bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicting the expression level of Ki-67 in breast cancer using multi-modal ultrasound parameters
Authors: Cheng Chen , Zhao Hongyan , Tian Wei , Hu Chunhong , Zhao Haitao 
Published: October 2021

Abstract
Objective
This study investigated the feasibility of predicting the expression levels of Ki-67 in breast cancer using ultrasonographic findings and clinical features.

Methods
Fifty-eight breast cancer patients, with 82 lesions confirmed by surgical pathology, were selected retrospectively for this study. Conventional ultrasound examination and elastography examination were performed before surgery. Clinical features (age, estrogen receptor (ER), progesterone receptor, and human epidermal growth factor receptor-2 expression levels), ultrasonographic findings, and elastography scores, including the maximum size, location, number, margin, borderline, blood flow, and elastography score of the mass, were collected. The expression of Ki-67 was recorded using immunohistochemical staining, and the patients were divided into a high (≥ 20%) expression group and a low (< 20%) expression group. SPSS 23.0 software was used for statistical analysis. An independent sample t-test was used for measurement data, and a χ2 test was used for enumeration data. Logistic regression analysis was performed for meaningful indicators, and the receiver operating characteristic curve was used to calculate the best diagnostic cut-off point.

Results
Monofactorial analysis showed that there was a statistically significant difference (p < 0.05) between the high expression of Ki-67 and the maximum diameter of the mass, the margin of the mass, the color Doppler flow imaging of the blood flow, and the resistance index of the blood flow. There were no significant differences in age, mass location, number, morphology, borderline, microcalcification, and elastography score (p > 0.05). Multiple factor regression analysis showed that a large mass and a mass with a rich blood flow had an independent predictive value for Ki-67. When the diameter was > 21.5 mm, the diagnostic sensitivity and specificity were 91.9% and 71.3%, respectively. The expression level of Ki-67 was negatively correlated with that of ER.

Conclusion
The tumor size and blood flow of breast cancer is correlated with the expression level of Ki-67 and, thus, it could be used to predict the expression level of Ki-67 in ultrasound diagnosis. The margin condition and the expression level of ER of an ultrasonic mass could also indirectly reflect the Ki-67 expression level of the mass.
A longitudinal study of cardiac structure and function using echocardiography in patients undergoing peritoneal dialysis
Authors: Zhu Yunyun , Zhang Difei , Hu Xiaoxuan , Liu Hui , Xu Yuan , Hou Haijing , Peng Yu , Lu Ying , Liu Xusheng , Lu Fuhua 
Published: October 2021

Abstract
Background
Peritoneal dialysis (PD) can be associated with abnormal cardiac structure and function and increased mortality risk. Therefore, in this study, we analyzed the cardiac structure and function dynamic changes using echocardiography during the first 2 years of PD therapy. We also assessed its associations with all-cause mortality risk after 2 years of follow-up.

Methods
End-stage renal disease (ESRD) patients that have started PD from 2011 to 2017, and had echocardiography at baseline and years 1 and 2, were included in this study. Echocardiographic parameters were compared between baseline and year 2. Multivariable Cox models were used to estimate the association between echocardiographic parameters changes and all-cause mortality risk.

Results
We finally enrolled 72 PD patients in this study. The mean right ventricular diameter (RVD) increased from baseline (18.31 mm) to year 1 (18.75 mm) and year 2 (19.65 mm). We also observed a significant decrease in cardiac output (CO) between baseline and year 2. Additionally, a slight decrease trend in ejection fraction (EF) was observed. Finally, every 1 % increase in RVD was associated with a 68.2 % higher mortality risk after dialysis (HR, 1.682; 95 % CI, 1.017–2.783).

Conclusions
Our results demonstrated a susceptibility for deteriorated right cardiac structure and function during the first 2 years of PD treatment. Also, higher all-cause mortality risk was observed after 2 years of PD. Altogether, these results highlighted the need for additional focus on regular echocardiographic examinations during long-term PD management.

