bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of Ki-67 in HR+/HER2- Breast Cancer: a Real-world Study of 956 Patients
Authors: Ma Qin , Liu Xin-Lan 
Published: March 2022

Abstract
Purpose: This retrospective study aimed to determine the most suitable cut-off value of Ki-67 expression and further explore the prognostic effect of Ki-67 in hormone receptor positive and human epidermal growth factor receptor 2 negative (HR+/HER2-) breast cancer;Methods: We assessed the Ki-67 expression of 956 patients with HR+/HER2 breast cancer diagnosed in General Hospital of Ningxia Medical University from 2015 to 2019 by immunohistochemistry, The disease-free survival (DFS) was defined as the time from postoperative to the first local recurrence, distant metastasis or death of the disease. Results: 22.5% was used as the cut-off for low/high Ki-67 expression in HR+/HER2- breast cancer; compared with the commonly used threshold value of Ki-67(14%) in clinic at present, the consistency of the two value is moderate (Kappa = 0.484, P<0.001). The expression of Ki-67 was increased with the increase of grade. (Median: G1:10%; G2:20%; G3:40%. Mean: G1:13%; G2:23%; G3:39%, P<0.001). During the follow-up that 61 patients developed recurrence or metastasis which Ki-67 low expression was found in 21 cases and high expression in 40 cases, the patients with Ki-67 ≥ 22.5% had a 2.937 higher risk of early recurrence and metastasis than the patients with Ki-67< 22.5%, the DFS in patients with high Ki-67 expression was lower than the patients with low Ki-67 expression (96% VS 89%, P<0.05). The common position of distant metastasis were bone, liver and lung, and rare metastases were adrenal gland, bone marrow and pericardium. Recurrence and metastasis mostly occurred in the second and third year after operation, and multi-site metastasis was more common.Conclusions: The cut-off value of Ki-67 expression in HR+/HER2- breast cancer is 22.5%; The patients with Ki-67 ≥ 22.5% had a 2.937 higher risk of early recurrence and metastasis than the patients with Ki-67 < 22.5%.
Surgical Outcomes of Congenital Heart Disease in Down Syndrome: Tertiary Centre Experience – Focus on the Electrical Conduction System
Authors: Ebrahim Mohammad , Balool Joud Al , Saegh Asia Al , Menshawi Hesham , Almeeri Nasreldeen , Elsayed Moustafa , Al-Saiedi Faisal , Lyubomudrov Vadim 
Published: March 2022

Abstract
Purpose: To document outcomes of cardiac surgical repair in Down syndrome (DS) patients with specific focus on the associated electrical conduction morbidities, ultimately leading to a higher incidence of pacemaker implantation (PMI). Methods: A retrospective study conducted between 2011 to 2020. Results: A total of 167 DS patients undergoing 204 surgeries were included. The mean gestational age (GA) and mean weight were 37.3 weeks and 5.5 kg respectively. Complete atrioventricular septal defect (AVSD) was the most common diagnosis. Pre-operative ECG revealed superior axis deviation (SAD) in 92% and 32% of patients with AVSD and isolated perimembranous ventricular septal defect (VSD), respectively (p < 0.01). Postoperative right bundle branch block (RBBB) was observed in 83% of patients post AVSD repair, and in 55% of patients following perimembranous VSD repair (p = 0.04). Ten patients underwent post-operative pacemaker implantation (PMI). Reintervention rate was around 8.9%. Three mortalities were encountered throughout the study period, 2 of which were in-hospital deaths. Conclusion: Low mortality was observed, however, a higher rate of PMI requirements noted with risk factors including lower age and weight.
An integrated Framework for Breast Mass Classification and Diagnosis using Stacked Ensemble of Residual Neural Networks
Authors: Baccouche Asma , Garcia-Zapirain Begonya , Elmaghraby Adel 
Published: March 2022

