bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic factors in patients with advanced HER2-positive gastric cancer treated with trastuzumab-based chemotherapy: a cohort study
Authors: Marshall Shoko , Wakatsuki Takeru , Takahari Daisuke , Matsushima Tomohiro , Ishizuka Naoki , Nakayama Izuma , Osumi Hiroki , Ogura Mariko , Ichimura Takashi , Shinozaki Eiji , Chin Keisho , Yamaguchi Kensei 
Published: July 2021

Abstract
Purpose
Prognostic factors for the survival of patients with advanced HER2-positive gastric cancer treated with trastuzumab-based chemotherapy remain controversial. The aim of this study was to identify the clinical factors that predict prognosis in patients with advanced HER2-positive gastric cancer.
Methods
We retrospectively reviewed the medical records of HER2-positive gastric cancer patients treated with trastuzumab-based chemotherapy at our institution. Clinical features and laboratory test results that considered prognostic factors were re-examined. Overall survival (OS) was estimated using the Kaplan-Meier method. Univariate analysis was performed with the log-rank test and multivariate analysis was performed using Cox’s proportional hazard regression model.
Results
A total of 133 patients with advanced HER2-positive gastric cancer were enrolled. The median OS in this cohort was 18.7 months. Four prognostic factors: visceral metastasis (lung or liver), levels of haemoglobin (Hb) (< 11.6 g/dL), lactate dehydrogenase (LDH) (> 222 mg/dL), and C-reactive protein (CRP) (> 0.14 mg/dl) were identified as independent prognostic factors. The patients were placed into three groups according to their number of prognostic factors. These included low (0,1), moderate (2,3), and high (4) risk factors. The OS was separated into three categories with a median OS of 32.0, 18.7 and 10.1 months respectively. Compared to the low-risk group, hazard ratios for the moderate- and high-risk groups were 1.75 and 3.49, respectively.
Conclusion
Visceral metastasis and abnormal Hb, LDH, and CRP levels were associated with unfavorable OS. These findings may be beneficial for the management of advanced HER2-positive gastric cancer treated with trastuzumab-based chemotherapy.
Bilateral Chylothorax Following Left Neck Dissection and Literature Review
Authors: Kimizuka Sachiko , Yamada Hiroyuki , Kawaguchi Koji , Horiuchi Toshikatsu , Takeda Akira , Hamada Yoshiki 
Published: July 2021

Abstract
BackgroundAlthough chyle leakage may occur in the neck when the thoracic duct is damaged during cervical dissection, it is extremely rare for the chylothorax alone to leak chyle into the thoracic cavity. Case presentationWe report a case of bilateral chylothorax without chyle cervical leakage after left neck dissection, wherein partial left upper jaw resection and left radical neck dissection were performed in a 46-year-old woman who was diagnosed with left upper gingival cancer. The thoracic duct was ligated and cut during surgery and, although no obvious leakage of lymph was observed, dyspnea and cough reflex during deep inhalation were observed from the 3rd postoperative day. Approximately 600 mL of yellowish-white pleural effusion was aspirated during bilateral thoracentesis, and chylothorax was diagnosed based on clinical findings and biochemical analysis results. The patient was put on a low-fat diet on the 4th postoperative day, and a total of 3 neck drains were removed 8 days after the operation. Conclusions﻿Pleural effusion disappeared on imaging examination 16 days after thoracentesis and 5 years and 6 months have passed since the operation. At this time, there has been no evidence of tumor recurrence, metastasis, or pleural effusion.
Acute Hepatitis B Associated Neuromyopathy
Authors: Maramattom Boby Varkey 
Published: July 2021

