bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Appropriateness for Empirical Antibiotics in Patients with Sepsis in the Emergency Department
Authors: Puntawang Panithan , Chenthanakij Boriboon , Tangsuwanaruk Theerapon , Laohakul Pavita , Phinyo Phichayut , Wittayachamnankul Borwon 
Published: February 2021

Abstract
BackgroundSepsis drives a worldwide impact on the health care system. The primary problem in treating sepsis is the emergence of multi-drug resistant microbials caused by the improper use of antibiotics. The mortality associated with the improper use of empirical antibiotics consequently adds a burden on the health care system.ObjectivesTo investigate the clinical impact of appropriate empirical antibiotics in sepsis patients who visited the emergency department.MethodsA retrospective cohort study was performed on sepsis patients receiving empirical antibiotics in the emergency department. The patients were grouped by laboratory culture results and appropriate use of empirical antibiotics. The impact of empirical antibiotic use such as 30-day mortality, length of hospital stays, length of ICU stays, cost of admission, were analyzed and survival analysis was assessed.ResultsAppropriate empirical antibiotic use in culture-negative sepsis groups significantly decreased 30-day mortality (Risk ratio (RR) = 0.26, 95% confidence interval (CI) = 0.15, 0.46, P < 0.01). While appropriate empirical antibiotic use in culture-positive sepsis groups did not significantly decrease mortality (RR 0.88; 95% CI 0.74, 1.05, P=0.08). The length of hospital stays for inappropriate use of empirical antibiotic culture-negative groups were significantly longer, but not significant in the culture-positive group. The length of ICU stays and cost of admission in both groups were not found to be statistically significant.ConclusionsAppropriate use of empirical antibiotics in patients with sepsis in culture-negative groups can significantly decrease the 30-day mortality. But in a culture-positive group, the appropriate use of an empirical antibiotic cannot significantly decrease mortality.
Metformin as a New Perspective in the Medical Management of Breast Fibroadenoma; A Randomized Clinical Trial Study
Authors: Alipour Sadaf , Abedi Mahboubeh , Saberi Azin , Maleki-Hajiagha Arezoo , Faiz Firoozeh , Shahsavari Saeed , Eslami Bita 
Published: February 2021

Abstract
Background: Fibroadenoma (FA) is the most common benign solid breast mass in women with no definite method of management. Because fibroadenoma is dependent on female sex hormones, we investigated the effects of metformin, a safe hypoglycemic agent with anti-estrogenic and anti-proliferative properties, in the management of fibroadenoma. Methods: In this randomized clinical trial study, eligible women with fibroadenomas were assigned randomly to the metformin (1000 mg daily), or the placebo group. Breast physical and ultrasound exam was performed before and after the intervention, and the changes in the size of fibroadenomas were compared in the two groups. Results: Overall, 83 patients in the treatment, and 92 in the placebo group completed the study. The mean age of participants was 39.65±10.30 years. The amount of reduction in the size of FA was two-fold in the treatment than placebo group. We categorized size changes of FAs into < 20% enlargement (success) and ≥ 20% enlargement (failure). The odds ratio (OR) for success was 1.48 (95% CI=1.10-1.99) in the treatment group in comparison with the placebo group; and the odds for success was higher in women with multiples fibroadenomas (OR=4.67, 95% CI: 1.34-16.28). Also, the rate of disappearance of fibroadenomas in the treatment group was two-fold higher than the placebo group, although the difference was not statistically significant. Conclusion: This is the first study that evaluates the effect of MF on the management of fibroadenoma, and the results suggest a favorable effect. Larger studies including only large lesions and using higher doses of metformin are suggested to confirm these results.Trial Registration: This trial (IRCT20100706004329N7) was retrospectively registered on 2018-10-07.
Southern Ocean surface pressure and winds during the 20th century from proxy-data assimilation
Authors: O'Connor Gemma , Steig Eric , Hakim Gregory 
Published: February 2021

