bluuebunny/crossref_metadata_2025_split huggingface dataset:
Feasibility and acceptability of a preoperative exercise program for patients undergoing major cancer surgery: results from a pilot randomized controlled trial
Authors: Steffens Daniel , Young Jane , Beckenkamp Paula R. , Ratcliffe James , Rubie Freya , Ansari Nabila , Pillinger Neil , Koh Cherry , Munoz Phillip A. , Solomon Michael 
Published: January 2021

Abstract
Objective
To establish the feasibility and acceptability of a preoperative exercise program, and to obtain pilot data on the likely difference in key surgical outcomes to inform the sample size calculation for a full-scale trial.

Design
Pilot randomized controlled trial.

Setting
Royal Prince Alfred Hospital, Sydney, Australia.

Subjects
We included patients undergoing elective pelvic exenteration or cytoreductive surgery aged 18 to 80 years, who presented to the participating gastrointestinal surgeon at least 2 weeks prior to surgery. Patients presenting cognitive impairment, co-morbidity preventing participation in exercise, inadequate English language, currently participating in an exercise program or unable to attend the exercise program sessions were excluded.

Methods
Participants were randomized to a 2–6 weeks preoperative, face-to-face, individualised exercise program or to usual care. Feasibility was assessed with consent rates to the study, and for the intervention group, retention and adherence rates to the preoperative exercise program. Acceptability of the exercise program was assessed with a semi-structured questionnaire exploring the advice received and the amount, duration and intensity of the exercise program. In addition, postoperative complication rates (Clavien-Dindo), length of hospital stay and self-reported measures of health-related quality of life (SF-36v2) were collected at baseline, day before surgery and in-hospital up to discharge from hospital.

Results
Of 122 patients screened, 26 (21%) were eligible and 22 (85%) accepted to participate in the trial and were randomized to the intervention (11; 50%) or control group (11; 50%). The median age of the include participants was 63 years. Adherence to the preoperative exercise sessions was 92.7%, with all participants either satisfied (33%) or extremely satisfied (67%) with the overall design of the preoperative exercise program. No significant differences in outcomes were found between groups.

Conclusions
The results of our pilot trial demonstrate that a preoperative exercise program is feasible and acceptable to patients undergoing major abdominal cancer surgery. There is an urgent need for a definite trial investigating the effectiveness of a preoperative exercise program on postoperative outcomes in patients undergoing major abdominal cancer surgery. This could potentially reduce postoperative complication rates, length of hospital stay and subsequently overall health care costs.

Trial registration
ACTRN12617001129370. Registered on August 1, 2017, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373396&showOriginal=true&isReview=true
Perspectives of pharmaceutical stakeholders on determinants of medicines accessibility at the primary care level
Authors: Rizk Hoda Ibrahim , Elkholy Monira Mahmoud , Barakat Abeer Abdou , Elsayed Raghda Mostafa Mostafa , Abd El Fatah Shaimaa A. M. 
Published: January 2021

Abstract
Background
Equitable access to essential medicines of maintained efficacy, safety, quality, and cost-effectiveness must be ensured by a well-functioning health system. This study aims to identify the determinants of patients’ access to medicines at the primary health care (PHC) level from the perspectives of various (internal and external) stakeholders of the pharmaceutical system.

Methods
The study employed both quantitative and qualitative components. Quantitative component applied a descriptive a cross-sectional design and qualitative component applied an in-depth interview design. It was a health system research conducted at two (PHC) facilities (one urban and the other rural) in Egypt. It inquired upon political, economic, and managerial aspects of the pharmaceutical system utilizing the “Health System Assessment Approach: a How-To Manual” and the “WHO operational package for assessing, monitoring and evaluating country pharmaceutical situations.”

Results
Analysis of the quantitative data extracted from the cross-sectional component with external stakeholders (patients) revealed that about one-third of patients in both facilities were unable to pay for the medicine. Patients in both settings took less than an hour to reach the PHC facility. The Percent of patients who believe that the private pharmacies’ medicine is better than the PHC one was significantly higher in rural than urban group (24% and 10% respectively) and the percent of medicines dispensed was 50% and 66.7% in rural and urban groups respectively. Analysis of the qualitative data extracted from in-depth interviews with internal stakeholders (key informants from regulatory agencies, pharmaceutical industry, academia, pharmacists, and physicians) were summarized utilizing Strengths-Weaknesses-Opportunities-Challenges (SWOC) analysis approach. Various viewpoints toward the determinants of patients’ access to medicines were disclosed.

