bluuebunny/crossref_metadata_2025_split huggingface dataset:
Colon cancer survival differs from right side to left side and lymph node harvest number matter
Authors: Mangone Lucia , Pinto Carmine , Mancuso Pamela , Ottone Marta , Bisceglia Isabella , Chiaranda Giorgio , Michiara Maria , Vicentini Massimo , Carrozzi Giuliano , Ferretti Stefano , Falcini Fabio , Hassan Cesare , Rossi Paolo Giorgi 
Published: May 2021

Abstract
Background
Right-sided colorectal cancer (CRC) has worse survival than does left-sided CRC. The objective of this study was to further assess the impact of right-side location on survival and the role of the extent of lymphadenectomy.

Methods
All CRCs diagnosed between 2000 and 2012 in Emilia-Romagna Region, Italy, were included. Data for stage, grade, histology, screening history, and number of removed lymph nodes (LN) were collected. Multivariable Cox regression models were used to estimate hazard ratios (HR), with relative 95% confidence intervals (95%CI), of right vs. left colon and of removing < 12, 12–21 or > 21 lymph nodes by cancer site.

Results
During the study period, 29,358 patients were registered (8828 right colon, 18,852 left colon, 1678 transverse). Patients with right cancer were more often older, females, with advanced stage and high grade, and higher number of removed LNs. Five-year survival was lower in the right than in the left colon (55.2% vs 59.7%). In multivariable analysis, right colon showed a lower survival when adjusting for age, sex, and screening status (HR 1.12, 95%CI 1.04–1.21). Stratification by number of lymph nodes removed (12–21 or > 21) was associated with better survival in right colon (HR 0.54, 95%CI 0.40–0.72 and HR 0.40, 95%CI 0.30–0.55, respectively) compared to left colon (HR 0.89, 95%CI 0.76–1.06 and HR 0.83, 95%CI 0.69–1.01, respectively).

Conclusions
This study confirms that right CRC has worse survival; the association is not due to screening status. An adequate removal of lymph nodes is associated with better survival, although the direction of the association in terms of causal links is not clear.
Lived experiences of people living with HIV: a descriptive qualitative analysis of their perceptions of themselves, their social spheres, healthcare professionals and the challenges they face daily
Authors: Senyurek Gamze , Kavas Mustafa Volkan , Ulman Yesim Isil 
Published: May 2021

Abstract
Background
Human immunodeficiency virus (HIV) infection rates have been gradually increasing in Istanbul, Turkey. Many people living with HIV (PLWH) here encounter difficulties, for example, in adapting to the chronic disease and obtaining continuous access to healthcare services. In this study, we aimed to explore the challenges PLWH face in their daily lives and understand their perceptions of themselves, healthcare professionals and services, and their social spheres via their expressed lived experiences in the healthcare setting.

Method
Individual semi-structured in-depth interviews were conducted face-to-face with 20 PLWH in Istanbul. All the interviews were voice-recorded and transcribed verbatim except one, upon participant request, for which the interviewer took notes. These logs and the interviewer’s notes were analyzed thematically using the inductive content analysis method.

Results
The themes concerned experiences in three distinct contexts: 1) Interactions with healthcare providers; 2) Participants’ responses to their HIV diagnosis; and 3) Interactions with their social networks. Firstly, the results highlighted that the participants perceived that healthcare professionals did not inform them about the diagnosis properly, failed to protect patients’ confidentiality and exhibited discriminative behaviors towards them. Secondly, after the diagnosis the participants had difficulty in coping with their unsettled emotional state. While many ceased sexual activities and isolated themselves, some sought support. Lastly, living with HIV affected their relationships with their families and friends either positively or negatively. Moreover, they had to face the difficulties concerning spouse/partner notification issues about which many needed professional support.

