AI systems in the healthcare domain.
Metastatic Colorectal Carcinoma to the Right Atrium: A Case Report and Review of Literature
Authors: Sarfraz Humaira , Arain Abeer , Divatia Mukul K. , Schwartz Mary R. , Heyne Kirk E. 
Published: January 2021

Abstract
Background: Cardiac metastasis due to colon cancer is extraordinarily uncommon. Given the rarity of diagnosis, there is paucity of evidence and hence, no established guidelines for evaluation or clinical management strategy. Clinical presentation: We present the case of a 59 year old male with a previously treated colonic carcinoma who presented with new onset exertional dyspnea. He was noted to be having a right atrial mass on an echocardiogram performed at his cardiologist’s office. Further workup with CT angiogram of the chest confirmed a right atrial mass measuring 4.0 cm. Serum CEA was normal. Biopsies of the right atrial mass demonstrated metastatic moderately differentiated colonic adenocarcinoma. Mismatch repair protein expression analysis by immunohistochemistry showed no loss of MLH1, MSH2, MSH6 or PMS2 expression. Next generation sequencing for RAS and BRAF mutations was negative. Patient received treatment with FOLFIRINOX/ bevacizumab with noted reduction in size of mass. Conclusion: To the best of our knowledge, this is the first report of next generation sequencing results available on a biopsy of metastatic colorectal cancer to the heart with the largest literature review of 31 reported cases of metastatic colorectal cancer to the heart. It will help direct clinical management and also adds evidence to the potential efficacy of treatment of this rare aggressive disease with chemotherapy in combination with VEGF inhibitors.
Lower Income Levels Correlate With Increased Prevalence of Gestational Diabetes Mellitus: A Systematic Review and Network Meta-Analysis
Authors: He Qiong , Zhang Mengyuan , Wang Yongle , Zhang Jin , Zhang Yi , Han Minmin , Yang Jing , Liu Yunfeng 
Published: January 2021

Abstract
BackgroundIncome level is an important factor that influences the occurrence of gestational diabetes. Thus, this systematic review and network meta-analysis aimed at evaluating the correlation between income levels and the prevalence of gestational diabetes. MethodsRelevant published studies were searched in Pubmed, Web of Science, Cochrane library, and Ovid from the establishment time of database to January 3, 2020. Finally, 13 eligible clinical studies involving 1,817,801 women were selected from a total of 3776 studies and included in this study. The statistical softwares Revman5.3 and Stata14.0 were used to compare the prevalence of gestational diabetes in five different income levels; low, lower middle, medium, upper middle, and high. ResultsThe incidences of gestational diabetes in people with different economic income levels were: high income <middle income <upper middle income <lower middle income <low income. ConclusionThere is no linear correlation between income levels and incidences of gestational diabetes. However, the overall prevalence of gestational diabetes is inversely proportional to income level, that is, the higher the income level, the lower the prevalence of gestational diabetes.
Knowledge, Attitude, and Practice of Farmers on Pesticide Use and Their Impacts on the Environment and Human Health From Small Scale Vegetable Farming Along the Littoral of Lake Ziway, Ethiopia
Authors: Mergia Mekuria , Weldemariam Ermias Deribe , Eklo Ole Martin , Yimer Girma Tilahun 
Published: January 2021

Abstract
Background: The insecure utilization and misapplication of pesticides in Ethiopia are major fears to farmers' wellbeing and the ecosystem. This study aimed to assess the level of knowledge, attitude, and practices of the small-scale vegetable farmers towards the use of pesticides in Ethiopia along the littoral of Lake Ziway. Methods: It was a cross-sectional study involving a total of 210 farmers randomly selected during pesticide application from a purposively selected irrigation-using village located in the immediate vicinity of Lake Ziway. Data were generated through structured in-depth interviews and observations on-farms. A chi-square test was applied to evaluate whether the collected data and their probable association were significant. Results: The results show that WHO class II pesticides (moderately toxic) are the most frequently used pesticides in the study area. The use of WHO classes 1a and 1b and banned or restricted pesticides such as DDT and Endosulfan were not reported. A great portion (92%) of farmers indiscriminately disposed of empty containers in the field while 86.7% apply the leftover pesticides to other crops. More than 90% of small-scale farmers did not use any personal protective equipment (PPE) when handling pesticides. About 95% of farmers had poor knowledge regarding pesticides. A significant association (p < 0.001) was observed between the knowledge of the farmers and their practices related to the pesticide. Conclusion: Generally, the Knowledge of small-scale farmers on pesticides was poor. Moreover inappropriate disposal of pesticides and its container will damage the environment. The finding of the study underlines the need to train framers concerning the safe and proper use of pesticides to prevent health and environmental hazards.
Impact of Overexpression of Immune Suppressor Siglec-15 on The Prognosis of Clear Renal Cell Carcinoma and Fibrosis Level
Authors: Yang Wenbo , Qin Caipeng , Du Yiqing , Han Songchen , Bai Wenjun , Xu Tao 
Published: January 2021