Abstract
Winds and pressure over the Southern Ocean are critical to many aspects of the climate system, including ocean circulation and carbon uptake, sea ice extent, and the mass balance of Antarctica. However, reliable climate data around Antarctica begin only in 1979. Here, we reconstruct sea level pressure and zonal surface wind anomalies over the Southern Ocean through the 20th century, using data assimilation with a global database of paleoclimate proxy records. There is very good agreement between the reconstructions and satellite-based reanalysis products both at the large scale and in the smaller Amundsen Sea, a key region of West Antarctica where rapid glacier retreat has occurred in recent decades. The reconstructions show insignificant trends in the zonal-average circumpolar westerlies, but a significant strengthening in mid-latitude Pacific westerlies, associated with a deepening of the Amundsen Sea Low, beginning well before the satellite era. The mean zonal-wind trend along the continental shelf break in the Amundsen Sea is easterly through the 20th century, contrasting with previous results that have suggested that glacier change in this region can be attributed to strengthening westerlies. Our reconstructions underscore the value of using paleoclimate data assimilation methods in assessing historical changes in Southern Hemisphere climate and suggest that zonally asymmetric features of atmospheric circulation may be key for understanding high-latitude climate and associated ice-sheet changes.
Experiences of Social Stigma Among Patients Tested Positive for COVID-19 and Their Family Members: A Qualitative Study
Authors: Chew Chii Chii , Lim Xin Jie , Chang Chee Tao , Rajan Philip , Nasir Nordin , Low Wah Yun 
Published: February 2021

Abstract
Background: Social stigma against persons infected with COVID-19 is not uncommon. This qualitative study aimed to explore the experience of social stigma among COVID-19 positive patients and their family members. This cross-sectional study was conducted between April to June 2020 in Malaysia. Patients recovered from COVID-19 for at least one month and their family members who were tested with negative results, Malaysian and aged 18-65 years old were purposively sampled. Cold call method was employed to recruit patients while their family members were recruited by their recommendations. Telephone interviews were conducted with the participants after obtaining their verbal consent.Results: Three themes emerged from the interviews: (Ι) experience of stigmatization, (ΙΙ) perspective on disease disclosure, and (ΙΙΙ) suggestion of coping and reducing stigma. The participants expressed their experiences of being isolated, labelled, stereotyped and blamed by the people surrounding them including the health care providers, neighbours, and staff at the service counters. Some respondents expressed their willingness to share their experience with others as a mean to stop the chain of virus transmission and while some of them chose to disclose the encountered history for official purpose because of fear and lack of understanding among the public. As suggested by the respondents, the approaches in addressing social stigma required the involvement of the government, the public, health care provider, and religious leader. Conclusion: Individuals recovered from COVID-19 and their families underwent experience of social stigma. Fear and lack of public understanding of the COVID-19 disease were the key factors for non-disclosure. Some expressed their willingness to share the experience and perceived it as method to increase public awareness and thereby reducing stigma. Multifaceted approaches with the involvement of multiple parties including the government, non-governmental organization as well as the general public were recommended as important measures to address the issues of social stigma.
Forkhead Box Q1 Expression Is Associated With Tumor Location of Right-Sided Colon, But Not With Acquisition of Oxaliplatin Resistance in Colorectal Cancer
Authors: Yamano Tomoki , Kubo Shuji , Kominato Tomoko , Yano Aya , Takenaka Yuya , Son Jihyung , Kimura Kei , Yasuhara Michiko , Babaya Akihito , Kataoka Kozo , Beppu Naohito , Ikeda Masataka , Nishio Kazuto , Tomita Naohiro 
Published: February 2021

Abstract
Oxaliplatin (OHP) is a reagent for the standard treatment of advanced and recurrent colorectal cancer (CRC), although OHP resistance mechanisms are not fully elucidated. We found that OHP-resistant clones derived from HCT116, but not DLD1 were also resistant against the other drugs used for CRC treatment (5-fluorouracil, OHP, and trifluorothymidine) and their xenograft tumors were resistant against OHP treatment. Among the candidate genes derived from microarray analysis using the samples of OHP-resistant cells and their xenografts derived from HCT116, Forkhead box Q1 (FOXQ1) was further assessed for validation of OHP resistance and its association with clinicopathological features. Modification of FOXQ1 via siRNA knockdown and expression vector could not confirm the involvement of FOXQ1 in OHP resistance. In 173 CRC patients, FOXQ1 was upregulated in most CRC tumors compared to normal colonic mucosa. FOXQ1 expression was significantly different by tumor location of the right-sided colon cancer compared with left-sided and rectal cancer. Moreover, expression level was significantly associated with prognosis in advanced and recurrent patients. TCGA data also showed significant association of FOXQ1 expression with tumor location. Our results indicated that FOXQ1 expression is associated with tumor location of right-sided colon, but not with acquisition of OHP resistance in colorectal cancer.
Effect of EPSPS Gene Copy Number and Glyphosate Selection on Fitness of Glyphosate-Resistant Bassia Scoparia in The Field
Authors: Lim Charlemagne Ajoc , Jha Prashant , Kumar Vipan , Dyer Alan T. 
Published: February 2021