Conclusion
Healthcare professionals’ discriminative or inappropriate attitudes and customs in healthcare institutions are perceived to impair PLWH’s utilization of healthcare services. Structural factors such as social pressure, societal ignorance about HIV, limited access to HIV prevention, and regulatory barriers might contribute to these challenges. The results suggest that it is necessary to raise healthcare professionals’ and society’s awareness about HIV and develop national policies to establish a well-functioning referral system and appropriate spouse/partner notification services.
Effects of the surface charge of polyamidoamine dendrimers on cellular exocytosis and the exocytosis mechanism in multidrug-resistant breast cancer cells
Authors: Zhang Jie , Li Mingjuan , Wang Mingyue , Xu Hang , Wang Zhuoxiang , Li Yue , Ding Baoyue , Gao Jianqing 
Published: May 2021

Abstract
Background
Polyamidoamine (PAMAM) dendrimer applications have extended from tumor cells to multidrug-resistant tumor cells. However, their transportation in multidrug-resistant tumor cells remains unclear. Herein, we investigated the exocytosis rule and mechanism of PAMAM dendrimers in multidrug-resistant tumor cells.

Results
Using a multidrug-resistant human breast cancer cell model (MCF-7/ADR), we performed systematic analyses of the cellular exocytosis dynamics, pathways and mechanisms of three PAMAM dendrimers with different surface charges: positively charged PAMAM-NH2, neutral PAMAM-OH and negatively charged PAMAM-COOH. The experimental data indicated that in MCF-7/ADR cells, the exocytosis rate was the highest for PAMAM-NH2 and the lowest for PAMAM-OH. Three intracellular transportation processes and P-glycoprotein (P-gp) participated in PAMAM-NH2 exocytosis in MCF-7/ADR cells. Two intracellular transportation processes, P-gp and multidrug resistance (MDR)-associated protein participated in PAMAM-COOH exocytosis. P-gp and MDR-associated protein participated in PAMAM-OH exocytosis. Intracellular transportation processes, rather than P-gp and MDR-associated protein, played major roles in PAMAM dendrimer exocytosis. PAMAM-NH2 could enter MCF-7/ADR cells by forming nanoscale membrane holes, but this portion of PAMAM-NH2 was eliminated by P-gp. Compared with PAMAM-OH and PAMAM-COOH, positively charged PAMAM-NH2 was preferentially attracted to the mitochondria and cell nuclei. Major vault protein (MVP) promoted exocytosis of PAMAM-NH2 from the nucleus but had no effect on the exocytosis of PAMAM-OH or PAMAM-COOH.

Conclusions
Positive charges on the surface of PAMAM dendrimer promote its exocytosis in MCF-7/ADR cells. Three intracellular transportation processes, attraction to the mitochondria and cell nucleus, as well as nuclear efflux generated by MVP led to the highest exocytosis observed for PAMAM-NH2. Our findings provide theoretical guidance to design a surface-charged tumor-targeting drug delivery system with highly efficient transfection in multidrug-resistant tumor cells. Especially, to provide more DNA to the nucleus and enhance DNA transfection efficiency in multidrug-resistant tumor cells using PAMAM-NH2, siRNA-MVP or an inhibitor should be codelivered to decrease MVP-mediated nuclear efflux.

Graphical abstract
Reliability of generic quality-of-life instruments in assessing health-related quality of life among children and adolescents with idiopathic nephrotic syndrome: a systematic review
Authors: Aronu Ann E. , Uwaezuoke Samuel N. , Muoneke Uzoamaka V. 
Published: May 2021

AbstractIntroductionMost of the studies reporting the negative impact of idiopathic nephrotic syndrome on health-related quality of life in children and adolescents were conducted with generic quality-of-life instruments rather than disease-specific instruments. The consistency of these studies' findings using these generic instruments is not well established.AimThis systematic review aims to determine the reliability of current generic quality-of-life instruments in assessing health-related quality of life among children and adolescents with idiopathic nephrotic syndrome.MethodsWe searched the PubMed, MEDLINE, EMBASE, and Google Scholar databases for articles published between 2000 and 2020, using appropriate descriptors. We included primary studies that met the eligibility criteria, independently screened their titles and abstracts, and removed all duplicates during the study-selection process. We resolved disagreements until a consensus was reached on study selection. We independently retrieved relevant data, including the generic quality-of-life instruments and the subjects’ and controls’ aggregate health-related quality of life scores, using a preconceived data-extraction form.ResultsTen original articles were selected for qualitative and quantitative analyses. Some of the studies reported the following significant findings. The mean health-related quality of life scores for children with prevalent and incident nephrotic syndrome were 68.6 (range, 52.6–84.6) and 73.7 (range, 55.9–91.5), respectively. Children with idiopathic nephrotic syndrome and their controls with other chronic diseases had median scores of 65 (interquartile range, 59–68.75) and 62.2 (interquartile range, 58.05–65.78). Patients on oral immunosuppressive drug and intravenous rituximab reportedly had median scores of 76.2 and 72.6 and mean scores of 71.4 (range, 55.4–87.4) and 61.6 (range, 42.1–81.1) respectively for quality-of-life assessment on the ‘school functioning domain.’ConclusionsThe health-related quality of life scores in patients with idiopathic nephrotic syndrome are consistently low. Lower scores occur in prolonged disease duration and severe clinical phenotypes, whereas the scores are higher than the scores obtained in other chronic diseases. These consistent findings underscore the reliability of the current generic instruments in assessing health-related quality of life in patients with idiopathic nephrotic syndrome.
Migrant physicians’ choice of employment and the medical specialty general practice: a mixed-methods study
Authors: Sturesson Linda , Palmgren Per J. , Öhlander Magnus , Nilsson Gunnar H. , Stenfors Terese 
Published: May 2021