Trial registration
The PD-CRISC cohort, registered with the Chinese Clinical Trial Registry (ChiCTR1900023565).
The quality of life in women with cervical cancer and precancerous lesions of Han and ethnic minorities in Southwest China
Authors: Zhao Min , Pu Xin , Yan Yi Jun , Zhang Shao , Long Xue , Luo Lei , Li Zheng 
Published: October 2021

Abstract
Background
As patients with cervical cancer and precancerous lesions can be diagnosed at early stage and live longer, it is imperative to understand their health-related quality of life so that better cancer-related policies could be promoted and reasonable distribution of limited resources could be implemented. We conducted a cross-sectional study in the Third Affiliated Hospital of Kunming Medical University to assess the health-related quality of life in our targeted population. Due to the characteristics of Yunnan nationality, our study population includes both Han people and ethnic minorities.

Methods
A cross-sectional study was conducted from January 2019 to December 2020, and 300 patients were selected, who were initially diagnosed with cervical cancer and cervical intraepithelial neoplasia (CIN) pathologically. EQ-5D questionnaire was used to evaluate their quality of life.

Results
Patients in Han and ethnic minorities showed good comparability. EQ-5D VAS score was statistically significant between Han and ethnic minorities (mean, 85.42 vs. 81.01; P<0.05). EQ-5D utility score was slightly different but without statistical significance between the two groups (mean, 0.959 vs. 0.932; P>0.05). Nationality, economic trouble, menopause status and participation of China National Cervical Cancer Screening Program (CNCCSP) are influencing factors of HRQoL among women with cervical cancer and precancerous lesions. Besides, we also found low awareness in the CNCCSP and human papilloma virus vaccine, as well as low participation in the national screening program.

Conclusion
The results of our study imply that the difference of HRQoL does exist between Han people and ethnic minorities with cervical cancer and precancerous lesions. Health providers and health-related departments need to invest more health and financial resources to expand the awareness and participation of the screening project. More efforts should be made in underdeveloped minority areas to assure the accessibility of health resources and interventions. To mitigate economic trouble caused by the diseases, more equal insurance reimbursement should be suggested and implemented in people with or without employee insurance.
Pooled analysis of combination antiemetic therapy for chemotherapy-induced nausea and vomiting in patients with colorectal cancer treated with oxaliplatin-based chemotherapy of moderate emetic risk
Authors: Shimokawa Mototsugu , Hayashi Toshinobu , Nishimura Junichi , Satoh Taroh , Fukunaga Mutsumi , Matsui Reiko , Tsuji Yasushi , Mizuki Fumitaka , Kogawa Takahiro 
Published: October 2021

Abstract
Background
Among patients with colorectal cancer (CRC) treated with oxaliplatin (L-OHP)-based chemotherapy, delayed chemotherapy-induced nausea and vomiting (CINV) have not been well controlled.

Methods
We pooled data from two prospective observational studies in Japan and one phase III clinical trial to assess whether delayed CINV could be controlled with a combination of three antiemetics adding a neurokinin-1 receptor antagonist and identified individual risk factors, using an inverse probability treatment-weighted analysis.

Results
A total of 661 patients were evaluable in this study (median age: 64 years; 391 male, and 270 female). 3 antiemetics controlled delayed nausea (33.18% vs. 42.25%; p = 0.0510) and vomiting (4.15% vs. 16.08%; p < 0.0001) better than with 2 antiemetics. Female and 2 antiemetics were risk factors for both delayed nausea (female—odds ratio [OR]: 1.918; 95% confidence interval [CI]: 1.292–2.848; p = 0.0012; 2 antiemetics—OR: 1.485; 95% CI: 1.000–2.204; p = 0.0498) and delayed vomiting (female—OR: 2.735; 95% CI: 1.410–5.304; p = 0.0029; 2 antiemetics—OR: 4.551; 95% CI: 2.116–9.785; p = 0.0001).

Conclusions
Identifying individual risk factors can facilitate personalized treatments for delayed CINV. We recommend a 3-antiemetic combination prophylaxis for CRC patients treated with L-OHP-based chemotherapy, especially for female patients.
A comparison of clinical outcomes and optical performance between monofocal and new monofocal with enhanced intermediate function intraocular lenses: a case-control study
Authors: Huh Jungah , Eom Youngsub , Yang Seul Ki , Choi Young , Kim Hyo Myung , Song Jong Suk 
Published: October 2021

Abstract
Background
To compare clinical outcomes and optical performance of a new monofocal with enhanced intermediate function intraocular lenses (IOLs) with that of conventional monofocal IOLs.