Abstract
The widespread evolution of glyphosate-resistant (GR) Bassia scoparia in the U.S. Great Plains poses a serious threat to the long-term sustainability of GR sugar beet. Glyphosate resistance in B. scoparia is due to an increase in the EPSPS (5-enolpyruvyl-shikimate-3-phosphate) gene copy number. The variation in EPSPS gene copies among individuals from within a single GR B. scoparia population indicated a differential response to glyphosate selection. We tested the hypothesis of reduced GR B. scoparia fitness (reproductive traits) to increasing glyphosate rates (applied as single or sequential applications) potentially experienced within a GR sugar beet field. The variation in EPSPS gene copy number and total glyphosate rate (single or sequential applications) did not influence any of the reproductive traits of GR B. scoparia, except seed production. Sequential applications of glyphosate with a total rate of 2,214 g ae ha− 1 or higher prevented seed production in B. scoparia plants with 2–4 (low levels of resistance) and 5–6 (moderate levels of resistance) EPSPS gene copies. Timely sequential applications of glyphosate (full recommended rates) can potentially slow down the evolution of GR B. scoparia with low to moderate levels of resistance (2–6 EPSPS gene copies), but any survivors (highly-resistant individuals with ≥ 8 EPSPS gene copies) need to be mechanically removed before flowering from GR sugar beet fields. This research warrants the need to adopt ecologically based, multi-tactic strategies to reduce exposure of B. scoparia to glyphosate in GR sugar beet.
Use of Different Devices for Surgical Treatment of Proximal Humerus Fractures in Adults: A Systematic Review
Authors: Pavone Vito , Vescio Andrea , Denaro Regina , Costa Danilo , Caruso Vincenzo Fabrizio , Condorelli Giuseppe , Sessa Giuseppe , Testa Gianluca 
Published: February 2021

Abstract
Background: Proximal humeral fracture is one of the most common osteoporotic fractures in elderly people. The proper treatment choice is controversial. Open reduction and internal fixation (ORIF) with plate and screws is currently the most common treatment for the majority of displaced proximal humeral fractures. The aim of this systematic review is to investigate the surgical treatment outcomes of PHFs, focusing on main used devices and surgical approaches.Methods: From the earliest record up to 21 July 2020, two independent authors conducted a systematic review of two medical electronic database (PubMed and Science Direct). To achieve the maximum sensitivity of the search strategy, the following terms were combined: “(proximal NOT shaft NOT distal) AND humeral AND fracture AND (plate OR locking plate OR osteosynthesis NOT nail NOT arthroplasty)” as either key words or MeSH terms. The risk of bias of the included studies was assessed, agreeing to the Cochrane Handbook guidelines. Results: Thirty-four articles were initially noticed after the term string research in the two electronic databases. Finally, after full-text reading and analyzing the reference list, 8 studies were selected. The mean age recorded was 69.5 years (Range 67-72). All the studies included two-, three-, four-fragments fracture. Seven studies investigated PHILOS (Synthes, Bettlach, Switzerland) implants results, while one investigated CFR-PEEK plate (PEEK Power Humeral Fracture Plate; Arthrex, Naples, Florida, USA) outcomes or other plates. Deltopectoral and Transdeltoid approaches were the more common used.Conclusions: Both deltopectoral and transdeltoid approaches are valid approach in plating after proximal humerus fractures, for these reasons, the surgeon experience is crucial in the choice. The more valid implant is still unclear. The develop of prospective randomized comparative studies is strongly encourages.
PD-1/PD-L1 Inhibitors vs. Chemotherapy For Previously Treated Advanced Gastroesophageal Cancer: A Meta-Analysis of Randomized Controlled Trials
Authors: Zhong Maoxi , Zeng Xiaozhu , Xue Jinmin , Yue Yubing , Zhu Yuxi 
Published: February 2021

