bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hepatitis B vaccination coverage across India: exploring the spatial heterogeneity and contextual determinants
Authors: Khan Junaid , Shil Apurba , Mohanty Sanjay K. 
Published: September 2019

Abstract

Background
Although hepatitis B vaccinations have been integrated in the Universal Immunization Program (UIP) in India over a decade, only half of the children are immunized against hepatitis B. The national average in hepatitis B vaccination conceals large variations across states, districts and socio-economic groups. In this context, the aim of this paper is to examine the spatial heterogeneity and contextual determinants of hepatitis B vaccination across the districts of India.

Methods
Using data of 199,899 children aged 12–59 months from the National Family Health Survey-4 (NFHS-4), 2015–16 we have examined the district level spatial distribution and clustering of hepatitis B vaccination with the help of Moran’s I and Local Indicator of Spatial Autocorrelation (LISA) measures. We investigated the low coverage of HBV vaccination using spatial autoregressive models (SAR) at the meso scale. And we applied multivariate binary logistic regression analysis to understand the micro-level predictors of hepatitis B vaccination.

Results
In 2015–16, 45% of the children aged 12–59 months were not vaccinated against hepatitis B in India. The coverage of hepatitis B vaccine across the districts of India showed a highly significant spatial dependence (Moran’s I = 0.580). Bivariate Moran’s I confirmed the spatial clustering of hepatitis B vaccination with mother’s education, full antenatal care (ANC) utilization, post natal care (PNC) utilization, institutional births and registration of births at the district level. Districts with a very low coverage of HBV vaccine are clustered in the western, north-eastern regions and in some parts of central India. At the unit (child) level, children’s hepatitis B immunization status is mostly determined by the socio-economic and demographic characteristics like their mother’s educational status, caste, religion, household’s wealth condition, birth order, year of birth and the region they belong to.

Conclusions
District level variation in hepatitis B vaccination is spatially heterogeneous and clustered in India with a strong neighbourhood effect. Uptake of hepatitis B vaccine among Indian children is predominantly dependent upon their socio-economic and demographic characteristics.
Development and validation of a pre-scoring system for nonspecific low back pain among general population in Guangzhou: a cross-sectional study
Authors: Wang Kai , Zhang Jing-wen , Min Shao-xiong , Xu Xin-yi , An Sheng-li 
Published: September 2019

Abstract

Background
Nonspecific Low Back Pain (NLBP) is a common disease with a low cure rate and significant impact on the population. This study aimed to develop and validate a pre-scoring system for identifying the risk of suffering from NLBP among the general population in Guangzhou.

Methods
A total of 1439 eligible subjects were surveyed in Guangzhou by stratified random sampling and was divided randomly into the development dataset (69.6%) and validation dataset (30.4%) subsequently. Based on the development dataset, potential associated factors (average exercise times weekly, the intensity of daily work, etc.) with NLBP were tested by the sequential logistic regression, and a pre-scoring system was formulated with Sullivan’s method and graded afterward. The internal validity of the system was assessed by AUC and calibration plot, and the external validation was performed in the validation dataset.

Results
The prevalence rates of NLBP in the development dataset and the validation dataset were 12.97 and 13.27%, respectively. Age, BMI, average exercise times weekly, gender, educational level, the intensity of daily work, place of residence, monthly income, overall evaluation of health condition and physiology health were identified as significant factors. The total risk score ranged from 0 to 38, which was split into three risk grades: low risk (0 to 18), intermediate risk (19 to 22) and high risk (23 to 38). The pre-scoring system had an adequate calibration and a good discriminating ability with bootstrap-corrected AUC equaling 0.861 in the development dataset and 0.821 in the validation dataset.

Conclusions
A pre-scoring system that could help clinicians to assess the risk of NLBP in the general population was validated. Further validation of the system in a new population or prospective cohort study is suggested.
Topical hydrogel containing Fumaria vaillantii Loisel. extract enhances wound healing in rats
Authors: Davoodi-Roodbordeii Fatemeh , Afshar Minoo , Haji Abas Tabrizi Fatemeh , Choopani Samira , Torkaman Giti , Moayer Fariborz , Salimi Mona 
Published: September 2019

Abstract

Background
Fumaria species (Fumariacea) has traditionally been used in wound healing in Iranian folk medicine. However, with the discovery of newer agents, its use has faded off into total obscurity. This study explored the wound healing potential of a gel containing 10% Fumaria vaillantii Loisel through topical application of total extract in a model of excisional as well as incisional wound healing in albino Wistar rats.

