bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unresected small lymph node assessment predicts prognosis for patients with pT3N0M0 thoracic esophageal squamous cell carcinoma
Authors: Wang Yi , Xiao Ping , Yang Ningjing , Wang Xiang , Ma Ke , Wu Lei , Zhang Wei , Zhuang Xiang , Xie Tianpeng , Fang Qiang , Lan Mei , Wang Qifeng , Peng Lin 
Published: October 2021

Abstract
Background
The role of unresected small lymph nodes (LNs) which may contain metastases for thoracic esophageal squamous cell carcinoma (TESCC) has not been addressed. The aim of the study was to investigate the role of unresected small LNs assessment using computed tomography (CT) in prognostic estimates of pT3N0M0 TESCC patients.

Methods
Between January 2009 and December 2017, 294 patients who underwent esophagectomy with R0 resection at Sichuan Cancer Hospital were retrospectively examined, and the last follow-up time was July 2018. Patients were classified into CT-suspect and CT-negative groups according to the shortest diameter and the shape (axial ratio) of the unresected small LNs on preoperative CT. The Kaplan–Meier method was used to compare survival differences in prognostic factors. Univariate and multivariate analyses were performed to identify prognostic factors for survival and recurrence.

Results
Eighty-four patients (28.6%) were classified as CT-suspect group according to the diagnostic criteria; survival analysis suggested that CT-suspect group of patients had a relatively poorer prognosis (P<0.05). Cox regression analysis indicated that unresected small LNs status, tumor grade, and postoperative adjuvant therapy were independent prognostic factors for patients with pT3N0M0 TESCC (P<0.05). Further analysis shown the rates of total recurrence (TR) and locoregional recurrence (LR) in the CT-suspect group were significantly higher than that in the CT-negative group (TR, P<0.001; LR, P<0.001). Among the LRs, the rate of supraclavicular lymph node recurrence in the CT-suspect group was significantly higher than that in the CT-negative group (P<0.001).

Conclusions
Unresected small lymph node assessment is critically important and predict prognosis for pT3N0M0 TESCC patients.
Factors affecting health services strategic purchasing for breast cancer patients: a mixed study in Iran
Authors: Yaghoubian Samereh , Jahani Mohammad Ali , Farhadi Zeynab , Mahmoudi Ghahraman 
Published: October 2021

Abstract
Background
Inappropriate ways of health services purchasing for cancer patients can be challengeable and costly and seriously affect the access to health services and outcomes. This study aimed at Factors affecting health services strategic purchasing for breast cancer patients.

Methods
As a mixed study, this research was conducted in Iran in 2020. In the qualitative phase, 21 specialists and professionals in the field of health services purchasing were purposefully selected and interviewed. After data saturation, interviews were analyzed with the framework analysis and a structured questionnaire was made based on these analyses. 400 breast cancer patients were selected by randomized sampling and completed the questionnaire. Data were analyzed with SPSS23 in p < .05.

Results
The highest mean rate of the three main categories belonged to “insurance trusteeship” (4.71 ± .35), followed by “supply management” (4.48 ± .27) and “financial performance” (4.48 ± .37). There were significantly differences between the mean rates of the main categories and the cut-off point (p < .001). In addition, “insurance trusteeship” ranked first (2.58), followed by financial performance (1.77) and supply management (1.65).

Conclusion
Of main components in health services strategic purchasing for breast cancer patients, insurance trusteeship, supply management, and financial performance ranked first to third, respectively. Therefore, healthcare policy-makers should consider the placement of insurance trusteeship and coordinate between purchasers and providers for making reform in the health system.
Media use trajectories and risk of metabolic syndrome in European children and adolescents: the IDEFICS/I.Family cohort
Authors: Sina Elida , Buck Christoph , Veidebaum Toomas , Siani Alfonso , Reisch Lucia , Pohlabeln Hermann , Pala Valeria , Moreno Luis A. , Molnar Dénes , Lissner Lauren , Kourides Yiannis , De Henauw Stefaan , Eiben Gabriele , Ahrens Wolfgang , Hebestreit Antje ,   the IDEFICS, I.Family consortia
Published: October 2021

Abstract
Background
Media use may influence metabolic syndrome (MetS) in children. Yet, longitudinal studies are scarce. This study aims to evaluate the longitudinal association of childhood digital media (DM) use trajectories with MetS and its components.

