bluuebunny/crossref_metadata_2025_split huggingface dataset:
Waveform Decontamination for Improving Satellite Radar Altimeter Data Over Nearshore Area: Upgraded Algorithm and Validation
Authors: Wang Haihong , Huang Zhengkai 
Published: September 2021

One of the thorniest problems in altimetry community is retrieving accurate coastal sea surface height, especially in the last several kilometers offshore. It is confirmed in previous studies that decontaminating waveforms is beneficial to improve the quality of coastal SSHs. In this article, we proposed an upgraded strategy for waveform decontamination, including a novel realignment algorithm and gate-wise outlier detector. We validated the new strategy in four test regions using Jason-2 altimeter data. In the validation process, we compared retracked SSHs by 16 retrackers, which include retrackers provided in SGDR (Sensor Geophysical Data Record), ALES (Adaptive Leading Edge Subwaveform), and PISTACH (Prototype Innovant de Système de Traitement pour les Applications Côtières et l’Hydrologie) products. Comparison results verified that retracking the waveforms decontaminated using our new method can greatly improve the SSHs in the coastal region. The 20% threshold retracker (DW-TR20) and the ICE1 retracker (DW-ICE1) based on the decontaminated waveforms outperform other retrackers, especially in 0–4 km zone offshore. DW-TR20 and DW-ICE1 can provide robust SSHs with a consistent accuracy in 0–20 km coastal band and a high correlation (&gt;0.9) with nearby gauge data. To conclude, the upgraded waveform decontamination strategy provides a promising solution for coastal altimetry, which makes it possible to extend reliable observations to the last several kilometers offshore.
The Effect of Loop Diuretics on 28-Day Mortality in Patients With Acute Respiratory Distress Syndrome
Authors: Zhang Rui , Chen Hui , Gao Zhiwei , Liang Meihao , Qiu Haibo , Yang Yi , Liu Ling 
Published: September 2021

Background: Diuretics have been widely used in critically ill patients while it remains uncertain whether they can reduce mortality in patients with acute respiratory distress syndrome (ARDS). This study aimed to investigate the associations between diuretics and 28-day mortality in patients with ARDS.Methods: This is a secondary analysis of the ARDS Network Fluid and Catheter Treatment Trial (FACTT) of National Heart, Lung, and Blood Institute. Those patients who did not receive renal replacement therapy within the first 48 h after enrollment in the FACTT were included in the analysis. A marginal structural Cox model (MSCM) was used to investigate the associations between diuretics and 28-day mortality after correction of both the baseline and time-varying variables. The latent class analysis (LCA) and subgroup analysis were performed to identify the kind of patients that could be benefited from diuretics.Results: A total of 932 patients were enrolled, i.e., 558 patients in the diuretics group and 374 patients in the no diuretics group within the first 48 h. The 28-day mortality was lower in the diuretics group (15.1 vs. 28.1%, p &lt; 0.001). In MSCM, diuretics use was related to the improved 28-day mortality (HR 0.78; 95% CI 0.62–0.99; p = 0.04). LCA identified three subtypes, and diuretics were associated with reduced mortality in subtype 3, which was characterized by worse renal function and higher central venous pressure (CVP). A subgroup analysis indicated survival advantage among the female patients, sepsis induced ARDS, and those with the ratio of partial pressure of oxygen to the fractional concentration of inspired oxygen (PaO2/FiO2) ≤ 150 mmHg, and mean arterial pressure (MAP) ≥ 65 mmHg.Conclusion: Loop diuretics were associated with the reduced 28-day mortality in the patients with ARDS, after controlling for time-varying confounders. Randomized trials are required to verify the association.
Development of a Toll-Like Receptor-Based Gene Signature That Can Predict Prognosis, Tumor Microenvironment, and Chemotherapy Response for Hepatocellular Carcinoma
Authors: Liu Lixia , Liu Bin , Yu Jie , Zhang Dongyun , Shi Jianhong , Liang Ping 
Published: September 2021