Methods
Rats were anesthetized, and excisional skin wound was established using a sterilized surgical scissors. The animals were then treated with 10% F.vaillantii topical gel formulation along with the gel base. The treatments were administered once a day after the injury for 21 days. For topical treatment, the hydrogel was formulated and evaluated for chemical and physical characteristics. Histopathological analysis with hematoxylin and eosin (H&E) was used for microscopic examination of the skin tissues on 21-day-old sections of excision wound. To verify collagen formation, hydroxyproline determination was performed 21 days post wound healing. Breaking strength was determined in a 10-day-old incision wound by the uniaxial tensile test.

Results
Topical administration of F.vaillantii gel formulation significantly enhanced skin wound closure on the 6th post-wounding day compared to both gel base and the negative control, indicating an accelerated wound healing process, while a significant difference was observed on 10th and 14th post –wound days in F.vaillantii treatment compared to the negative control groups. Gel formulation prepared with a 10% F. vaillantii extract exhibited a response in terms of wound epithelialization, angiogenesis and number of hair follicles at wound area better than the gel base on the 21st post-wound day. Application of gel base produced further advantages by increasing hydroxyproline content and collagen fiber thickness. Our results on incision wound model were supported by histopathological data indicating the role of gel base in the enhancement of breaking strength.

Conclusion
Traditional use of Fumaria species in the skin diseases was justified in this study by revealing the increase in wound healing activity after hydrogel containing F. vaillantii total extract administration.

Graphical abstract
Radiomic signatures with contrast-enhanced magnetic resonance imaging for the assessment of breast cancer receptor status and molecular subtypes: initial results
Authors: Leithner Doris , Horvat Joao V. , Marino Maria Adele , Bernard-Davila Blanca , Jochelson Maxine S. , Ochoa-Albiztegui R. Elena , Martinez Danny F. , Morris Elizabeth A. , Thakur Sunitha , Pinker Katja 
Published: September 2019

Abstract

Background
To evaluate the diagnostic performance of radiomic signatures extracted from contrast-enhanced magnetic resonance imaging (CE-MRI) for the assessment of breast cancer receptor status and molecular subtypes.

Methods
One hundred and forty-three patients with biopsy-proven breast cancer who underwent CE-MRI at 3 T were included in this IRB-approved HIPAA-compliant retrospective study. The training dataset comprised 91 patients (luminal A, n = 49; luminal B, n = 8; HER2-enriched, n = 11; triple negative, n = 23), while the validation dataset comprised 52 patients from a second institution (luminal A, n = 17; luminal B, n = 17; triple negative, n = 18). Radiomic analysis of manually segmented tumors included calculation of features derived from the first-order histogram (HIS), co-occurrence matrix (COM), run-length matrix (RLM), absolute gradient (GRA), autoregressive model (ARM), discrete Haar wavelet transform (WAV), and lesion geometry (GEO). Fisher, probability of error and average correlation (POE + ACC), and mutual information coefficients were used for feature selection. Linear discriminant analysis followed by k-nearest neighbor classification (with leave-one-out cross-validation) was used for pairwise radiomic-based separation of receptor status and molecular subtypes. Histopathology served as the standard of reference.

Results
In the training dataset, radiomic signatures yielded the following accuracies > 80%: luminal B vs. luminal A, 84.2% (mainly based on COM features); luminal B vs. triple negative, 83.9% (mainly based on GEO features); luminal B vs. all others, 89% (mainly based on COM features); and HER2-enriched vs. all others, 81.3% (mainly based on COM features). Radiomic signatures were successfully validated in the separate validation dataset for luminal A vs. luminal B (79.4%) and luminal B vs. triple negative (77.1%).

Conclusions
In this preliminary study, radiomic signatures with CE-MRI enable the assessment of breast cancer receptor status and molecular subtypes with high diagnostic accuracy. These results need to be confirmed in future larger studies.
Deriving objectively-measured sedentary indices from free-living accelerometry data in rural and urban African settings: a cost effective approach
Authors: Cook Ian 
Published: September 2019

Abstract

Objectives
To investigate the agreement between two data reduction approaches for detecting sedentary breaks from uni-axial accelerometry data collected in human participants. Free-living, uni-axial accelerometer data (n = 318) were examined for sedentary breaks using two different methods (Healy–Matthews; MAH/UFFE). The data were cleaned and reduced using MAH/UFFE Analyzer software and custom Microsoft Excel macro’s, such that the average daily sedentary break number were calculated for each data record, for both methods.