Conclusions
The Percent of medicines dispensed was insufficient in both rural and urban facilities. There is a need to invest in building trust in generic medicine quality in the government health facilities focusing on improving medicine availability and ensuring enough amounts of high-quality drugs. Although there are drug committees in the two studied PHC facilities for demonstrating the prescribing and dispensing policies, yet the system required to enforce these policies is still deficient.
Tail suspension is useful as a sarcopenia model in rats
Authors: Nemoto Akira , Goyagi Toru 
Published: January 2021

Abstract
Background
Sarcopenia promotes skeletal muscle atrophy and exhibits a high mortality rate. Its elucidation is of the highest clinical importance, but an animal experimental model remains controversial. In this study, we investigated a simple method for studying sarcopenia in rats.

Results
Muscle atrophy was investigated in 24-week-old, male, tail-suspended (TS), Sprague Dawley and spontaneously hypertensive rats (SHR). Age-matched SD rats were used as a control group. The skeletal muscle mass weight, muscle contraction, whole body tension (WBT), cross-sectional area (CSA), and Muscle RING finger-1 (MuRF-1) were assessed. Enzyme-linked immunosorbent assay was used to evaluate the MuRF-1 levels. Two muscles, the extensor digitorum longus and soleus muscles, were selected for representing fast and slow muscles, respectively. All data, except CSA, were analyzed by a one-way analysis of variance, whereas CSA was analyzed using the Kruskal-Wallis test.
Muscle mass weight, muscle contraction, WBT, and CSA were significantly lower in the SHR (n = 7) and TS (n = 7) groups than in the control group, whereas MuRF-1 expression was dominant.

Conclusions
TS and SHR presented sarcopenic phenotypes in terms of muscle mass, muscle contraction and CSA. TS is a useful technique for providing muscle mass atrophy and weakness in an experimental model of sarcopenia in rats.
Value of diffusion tensor imaging and tractography in unilateral lumbar disc prolapse
Authors: El Basset Ahmed Sayed Abd , Saeed Ahmed Hesham Mohamed , Tawfik Mona Hussein , El Hady Marwa Shehata Abd 
Published: January 2021

Abstract
Background
Conventional MR imaging is not enough for evaluation of symptomatic foraminal stenosis, because there is high incidence of false-positive results in asymptomatic elderly patients. Conventional MR cannot quantitatively assess the severity of the nerve lesion. DTI is a non-invasive way to effectively trace the nerve fiber bundle and quantitatively evaluate the nerve injury. DTI with fiber tracking may describe abnormalities beyond the resolution of conventional MR techniques. The aim of this work was to compare between the mean values of diffusion parameters such as fractional anisotropy and apparent diffusion coefficient of the compressed lumbar spinal nerve roots and of the contralateral normal nerve roots. Correlate these parameters with the severity of neurological symptoms. This is a prospective study that was conducted on 50 patients with symptomatic unilateral posterolateral lumbar disc prolapse at a university hospital. They were investigated with diffusion tensor imaging with tractography on a 1.5-T MR. The changes in the mean fractional anisotropy and apparent diffusion coefficient values of the compressed nerves and the relationship between these changes and the severity of the neurological side effects using Japanese Orthopedic Association score and visual analogue scale were investigated.

Results
The mean fractional anisotropy values were significantly lower (p ≤ 0.001), and mean apparent diffusion coefficient values were significantly higher (p ≤ 0.001) in compressed nerves than in contralateral intact nerves. There were strong correlations between the DTI parameters and the severity of the neurological symptoms as assessed using the Japanese Orthopedic Association score and the visual analogue scale.