Methods
Children from Belgium, Cyprus, Estonia, Germany, Hungary, Italy, Spain and Sweden participating in the IDEFICS/I.Family cohort were examined at baseline (W1: 2007/2008) and then followed-up at two examination waves (W2: 2009/2010 and W3: 2013/2014). DM use (hours/day) was calculated as sum of television viewing, computer/game console and internet use. MetS z-score was calculated as sum of age- and sex-specific z-scores of four components: waist circumference, blood pressure, dyslipidemia (mean of triglycerides and HDL-cholesterol−1) and homeostasis model assessment for insulin resistance (HOMA-IR). Unfavorable monitoring levels of MetS and its components were identified (cut-off: ≥ 90th percentile of each score). Children aged 2–16 years with ≥ 2 observations (W1/W2; W1/W3; W2/W3; W1/W2/W3) were eligible for the analysis. A two-step procedure was conducted: first, individual age-dependent DM trajectories were calculated using linear mixed regressions based on random intercept (hours/day) and linear slopes (hours/day/year) and used as exposure measures in association with MetS at a second step. Trajectories were further dichotomized if children increased their DM duration over time above or below the mean.

Results
10,359 children and adolescents (20,075 total observations, 50.3% females, mean age = 7.9, SD = 2.7) were included. DM exposure increased as children grew older (from 2.2 h/day at 2 years to 4.2 h/day at 16 years). Estonian children showed the steepest DM increase; Spanish children the lowest. The prevalence of MetS at last follow-up was 5.5%. Increasing media use trajectories were positively associated with z-scores of MetS (slope: β = 0.54, 95%CI = 0.20–0.88; intercept: β = 0.07, 95%CI = 0.02–0.13), and its components after adjustment for puberty, diet and other confounders. Children with increasing DM trajectories above mean had a 30% higher risk of developing MetS (slope: OR = 1.30, 95%CI = 1.04–1.62). Boys developed steeper DM use trajectories and higher risk for MetS compared to girls.

Conclusions
Digital media use appears to be a risk factor for the development of MetS in children and adolescents. These results are of utmost importance for pediatricians and the development of health policies to prevent cardio-metabolic disorders later in life.

Trial registration
ISRCTN, ISRCTN62310987. Registered 23 February 2018- retrospectively registered.
Immunobiology of cancer-associated fibroblasts in the context of radiotherapy
Authors: Hellevik Turid , Berzaghi Rodrigo , Lode Kristin , Islam Ashraful , Martinez-Zubiaurre Inigo 
Published: October 2021

AbstractRadiotherapy (RT) still represents a mainstay of treatment in clinical oncology. Traditionally, the effectiveness of radiotherapy has been attributed to the killing potential of ionizing radiation (IR) over malignant cells, however, it has become clear that therapeutic efficacy of RT also involves activation of innate and adaptive anti-tumor immune responses. Therapeutic irradiation of the tumor microenvironment (TME) provokes profound cellular and biological reconfigurations which ultimately may influence immune recognition. As one of the major constituents of the TME, cancer-associated fibroblasts (CAFs) play central roles in cancer development at all stages and are recognized contributors of tumor immune evasion. While some studies argue that RT affects CAFs negatively through growth arrest and impaired motility, others claim that exposure of fibroblasts to RT promotes their conversion into a more activated phenotype. Nevertheless, despite the well-described immunoregulatory functions assigned to CAFs, little is known about the interplay between CAFs and immune cells in the context of RT. In this review, we go over current literature on the effects of radiation on CAFs and the influence that CAFs have on radiotherapy outcomes, and we summarize present knowledge on the transformed cellular crosstalk between CAFs and immune cells after radiation.
Centenarian longevity had inverse relationships with nutritional status and abdominal obesity and positive relationships with sex hormones and bone turnover in the oldest females
Authors: Fu Shihui , Ping Ping , Li Yulong , Li Bo , Zhao Yali , Yao Yao , Zhang Pei 
Published: October 2021

Abstract
Objective
The number of older people is estimated to increase from 524 million in 2010 to 1.5 billion in 2050. The factors and models of human longevity and successful aging are questions that have intrigued individuals for thousands of years. For the first time, the current study was designed to investigate the relationships between sex hormones, bone turnover, abdominal obesity, nutritional status and centenarian longevity in the oldest females.

Methods
The China Hainan Centenarian Cohort Study was performed in 18 cities and counties of Hainan Province using standard methodology in 500 centenarian females and 237 oldest females aged between 80 and 99 years.