Results
The Healy–Matthews and MAH/UFFE average daily break number correlated closely (R2 = 99.9%) and there was high agreement (mean difference: + 0.7 breaks/day; 95% limits of agreement: − 0.06 to + 1.4 breaks/day). A slight bias of approximately + 1 break/day for the MAH/UFFE Analyzer was evident for both the regression and agreement analyses. At a group level there were no statistically or practically significant differences within sample groups between the two methods.
Munchausen syndrome mimicking refractory subcutaneous abscess with bacteremia, diagnosed by repetitive element sequence-based polymerase chain reaction: a case report
Authors: Iwanaga Naoki , Yamamoto Kazuko , Takazono Takahiro , Saijo Tomomi , Imamura Yoshifumi , Miyazaki Taiga , Izumikawa Koichi , Yamamoto Yoshihiro , Yanagihara Katsunori , Yasuoka Akira , Mukae Hiroshi 
Published: September 2019

Abstract

Background
Rapid diagnosis and appropriate treatment of Munchausen syndrome is important not only for the patient but also for health care workers because a delay in diagnosis can worsen patients’ clinical outcomes, and result in a substantial medical cost.

Case presentation
A young and previously healthy 24-year-old Japanese woman, a nurse, presented with complaints of refractory abscess on her left upper limb for 3 months. A physical examination on admission revealed low-grade fever and a subcutaneous abscess in her left forearm. Laboratory data suggested mild systemic inflammation and liver dysfunction, but no abnormalities of the immune system, including changes in the number of lymphocytes and neutrophils, neutrophil phagocytic capacity, and natural killer (NK) cell activity, were observed. A human immunodeficiency virus test was also negative. Multiple modalities, including positron emission tomography-computed tomography, failed to detect any cause and focus of infection except her left upper limb. Streptococcus mitis and Prevotella buccae were detected from the wound, but no microorganisms were detected in a blood culture. The cellulitis promptly resolved; however, exacerbation of the subcutaneous abscess with polymicrobial bacteremia repeatedly occurred unexpectedly. Because of this puzzling clinical course, the possibility of self-injury was finally suspected. Three syringes with needles, with a turbid liquid, were found in our patient’s bag. Enterobacter cloacae and Enterococcus faecalis were detected in the liquid, and an analysis via repetitive element sequence-based polymerase chain reaction determined that Enterococcus faecalis in the wound and syringe contents were genetically identical. She was diagnosed as having Munchausen syndrome and treated with the collaboration of a psychiatrist. She finally confessed that she had injected her own saliva and toilet water into the drip line and wound.

Conclusions
This case report is valuable in that it is the first case in which this syndrome was diagnosed by a genetic method. Munchausen syndrome should not be neglected as a possible cause of refractory and recurrent infection.
Estimation of body height from percutaneous length of tibia in Debre Markos University students, North West Ethiopia
Authors: Sume Bickes Wube 
Published: September 2019

Abstract

Introduction
Estimation of body height from measurement of various body parts is a particular interest to forensic scientists to complete biological profile after death. However, establishing the identity of an individual from mutilated, decomposed, and amputated body fragments has become a challenging task in medico-legal cases.

Objective of the study
To estimate body height from percutaneous length of the tibia in Debre Markos University (DMU) students.

Materials and methods
Institution-based cross-sectional prospective study was conducted in undergraduate students of DMU. The sample size was 572, and data were collected from April 2018 to December 2018. Height and percutaneous tibial length were measured in both sexes. Data were analyzed through SPSS version 25. Level of significance was set at P < 0.05.

Results
The mean age of study participants was 21.27 ± 1.74 years for males and 20.41 ± 1.58 years for females. The mean height of study participants was also 168.36 ± 5.89 cm for males and 165.24 ± 4.01 cm for females. The tibial length was strongly correlated with body height in the males than the females: right tibial length (males R = 0.634, females R = 0.259) and left tibial length (males R = 0.632, females R = 0.258). Independent t test exhibited statistically significant gender differences (P < 0.05) with the males having consistently higher values than the females. Paired t test revealed the existence of bilateral asymmetry between the right and left tibial lengths (P < 0.05). The relatively highest correlation was depicted in the right tibial length in both males and females.