Abstract
A 67 year old man presented with abdominal discomfort and jaundice for 1 month with difficulty in walking with severe pain in both thighs of 3 days duration. He was a diabetic and hypertensive on medications. There was no history of HMG CoA reductase inhibitor use. On examination he had icterus and grade 2 power in the proximal upper and lower limbs. Deep tendon reflexes were inelicitable. On day 1, CRP was 37mg/L and liver function tests were deranged [ Total Bilirubin 16 mg%, direct 14.3mg%, SGOT [920 U/L], SGPT [590 U/L], Alkaline Phosphatase 276.5 U/L. Serum CPK levels [9768 U/L], LDH [979 U/L] and Ferritin [7264 ng/ml] were elevated on day 2. ANA profile was negative. Leptospiral antibody, dengue serology and SARS-CoV2 RT-PCR were negative. Hepatitis B serology was compatible with an acute infection. On day 3, nerve conduction studies showed an axonal sensory-motor polyneuropathy predominantly involving the lower limbs. F waves were absent. Fibrillations and positive waves were picked up from the Tibialis anterior muscles bilaterally. He was started on IVIG 2gm/kg x 5 days. On day 4, his CPK levels increased to >42,000 U/L and he was shifted to the ICU and started on forced alkaline diuresis. Urine myoglobin was positive.. On day 6, MRI whole body muscle STIR imaging showed patchy ill-defined STIR hyperintensities involving the muscles of the gluteal, pelvic girdle muscles, both thighs and leg muscles with fascial edema. The muscles of the upper limbs and shoulder girdles also showed patchy STIR hyperintensities. Diffuse subcutaneous oedema was noted in the soft tissue of the thighs, legs and abdominal wall. Over the next few days, the weakness in the upper limbs worsened and he developed a weak cough. He did not consent to a lumbar puncture or muscle biopsy. Over the next 9 days, his liver function tests and CPK levels gradually normalised. He was also started on Entacavir. By day 10, his upper limb and distal lower limb had improved to grade 4/5 power and he was able to stand with support and he was discharged.
A Method for Quantifying Cervical Sagittal Morphology Using the Cervical Sagittal Triangle Area Coefficient
Authors: Guo Yingjun , Wang Han , Liu Hao , Wang Beiyu , Ding Chen , Meng Yang , Yang Yi 
Published: July 2021

Abstract
BackgroundA series of methods, which use angle to quantitatively evaluate cervical sagittal morphology cannot objectively reflect the advantages and disadvantages in some cases. In this study, we try to use the area methods to supplement it in above cases.MethodsThe Cobb angle, range of motion (ROM) of C2-7, and antero-posterior diameter of atlas (C1-APD) were measured at neutral, flexion, and extension X-ray radiographs of the cervical spine in all 191 patients. Patients were divided into Group A and Group B according to whether their cervical sagittal morphology can be objectively quantified with Cobb angle. Pearson correlation analysis was used to compare the consistency of the results, paired t-test was used to compare the dispersion coefficient, receiver operator characteristic (ROC) curve was used to evaluate the diagnostic value.ResultsThe C5 vertebra was used as the vertex to construct the cervical sagittal triangle, and according to the different selection of the other two points, the triangle was further divided into four types. The Area Coefficient (AC) was defined as "\(\text{A}\text{C}=\frac{\left(\text{A}\text{r}\text{e}\text{a} \text{o}\text{f} \text{s}\text{a}\text{g}\text{i}\text{t}\text{t}\text{a}\text{l} \text{t}\text{r}\text{i}\text{a}\text{n}\text{g}\text{l}\text{e}\right)}{{\text{C}1-\text{A}\text{P}\text{D}}^{2}}\)". In Group A, whose cervical sagittal morphology could be objectively quantified with Cobb angle, the AC showed greatly consistency, while in Group B, it was less consistent. AC results have stronger predictive value for clinical symptoms in Group B. The dispersion coefficients of the results measured by the four area methods are significantly smaller than the Cobb angle. The results of quantifying cervical ROM by area methods were also in good agreement with Cobb angle.ConclusionCompared with Cobb angle, AC has better objectivity, stability, and clinical significance.
Cd5+ Diffuse Large B Cell Lymphoma of the Liver Presenting as Cholestatic Transaminitis.
Authors: Latef Taroob Jawad , Bilal Muhammad , Malleshappa Sudeep Siddappa , Loke Chandravathi 
Published: July 2021

