bluuebunny/crossref_metadata_2025_split huggingface dataset:
Considering Low Health Literacy: How Do the Pelvic Floor Distress Inventory—Short Form 20 and Pelvic Floor Impact Questionnaire—Short Form 7 Measure Up?
Authors: Spencer Jordan , Hadden Kristie , Brown Heidi , Oliphant Sallie S. 
Published: February 2019

Objective
The objective of this study was to evaluate the readability and understandability of 2 commonly used pelvic floor disorder questionnaires, Pelvic Floor Distress Inventory—Short Form 20 (PFDI-20) and Pelvic Floor Impact Questionnaire—Short Form 7 (PFIQ-7), in a low health literacy patient population.

Methods
Flesh-Kincaid, SMOG, Fry, and FORCAST readability assessment tools were used to assign US grade levels to each questionnaire (PFDI-20, PFIQ-7). Two health literacy experts used PEMAT and ELF-Q tools to determine understandability, organization, content, and quality of each form. A focus group of women with low health literacy used Stop Light Coding and a facilitator-prompted discussion to further evaluate understandability and critique the forms.

Results
The PFIQ-7 required higher reading ability compared with PFDI-20 (ninth to 11th vs sixth to eighth mean grade level equivalents). Expert and focus group reviews identified concerns regarding purpose, formatting, and word choice in both forms. Focus group participants recommended assistance with questionnaire completion from clinical staff and gave mean overall ratings of 5.4 (0–10/worst to best) for PFDI-20 and 8.0 for PFIQ-7.

Conclusions
Knowledge of potential barriers to understanding and completion may improve utilization of and accuracy of patient responses to PFDI-20 and PFIQ-7 in women with low health literacy.
Obstetrical Anal Sphincter Injuries and the Need for Adequate Care
Authors: Elliot Victoria , Yaskina Maryna , Schulz Jane 
Published: February 2019

Background
An estimated 4% to 6.6% of women delivering vaginally sustain obstetrical anal sphincter injuries (OASI). Despite this, a gap exists in the provision of postpartum care to women globally. Given the negative impact of OASI, action is needed, and multidisciplinary perineal clinics can help. Consequently, such a clinic was established in 2011 at the Royal Alexandra Hospital (RAH), a tertiary care center in Edmonton, Alberta.

Objective
This study assesses the state of perineal clinics specializing in OASI internationally and locally by investigating the literature for descriptions of specialized perineal clinics for women with OASI, describing the RAH perineal clinic, and assessing the prevalence of OASI at the RAH in the context of the clinic.

Methods
A search of peer-reviewed literature was conducted on Medline and observations and interviews of RAH perineal clinic staff were conducted, as was a medical chart review.

Results
Articles describing only 10 perineal clinics specializing in OASI were found, with varying structures. The multidisciplinary RAH clinic, like one other clinic, has a strong physiotherapy focus, with education and Pilates classes and one-on-one appointments offered by pelvic floor physiotherapists. In 2016, of the 326 (6.9%) vaginal deliveries that resulted in OASI at the RAH, only 66.0% (215) were referred to the clinic.

Conclusions
Multidisciplinary perineal clinics are needed globally. Despite the creation of the perineal clinic at the RAH, women continue to lack specialized care after OASI. It is crucial that healthcare professionals specializing in OASI share their experiences to establish best practices and create new, and improve existing, perineal clinics.
Predictive Factors of Postdischarge Narcotic Use After Female Pelvic Reconstructive Surgery
Authors: Ramaseshan Aparna S. , Tunitsky-Bitton Elena , O’Sullivan David M. , Reagan Krista M. L. , Steinberg Adam C. 
Published: February 2019

Objective
The aim of the study was to evaluate the association of patient factors, amount of in-hospital postoperative narcotics, and pain scores on postdischarge narcotic use (PDNU).

Methods
This is a secondary analysis of a randomized controlled trial comparing a postoperative usual-care regimen with multimodal pain regimen after pelvic reconstructive surgery. This analysis evaluated patients in the multimodal arm. Postdischarge narcotic use (as mg oral morphine equivalents, MME, calculated from narcotic tablets remaining) was assessed postoperative days 7 to 10. Brief Pain Inventory (BPI) surveys were collected preoperatively and at postoperative day 1. Patient factors were evaluated using univariate and multivariate analysis. Correlations examined the relationships between PDNU and postoperative in-hospital narcotic use and BPI scores.