Conclusion
The mean value of height and tibial length was greater in males than that of females, and these differences were statistically significant (P < 0.05). Tibial length was significantly (P < 0.05) correlated with height in both sexes. Therefore, tibial length can predict body height in both sexes.
A Novel Anti-CD40 Monoclonal Antibody, Iscalimab, for Control of Graves Hyperthyroidism—A Proof-of-Concept Trial
Authors: Kahaly George J , Stan Marius Nicolae , Frommer Lara , Gergely Peter , Colin Laurence , Amer Ahmed , Schuhmann Imelda , Espie Pascal , Rush James S , Basson Craig , He Yanling 
Published: September 2019

Abstract

Context
The CD40-CD154 co-stimulatory pathway plays an important role in the pathogenesis of Graves disease (GD) by promoting autoreactive B-cell activation.

Objective
Evaluate efficacy and safety of a human, blocking, nondepleting anti-CD40 monoclonal antibody, iscalimab, in hyperthyroid patients with GD.

Design
Open-label, phase II proof-of-concept study.

Setting
Multicenter.

Patients
Fifteen with GD.

Intervention
Patients received 5 doses of iscalimab at 10 mg/kg intravenously over 12 weeks.

Main outcome measures
Thyroid-related hormones and autoantibodies, plasma soluble CD40, free CD40 on B cells, soluble CXCL13, pharmacokinetics, and safety were assessed.

Results
The iscalimab intervention resulted in complete CD40 engagement for up to 20 weeks. A clinical response and biochemical euthyroidism was observed in 7 of 15 (47%) patients. Free and total triiodothyronine and thyroxine normalized in 7 patients who did not receive any rescue medication with antithyroid drugs (ATD), and 2/15 (13.3%) showed normal thyrotropin. Six (40%) patients required ATD. Four of 7 responders relapsed after treatment completion. Serum concentrations of thyrotropin receptor autoantibodies (TSH-R-Ab) significantly declined in all patients (mean 15.3 IU/L vs 4.0 IU/L, 66% reduction; P &lt; 0.001) and TSH-R-Ab levels normalized in 4 (27%). Thyroperoxidase and thyroglobulin autoantibodies significantly decreased in responders. Iscalimab rapidly reduced serum CXCL13 concentrations (P &lt; 0.001). Twelve (80.0%) patients reported at least 1 adverse event (AE). All treatment-related AE were mild or moderate and resolved by end of the study.

Conclusion
Iscalimab was generally safe and clinically effective in a subgroup of hyperthyroid GD patients. The potential therapeutic benefit of iscalimab should be further tested.
Mitochondrial Dysfunction Induced by High Estradiol Concentrations in Endometrial Epithelial Cells
Authors: Chou Chia-Hung , Chen Shee-Uan , Chen Chin-Der , Shun Chia-Tung , Wen Wen-Fen , Tu Yi-An , Yang Jehn-Hsiahn 
Published: September 2019

Abstract

Context
A supraphysiological estradiol (E2) concentration after ovarian stimulation is known to result in lower embryo implantation rates in in vitro fertilization. Endometrial epithelial cell (EEC) apoptosis occurs after the stimulation with high E2 concentrations, and mitochondria play important roles in cell apoptosis.

Objective
To investigate the mitochondrial function in EECs after the stimulation with high E2 concentrations.

Materials and Methods
Human EECs were purified and cultured with different E2 concentrations (10-10, 10–9, 10–8, 10–7 M) in vitro, in which 10–7 M is supraphysiologically high. Eight-week-old female mouse endometrium was obtained 5.5 days after the injection of 1.25 IU or 20 IU equine chorionic gonadotropin, roughly during the embryo implantation window, to examine the in vivo effects of high E2 concentrations on mouse EECs.

Results
In vivo and in vitro experiments demonstrated decreased mitochondrial DNA contents and ATP formation after EECs were stimulated with supraphysiologically high E2 concentrations than those stimulated with a physiologic E2 concentration. Less prominent immunofluorescence mitochondrial staining, fewer mitochondria numbers under electron microscopy, lower 5,5′,6,6′-tetrachloro-1,1′,3,3′-tetraethylbenzimidazolylcarbocyanine iodide aggregate/monomer ratio, and greater reactive oxygen species (ROS) production were found after EECs were stimulated with supraphysiologically high E2 concentrations. The high E2-induced ROS production was reduced when EECs were pretreated with N-acetyl-cysteine in vitro, but remained unchanged after the pretreatment with coenzyme Q10.