Methods
Sixty eyes of 30 patients who underwent phacoemulsification with bilateral implantation of the ICB00 (15 patients) or ZCB00 (15 patients) IOLs were enrolled. Binocular corrected distance visual acuity (CDVA), distance corrected near visual acuity (DCNVA), and distance corrected intermediate visual acuity (DCIVA) were measured at 4 weeks after surgery. Patient satisfaction for overall, near, intermediate, and distance vision were assessed. The binocular defocus curves were measured. The root mean square of modulation transfer function (MTFRMS) was measured in the optical bench study.

Results
The mean binocular DCIVA was significantly better in the ICB00 group (0.01 logMAR) compared to the ZCB00 group (0.13 logMAR), but CDVA and DCNVA were not. The patient satisfaction for near and intermediate vision was significantly higher in the ICB00 group compared to the ZCB00. However, there was no difference in patient satisfaction for overall and distance vision between two groups. The defocus curves showed that mean visual acuity of the ICB00 group was significantly better than that of the ZCB00 group at between − 1.00 D to − 3.00 D of defocus. The ICB00 IOL had higher MTFRMS values at between − 0.50 D to − 2.00 D of defocus compared to the ZCB00 IOL.

Conclusions
The ICB00 IOL provides better binocular intermediate vision and higher satisfaction for near and intermediate vision than the ZCB00 IOL while maintaining excellent distance vision.
Severe protein C deficiency in a newborn caused by a homozygous pathogenic variant in the PROC gene: a case report
Authors: Song Uisook , Ryu Young Hye , Hong Kiteak , Shim So-Yeon , Park Seongyeol , Lee Jeong Seok , Ju Young Seok , Shin Seung Han , Lee Soyoung 
Published: October 2021

Abstract
Background
Severe protein C deficiency is a rare and inherited cause of thrombophilia in neonates. Protein C acts as an anticoagulant, and its deficiency results in vascular thrombosis. Herein, we report a case of protein C deficiency with a homozygous pathogenic variant in a term neonate, with good outcomes after proper treatment.

Case presentation
A four-day-old male newborn was transferred to the Seoul National University Hospital on account of dark red to black skin lesions. He was born full-term with an average birth weight without perinatal problems. There were no abnormal findings in the prenatal tests, including intrauterine sonography. The first skin lesion was observed on his right toes and rapidly progressed to proximal areas, such as the lower legs, left arm, and buttock. Under the impression of thromboembolism or vasculitis, we performed a coagulopathy workup, which revealed a high D-dimer level of 23.05 μg/ml. A skin biopsy showed fibrin clots in most capillaries, and his protein C activity level was below 10%, from which we diagnosed protein C deficiency. On postnatal day 6, he experienced an apnea event with desaturation and an abnormal right pupillary light reflex. Brain computed tomography showed multifocal patchy intracranial hemorrhage and intraventricular hemorrhage with an old ischemic lesion. Ophthalmic examination revealed bilateral retinal traction detachments with retinal folds. Protein C concentrate replacement therapy was added to previous treatments including steroids, prostaglandin E1, and anticoagulation. After replacement therapy, there were no new skin lesions, and the previous lesions recovered with scarring. Although there were no new brain hemorrhagic infarctions, there was ongoing ischemic tissue loss, which required further rehabilitation. Ophthalmic surgical interventions were performed to treat the bilateral retinal traction detachments with retinal folds. Molecular analysis revealed a homozygous pathogenic variant in the PROC gene.

Conclusion
Severe protein C deficiency can manifest as a fatal coagulopathy in any organ. Early diagnosis and proper treatment, including protein C concentrate replacement, may improve outcomes without serious sequelae.
The impact of equity factors on receipt of timely appropriate care for children with suspected malaria in eastern Uganda
Authors: Humphreys David , Kalyango Joan Nakayaga , Alfvén Tobias 
Published: October 2021

Abstract
Introduction
Malaria accounts for more than one-tenth of sub-Saharan Africa’s 2.8 million annual childhood deaths, and remains a leading cause of post-neonatal child mortality in Uganda. Despite increased community-based treatment in Uganda, children continue to die because services fail to reach those most at risk. This study explores the influence of two key equity factors, socioeconomic position and rurality, on whether children with fever in eastern Uganda receive timely access to appropriate treatment for suspected malaria.