Results
Sixty-eight patients randomized to the multimodal pain regimen arm had median (interquartile range) PDNU of 22.5 (0–159.4) MME. After excluding postdischarge narcotic nonusers (34.8%), the median PDNU was 127.5 (22.5–180.0) MME. The median PDNU was 172.5 (150.0–180.0) MME after abdominal reconstructive surgery (n = 7), 82.5 (28.1–180.0) MME after laparoscopic reconstructive surgery (n = 22), and 37.5 (13.1–181.2) MME after vaginal reconstructive surgery (n = 14). A linear correlation was noted between the amount of postoperative narcotics used in-hospital and the amount needed postdischarge after abdominal (r = 0.588, P = 0.057), laparoscopic (r = 0.439, P = 0.019), and vaginal (r = 0.455, P = 0.017) reconstructive surgeries. The BPI scores on postoperative day 1 for “average” pain (r = 0.388, P = 0.002) and “now” pain (r = 0.490, P < 0.001), and on postoperative week 1 for “average” pain (r = 0.383, P = 0.002) and “now” pain (r = 0.389, P = 0.002) correlated with PDNU.

Conclusions
Amount of postoperative in-hospital use of narcotic medications and BPI scores can be valuable predictors of PDNU in patients undergoing pelvic reconstructive surgery.
A 3-Dimensional Anatomical Education Model in Postpartum Perineal Laceration Care: A Pre-Post Intervention Study
Authors: Koury Hannah , Corral Janet , Bastow Brittney D. , Sheeder Jeanelle , Muffly Tyler M. 
Published: February 2019

Objective
The aim of this study was to investigate the effects of postpartum patients introduction to and interaction with a virtual 3-dimensional (3D) pelvic model on the self-care, knowledge, and anxiety parameters.

Methods
The model was designed from computed tomography data displaying the involvement of the levator ani in a fourth-degree perineal laceration. This 3D model was used to educate postpartum day 1 patients at the bedside. Patient data were collected using a pre and post questionnaire assessing knowledge, anxiety, and confidence in perineal wound self-care.

Results
Thirty-six patients were enrolled with a median age of 28.5 years (interquartile range, 31, 21.75 years) and a median parity of 1 (interquartile range, 2, 1). Patient use of the tool significantly decreased patient anxiety regarding perineal lacerations (P < 0.01) and significantly increased patient knowledge on what part of their vagina was lacerated during vaginal delivery (P < 0.01).

Conclusions
Reviewing a 3D model of perineal lacerations with patients on postpartum day 1 is associated with less anxiety and increased knowledge of pelvic floor anatomy. These pilot data represent a preliminary investigation into the relations between 3D model of perineal lacerations and a range of patient outcomes.
Uterosacral Ligament Suspension Versus Robotic Sacrocolpopexy for Treatment of Apical Pelvic Organ Prolapse
Authors: Smith Benjamin C. , Crisp Catrina C. , Kleeman Steven D. , Yook Eunsun , Pauls Rachel N. 
Published: February 2019

Objective
The aim of the study was to compare long-term outcomes of uterosacral ligament suspension (USLS) versus robotic sacrocolpopexy (RSC) in patients with pelvic organ prolapse.

Methods
This was an institutional review board–approved retrospective cohort study. Women 3 to 7 years after USLS or RSC were contacted for enrollment. Participants were asked to complete validated questionnaires and physical examinations. The primary outcomes were no symptoms of bulge or retreatment for prolapse (subjective) and POP-Q examination demonstrating prolapse above or equal to −1 (objective). For the subjective outcome, a noninferiority calculation with 10% noninferiority margin deemed 91 subjects in each group were required.

Results
We identified the following 770 eligible subjects: 205 were contacted, 19 declined, 186 subjects agreed to participate, and 2 were excluded. There were 92 subjects per group in the analysis for the primary subjective outcome, and 84% underwent examinations for the objective outcome. Baseline characteristics were overall similar; however, previous prolapse surgery was more common in the RSC group (P < 0.001). Subjective success was achieved in 83 subjects in the USLS group and 78 subjects in the RSC group (90.2% vs 84.4%, respectively, P = 0.265 [95% confidence interval = −0.036 to 1.000]). Objective success was noted in 93.2% and 91.3% of the USLS and RSC groups, respectively (P = 0.869). Postoperative complication rates were low and did not differ between groups. Mesh complications were noted in 6.6% of the RSC group. One subject in the USLS group reported pain related to surgery.