Conclusion
In patients with lumbar disc prolapse, radicular diffusion parameters are affected in the compressed roots in comparison to the healthy roots and this affection is correlated with the degree of prolapse and with the severity of neurological symptoms. DTI with fiber tracking provide clinically relevant information and describe abnormalities beyond the resolution of conventional MR techniques.
Early Outcomes of a National Cancer Center's Strategy Against COVID-19 Executed Through a Disease Outbreak Response Taskforce
Authors: Kwek Jin Wei , Chan Jack J. , Kanesvaran Ravindran , Wang Michael L. C. , Neo Patricia S. H. , Chia Claramae S. , Tham Chee Kian , Chew Lita S. T. , Tan Hiang Khoon , Yap Swee Peng , Dent Rebecca A. , Hwang William Y. K. , Lim Soon Thye 
Published: January 2021

PURPOSE:We present the strategy of a comprehensive cancer center organized to make operations pandemic proof and achieve continuity of cancer care during the COVID-19 pandemic.METHODS:Disease Outbreak Response (DORS) measures implemented at our center and its satellite clinics included strict infection prevention, manpower preservation, prudent resource allocation, and adaptation of standard-of-care treatments. Critical day-to-day clinical operations, number of persons screened before entry, staff temperature monitoring, and personal protection equipment stockpile were reviewed as a dashboard at daily DORS taskforce huddles. Polymerase chain reaction swab tests performed for patients and staff who met defined criteria for testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were tracked. Descriptive statistics of outpatient attendances and treatment caseloads from February 3 to May 23, 2020, were compared with the corresponding period in 2019.RESULTS:We performed COVID-19 swabs for 80 patients and 93 staff, detecting three cancer patients with community-acquired COVID-19 infections with no nosocomial transmission. Patients who required chemotherapy, radiotherapy, or surgery and patients who are on maintenance treatment continued to receive timely treatment without disruption. The number of intravenous chemotherapy treatments was maintained at 97.8% compared with 2019, whereas that of weekly radiotherapy treatments remained stable since December 2019. All cancer-related surgeries proceeded without delay, with a 0.3% increase in workload. Surveillance follow-ups were conducted via teleconsultation, accounting for a 30.7% decrease in total face-to-face clinic consultations.CONCLUSION:Through the coordinated efforts of a DORS taskforce, it is possible to avoid nosocomial SARS-CoV-2 transmissions among patients and staff without compromising on care delivery at a national cancer center.
Do It Often, Do It Better: Association Between Pairs of Experienced Subspecialty Anesthesia Caregivers and Postoperative Outcomes. A Retrospective Observational Study
Authors: Saager Leif , Ruetzler Kurt , Turan Alparslan , Maheshwari Kamal , Cohen Barak , You Jing , Mascha Edward J. , Qiu Yuwei , Ince Ilker , Sessler Daniel I. 
Published: January 2021

BACKGROUND:
Anesthesiologists typically care for patients having a broad range of procedures. Outcomes might be improved when care is provided by caregivers experienced in particular types of surgery. We tested the hypothesis that intraoperative care provided by pairs of anesthesia caregivers having significant experience with a particular type of surgery reduces a composite of in-hospital death and 6 serious complications, including bleeding, cardiac, gastrointestinal, infectious, respiratory, and urinary complications, compared to care provided by pairs of anesthesia caregivers with less experience.

METHODS:
We included patients having surgery lasting at least 30 minutes. Using cluster analysis, attending anesthesiologists, and Certified Registered Nurse Anesthetists (CRNAs) were identified as experienced or inexperienced caregivers for each type of surgery at the case level. We then compared surgeries for which anesthesia was provided by a pair of experienced caregivers versus a pair of inexperienced caregivers on our composite outcome. We estimated the average relative effect (ie, the exponentiated average log odds ratio) of receiving anesthesia from an experienced versus inexperienced caregiver pair across the 7 components of the composite outcome using a generalized estimating equation (GEE) model to adjust for between-component correlation and with inverse propensity score weighing to adjust for potential confounding from a host of variables.

RESULTS:
A total of 8968 patients who received anesthesia care by an experienced pair were compared with 25,361 patients who received care from an inexperienced pair, adjusting for potential confounding. The incidence of composite complications (ie, any component event) was 7.6% (677/8968) for experienced pairs and 12% (2976/25,361) for inexperienced pairs (P < .001). Care by experienced pairs of caregivers was associated with lower odds of the composite outcome with an estimated average relative effect odds ratio across the individual components of 0.61 (95% confidence interval [CI], 0.54-0.71), P < .001. Among the 7 components of the primary outcome, experienced pairs of providers had significantly lower estimated odds of bleeding, infection, and mortality.