Abstract
Background: Patients with advanced gastroesophageal cancer refractory to previous regimen of chemotherapy suffered from poor prognosis without many effective treatment options. Immune checkpoint inhibitors (ICIs) provide promising efficacy, but the relevant clinical trials have offered controversial data. Therefore, we performed this meta-analysis to compare the efficacy and safety of inhibitors against programmed cell death receptor 1 (PD-1) and its ligand PD-L1 versus chemotherapy as second or third-line therapy in patients with advanced gastroesophageal cancer.Materials and methods: We systematically searched PubMed, Cochrane Library, Web of Science, Embase, and China National Knowledge Web. All studies regarding ICIs compared chemotherapy for advanced gastroesophageal cancer were included. Outcomes included the overall survival (OS)，progression-free survival (PFS), objective response rate (ORR) and treatment-related adverse events (TRAEs). The hazard ratio (HR) and odds ratio (OR) were the principal measure of effect.Results: Finally we selected 7 randomized controlled trials (RCTs) including 3,141 patients. One study compared ICIs with placebo therapy only as reference. The meta-analysis was performed by combining 6 RCTs about the comparing ICIs with chemotherapy. Results indicated that both ORR (RR = 1.39, 95%CI 0.85-2.25, P = 0.188) and PFS (HR = 1.14, 95%CI 0.88-1.46, P = 0.316) were not significantly improved by ICIs compared with chemotherapy. However, the OS was significantly prolonged (HR = 0.85, 95%CI 0.75-0.97, P = 0.018) in ICIs group compared with chemotherapy. Subgroup analysis showed that ICIs provide statistically significant OS benefits over chemotherapy in patients of PD-L1 positive, squamous cell carcinoma, Asia origin, esophageal cancer, second-line treatment, male and patients aged 65 or older. Compared with chemotherapy, the TRAEs risk of ICIs was reduced by 33% (RR = 0.67, 95%CI 0.62-0.73, P = 0.000). And the risk of grade 3-5 TRAEs was reduced by 60% (RR = 0.40, 95%CI 0.33-0.49, P = 0.000). Conclusions: Compared to chemotherapy, ICIs appears to improve OS and are better tolerated in previously treated patients with advanced esophageal cancer. We recommend PD-1/PD-L1 inhibitors as an optimal treatment option for patients with positive PD-L1 expression, squamous cell carcinoma, Asia origin, esophageal cancer, second-line treatment, male and ≥65 years of age.
Topical Administration of Raloxifene Does Not Significantly Improve Bone Toughness or Screw Pull-Out Strength in Multiple In Vitro Models
Authors: Eby Michael R. , Cristino Danielle M. , Counihan Matthew , Masada Kendall M. , Ahn Jaimo , Hast Michael W. 
Published: February 2021

Abstract
Background: A previous study has demonstrated an increase in mechanical properties of acellular canine bone after topical raloxifene exposure. The goal of this study was to determine if similar treatment yields the same results in bovine bone and whether this translates into a difference in screw pull-out strength in human cadaveric tissue. Methods: Matched pairs of bone specimens were submerged in solutions of either raloxifene (20 µM) or phosphate-buffered saline as a control for 7 days. In the first experiment, cancellous bone from fetal bovine distal femora underwent quasi-static four-point bending tests. In the second experiment, 3.5 mm unicortical cancellous screws were inserted to a 30 mm depth in human osteoporotic cadaveric humeral heads and quasi-static screw pull-out tests were performed. Results: In the four-point bending tests, there were no significant differences between the raloxifene and control groups for any of the mechanical properties - including stiffness (p = 0.326) and toughness (p = 0.850). In the screw pull-out tests, the raloxifene soaked samples trended towards a higher load at failure, without statistical significance (p = 0.099). Failure loads were 122 ± 74.3 N and 89.5 ± 63.8 N for the raloxifene and control groups, respectively.Conclusions: Biologic solutions that address the acute improvement of bone quality during the fracture healing timeframe are an important area of future research and untapped potential for reducing construct failure in osteoporotic fracture fixation. The bovine samples did not demonstrate an increase in toughness with raloxifene treatment, which is in contrast to previously published data. In vivo experiments are likely required to determine whether topical use of raloxifene will improve implant fixation.
Red Blood Cells in The First Trimester and The Risk of Gestational Diabetes: A Prospective Cohort Study
Authors: Jia Jiajing , Yang Ying , Zhang Minjin , Lin Li , Chen Yequn , Guo Tonglei , Xu Qin , Wang Long , Peng Zuoqi , Guo Changlong , Wang Xingyu , Chen Yixin , Ma Xu 
Published: February 2021