Results
Centenarians were inversely associated with the geriatric nutritional risk index [Exp(B) (95% CI): 0.901 (0.883–0.919)] and abdominal obesity [Exp(B) (95% CI): 0.719 (0.520–0.996)] and positively associated with prolactin [Exp(B) (95% CI): 1.073 (1.044–1.103)], progesterone [Exp(B) (95% CI): 44.182 (22.036–88.584)], estradiol [Exp(B) (95% CI): 1.094 (1.071–1.119)], osteocalcin [Exp(B) (95% CI): 1.041 (1.028–1.054)], β-crossLaps [Exp(B) (95% CI): 63.141 (24.482–162.848)] and parathyroid [Exp(B) (95% CI): 1.022 (1.013–1.031)] hormone levels (P < 0.05 for all). The geriatric nutritional risk index and abdominal obesity were inversely associated with luteinizing hormone [β coefficient (95% CI): − 0.001 (− 0.002 to 0.001)]; Exp(B) (95% CI): 0.985 (0.974–0.996)], follicle-stimulating hormone [β coefficient (95% CI): 0.000 (− 0.001 to 0.000)]; Exp(B) (95% CI): 0.990 (0.985–0.996)], osteocalcin [β coefficient (95% CI): − 0.001 (− 0.001 to 0.000)]; Exp(B) (95% CI): 0.987(0.977–0.997)] and β-crossLaps [β coefficient (95% CI): − 0.100 (− 0.130 to 0.071)]; Exp(B) (95% CI): 0.338 (0.166–0.689)] levels (P < 0.05 for all).

Conclusions
Centenarian longevity had inverse relationships with nutritional status and abdominal obesity and positive relationships with sex hormones and bone turnover. Nutritional status and abdominal obesity had inverse relationships with sex hormones and bone turnover. Increased sex hormones and bone turnover may be representative of centenarian longevity. Optimizing nutritional status and avoiding abdominal obesity may increase sex hormones and bone turnover and promote centenarian longevity and successful aging.
Factors influencing contraceptive decision making and use among young adolescents in urban Lilongwe, Malawi: a qualitative study
Authors: Dombola Gift Mtawali , Manda Wanangwa Chimwaza , Chipeta Effie 
Published: October 2021

Abstract
Background
The prevalence of teenage pregnancies in Malawi is 29%. About 25% of those are married while 30% are unmarried adolescents (15–19 years old) who use contraceptives. Data on contraceptive use has focused on older adolescents (15–19 years old) leaving out the young adolescents (10–14 years old). This study assessed factors that influence contraceptive decision-making and use among young adolescents aged 10–14 years.

Methods
This was a qualitative study that used the Theory of Reasoned Action (TRA) model to understand the processes that influence contraceptive decision-making among young adolescents (10–14 years old) in urban Lilongwe. The study was conducted in six youth health-friendly service centers and 12 youth clubs. Two focus group discussions and 26 in-depth interviews were conducted among sexually active in and out of school young adolescents and key informants. The results are organized into themes identified during the analysis.

Results
Results showed that contraceptive decision-making is influenced by social factors (individual, interpersonal, society) and adolescents’ perceptions regarding hormonal contraceptives. There is also a disconnect between Education and Adolescent Sexual and Reproductive Health policies.

Conclusion
The findings suggest that interventions that scale up contraceptive use need male and female involvement in decision making. Addressing myths around contraceptives, and harmonization of Education and Sexual and Reproductive Health policies in the country would motivate adolescents to use contraceptives.
Sex affects the response of Wistar rats to polyvinyl pyrrolidone (PVP)-coated silver nanoparticles in an oral 28 days repeated dose toxicity study
Authors: Ćurlin Marija , Barbir Rinea , Dabelić Sanja , Ljubojević Marija , Goessler Walter , Micek Vedran , Žuntar Irena , Pavić Mirela , Božičević Lucija , Pavičić Ivan , Vinković Vrček Ivana 
Published: October 2021

Abstract
Background
Silver nanoparticles (AgNPs) are widely used in biomedicine due to their strong antimicrobial, antifungal, and antiviral activities. Concerns about their possible negative impacts on human and environmental health directed many researchers towards the assessment of the safety and toxicity of AgNPs in both in vitro and in vivo settings. A growing body of scientific information confirms that the biodistribution of AgNPs and their toxic effects vary depending on the particle size, coating, and dose as well as on the route of administration and duration of exposure. This study aimed to clarify the sex-related differences in the outcomes of oral 28 days repeated dose exposure to AgNPs.