Abstract
A 72-year-old male with nonspecific symptoms was found to have pancytopenia and transaminitis. The pancytopenia began to improve early in the hospital course without specific treatment. A liver biopsy, obtained later to determine the etiology of the transaminitis, eventually confirmed CD5+ diffuse large B cell lymphoma (DLBCL). DLBCL typically presents with painless lymphadenopathy and constitutional symptoms although it may also present as a rapidly enlarging mass in any part of the body. However, in rarer cases its presentation can be misleading. Conditions such as HLH or viral infections, can confound a patient’s presentation and delay the diagnosis. High index of suspicion is warranted for the diagnosis of DLBCL in atypical cases to prevent mortality associated with late diagnosis. Early recognition and biopsy of involved organ, in the absence of clear etiology, is vital for timely diagnosis and prompt treatment to achieve a favorable cure rate. CD5+ DLBCL may have unusual involvement of extra nodal organs such as the liver and may need further investigations.
Causal Deep Learning on Real-world Data Reveals the Comparative Effectiveness of Anti-hyperglycemic Treatments
Authors: Belthangady Chinmay , Giampanis Stefanos , Stedden Will , Alves Paula , Chong Stephanie , Knott Charlotte , Jankovic Ivana , Norgeot Beau 
Published: July 2021

Abstract
Type 2 Diabetes is associated with severe health outcomes, the effects of which are responsible for approximately 1/4 of total U.S. healthcare spending. Current treatment guidelines endorse a massive number of potential anti-hyperglycemic treatment options in various permutations and combinations. Personalized strategies for optimizing treatment selection are lacking. Real-world data from a nationwide population of over one million diabetics was analyzed to evaluate the comparative effectiveness of more than 80 different treatment strategies ranging from monotherapy up to combinations of five concomitant classes of drugs across each of 10 clinical subgroups defined by age, insulin dependence, and number of other chronic conditions. A causal deep learning approach developed on such data allows for more personalized recommendations of treatment selection. Significant differences were observed in blood sugar reduction between patients receiving high vs low ranked treatment options and that less than 2% of the population is on a highly ranked treatment. This method can be extended to explore treatment optimization of other chronic conditions.
The Relationship between Sleep Hygiene, Mood, and Insomnia Symptoms in Men with Prostate Cancer
Authors: Galvin Kathleen T. , Garland Sheila N. , Wibowo Erik 
Published: July 2021

Abstract
PurposeInsomnia symptoms are commonly experienced by men after prostate cancer (PCa) treatment. Here we explored how sleep hygiene behaviours and psychological symptoms are associated with insomnia symptoms in PCa patients.MethodsAn online survey was posted on social media and sent to mailing lists of PCa and general cancer organisations. The survey collected information on demographic, sleep hygiene and psychological symptoms using validated questionnaires. ResultsData from 142 participants were compared based on the absence (age = 68.3 ± 8.9 years) and presence (age = 66.6 ± 9.0 years) of insomnia symptoms. Participants with insomnia symptoms had significantly higher levels of anxiety, depression, fatigue, and daytime sleepiness as well as poorer sleep hygiene than those without insomnia symptoms. Control variables (age, comorbidities, ADT experience and BMI) accounted for 12.5% of the variance in insomnia symptoms. Adding sleepiness, fatigue, anxiety, depressive symptoms to the model explained an additional 45.1% of the variance in insomnia symptoms. Further, including the sleep hygiene item “I think, plan, or worry when I am in bed” and “I sleep in an uncomfortable bedroom” explained an additional 3.6% of the variance in insomnia symptoms. Conclusions﻿Poor sleep hygiene, fatigue, daytime sleepiness, anxiety, depressive symptoms were all associated with worse insomnia symptoms in PCa patients. Improving sleep hygiene and treating psychological conditions may potentially help prevent and/or alleviate insomnia symptoms in PCa patients.
Stress and Coping Among Unmarried Pregnant University Students in South Africa
Authors: Phiri Thandiwe Msipu , Nyamaruze Patrick , Akintola Olagoke 
Published: July 2021