Conclusion
Uterosacral ligament suspension was noninferior to RSC at 3- to 7-year postsurgery for subjective symptoms and similar for objective outcomes. Both approaches showed high success rates and strong patient satisfaction.
Apical Suspension Utilization at the Time of Vaginal Hysterectomy for Pelvic Organ Prolapse Varies With Surgeon Specialty
Authors: Sheyn David , El-Nashar Sherif , Mahajan Sangeeta T. , Mangel Jeffrey M. , Chapman Graham C. , Hijaz Adonis K. 
Published: February 2019

Objective
To evaluate whether utilization of apical suspension procedures at the time of vaginal hysterectomy for pelvic organ prolapse varies with surgeon specialty.

Methods
This was a retrospective cohort study using data from the American College of Surgeons National Surgical Quality Improvement Program database from 2014 to 2016. International Classification of Diseases, Ninth Revision, Clinical Modification with a diagnosis of pelvic organ prolapse who underwent vaginal hysterectomy with any combination of pelvic reconstructive procedures. Propensity score matching using available preoperative clinical data was used to ameliorate selection bias by specialty at a ratio of 1 female pelvic reconstructive surgeon (FPMRS) surgeon to 2 obstetrician-gynecologists (OBG). Descriptive statistics were reported as means with standard deviations. Pairwise analysis using Student t test and Fisher exact test was performed where appropriate.

Results
After propensity score matching, there were 901 cases performed by FPMRS and 1802 performed by OBG. The overall utilization rate of apical suspension in the matched cohort was 81.7% for FPMRS and 19.8% for OBG (P < 0.001). Obstetrician-gynecologists were more likely to perform vaginal hysterectomy without apical suspension compared with FPMRS (44.3% vs 5.8%; P < 0.001) and were also more likely to perform nonapical vaginal repair without also performing an apical suspension, (17.7% vs 9.3%, P < 0.001), compared to urogynecologists. On multivariable logistic regression, having surgery performed by FPMRS was the only significant variable associated with an increased likelihood of undergoing apical suspension (adjusted odds ratio, 5.34; 95% confidence interval, 4.48–6.36).

Conclusions
The FPMRS physicians are more likely to perform apical suspension with vaginal hysterectomy for prolapse repair compared with OBG.
CNN Model With Hilbert Curve Representation of DNA Sequence For Enhancer Prediction
Authors: Anjum Monowar Md. , Tahmid Ibrahim Asadullah , Rahman M. Sohel 
Published: February 2019

AbstractMotivationEnhancers are distal cis-acting regulating regions that play a vital role in gene transcription. However, due to the inherent nature of enhancers being linearly distant from the affected gene in an irregular manner while being spatially close at the same time, systematically predicting enhancers has been a challenging task. Although several computational predictor models through both epigenetic marker analysis and sequence-based analysis have been proposed, they lack generalization capacity across different enhancer datasets and have feature dependency. On the other hand, the recent proliferation of deep learning methods has opened previously unknown avenues of approach for sequence analysis tasks which eliminates feature dependency and achieves greater generalization. Therefore, harnessing the power of deep learning based sequence analysis techniques to develop a more generalized model than the ones developed before to predict enhancer region in a DNA sequence is a topic of interest in bioinformatics.ResultsIn this study, we develop the predictor model CHilEnPred that has been trained with the visual representation of the DNA sequences with Hilbert Curve. We report our computational prediction result on FANTOM5 dataset where CHilEnPred achieves an accuracy of 94.97% and AUC of 0.987 on test data.AvailabilityOur CHilEnPred model can be freely accessed at https://github.com/iatahmid/chilenpredContactmsrahman@cse.buet.ac.bd
Modeling cell shape diversity arising from complex Rho GTPase dynamics
Authors: Zmurchok Cole , Holmes William R. 
Published: February 2019

ABSTRACTIt is well known that cells exhibit a variety of morphologically distinct responses to their environments that manifest in their cell shape. Some protrude uniformly to increase substrate contacts, others are broadly contrac-tile, some polarize to facilitate migration, and yet others exhibit mixtures of these responses. Prior imaging studies have identified a discrete collection of shapes that the majority of cells display and have demonstrated links between those shapes and activity levels of the cytoskeletal regulators Rho GTPases. Here we use a novel computational modeling approach to demonstrate that well known Rho GTPase signaling dynamics naturally give rise to this diverse but discrete (rather than continuum) set of morphologies. Specifically, the combination of auto-activation and mutually-antagonistic crosstalk between GTPases along with the conservative membrane (un)binding dynamics readily explain at least 6 of the 7 commonly observed morphologies. We further use this methodology to map the entire parameter space of this model and show that in appropriate regimes, individual parameter sets give rise to a variety of different morphologies. This provides an explanation for how seemingly similar cells of the same fate derived from the same population can exhibit a diverse array of cell shapes in imaging studies. These results thus demonstrate that Rho GTPases form the core of a cytoskeletal regulatory system governing cell shape, further supporting the picture that they act as a central signaling hub determining how cells respond to their environmental context.
The tumour microenvironment shapes dendritic cell plasticity in a human organotypic melanoma culture
Authors: Di Blasio S , Tazzari M , van Wigcheren G , van Duffelen A , Stefanini I , Bloemendal M , Gorris M , Vasaturo A , Bakdash G , Hato SV , Schalkwijk J , de Vries IJM , van den Bogaard EH , Figdor CG 
Published: February 2019