Objective: Emerging evidence highlights the implications of the toll-like receptor (TLR) signaling pathway in the pathogenesis and therapeutic regimens of hepatocellular carcinoma (HCC). Herein, a prognostic TLR-based gene signature was conducted for HCC.Methods: HCC-specific TLRs were screened in the TCGA cohort. A LASSO model was constructed based on prognosis-related HCC-specific TLRs. The predictive efficacy, sensitivity, and independency of this signature was then evaluated and externally verified in the ICGC, GSE14520, and GSE76427 cohorts. The associations between this signature and tumor microenvironment (stromal/immune score, immune checkpoint expression, and immune cell infiltrations) and chemotherapy response were assessed in HCC specimens. The expression of TLRs in this signature was verified in HCC and normal liver tissues by Western blot. Following si-MAP2K2 transfection, colony formation and apoptosis of Huh7 and HepG2 cells were examined.Results: Herein, we identified 60 HCC-specific TLRs. A TLR-based gene signature (MAP2K2, IRAK1, RAC1, TRAF3, MAP3K7, and SPP1) was conducted for HCC prognosis. High-risk patients exhibited undesirable outcomes. ROC curves confirmed the well prediction performance of this signature. Multivariate Cox regression analysis demonstrated that the signature was an independent prognostic indicator. Also, high-risk HCC was characterized by an increased immune score, immune checkpoint expression, and immune cell infiltration. Meanwhile, high-risk patients displayed higher sensitivity to gemcitabine and cisplatin. The dysregulation of TLRs in the signature was confirmed in HCC. MAP2K2 knockdown weakened colony formation and elevated apoptosis of Huh7 and HepG2 cells.Conclusion: Collectively, this TLR-based gene signature might assist clinicians to select personalized therapy programs for HCC patients.
Widespread White Matter Alterations in Patients With Visual Snow Syndrome
Authors: Michels Lars , Stämpfli Philipp , Aldusary Njoud , Piccirelli Marco , Freund Patrick , Weber Konrad P. , Fierz Fabienne C. , Kollias Spyros , Traber Ghislaine 
Published: September 2021

Background: Visual snow is considered a disorder of central visual processing resulting in a perturbed perception of constant binocular flickering or pixilation of the whole visual field. The underlying neurophysiological and structural alterations remain elusive.Methods: In this study, we included patients (final n = 14, five dropouts; five females, mean age: 32 years) with visual snow syndrome (VSS) and age- and sex-matched controls (final n = 20, 6 dropouts, 13 females, mean age: 28.2 years). We applied diffusion tensor imaging to examine possible white matter (WM) alterations in patients with VSS.Results: The patient group demonstrated higher (p-corrected &lt; 0.05, adjusted for age and sex) fractional anisotropy (FA) and lower mean diffusivity (MD) and radial diffusivity (RD) compared to controls. These changes were seen in the prefrontal WM (including the inferior fronto-occipital fascicle), temporal and occipital WM, superior and middle longitudinal fascicle, and sagittal stratum. When additionally corrected for migraine or tinnitus—dominant comorbidities in VSS—similar group differences were seen for FA and RD, but less pronounced.Conclusions: Our results indicate that patients with VSS present WM alterations in parts of the visual cortex and outside the visual cortex. As parts of the inferior fronto-occipital fascicle and sagittal stratum are associated with visual processing and visual conceptualisation, our results suggest that the WM alterations in these regions may indicate atypical visual processing in patients with VSS. Yet, the frequent presence of migraine and other comorbidities such as tinnitus in VSS makes it difficult to attribute WM disruptions solely to VSS.
Small vs. Large Unruptured Cerebral Aneurysm: Concerns With the Age of Patient
Authors: Zheng Jianfeng , Xu Ru , Sun Xiaochuan , Zhang Xiaodong 
Published: September 2021

Objective: The coiling and clipping of unruptured cerebral aneurysms (UCAs) in older patients has increased rapidly, and aneurysm size was a significant factor for decision-making in the treatment of UCAs. The purpose of the study was to investigate the impact of age on the functional outcomes of patients between the small versus large UCAs.Methods: We conducted a retrospective study for consecutive cases of UCAs admitted from May 2011 to December 2020. According to the maximum diameter of UCA, patients were divided into small UCAs (≤ 5 mm) group and large UCAs (&gt;5 mm) group. Baseline characteristics, clinical complications, and outcomes of patients between the two groups were analyzed.Results: A total of 564 UCA patients received preventive treatment, including 165 small UCAs and 399 large UCAs. Compared with the small UCA group, the incidence of ischemia event in the large UCA group was significantly higher (7.3 vs. 2.4%; p = 0.029). Multivariable analysis demonstrating age (p = 0.006) and treatment modality (p &lt; 0.001) were independent risk factors associated with poor outcome for patients with large UCAs.Conclusions: Preventive treatment of small UCAs is safe and effective, but older patients with large UCAs are at high risk of poor outcome, and the operations should be more cautious.
The Effect of Transcranial Direct Current Stimulation and Functional Electrical Stimulation on the Lower Limb Function of Stroke Patients
Authors: Zhang Xiao-Hua , Gu Tao , Liu Xuan-Wei , Han Ping , Lv Hui-Lan , Wang Yu-Long , Xiao Peng 
Published: September 2021