Abstract
Background: The improvement of maternal and child health (MCH) outcomes is an important part of the sustainable development goals (SDGs). MCH remains an important issue globally as the SDGs have not yet been achieved in most countries. Young women in universities are likely to experience unintended pregnancy due to the risky sexual behavior in tertiary institutions which is characterized by lack of condom and/or contraceptive use and coercion. Pregnant young women in an academic environment are susceptible to stressors associated with unintended pregnancy and academic demands of universities. However, very little is known about the stress and coping among young people in tertiary institutions who get pregnant during the course of their studies and choose to keep the pregnancy. Methods: Participants were purposively selected among pregnant students and those in the puerperal period at the time of the study. Semi-structured qualitative interviews were undertaken to explore the experiences of pregnancy and early motherhood, with particular focus on the various stressors experienced and possible coping strategies employed by students. The data were audio-recorded and transcribed verbatim, then analysed using thematic analysis. Results: The findings show that pregnancy and early motherhood was an experience that came with a lot of stress emanating from fear of parents’ reactions, academic pressure, financial constraints, relationship problems with male partners and experiences of social stigma. Participants used emotion-focused and problem-focused coping strategies to deal with the stressors confronting them during and after their pregnancy.Conclusion: The experiences of pregnant students are multifaceted and generally characterised by financial crisis, academic challenges, shame, strenuous relationships and transitioning into a new identity. A multipronged approach to healthcare for pregnant students that focus on comprehensive antenatal services, health education, health promotion, psychosocial interventions including academic counselling will have positive outcomes for adolescent mothers and their children.
Zincum Metallicum an Homeopathic Drug Alleviates Zn-Induced Toxic Effects, Promotes Plant Growth and Antioxidants Capacity in Lepidium Sativum
Authors: BOUDALI Ghazwa , Ghnaya Tahar , BEN-ABDALLAH Saoussen , CHALAH Abdala , SEBEI Abdelaziz , OUIRGHI Zeineb , CHAFFEI-HAOUARI Chiraz 
Published: July 2021

Abstract
In this study, we investigated the effect of Zincum Metallicum (ZM) on zinc (Zn) toxicity in the plant species Lepidium sativum. We focused on growth, Zn uptake and numerous biochemical parameters. Seedlings were hydroponically subjected during 7 days to 0.05, 500, 1000, 1500 and 2000 µM Zn2+, in the absence or presence of 15ch or 9ch ZM. In the absence of ZM, Zn induced negative effect on growth especially at the dose of 2mM. Zn induced also chlorosis, reduced total chlorophyll and/or carotenoid content and increased the level of malondialdehyde (MDA). Under Zn-toxicity (500, 1000 and 1500 µM), the superoxide dismutase (SOD), catalase (CAT), gaiacol peroxidase (GPX) and glutathione reductase (GR) activities were increased and/or unaltered, while at 2000 µM Zn affected the activity of these enzymes. At the highest Zn level (2 mM), proline and total polyphenols and flavonoids contents were markedly induced in leaves and roots of L. sativum. Additionally, the supply of ZM in the nutrient medium considerably ameliorated the plant growth, photosynthetic pigments and the studied non-enzymatic antioxidant molecules and enzymatic activities against Zn induced-oxidative stress. Our data suggest that the potential homeopathy properties of ZM may be efficiently involved in the restriction of Zn-induced oxidative damages, by lowering Zn accumulation and translocation in the leaves and roots of Lepidium sativum.
Generating Quantum Random Numbers Using Entanglement in Low Earth Orbit
Authors: Reezwana Ayesha , Islam Tanvirul , Bai Xueliang , Wildfeuer Christoph , Ling Alexander , Grieve James 
Published: July 2021

Abstract
We describe the implementation of a quantum random number generator (QRNG) on-board a nanosatellite deployed to low Earth orbit (LEO). The generator samples shot noise from an entangled photon-pair source based on spontaneous parametric down conversion, linking the entropy of the QRNG to fluctuations in the vacuum field. We present analysis of data acquired in lab-based acceptance testing as well as on-orbit, and use the source to implement a prototype for an off-grid randomness beacon.
Methylome and Transcriptome Analyses of Soybean Response to Bean Pyralid Larvae
Authors: Zeng Wei-Ying , Tan Yu -Rong , Long Sheng-Feng , Sun Zu-Dong , Lai Zhen-Guang , Yang Shou-Zhen , Chen Huai-Zhu , Qing Xia-Yan 
Published: July 2021