Methods
Wistar rats of both sexes were gavaged daily using low doses (0.1 and 1 mg Ag/kg b.w.) of polyvinylpyrrolidone (PVP)-coated small-sized (10 nm) AgNPs. After exposure, blood and organs of all rats were analysed through biodistribution and accumulation of Ag, whereas the state of the liver and kidneys was evaluated by the levels of reactive oxygen species (ROS) and glutathione (GSH), catalase (CAT) activity, superoxide dismutase (SOD) and glutathione peroxidase (GPx), expression of metallothionein (Mt) genes and levels of Mt proteins.

Results
In all animals, changes in oxidative stress markers and blood parameters were observed indicating the toxicity of AgNPs applied orally even at low doses. Sex-related differences were noticed in all assessed parameters. While female rats eliminated AgNPs from the liver and kidneys more efficiently than males when treated with low doses, the opposite was observed for animals treated with higher doses of AgNPs. Female Wistar rats exposed to 1 mg PVP-coated AgNPs/kg b.w. accumulated two to three times more silver in the blood, liver, kidney and hearth than males, while the accumulation in most organs of digestive tract was more than ten times higher compared to males. Oxidative stress responses in the organs of males, except the liver of males treated with high doses, were less intense than in the organs of females. However, both Mt genes and Mt protein expression were significantly reduced after treatment in the liver and kidneys of males, while they remained unchanged in females.

Conclusions
Observed toxicity effects of AgNPs in Wistar rats revealed sex-related differences in response to an oral 28 days repeated exposure.
Psychosocial demands and resources for working time organization in GP practices. Results from a team-based ethnographic study in Germany
Authors: Preiser Christine , Tsarouha Elena , Weltermann Birgitta , Junne Florian , Seifried-Dübon Tanja , Hartmann Sigrid , Bleckwenn Markus , Rieger Monika A. , Rind Esther ,   on behalf of the IMPROVEjob-Consortium
Published: October 2021

Abstract
Background
General practitioners (GPs) are challenged, e.g. by long working hours, and as employers they are responsible for the creation of working conditions that prevent work-related psychosocial risks. Leadership behaviour plays an important role within the working conditions of employees, thus we focused on two research questions: To what extent and how do GPs fulfil their role as entrepreneurs and leaders responsible for occupational safety and health of the team members in the organization of working time of the employees? What psychosocial factors result from the way of organization of working time for the practice team?

Methods
Data was collected by participant observations, individual interviews with six GPs, and five focus group discussions with 19 members of the practice staff in total. We gained access to five general practices through a teaching network associated with the Institute for General Medicine, University Hospital Essen (Germany). The analysis was carried out according to the Grounded Theory approach.

Results
GPs have several roles and related tasks to fulfil in the organization of working time. This can lead to perceived psychological stress. With regard to the organization of predictable working hours, vacations and sickness absence, the GPs determined the scope of action of the practice assistants. The delegation of these tasks took place to varying degrees and resulted in different work-related resources and stressors.

Conclusion
We described transactional and transformational leadership behaviours which are all related to specific psychosocial demands and resources and may overlap on site. Leadership training seems recommendable as part of the training of GPs and other future leaders of micro-enterprises to promote self-reflection by the entrepreneurs and leaders and strengthen occupational health of leaders and staff.
Prescribers’ satisfaction with delivering medications for opioid use disorder
Authors: Knudsen Hannah K. , Brown Randy , Jacobson Nora , Horst Julie , Kim Jee-Seon , Kim Hanna , Madden Lynn M. , Haram Eric , Molfenter Todd 
Published: October 2021

Abstract
Background
Expanding access to medications for opioid use disorder (MOUD), such as buprenorphine and extended release (XR) naltrexone, is critical to addressing the US opioid epidemic, but little is known about prescriber satisfaction with delivering these two types of MOUD. The current study describes the satisfaction of prescribers delivering buprenorphine and XR-naltrexone while examining whether satisfaction is associated with current patient census and organizational environment.

Methods
As part of a cluster randomized clinical trial (RCT) focused on expanding access to medication for opioid use disorder, 41 MOUD prescribers in Florida, Ohio, and Wisconsin completed a web-based survey. The survey included measures of prescriber satisfaction with delivering buprenorphine treatment and XR-naltrexone. In addition, the survey measured several prescriber characteristics and their perceptions of the organizational environment.