Abstract
Background: This research aimed to assess the potential association of gestational diabetes (GDM) with early trimester hematological parameters including hemoglobin (Hb), red blood cell (RBC), white blood cell (WBC), and platelet count (PLT) through a prospective cohort study.Methods: The prospective cohort included pregnant women subjected to prenatal examination at Shantou and Beijing hospitals in China from March 2014 to December 2015. Data were collected since the first perinatal visit in obstetrics clinics, and then participants were followed up at 24, 32, 36 gestational weeks and the time of delivery, respectively. Multivariable adjusted logistic regression models were conducted to estimate odds ratio (OR) and its corresponding 95% confidence interval (95% CI).Results: A total of 1004 pregnant women with singletons, less than 12 gestational weeks, and without history of chronic disease were eligible for analysis. The incidence of GDM was 18.82%, and the mean age was 29.50 ± 3.84 years. Total of 187 (18.63%) women who had abnormal RBC level and 222 (22.11%) had abnormal Hb in the first trimester of pregnancy. After multivariable adjustment, each unit increment in numeric RBC or Hb was associated with 177% and 4% increased risk for GDM. The risk for GDM was significantly increased with higher RBC (OR: 2.00 for RBC>4.55×1012 /L) and Hb (OR: 2.14 for Hb>139 g/L) levels in the first trimester.Conclusions: Elevated RBC and Hb in the first trimester are associated with increasing risk of GDM. Further evidence are warranted to confirm these possible causal relationships.
A Stable Gene Set for Prediction of Prognosis and Efficacy of Chemotherapy in Gastric Cancer
Authors: Wu Rui , Guo Sixuan , Lai Shuhui , Pan Guixing , Zhang Linyi , Liu Huanbing 
Published: February 2021

Abstract
Background

Gastric cancer is one of the leading causes of cancer-related death worldwide. How to eliminate gastric cancer is an urgent public health problem. Prediction of prognosis is critical to the development of clinical treatment regimens. The aim of this study was to establish a stable prognostic gene set to guide the clinical diagnosis and treatment of gastric cancer.
Methods

A public microarray dataset of TCGA providing clinical information was obtained. The selection operator regression method was used to reduce the dimensionality of stable prognostic genes identified via the bootstrap method and survival analysis.
Conclusion

We established two prognostic models, respectively designated as stable gene risk score of OS(SGRS-OS) and stable gene risk score of PFI(SGRS-PFI) consisting of 18 and 21 genes. With specific risk score formulae, the SGRS set possesses a strong ability to predict overall survival and progression-free interval through both univariate and multivariate analyses. Compared with the TNM stage, the SGRS set showed much higher predictive accuracy. Further analysis revealed that patients with higher SGRS exhibited worse chemotherapy outcomes. Our SGRS set may be an effective tool to predict survival and guide treatment in patients with gastric cancer.
Which Renewable Energy Consumption Is More Efficient by Fuzzy Edas Method Based on Pestle Dimensions
Authors: DEMIRTAS Ozgur , DERINDAG Omer Faruk , Zaralı Fulya , Ocal Oguz , Aslan Alper 
Published: February 2021

Abstract
Energy planning contains a continuous process to reassess alternative energy strategies. The authorities responsible for energy planning and management have to adjust their strategies to new and improved alternative resources according to sustainability criteria. The most efficient forms of renewable energy such as geothermal, solar, wind, hydroelectricity and biomass. In this paper, Analytical Hierarchy Process (APH) is employed to see the best renewable energy resources by taking Political, Economic, Social, Technological, Legal and Environmental dimensions into account. We concluded that the most efficient use of renewable energy alternatives is based on Political, Economic, Social, Technological, Legal and Environmental different dimensions, from the most effective to the least effective such as geothermal, solar, biomass, wind and hydropower.