Conclusion
High E2 concentrations increase extramitochondrial ROS production in EECs and subsequently result in mitochondrial dysfunction.
Autoimmune Pituitary Disease: New Concepts With Clinical Implications
Authors: Yamamoto Masaaki , Iguchi Genzo , Bando Hironori , Kanie Keitaro , Hidaka-Takeno Ryoko , Fukuoka Hidenori , Takahashi Yutaka 
Published: September 2019

Abstract
Some endocrine disorders, including hypophysitis and isolated adrenocorticotropic hormone (ACTH) deficiency, are caused by an autoimmune response to endocrine organs. Although the pathogenesis of some autoimmune endocrine diseases has been elucidated, it remains obscure for most.
Anti-PIT-1 hypophysitis (anti-PIT-1 antibody syndrome) is a newly described pituitary autoimmune disease characterized by acquired and specific growth hormone (GH), prolactin (PRL), and thyroid-stimulating hormone (TSH) deficiencies. This disorder is associated with a thymoma or neoplasm that ectopically expresses pituitary-specific transcription factor 1 (PIT-1) protein. Circulating anti-PIT-1 antibody is a disease marker, and PIT-1-reactive cytotoxic T cells (CTLs) play a pivotal role in disease development.
In addition, isolated ACTH deficiency appears to be caused by autoimmunity to corticotrophs; however, the pathogenesis remains unclear. A recently described case of isolated ACTH deficiency with large cell neuroendocrine carcinoma (LCNEC) showed ectopically expressed proopiomelanocortin (POMC), and circulating anti-POMC antibody and POMC-reactive CTLs were also detected. As CTL infiltrations around corticotrophs were also observed, isolated ACTH deficiency may be associated at least in part with a paraneoplastic syndrome.
Although several underlying mechanisms for pituitary autoimmunity have been proposed, these observations highlight the importance of paraneoplastic syndrome as a cause of pituitary autoimmune disease. In this review, we focus on the pathophysiology and connection of anti-PIT-1 hypophysitis and isolated ACTH deficiency and discuss the state-of-art knowledge for understanding pituitary autoimmunity.
Uterine fluid proteins for minimally invasive assessment of endometrial receptivity
Authors: Kasvandik Sergo , Saarma Merilin , Kaart Tanel , Rooda Ilmatar , Meikas Agne-Velthut , Ehrenberg Aivar , Gemzell Kristina , Lalitkumar Parameswaran Grace , Salumets Andres , Peters Maire 
Published: September 2019

Abstract

Context
Clinically used endometrial (EM) receptivity assays are based on transcriptomic patterning of biopsies at mid-secretory endometrium (MSE) to identify the possible displacement or disruption of window of implantation (WOI) in patients with recurrent implantation failure (RIF). However, biopsies are invasive and cannot be performed in the same cycle with IVF embryo transfer, while uterine fluid (UF) analysis is considered minimally invasive and can immediately precede embryo transfer.

Objective
To determine whether UF proteome can be used for WOI monitoring and whether it would highlight the etiology of RIF.

Patients
Paired early secretory endometrial (ESE) and MSE UF samples from six fertile control women for discovery, and additional 11 paired ESE/MSE samples from controls and 29 MSE samples from RIF patients for validation.

Results
Using discovery mass spectrometry (MS) proteomics we detected 3,158 proteins from secretory phase UF of which 367 undergo significant (q < 0.05) proteomic changes while transitioning from ESE to MSE. 45 proteins were further validated with targeted MS, and 21 were found to display similar levels between control ESE and RIF MSE, indicating displacement of the WOI. Panel of PGR, NNMT, SLC26A2 and LCN2 demonstrated specificity and sensitivity of 91.7% for distinguishing MSE from ESE samples. The same panel distinguished control MSE samples from RIF MSE with a 91.7% specificity and 96.6% sensitivity.

Conclusion
UF proteins can be used for estimating uterine receptivity with minimal invasiveness. Women with RIF appear to have altered MSE UF profiles that may contribute to their low IVF success rate.