CONCLUSIONS:
Anesthesia care by experienced pairs was associated with fewer bleeding complications, fewer infections, shorter hospitalization, and reduced in-hospital mortality.
The use of virtual reality simulation to facilitate surgical ward-based learning in medical students during the COVID-19 Pandemic
Authors: Carty Isabelle , Shah Rupali 
Published: January 2021

doi: https://doi.org/10.12669/pjms.37.2.4118
How to cite this: Carty I, Shah R. The use of virtual reality simulation to facilitate surgical ward-based learning in medical students during the COVID-19 Pandemic. Pak J Med Sci. 2021;37(2):609. doi: https://doi.org/10.12669/pjms.37.2.4118
Exclusive human milk diet for very preterm babies in England: protocol for a cost-effectiveness and budget impact analysis
Authors: Sampson Chris , Zhang Kyann , Parkin David , Hampson Grace 
Published: January 2021

Introduction: Babies born before 30 weeks’ gestation are at increased risk of major clinical complications and have greater nutritional requirements. Where nutritional requirements cannot be sufficiently provided for by the mother’s own milk (MOM), routine care in England uses cow milk-derived fortifiers and formulas. However, the use of cow milk in the diets of preterm babies has been associated with adverse health outcomes. Clinical trials have shown that an exclusive human milk diet (EHMD) – where MOM is supplemented by donor human milk-derived formulas and fortifiers – has the potential to be clinically beneficial and reduce the risk of complications. Objectives: This study has two key objectives: 1) estimate the cost-effectiveness of an EHMD for babies born before 30 weeks’ gestation, relative to routine care; 2) estimate the budget impact of adopting EHMDs in practice in England. Methods: The analysis will use a modelling approach based on the most relevant data available. The population will consist of babies born in England before 30 weeks’ gestation. Babies in the intervention arm will be simulated to represent outcomes associated with babies fed an EHMD, and those in the comparator arm to receive routine care. Model parameters will be drawn from three sources: i) a recently completed randomised clinical trial, ii) the National Neonatal Research Database, and iii) published literature. The model will adopt a time horizon of two years following initial admission to a neonatal unit. The primary outcome for the cost-effectiveness analysis will be the incremental cost per life-year gained (if observed) associated with the intervention, relative to the comparator. We will also present disaggregated outcomes in a cost-consequence analysis. The primary outcome for the budget impact analysis will be the total cost associated with EHMD compared with current practice from the perspective of the English National Health Service (NHS).
Insulin Receptors and Intracellular Ca2+ Form a Double-Negative Regulatory Feedback Loop Controlling Insulin Sensitivity
Authors: Pomytkin Igor , Pinelis Vsevolod 
Published: January 2021

Since the discovery of insulin and insulin receptors (IR) in the brain in 1978, numerous studies have revealed a fundamental role of IR in the central nervous system and its implication in regulating synaptic plasticity, long-term potentiation and depression, neuroprotection, learning and memory, and energy balance. Central insulin resistance has been found in diverse brain disorders including Alzheimer’s disease (AD). Impaired insulin signaling in AD is evident in the activation states of IR and downstream signaling molecules. This is mediated by Aβ oligomer-evoked Ca2+ influx by activating N-methyl-D-aspartate receptors (NMDARs) with Aβ oligomers directly, or indirectly through Aβ-induced release of glutamate, an endogenous NMDAR ligand. In the present opinion article, we highlight evidence that IR activity and free intracellular Ca2+ concentration [Ca2+]i form a double-negative regulatory feedback loop controlling insulin sensitivity, in which mitochondria play a key role, being involved in adenosine triphosphate (ATP) synthesis and IR activation. We found recently that the glutamate-evoked rise in [Ca2+]i inhibits activation of IR and, vice versa, insulin-induced activation of IR inhibits the glutamate-evoked rise in [Ca2+]i. In theory, such a double-negative regulatory feedback loop predicts that any condition leading to an increase of [Ca2+]i may trigger central insulin resistance and explains why central insulin resistance is implicated in the pathogenesis of AD, with which glutamate excitotoxicity is a comorbid condition. This model also predicts that any intervention aiming to maintain low [Ca2+]i may be useful for treating central insulin resistance.
Identification and Estimation of Endogenous Peer Effects Using Partial Network Data from Multiple Reference Groups
Authors: Reza Sadat , Manchanda Puneet , Chong Juin-Kuan 
Published: January 2021