AbstractThe tumour microenvironment (TME) forms a major obstacle in effective cancer treatment and for clinical success of immunotherapy. Conventional co-cultures have shed light into multiple aspects of cancer immunobiology, but they are limited by the lack of physiological complexity. We developed a novel human, organotypic skin melanoma culture (OMC) that allows real-time study of host-malignant cell interactions within a multi-cellular tissue architecture. By co-culturing keratinocytes, fibroblasts and immune cells with melanoma cells, onto a de-cellularized dermis, we generated a reconstructed TME that closely recapitulates tumour growth as observed in human lesions and supports cell survival and function. We demonstrate that the OMC is suitable and outperforms conventional 2D co-cultures for the study of TME-imprinting mechanisms. Within the OMC we observed the tumour-driven conversion of cDC2s into CD14+DCs, characterized by a an immunosuppressive phenotype. The OMC provides a valuable complement to current approaches to study the TME.
Structural insight into the mechanism of 4-aminoquinolines selectivity for the alpha2A-adrenoceptor
Authors: Li Zaibing , Li Jingyu , Liu Liyan , Deng Wenyi , Zhang Wen , Hou Huifang , Wang Xinyuan , Yang Zhimei , Wang Xiaoying , Chen Shanze , Wang Yi , Chen Junli , Huang Ning 
Published: February 2019

Abstractα2A-adrenoceptor (AR) is a potential target for the treatment of degenerative diseases of the central nervous system, and α2A-AR agonists are one of the most effective drugs for this condition. However, the lack of high selectivity for α2A-AR subtype of traditional drugs greatly limits their clinic usage. In this study, a series of homobivalent 4-aminoquinolines conjugated by two 4-aminoquinoline moieties via varying alkane linker length (C2-C12) were characterized for their affinities for each α2-AR subtype. Subsequently, docking, molecular dynamics and mutagenesis were applied to uncover the molecular mechanism. Most 4-aminoquinolines (4-aminoquinoline monomer, C2-C6, C8-C10) were selective for the α2A-AR over α2B- and α2C-ARs. Besides, the affinities are of similar linker length-dependence for each α2-AR subtype. Among all the compounds tested, C10 has the highest affinity for the α2A-AR (pKi=-7.45±0.62), which is 12-fold and 60-fold selective over α2B-AR and α2C-AR, respectively. Docking and molecular dynamics studies suggest that C10 simultaneously interacts with an orthosteric and an “allosteric site” of the α2A-AR. The mutation of F205, which is situated at the orthosteric binding pocket decreases the affinity by 2-fold. The potential allosteric residues include Ser90, Asn93, Glu94 and W99. The specificity of C10 for the α2A-AR and the potential orthosteric and allosteric binding sites proposed in this study provide valuable guidance for the development of novel α2A-AR subtype selective compounds.
Left Ventricular Chamber Shape During Vena Caval Occlusion: Improved MRI-based Measurement of the End-Systolic Pressure-Volume Relationship in Normal Sheep
Authors: Giao Duc M. , Wang Yan , Rojas Renan , Takaba Kiyoaki , Badathala Anusha , Spaulding Kimberly A. , Soon Gilbert , Zhang Yue , Wang Vicky Y. , Haraldsson Henrik , Liu Jing , Saloner David , Ge Liang , Guccione Julius M. , Wallace Arthur W. , Ratcliffe Mark B. 
Published: February 2019