Objective:This study aimed to research the effect of transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) on the lower limb function of post-convalescent stroke patients.Methods:A total of 122 patients in the stroke recovery stage who suffered from leg dysfunction were randomly divided into two groups: a tDCS group (n= 61) and a FES group (n= 61). All patients received same routine rehabilitation and equal treatment quality, the tDCS group was treated with tDCS, while the FES group received FES. The lower limb Fugl-Meyer assessment (FMA), modified Barthel index (MBI), functional ambulatory category (FAC), and somatosensory evoked potential (SEP) were used to assess the patients at three different stages: prior to treatment, 4 weeks after treatment, and 8 weeks after treatment.Results:The assessment scores for FMA, MBI, and FAC for the lower extremities after treatment (P&gt; 0.05) were compared with those before treatment. The FMA, MBI, and FAC scores of the tDCS group were significantly higher than those of the FES group in all three stages (P&lt; 0.05). The FMA, MBI, and FAC assessment scores of both groups were significantly higher after 4 weeks of treatment than that before treatment, and the scores after 8 weeks of treatment were significantly higher than those after 4 weeks after treatment (P&lt; 0.05). The P40, N45 latencies decreased and the P40, N45 amplitudes increased, but there was no significant difference before treatment and after treatment (P&gt;0.05), and there was no significant difference of the tDCS and FES groups before treatment and after treatment.Conclusion:In conclusion, FMA, MBI, and FAC indicate that both tDCS and FES can significantly promote the recovery of a patient’s leg motor function and tDCS is more effective than FES in the stroke recovery stage. The application value of SEP in stroke patients remains to be further studied.
Irinotecan Plus Doxorubicin Hydrochloride Liposomes for Relapsed or Refractory Wilms Tumor
Authors: Wang Juan , Zhang Lian , Guo Lanying , Que Yi , Zhang Yu , Sun Feifei , Zhu Jia , Lu Suying , Huang Junting , Wu Liuhong , Cai Ruiqing , Zhen Zijun , Zeng Sihui , Zhang Yizhuo , Sun Xiaofei 
Published: September 2021

PurposeThe prognosis of relapsed or refractory pediatric Wilms tumor (WT) is dismal, and new salvage therapies are needed. This study aimed to evaluate the efficacy of the combination of irinotecan and a doxorubicin hydrochloride liposome regimen for relapsed or refractory pediatric WT.Patients and MethodsThe present study enrolled relapsed or refractory pediatric WT patients who were treated with the AI regimen (doxorubicin hydrochloride liposomes 40 mg/m2 per day, day 1, and irinotecan 50 mg/m2 per day with 90-min infusion, days 1–5; this regimen was repeated every 3 weeks) at Sun Yat-sen University Cancer Center from July 2018 to September 2020. The response was defined as the best-observed response after at least two cycles according to the Response Evaluation Criteria of Solid Tumors (RECIST 1.1), and toxicity was evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE 4.03).ResultsA total of 16 patients (male:female, 8:8) with a median age of 4.2 years (0.5–11 years) with relapsed or refractory disease were enrolled in this study, including 14 patients with relapsed disease and two patients with refractory disease. These patients received 1–8 courses (median, 3 courses) of the AI regimen. Fourteen patients were assessable for response: two with complete response (CR), five with partial response (PR), two with stable disease (SD), and five with progressive disease (PD). The objective response rate was 50% (two CR, five PR), and the disease control rate was 64% (two CR, five PR, and two SD). Seven out of 14 patients (50%) were alive at the last follow-up, ranging from 2.6 to 32.4 months. The median progression-free survival and median overall survival were 3.5 months (range 0.5–12 months) and 8 months (range 1–28 months), respectively. Sixteen patients were assessable for toxicity, with the most common grade 3 or 4 adverse events being alopecia (62%), leukopenia (40%), abdominal pain (38%), diarrhea (23%), and mucositis (16%), etc. No fatal adverse events have been observed, and modest adverse effects can be administered.ConclusionIrinotecan and doxorubicin hydrochloride liposome regimens have positive efficacy on relapsed or refractory pediatric WT with well-tolerated toxicity. A prospective clinical trial is warranted.
The Clinicopathological Features and Prognosis in Patients With Papillary Renal Cell Carcinoma: A Multicenter Retrospective Study in Chinese Population
Authors: Hong Baoan , Hou Huimin , Chen Lingxiao , Li Zhi , Zhang Zhipeng , Zhao Qiang , Du Xin , Li Yuan , Ye Xiongjun , Xu Wanhai , Liu Ming , Zhang Ning 
Published: September 2021