Results
Prescribers were generally satisfied with their work in delivering these two types of MOUD. Prescribers reporting a greater number of patients (r = .46, p = .006), those who would recommend the center to others (r = .56, p < .001), and those reporting positive relationships with staff (r = .56, p < .001) reported significantly greater overall satisfaction with delivering buprenorphine treatment. Prescribers who more strongly endorsed feeling overburdened reported lower overall buprenorphine satisfaction (r = -.37, p = .02). None of the prescriber characteristics or perceptions of the organizational environment were significantly associated with overall satisfaction with delivering XR-naltrexone treatment.

Conclusions
The generally high levels of satisfaction with both types of MOUD is notable given that prescriber dissatisfaction can lead to turnover and impact intentions to leave the profession. Future research should continue to explore the prescriber characteristics and organizational factors associated with satisfaction in providing different types of MOUD.

Registration
ClinicalTrials.gov. NCT02926482. Date of registration: September 9, 2016. https://clinicaltrials.gov/ct2/show/NCT02926482.
Poor outcomes of revision total knee arthroplasty in patients with septic loosening compared to patients with aseptic loosening
Authors: Baek Ji-Hoon , Lee Su Chan , Jin Hosun , Kim Jin-Woo , Ahn Hye Sun , Nam Chang Hyun 
Published: October 2021

AbstractBackgroundThe purpose of this study was to compare the functional outcomes, activity levels, mortalities, implant survival rates, and complications in revision total knee arthroplasty (TKA) of patients with septic loosening with those in patients with aseptic loosening over a minimum 10-year follow-up period.MethodsA cohort of 78 patients (36 septic loosening and 42 aseptic loosening) was selected between January 2008 and December 2009. The functional outcomes, activity levels, mortalities, implant survival rates, and complications of revision TKA in patients with septic and aseptic loosening were compared.ResultsThe mean Knee Society knee scores in the septic and aseptic groups improved from 36.7 and 37.4 preoperatively to 65.3 and 76.8 points at the final follow-up, respectively (p < 0.05). Outdoor ambulatory patients at the final follow-up included 20 of 29 (69.0%) patients in the septic group and 35 of 39 (89.7%) patients in the aseptic group (p < 0.05). The cumulative mortality rates in the septic and aseptic groups were 19.4% (7/36) and 7.1% (3/42) (p = 0.102) at final follow-up, respectively. Kaplan–Meier survivorship analysis with re-revision of either component as an endpoint in the septic and aseptic groups estimated 86.5% and 95.5% chance of survival for 10 years, respectively.ConclusionsRevision TKA in patients with septic loosening had worse functional outcomes and higher mortality over a minimum 10-year follow-up period compared with that in patients with aseptic loosening.Level of evidenceIV.
Elevated tumor markers in a benign lung disease
Authors: Chen Quan , Lu Qijue , Fei Xiang , Li Chunguang , Li Bai 
Published: October 2021

Abstract
Background
This study aimed to determine the underlying pathophysiologic mechanism of elevated carbohydrate antigen 19-9 (CA19-9) in pulmonary sequestration (PS) patients.

Materials and methods
Four pulmonary sequestration patients, 12 pneumonia patients and 12 healthy adult volunteers were prospectively studied. Specimens from another 34 pulmonary sequestration patients were retrospectively analyzed. Serum CA19-9 levels of 4 patients were tested before and 1 week, 1 month and 3 months after surgery. The CA19-9 levels of 12 pneumonia patients and 12 healthy adult volunteers were tested as controls. The expression and localization of CA19-9 in diseased lesions and corresponding normal lung tissues were analyzed by Immunohistochemical (IHC). Hematoxylin–eosin (HE) staining was performed to observe the pathological changes in pulmonary sequestration tissues.

Results
Serum CA19-9 levels were significantly higher in the 4 patients (797.3 ± 316 IU/ml) than in the pneumonia patients (10.07 ± 5.01 IU/ml) and healthy volunteers (9.85 ± 4.12 IU/ml). In addition, serum CA19-9 levels decreased dramatically after the focus was removed. Positive staining of CA19-9 was found in 70% (24/34) of pulmonary sequestration tissues, and CA19-9 was mainly expressed in the bronchial mucus. In the 4 diseased lesions, deformed alveolar structure and inflammatory cell infiltration were observed, and the degree of damage was positively correlated with serum CA19-9 levels.

Conclusions
CA19-9 could be generated by abnormal columnar epithelia in pulmonary sequestration tissues and was transported into circulation after alveoli damage. CA19-9 could serve as an adjuvant diagnostic marker in pulmonary sequestration.