AbstractThe left ventricular (LV) end-systolic pressure volume relationship (ES; ESPVR) is the cornerstone of systolic LV function analysis. Recently, it became possible to measure 2D LV chamber shape during vena cava occlusion (VCO) with MRI. We used an improved level-set semi-automatic segmentation method (LSSM) to determine the effect of VCO on LV geometry, ES pressure area (PA) and ESPVR.10 healthy adult sheep were anesthetized. LV pressure transducer and inferior vena cava (IVC) balloon catheter were percutaneously inserted. Ferumoxytol (0.125 ml/kg iv; AMAG Pharmaceuticals, Waltham, MA) was given to enhance blood pool contrast. LV pressure and 2D retrospectively-gated cine MRI of LV cross sections 25 (Apex), 50 (Mid) and 75% (Base) of the distance from the apex to the base of the LV were obtained during separate IVC balloon inflations (VCO). LV pressure was digitally filtered and LV chamber segmented with the LSSM. Cross sectional area, major and minor axes, major axis orientation, ESPAR and ESPVR were calculated.The LSSM had excellent reliability. All cross sections became more elliptical during VCO. The orientation (angle) of each major axis relative to the anterior RV insertion shifted during VCO. However, the orientation remained toward the septum. There was chamber collapse (LV area < 0.25 cm2) at the apical level during VCO (7 cases). ESPAR was non-linear at all levels. ESPVR was non-linear because of apical collapse.In conclusion, MRI-based measurement of LV geometry, ESPAR and ESPVR during VCO is a valuable method that may lead to improved understanding of systolic LV function.New and NoteworthyReal-time MRI was used to continuously measure the LV PA relationship as loading conditions were transiently varied in anesthetized sheep. All three examined cross-sections became more elliptical during VCO. The ESPAR were non-linear at all three cross-sections. Chamber collapse at the apical level during VCO resulted in a non-linear ESPVR. The heart contracted in a non-concentric manner during VCO which could inform modeling studies and elucidate mechanisms underlying LV adaptations to sudden load changes.
Pressure overload leads to coronary plaque formation, progression and myocardial events in ApoE-/- mice
Authors: Marino Alice , Zhang Yi , Rubinelli Luisa , Ip James E , Di Lorenzo Annarita 
Published: February 2019

AbstractHypercholesterolemia and hypertension are two major risk factors for coronary artery diseases, which remain the major cause of mortality in the industrialized world. Current animal models of atherosclerosis do not recapitulate coronary plaque disruption, thrombosis and myocardial infarction occurring in human. Recently, we demonstrated that exposure of the heart to high pressure, by transverse aortic constriction (TAC), induced coronary lesions in ApoE-/- mice on chow diet.The aim of this study was to characterize the magnitude and location of coronary lesions in ApoE-/- mice post-TAC, and to assess the susceptibility of coronary plaque to disruption, leading to myocardial events.Here we describe a reliable pathological condition in mice characterized by the development of coronary lesions and its progression leading to myocardial infarction, which better recapitulate human disease. Following TAC surgery, about 90% of ApoE-/- mice develop coronary lesions, especially in the left anterior descending artery, with 59% of the mice manifesting different magnitude of LAD stenosis. Myocardial events, identified in 74% of the mice, were mainly due to coronary plaque thrombosis and occlusion.That TAC induces the development and progression of coronary lesions in ApoE-/- mice leading to myocardial events represents a novel and important tool to investigate the development of coronary lesions and its sequelae in a setting that better resemble human conditions.
Supportive mentoring behaviours in a public medical school
Authors: Mohammad Jamilah Al-Muhammady , Abdul Rahim Ahmad Fuad , Mat Nor Mohd Zarawi , Ahmad Rozaziana , Yusoff Muhamad Saiful Bahri 
Published: February 2019

Purpose
The purpose of this paper is to evaluate mentoring behaviours in a public medical school in Malaysia and examine factors associated with those mentoring behaviours. The study is important because effective mentoring promotes the personal and professional growth of mentees.

Design/methodology/approach
A cross-sectional study was conducted with a population of 632 medical students. The authors used the Mentor Behaviour Scale (MBS) to measure four domains of mentoring behaviour: mentoring relationship structure, engagement, autonomy support and competency support. The authors evaluated the scoring of these domains as high, moderate or low scores.

Findings
A total of 508 (80.4 per cent) medical students in Years 2–5 participated in this study. Mentoring relationship structure, engagement and competency support were perceived as moderate scores, whereas autonomy support was perceived as a low score. Students in the early phases of study had better attitudes regarding mentoring behaviours. More frequent meetings and longer duration of meetings were significantly associated with better attitudes towards mentoring behaviour.

Originality/value
This paper evaluates contemporary mentoring behaviours in a Malaysian public medical school and contributes to non-western literature on mentoring. These behaviours were reflected in the four domains of the theory-based MBS.