Methods
This was a cross-sectional study in which data were collected from 1094 caregivers of children aged 6–59 months on: illness and care-seeking during the previous two weeks, treatment received, and treatment dosing schedule. Additional data on rurality and household socioeconomic position were extracted from the Iganga-Mayuge Health and Demographic Surveillance Site (HDSS) database. A child was considered to have received prompt and appropriate care for symptoms of malaria if they received the recommended drug in the recommended dosing schedule on the day of symptom onset or the next day. Unadjusted and adjusted logistic regression models were developed to explore associations of the two equity factors with the outcome. The STROBE checklist for observational studies guided reporting.

Results
Seventy-four percent of children had symptoms of illness in the preceding two weeks, of which fever was the most common. Children from rural households were statistically more likely to receive prompt and appropriate treatment with artemisinin-combination therapy than their semi-urban counterparts (OR 2.32, CI 1.17–4.59, p = 0.016). This association remained significant following application of an adjusted regression model that included the age of the child, caregiver relationship, and household wealth index (OR 2.4, p = 0.036). Wealth index in its own right did not exert a significant effect for children with reported fever (OR for wealthiest quintile = 1.02, CI 0.48–2.15, p = 0.958).

Conclusions
The findings from this study help to identify the role and importance of two key equity determinants on care seeking and treatment receipt for fever in children. Whilst results should be interpreted within the limitations of data and context, further studies have the potential to assist policy makers to target inequitable social and spatial variations in health outcomes as a key strategy in ending preventable child morbidity and mortality.
A mixed methods analysis of environmental and household chaos: considerations for early-childhood obesity research
Authors: Krupsky Kathryn L. , Parrott Andria , Andridge Rebecca , Zvara Bharathi J. , Keim Sarah A. , Anderson Sarah E. 
Published: October 2021

Abstract
Background
Chaos has implications for child health that may extend to childhood obesity. Yet, results from studies describing associations between chaos and childhood obesity are mixed. New approaches to studying the environments of young children may help to clarify chaos-obesity relationships.

Methods
We conducted a concurrent mixed methods analysis of quantitative and qualitative data describing home and neighborhood chaos among a diverse cohort of 283 caregiver-toddlers dyads from Ohio. We examined the underlying structure of environmental and household chaos using exploratory factor analysis then sought to validate the structure using qualitative field notes. We generated total scores for factors of chaos and described their distributions overall and according to cohort characteristics. Additionally, we conducted a thematic content analysis of brief ethnographies to provide preliminary construct validity for our indicators of chaos.

Results
Dyads varied according to household composition, income, education, and race/ethnicity. We found evidence for a multi-factor structure for chaos, which included disorganization and neighborhood noise. Household disorganization scores ranged from 0 to 7.3 and were on average 2.1 (SD = 1.8). Neighborhood noise scores ranged from 0 to 4 and were on average 1.1 (SD = 1.1). Both disorganization and neighborhood noise were associated with indicators of socioeconomic disadvantage, such as lower educational attainment and household income. Qualitative data from households with high and low scores on the two identified factors were aligned in ways that were supportive of construct validity and further contextualized the social and material environments in which chaos occurred.

Conclusions
Chaos represents a complex construct with implications spanning various disciplines, including childhood obesity research. Previous studies suggest challenges associated with measuring chaos may limit the conclusions that can be drawn about which aspect of chaos (if any) matter most of early childhood weight development. We advance the literature by demonstrating chaos may be comprised of conceptually distinct subdomains. Future childhood obesity prevention research may benefit from more contemporary measure of chaos, such as those relying on direct observations that account for a multifaceted underlying structure.
Implementation of an organizational intervention to improve low-wage food service workers’ safety, health and wellbeing: findings from the Workplace Organizational Health Study
Authors: Sorensen Glorian , Peters Susan E. , Nielsen Karina , Stelson Elisabeth , Wallace Lorraine M. , Burke Lisa , Nagler Eve M. , Roodbari Hamid , Karapanos Melissa , Wagner Gregory R. 
Published: October 2021