Abstract
Objective
In many countries, migrant physicians (MP) tend to fill staff shortages in medical specialties perceived as low status. The aim of this study was to explore aspects that influence MPs’, with a medical degree from outside EU/EEA, choice of employment and medical specialty in Sweden, and to explore and understand a potential over-representation in general practice (family medicine), a specialty suffering from staff shortages in Sweden.

Methods
A mixed-methods approach was applied. This included questionnaire data from 101 MPs training and working as medical specialists in Sweden and semi-structured interview data from four MPs specializing in general practice.

Results
Regardless of specialty, the most influential aspects when choosing employment were the ability to combine work with family, to develop one´s competence, and to have highly competent colleagues. Women scored higher on some aspects related to private life and the surroundings. More than half (55%) of the respondents specialized in general practice, and more women than men. The MPs in general practice scored higher on the aspect ‘ability to have the same patients for a longer period’ than MPs specializing in other specialties. No significant difference between MP general practitioner respondents and MPs in other medical specialties was found in relation to the item ‘Was the specialty your first choice?ʼ. Aspects identified in the interviews that influenced the choice to specialize in general practice related to job opportunities, positive experiences of primary health care, working conditions, and family conditions.

Conclusion
Labour market conditions such as high competition, and the time-consuming recertification process, can influence the choice to specialize in general practice as this reduces the time to become a medical specialist. We however did not find any results indicating that MPs’ decision to specialize in general practice and to work as general practitioners was any less voluntary than that of MPs who chose other specialties.
Barriers and facilitators to online medical and nursing education during the COVID-19 pandemic: perspectives from international students from low- and middle-income countries and their teaching staff
Authors: Li Wen , Gillies Robyn , He Mingyu , Wu Changhao , Liu Shenjun , Gong Zheng , Sun Hong 
Published: May 2021

Abstract
Background
The COVID-19 pandemic posed a huge challenge to the education systems worldwide, forcing many countries to provisionally close educational institutions and deliver courses fully online. The aim of this study was to explore the quality of the online education in China for international medical and nursing students from low- and middle-income countries (LMICs) as well as the factors that influenced their satisfaction with online education during the COVID-19 pandemic.

Methods
Questionnaires were developed and administered to 316 international medical and nursing students and 120 teachers at a university in China. The Chi-square test was used to detect the influence of participants’ personal characteristics on their satisfaction with online education. The Kruskal–Wallis rank-sum test was employed to identify the negative and positive factors influencing the online education satisfaction. A binary logistic regression model was performed for multiple-factor analysis to determine the association of the different categories of influential factors—crisis-, learner-, instructor-, and course-related categories, with the online education satisfaction.

Results
Overall, 230 students (response rate 72.8%) and 95 teachers (response rate 79.2%) completed the survey. It was found that 36.5% of students and 61.1% of teachers were satisfied with the online education. Teachers’ professional title, students’ year of study, continent of origin and location of current residence significantly influenced the online education satisfaction. The most influential barrier for students was the severity of the COVID-19 situation and for teachers it was the sense of distance. The most influential facilitating factor for students was a well-accomplished course assignment and for teachers it was the successful administration of the online courses.