ObjectiveThe purpose of this study was to compare the clinicopathological characteristics of type 1 and type 2 papillary renal cell carcinoma (PRCC) and to explore the prognostic factors of PRCC in the Chinese population.MethodsA total of 242 patients with PRCC from five Chinese medical centers were retrospectively included. From them, 82 were type 1 PRCC and 160 were type 2 PRCC. Clinicopathological features and oncologic outcomes were reviewed. The Kaplan–Meier analysis and log-rank test were performed to describe the progression-free survival (PFS) and overall survival (OS). Univariate and multivariate Cox proportional hazards regression models were used to analyze the prognostic factors of PRCC.ResultsOf the 242 patients, the average age at surgery was 55.3 ± 13.1 years. The mean tumor size was 5.1 ± 3.1 cm. Compared with type 1 PRCC patients, type 2 PRCC patients had a larger tumor size and were more likely to undergo radical nephrectomy. Besides, type 2 PRCC patients had higher tumor stage (p &lt; 0.001) and WHO International Society of Urological Pathology (WHO/ISUP) grading (p &lt; 0.001). Furthermore, tumor necrosis was more common in type 2 PRCC than type 1 PRCC (p = 0.030). The Kaplan–Meier survival analysis showed that the PFS and OS of type 1 PRCC patients were significantly better than those of type 2 PRCC patients (p = 0.0032 and p = 0.0385, respectively). Univariate analysis showed that tumor size, surgical procedures, pT stage, WHO/ISUP grading, and microvascular invasion were significant predictors of PFS and OS for type 2 PRCC patients. In the multivariate analysis, only pT stage (p = 0.004) and WHO/ISUP grading (p = 0.010) were the independent risk factors. Among type 2 PRCC patients with pT1 stage, no significant difference was found in PFS and OS between the partial nephrectomy and radical nephrectomy groups (p = 0.159 and p = 0.239, respectively).ConclusionThis multi-institutional study reveals the significant differences in clinicopathological variables and oncologic outcomes between type 1 and 2 PRCC. For type 2 PRCC in pT1 stage, the prognosis of partial nephrectomy is not inferior to that of radical nephrectomy, and nephron-sparing surgery can be considered.
Explore the Usefulness of Concurrent Chemotherapy in Stage II Nasopharyngeal Carcinoma: A Retrospective Study
Authors: Li Pei-Jing , Lai Yu-Lin , He Fang , Chen Yuan-Yuan , Gu Zhuo-Sheng , Luo Wei , Zhang Qun 
Published: September 2021