AbstractBackgroundMany organizational interventions aim to improve working conditions to promote and protect worker safety, health, and well-being. The Workplace Organizational Health Study used process evaluation to examine factors influencing implementation of an organizational intervention. This paper examines the extent to which the intervention was implemented as planned, the dose of intervention implemented, and ways the organizational context hindered or facilitated the implementation of the intervention.MethodsThis proof-of-concept trial was conducted with a large, multinational company that provides food service through contractual arrangements with corporate clients. The 13-month intervention was launched in five intervention sites in October 2018. We report findings on intervention implementation based on process tracking and qualitative data. Qualitative data from 25 post-intervention interviews and 89 process tracking documents were coded and thematically analyzed.ResultsOver the 13-month intervention, research team representatives met with site managers monthly to provide consultation and technical assistance on safety and ergonomics, work intensity, and job enrichment. Approximately two-thirds of the planned in-person or phone contacts occurred. We tailored the intervention to each site as we learned more about context, work demands, and relationships. The research team additionally met regularly with senior leadership and district managers, who provided corporate resources and guidance. By assessing the context of the food service setting in which the intervention was situated, we explored factors hindering and facilitating the implementation of the intervention. The financial pressures, competing priorities and the fast-paced work environment placed constraints on site managers’ availability and limited the full implementation of the intervention.ConclusionsDespite strong support from corporate senior leadership, we encountered barriers in the implementation of the planned intervention at the worksite and district levels. These included financial demands that drove work intensity; turnover of site and district managers disrupting continuity in the implementation of the intervention; and staffing constraints that further increased the work load and pace. Findings underscore the need for ongoing commitment and support from both the parent employer and the host client.Trial registrationThis study was retrospectively registered with the Clinical Trials. Gov Protocol and Results System on June 2, 2021 with assigned registration numberNCT04913168.
Metal stent for the ureteral stricture after surgery and/or radiation treatment for malignancy
Authors: Wang Wei , Gao Xiaoshuai , Chen Jixiang , Liu Zhenghuan , Peng Liao , Wei Xin 
Published: October 2021

Abstract
Background
To assess the efficacy and safety of self-expanding metal ureteral stent for the stricture following surgery and/or radiation for malignancy.

Methods
We performed 36 metal ureteral stent insertion procedures (32 patients) between May 2019 and June 2020. The main inclusion criterion was the patients with ureteral stricture due to surgery and/or radiation treatment for malignancy. The diagnosis of stricture was ascertained by history and radiographic imaging. The etiologies underlying the strictures were: surgery and/or radiation therapy for cervical and rectal cancer, surgery for ovarian cancer. The primary outcome was the stent patency rate, and the secondary outcomes were the postoperative complications and glomerular filtration rate (GFR). Stent patency was defined as stent in situ without evident migration, unanticipated stent exchange or recurrent ureteral obstruction. Cost analysis was calculated from stent cost, anesthesia cost and operating room fee.

Results
The pre-metallic stent GFR was 22.53 ± 6.55 mL/min/1.73 m2. Eight patients were on double-J stents before insertion of metallic stents. The total annual cost of per patient in our study was $10,600.2 US dollars (range $9394.4–$33,527.4 US dollars). During a median follow-up time of 16 months (range 8–21 months), 27 cases (31 sides, 84%) remained stent patency. Twelve patients died from their primary malignancy carrying a patency stent. Stent migration was observed in 4 patients within 10 months after insertion. Ectopic stents were endoscopically removed and replaced successfully. Three stents were occluded, and no encrustation was seen in our study. Three and four patients had postoperative fever and gross hematuria, respectively. Infection was observed in 2 cases, mandating antibiotics therapy. In addition, postoperative volume of hydronephrosis postoperatively was significantly reduced compared with preoperation (54.18 ± 15.42 vs 23.92 ± 8.3, P = 0.019). However, no statistically significant differences regarding GFR, creatinine levels, blood urea nitrogen and hemoglobin existed between preoperation and last follow-up.

Conclusions
The current study demonstrated that metal ureteral stent is effective and safe in the treatment of stricture following surgery and/or radiation therapy for malignant cancer. Patients hydronephrosis could be improved by the stent placement.