Conclusions
Several key factors have been identified that affected the attitudes of international health science students from LMICs and their teachers towards online education in China during the COVID-19 pandemic. To improve the online education outcome, medical schools are advised to promote the facilitating factors and cope with the barriers, by providing support for students and teaching faculties to deal with the anxiety caused by the pandemic, caring for the state of mind of in-China students away from home, maintaining the engagement of out-China students studying from afar and enhancing collaborations with overseas institutions to create practice opportunities at students’ local places.
Age, gender, height and weight in relation to joint cartilage thickness among school-aged children from ultrasonographic measurement
Authors: Gau Chun-Chun , Yao Tsung-Chieh , Gan Shu-Ting , Lin Syh-Jae , Yeh Kuo-Wei , Chen Li-Chen , Ou Liang- Shiou , Lee Wen-I , Wu Chao-Yi , Huang Jing-Long 
Published: May 2021

Abstract
Background
Among school-age children, the decrease of cartilage thickness (Cth) with increasing age is well known. However, the influence of body mass index (BMI), height or weight on Cth has not been revealed. Here in, we aim to establish an age- and gender-specific Cth standard reference among Asians and investigate the possible prestige of BMI, height and weight.

Methods
A cross-sectional study was performed in healthy Asian children. Bilateral knees, ankles, wrists, second metacarpophalangeals (MCPs) and proximal interphalangeals (PIPs) were measured using ultrasound. The children’s height, weight and BMI were also recorded for later adjustment.

Results
A total of 200 school age Asian children (including 86 girls and 114 boys, aged between 5 to 13 years-old) were investigated. Cth differences were observed in the knees, ankles, wrists, MCPs and PIPs between sexes (p < 0.05), with girls having thinner cartilage thickness. While Cth decreases with increasing age (p < 0.0001, 0.039, 0.001, 0.023, 0.091 in girls’ knees, ankles, wrists, MCPs and PIPs and p = 0.002, 0.001, < 0.0001, 0.001, 0.045 in boys’, respectively). Our data showed that weight, height and BMI are not the main factors contributing to Cth. A formula to calculate gender-specific cartilage thickness for Asian school age children is suggested. There was no difference in Cth after adjusting for height or weight between Asian or Caucasian group.

Conclusions
A formula to calculate gender-specific cartilage thickness for Asian school age children is suggested. Height, weight and BMI were not the major contributor for Cth among school age children.
A bibliometric review of oncolytic virus research as a novel approach for cancer therapy
Authors: Mozaffari Nejad Amir Sasan , Noor Tehjeeb , Munim Ziaul Haque , Alikhani Mohammad Yousef , Ghaemi Amir 
Published: May 2021

Abstract
Background
In recent years, oncolytic viruses (OVs) have drawn attention as a novel therapy to various types of cancers, both in clinical and preclinical cancer studies all around the world. Consequently, researchers have been actively working on enhancing cancer therapy since the early twentieth century. This study presents a systematic review of the literature on OVs, discusses underlying research clusters and, presents future directions of OVs research.

Methods
A total of 1626 published articles related to OVs as cancer therapy were obtained from the Web of Science (WoS) database published between January 2000 and March 2020. Various aspects of OVs research, including the countries/territories, institutions, journals, authors, citations, research areas, and content analysis to find trending and emerging topics, were analysed using the bibliometrix package in the R-software.

Results
In terms of the number of publications, the USA based researchers were the most productive (n = 611) followed by Chinese (n = 197), and Canadian (n = 153) researchers. The Molecular Therapy journal ranked first both in terms of the number of publications (n = 133) and local citations (n = 1384). The most prominent institution was Mayo Clinic from the USA (n = 117) followed by the University of Ottawa from Canada (n = 72), and the University of Helsinki from Finland (n = 63). The most impactful author was Bell J.C with the highest number of articles (n = 67) and total local citations (n = 885). The most impactful article was published in the Cell journal. In addition, the latest OVs research mainly builds on four research clusters.