Objective: This study aims to compare the treatment outcomes of concurrent chemoradiotherapy (CCRT) versus radiotherapy (RT) alone in stage II nasopharyngeal carcinoma (NPC) patients.Methods: We retrospectively collected 601 stage II NPC patients treated in two hospitals between June 2003 to June 2016. All patients were divided into the CCRT group (n = 255) and the RT group (n = 346). Overall survival (OS), locoregional failure-free survival (LRFFS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) were assessed using the Kaplan-Meier method. The log-rank test was used to compare the differences between the groups. The Cox-regression hazards model was performed to determine potential prognostic factors.Results: The median follow-up was 99 months. No significant difference was found in locoregional recurrence, distant metastasis, disease progression, and death between the two groups (all p &gt; 0.05). In univariate analysis, the 5-years OS, PFS, LRFFS, and DMFS had no significant differences between the CCRT and RT groups (all p &gt; 0.05). Two-dimensional radiotherapy (2DRT) sub-analysis showed that CCRT remarkably increased DMFS, PFS, and OS rates (all p &lt; 0.05) but not LRFFS (p = 0.258) compared with RT alone. While intensity-modulated radiotherapy (IMRT) sub-analysis showed that the prognosis of the two groups had no significant differences (all p &gt; 0.05). In multivariate analyses, age was significantly and inversely related to OS, PFS, LRFFS, and DMFS. IMRT was an independent favorable factor for improving LRFFS, PFS, and OS. Concurrent chemotherapy was an independent protective factor for DMFS.Conclusion: In the context of 2DRT, it is definite that concurrent chemotherapy provides survival benefits for patients with stage II NPC. While in the IMRT era, the impact of chemotherapy on survival in patients with stage II NPC is weakened. Prospective randomized controlled studies are required to confirm these results.
An Exploratory Pilot Study of Changes in Global DNA Methylation in Patients Undergoing Major Breast Surgery Under Opioid-Based General Anesthesia
Authors: Caputi Francesca Felicia , Carboni Lucia , Rullo Laura , Alessandrini Irene , Balzani Eleonora , Melotti Rita Maria , Romualdi Patrizia , Candeletti Sanzio , Fanelli Andrea 
Published: September 2021

This study aimed to investigate DNA methylation levels in patients undergoing major breast surgery under opioid-based general anesthesia. Blood samples were collected from eleven enrolled patients, before, during and after anesthesia. PBMC were isolated and global DNA methylation levels as well as DNA methyltransferase (DNMT) and cytokine gene expression were assessed. DNA methylation levels significantly declined by 26%, reversing the direction after the end of surgery. Likewise, DNMT1a mRNA expression was significantly reduced at all time points, with lowest level of −68%. DNMT3a and DNMT3b decreased by 65 and 71%, respectively. Inflammatory cytokines IL6 and TNFα mRNA levels showed a trend for increased expression at early time-points to end with a significant decrease at 48 h after surgery. This exploratory study revealed for the first time intraoperative global DNA hypomethylation in patients undergoing major breast surgery under general anesthesia with fentanyl. The alterations of global DNA methylation here observed seem to be in agreement with DNMTs gene expression changes. Furthermore, based on perioperative variations of IL6 and TNFα gene expression, we hypothesize that DNA hypomethylation may occur as a response to surgical stress rather than to opiate exposure.
What Factors Hindered the Access to Essential Anticancer Medicine in Public Hospitals for the Local Population in Hubei Province, China
Authors: Chen Chaoyi , Feng Zhanchun , Ding Yufeng , Yan Ziqi , Wang Jia , Wang Ruoxi , Feng Da 
Published: September 2021

Background:Cancer poses a serious threat to one’s health, which caused significant economic burden on the family and society. Poor availability and affordability resulted in some essential medicines failing to meet the basic health needs of this group of patients. The objective of this study was to evaluate the availability, prices and affordability of 32 anticancer essential medicines in Hubei Province, China.Methods: Data on the availability and price related information of 32 essential anticancer medicines in the capital and five other cities of Hubei Province were collected. A total of 28 hospitals were sampled, which included 13 tertiary hospitals and 15 secondary hospitals. We used the standard methods developed by the World Health Organization and Health Action International to compare the differences in drug price, availability and affordability between secondary hospitals and tertiary hospitals.Results: Overall, the availability of medicine was higher in tertiary hospitals. The average availability of originator brand (OBs) was 13.70% (tertiary hospitals) VS 6.67% (secondary hospitals), and lowest-priced generic (LPGs) was 62.83% (tertiary hospitals) VS 42.92% (secondary hospitals). The MPR value of most sampled medicines in secondary hospitals were less than 1. In contrast, the MPR of Cytarabine (17.15), Oxaliplatin (12.73) were significantly higher than the international reference price. The top three OBs’ total expenses for 30-days treatment were Irinotecan, Oxaliplatin, Bicalutamide. Further, their affordability was relative low, as the costs for one course using these medicines were much higher than 20% of the minimum family monthly income.Conclusion: Though the “Zero Mark-Up” and “Centralized procurement policy of anti-tumor drugs” policies have been implemented in China, the availability issue yet to be addressed. High price and low affordability were the major barriers to the access of essential anticancer medicines. Measures should be taken to provide sufficient, available and affordable medicines to patients in need.