Abstract
Background: Bean pyralid is an important leaf-feeding insect which affects soybean production. DNA methylation can control the networks of gene expressions, and it plays an important role in the growth, development, and responses to biotic stress. However, the genome-wide DNA methylation profile of the soybean resistance to bean pyralid has not been reported so far. Results: Using whole-genome bisulfite sequencing (WGBS) and RNA-sequencing (RNA-seq), we analysed the highly resistant material (Gantai-2-2) and highly susceptible material (Wan82-178), under the conditions of 0 h and 48 h feeding by bean pyralid larvae, to clarify the molecular mechanism of the soybean resistance and explore its insect-resistant genes. We identified 2,194, 6,872, 39,704, and 40,018 differentially methylated regions (DMRs), as well as 497, 1,594, 9,596, and 9,554 differentially methylated genes (DMGs) in the HRK0/HRK48, HSK0/HSK48, HSK0/HRK0, and HSK48/HRK48 comparisons, respectively. We found that 265 differentially expressed genes (DEGs) were negatively correlated with the DMGs, there were 34, 49, 141, and 116 negatively correlated genes in the HRK0/HRK48, HSK0/HSK48, HSK0/HRK0, and HSK48/HRK48 comparisons, respectively. The MapMan cluster analysis results indicated that negatively correlated genes in the pathways, such as protein biosynthesis and modification; primary metabolism; secondary metabolism; cell cycle, cell structure and component; RNA biosynthesis and processing, and so on. Finally, the PS-PCR and qRT-PCR were used to validate the expression patterns of several genes and the results showed an excellent agreement with deep sequencing. Conclusions: Through the analysis of global methylation and transcription, we speculated that the expression levels of CRK40; CRK62; STK; L-type lectin-domain containing receptor kinase VIII.2; CesA; CSI1; fimbrin-1; KIN-14B; KIN-14N; KIN-4A; cytochrome P450 81E8; BEE1; ERF; SPATULA; bHLH25; bHLH79; GATA26, were regulated by methylation, and they may potentially play important roles in the soybean responses to bean pyralid larvae. Our results laid a foundation for revealing the occurrence mechanism of soybean response to bean pyralid at the level of DNA methylation.
Hydrofracturing in Situ Stress Measurements in Itabirite Brazilian Ferriferous Quadrilater, and their Limitations
Authors: Penido Henrique de Andrade , de Figueiredo Rodrigo Peluci , de Assis André Pacheco , Torres Vidal Félix Navarro , Sotomayor Juan Manuel Girao , Guimarães Alessandro 
Published: July 2021

Abstract
This article presents a first attempt to carry out measurements (magnitudes and orientations) of the in situ stress in itabirite rocks in the region of the Brazilian Ferriferous Quadrilater obtained by hydraulic fracture tests at a depth of 399 m. Previous studies available in this rock mass consider estimated values of k index (Sh / Sv), and it is not a practice adopted to carry out in situ stress tests in this region and rockmass to support geotechnical analysis. The area of study is located at a depth of 500 m in a pit; therefore, the determination of the in situ stress distribution is very important to assess the stability of the mining open pit. The activities, from the planning to the execution of the tests, and the results are presented. The rock mass under study shows the presence of different geological structures, such as banding and foliation, which resulted in difficulties with performing the tests, and only 12.5% of the tests were successful. The results contribute to understanding the strains and stresses induced by mining activities in slopes in the Brazilian Ferriferous Quadrilater and their impacts on surrounding structures. For a better determination of the regional in situ stresses in the rock mass of the Brazilian Ferriferous Quadrilater, it is recommended to perform hydraulic tests on pre-existing fractures.
Projections of Cold Air Outbreaks In CMIP6 Earth System Models
Authors: Smith Erik T. , Sheridan Scott 
Published: July 2021

Abstract
Historical and future simulated temperature data from five climate models in the Coupled Model Intercomparing Project Phase 6 (CMIP6) are used to understand how climate change might alter cold air outbreaks (CAOs) in the future. Three different Shared Socioeconomic Pathways (SSPs), SSP 1 – 2.6, SSP 2 – 4.5, and SSP 5 – 8.5 are examined to identify potential fluctuations in CAOs across the globe between 2015 and 2054. Though CAOs may remain persistent or even increase in some regions through 2040, all five climate models show CAOs disappearing by 2054 based on current climate percentiles. Climate models were able to accurately simulate the spatial distribution and trends of historical CAOs, but there were large errors in the simulated interannual frequency of CAOs in the North Atlantic and North Pacific. Fluctuations in complex processes, such as Atlantic Meridional Overturning Circulation, may be contributing to each model’s inability to simulate historical CAOs in these regions.