Conclusion
The domain of OVs research has increased at a rapid rate from 2000 to 2020. Based on the synthesis of reviewed studies, adenovirus, herpes simplex virus, reovirus, and Newcastle disease virus have shown potent anti-cancer activity. Developed countries such as the USA, Canada, the UK, and Finland were the most productive, hence, contributed most to this field. Further collaboration will help improve the clinical research translation of this therapy and bring benefits to cancer patients worldwide.
Patient-specific instrumentation combined with a new tool for gap balancing is useful in total knee replacement: a 3-year follow-up of a retrospective study
Authors: Deng Ting , Liu Tangyou , Lei Qing , Cai Lihong , Chen Song 
Published: May 2021

Abstract
Objective
The purpose of this study was to determine whether the gap-balancing technique with patient-specific instrumentation (PSI) and a new balancing device in total knee arthroplasty (TKA) can improve knee function to a greater extent than can the measured resection technique.

Materials and methods
Data from 150 patients who underwent TKA from August 2014 to June 2016 were studied retrospectively. The gap-balancing technique assisted by PSI and the new balancing device was used in 80 patients (82 knees), and the measured resection technique was used in 70 patients (70 knees). The surgical, imaging, and knee function data were compared.

Results
The gap-balancing technique assisted by PSI and the new balancing device was found to be feasible in all operated knees and reliable. In total, 150 patients (152 knees) of ages ranging from 52 to 78 years (mean 67 years) underwent TKA during the study period. The follow-up period ranged from 35 to 52 months (mean 45 months). Only one patient, who was included in the gap-balancing group, underwent a revision surgery at 2 years postoperatively due to infection. There were no differences in the incidence of anterior knee pain between the two groups. The mean flexion angle, KSS scores, and VAS scores did not significantly differ between the measured resection group and gap-balancing group at 12 weeks or 36 weeks postoperatively. The average joint line displacement was 1.3 ± 1.1 mm (range 0–3) proximally in the GB (gap-balancing) group and 1.2 ± 1.4 mm in the MR (measured-resection) group. No outliers >5 mm in either group were recorded. The mean leg axis deviation from the neutral mechanical axis was 1.8°±1.5° varus (range 0°–3°varus) versus the neutral mechanical axis in the GB group and 1.4°±1.2°(range 0°–3°)in the MR group. No outliers with >3° deviation in either group were recorded.

Conclusions
The gap-balancing technique performed with the new balancing device and PSI can yield accurate femoral component alignment as well as outcomes similar to those of measured resection at 3 years. The new balancing device can be taken into consideration by surgeons who prefer performing the gap-balancing technique with PSI.
Neonatal screening and genotype-phenotype correlation of hyperphenylalaninemia in the Chinese population
Authors: Wang Xin , Wang Yanyun , Ma Dingyuan , Zhang Zhilei , Li Yahong , Yang Peiying , Sun Yun , Jiang Tao 
Published: May 2021

Abstract
Background
Hyperphenylalaninemia (HPA) is the most common amino acid metabolic disease involving phenylalanine hydroxylase (PAH, OMIM*612,349) deficiency or coenzyme tetrahydrobiopterin (BH4) deficiency. Patients with severe HPA often have a difficult life. Early diagnosis of HPA before the development of symptoms is possible via neonatal screening, facilitating appropriate treatment and reducing mortality and disability rates. This study revealed the prevalence, mutational and phenotypic spectrum, and prognosis of HPA by neonatal screening from January 2001 to September 2020 in Nanjing, Jiangsu Province, China.

Methods
Through a retrospective analysis of the information available in the neonatal screening database, the clinical presentations, laboratory data, molecular characteristics and treatment follow-up data of HPA patients detected by neonatal screening were evaluated.

Results
We diagnosed 181 patients with HPA from 1 to 957 newborns, giving an incidence of 1:6873. Among these patients, 177 were identified as PAH deficient and four patients were BH4 deficient. The average current age of the patients was 6.38 years old. The most common mutations of PAH were c.728 C > A/ p.Arg243Gln (13.83 %), c.158G > A/ p.Arg53His (9.57 %), c.611 A > G/ p.Tyr204Cys (7.44 %), and c.721 C > T/ p.Arg241Cys (6.38 %).

Conclusions
This study revealed the prevalence, phenotype-genotype, and prognosis of HPA in China and contributes to the updating of PAHD data for China and worldwide. Our study not only expanded the spectrum of phenotypes and genotype but also provided a valuable tool for improved genetic counseling and management of future cases.