Abstract
Background The expression of Siglec-15, as a critical immune suppressor, in renal clear cell carcinoma (ccRCC) was few evaluated and remains unclear, especially in protein level. As previous studies reported, tumor fibrosis plays an essential role in assessing the prognosis of ccRCC, but the exact mechanism is not precise. This study evaluated the expression of Siglec-15, its role in prognosis, and the association with tumor fibrosis in ccRCC.Methods: Immunohistochemistry was used to analyze the Siglec-15 expression in one tissue microarray (cohort A, tumor: n=134, adjacent normal tissues: n=29). Subsequently, the mRNA expression of Siglec-15 and its clinical significance in ccRCC were analyzed using The Cancer Genome Atlas database (TCGA, cohort B, n = 534) and samples. Spearman correlation coefficients were calculated for correlation analysis of correlated expression genes of Siglec-15, and then functional annotation analysis was obtained with correlated expression genes. We detected the tumor fibrosis grade in cohort C (n=32) via second harmonic generation/two-photon excitation fluorescence. Results: Siglec-15 was overexpressed in tumor tissues compared with adjacent normal tissues in both cohort A (n=29, p<0.001) and cohort C (n=25, p<0.001). However, there was no significant difference in mRNA expression of Siglec-15 between tumor and adjacent normal tissues in cohort B (p>0.05). Moreover, over-expression of Siglec-15 is associated with higher Fuhrman grade in cohort A＆C (n=166, p=0.001, OR=3.132, 1.563-6.275), cohort B (n=534, p=0.008, OR=1.606, 1.138-2.267). Univariate Kaplan-Meir survival analysis showed that patients with high Siglec-15 mRNA expression had shorter survival periods without significance in cohort B (p=0.073). Multivariate analysis employing the Siglec-15 regression model revealed that AJCC and Fuhrman grade was the only significant independent prognostic indicators. Besides, an inverse correlation was found between Siglec-15 protein expression and the tumor's fibrosis level (p = 0.02).Conclusions: Siglec-15 expression increases in ccRCC compared with adjacent normal tissues. Siglec-15 was frequently expressed and positively associated with pathology grade in ccRCC. This study indicated a significant role of Siglec-15 in the prognosis and immunotherapy target of ccRCC. This study also found an inverse correlation between Siglec-15 protein expression and the fibrosis level of the tumor.
Actinomyces as a Cause of Unexplained Fever Diagnosed by Next-Generation Sequencing: Case Report and Review
Authors: Huang Xiu , Du Na , He jiaxue , Du yujun 
Published: January 2021

Abstract
Background: Actinomycosis is a rare cause of unexplained origin fever (FUO). The NGS, particularly in cases of FUO in conventional microbiology, is a promising and advantageous technology for earlier diagnosis and more success. It gives new insights in the management of FUO, especially in infectious diseases.Case presentation: We present a case of a 71-year-old woman who had FUO that the etiology was endobronchial actinomycosis eventually diagnosed by next-generation sequencing of bronchoalveolar lavage fluid. She was admitted to the our department with intermittent fever up to 40.0℃, chills, cough with white sputum, chest distress and slightly dyspnea over one month. According to special clinical course and laboratory data of the patient, she was given intravenous sulbenicillin sodium for 11 days and oral amoxicillin at 500 mg every 8 h for another 1 month. When she returned for follow-up, she reported a notable improvement in her cough, dyspnea, sputum production and fever that was completely absent.Conclusion: In obscure causes of FUO, clinicians should consider the possibility of thoracic actinomycosis and actively use next-generation sequencing to help diagnose.