There has been a considerable amount of interest in the empirical investigation of social influence in the marketing and economics literature in the last decade or so. Among the many different empirical models applied for such investigations, the most common class of model is the linear-in-means model. These models can be used to examine whether social influence is truly a result of agents affecting each other through their choices simultaneously (endogenous effect) or of having similar taste and characteristics (homophily). However, the two effects are not separately identified in general in the standard linear-in-means model unless data on all members of an individual’s network are available. With data on a sample of individuals from a network, these effects are not identified. In this research, we leverage a very natural aspect of social settings, namely that consumers are usually part of multiple—as opposed to single—networks. We discuss the sufficient conditions for identification when the standard linear-in-means model is extended to allow for multiple sources of social influence. We also show how the additional variation generated by more than one source of social influence actually allows estimation of endogenous effects with sample data. We demonstrate the feasibility of our approach via simulation and on the National Longitudinal Study on Adolescent Health data, which has been used in a number of studies examining social influence. Our approach is, therefore, likely to be useful in typical marketing settings. This paper was accepted by Matthew Shum, marketing.
Structured laser beams: toward 2-μm femtosecond laser vortices
Authors: Zhao Yongguang , Wang Li , Chen Weidong , Loiko Pavel , Mateos Xavier , Xu Xiaodong , Liu Ying , Shen Deyuan , Wang Zhengping , Xu Xinguang , Griebner Uwe , Petrov Valentin 
Published: January 2021

Structured ultrashort-pulse laser beams, and in particular eigenmodes of the paraxial Helmholtz equation, are currently extensively studied for novel potential applications in various fields, e.g., laser plasma acceleration, attosecond science, and fine micromachining. To extend these prospects further, in the present work we push forward the advancement of such femtosecond structured laser sources into the 2-μm spectral region. Ultrashort-pulse Hermite– and Laguerre–Gaussian laser modes both with a pulse duration around 100 fs are successfully produced from a compact solid-state laser in combination with a simple single-cylindrical-lens converter. The negligible beam astigmatism, the broad optical spectra, and the almost chirp-free pulses emphasize the high reliability of this laser source. This work, as a proof of principle study, paves the way toward few-cycle pulse generation of optical vortices at 2 μm. The presented light source can enable new research in the fields of interaction with organic materials, next generation optical detection, and optical vortex infrared supercontinuum.
Comparison of pathologic outcomes of robotic and open resections for rectal cancer: A systematic review and meta-analysis
Authors: Guo Yinyin , Guo Yichen , Luo Yanxin , Song Xia , Zhao Hui , Li Laiyuan 
Published: January 2021

Objective
The application of robotic surgery for rectal cancer is increasing steadily. The purpose of this meta-analysis is to compare pathologic outcomes among patients with rectal cancer who underwent open rectal surgery (ORS) versus robotic rectal surgery (RRS).

Methods
We systematically searched the literature of EMBASE, PubMed, the Cochrane Library of randomized controlled trials (RCTs) and nonrandomized controlled trials (nRCTs) comparing ORS with RRS.

Results
Fourteen nRCTs, including 2711 patients met the predetermined inclusion criteria and were included in the meta-analysis. Circumferential resection margin (CRM) positivity (OR: 0.58, 95% CI, 0.29 to 1.16, P = 0.13), number of harvested lymph nodes (WMD: −0.31, 95% CI, −2.16 to 1.53, P = 0.74), complete total mesorectal excision (TME) rates (OR: 0.93, 95% CI, 0.48 to 1.78, P = 0.83) and the length of distal resection margins (DRM) (WMD: −0.01, 95% CI, −0.26 to 0.25, P = 0.96) did not differ significantly between the RRS and ORS groups.

Conclusion
Based on the current evidence, robotic resection for rectal cancer provided equivalent pathological outcomes to ORS in terms of CRM positivity, number of harvested lymph nodes and complete TME rates and DRM.