Abstract
A computer-aided diagnosis (CAD) system requires automated stages of tumor detection, segmentation, and classification that are integrated sequentially in one framework to assist the radiologists with a final diagnosis decision. In this paper, we introduce the final step of breast mass classification and diagnosis using a stacked ensemble of residual neural network (ResNet) models (i.e. ResNet50V2, ResNet101V2, and ResNet152V2). The work presents the task of classifying the detected and segmented breast masses into malignant or benign, and diagnosing the Breast Imaging Reporting and Data System (BI-RADS) assessment category with a score from 2 to 6 and the shape as oval, round, lobulated, or irregular. The proposed methodology was evaluated on two publicly available datasets, the Curated Breast Imaging Subset of Digital Database for Screening Mammography (CBIS-DDSM) and INbreast, and additionally on a private dataset. Comparative experiments were conducted on the individual models and an average ensemble of models with an XGBoost classifier. Qualitative and quantitative results show that the proposed model achieved better performance for 1) Pathology classification with an accuracy of 95.13%, 99.20%, and 95.88%; 2) BI-RADS category classification with an accuracy of 85.38%, 99%, and 96.08% respectively on CBIS-DDSM, INbreast, and the private dataset; and 3) shape classification with 90.02% on the CBIS-DDSM dataset. Our results demonstrate that our proposed integrated framework could benefit from all automated stages to outperform the latest deep learning methodologies.
The Development and Verification for Reliability and Validity of a Japanese Version of Greene et al.'s Moral Dilemma Questionnaire
Authors: TAKIMOTO YOSHIYUKI , Yasumura Akira 
Published: March 2022

Abstract
Background: A difference exists in people's judgements between the switch case and pedestrian bridge case of the trolley problem, which is explained by the concept of personalness or directness. The moral dilemma task questionnaire developed by Greene, which comprises personal and impersonal moral dilemmas, is useful for clarifying people's moral judgements. However, the validity of Green’s questionnaire was not validated. We developed and validated a Japanese version of this questionnaire. Methods and Results: Ten new questions were added to the Japanese version using double translation and its internal validity was tested. A second survey was conducted on the same participants one month after the first survey (n=231). The intraclass correlation coefficient by retest was found to be 0.781. Conclusion: Reproducibility, internal consistency, and criterion-related validity were confirmed by retesting the Japanese version of the moral dilemma task by Greene et al. The current study proved the reliability of the original version.
Birth and Regulation of head Extension to Guide Manual perineal Assistance (BREGMA) study
Authors: Abouelhassan Abdelrahman , Kalis Vladimir , Schüssler Marc , Awwad Hassan , Hassan Rania , Ismail Khaled M 
Published: March 2022

Abstract
Introduction and Hypothesis: The exact positioning of the dominant hand at the time of manual perineal protection is not clearly specified. The overarching aim of this work was to collect data on the bregma to posterior fourchette distance (BFD), as a surrogate measure for the degree of fetal head extension, and maternal perineal body length (PBL) at the time of manual perineal protection (MPP). Methods: This was a two-center study. Term cephalic singleton nulliparous women having spontaneous vaginal delivery were considered eligible for recruitment into the study. Once crowning was diagnosed and just prior the initiation of manual perineal protection (MPP) or cutting an episiotomy, the BFD and PBL were measured using a standardized measurement protocol.Results: A total of 100 women (50 women in each center) were recruited into the study. The overall mean BFD was 2.8 ± 0.5 cm. The overall mean PBL was 4.4 ± 0.8 cm. There were no statistically significant differences between the measurements taken in both units regarding BFD or PBL (p = 0.81 and 0.10 respectively). There was a weak correlation between both measurements.Conclusion: This is the first study to generate data on the bregma to fourchette distance and the perineal body length just prior to fetal head expulsion. This information will probably be useful to inform future biomechanical computational modeling studies to optimize hands and fingers placement during manual perineal protection.
Prognosis by novel staging systems incorporating tumor biology in estrogen receptor positive and human epidermal growth factor receptor negative breast tumors
Authors: Vane Marissa , Traa Fenna , Roozendaal Lori van , Kuijk Sander van , Engelen Sanne , Maaren Marissa van , Siesling Sabine , de Wilt Johannes , Smidt Marjolein 
Published: March 2022

Abstract
Purpose The prognostic stage group and Bioscore are novel staging systems for breast cancer patients. They provide a better view on five-year disease-specific survival (DSS) compared to the traditional staging system. Five-year follow-up might not be sufficient for ER+HER2- tumors. This study determines five- and 10-year recurrence-free survival (RFS) for the anatomic and prognostic stage group of the 8 th AJCC TNM and Bioscore staging system, and compares these systems for ER+HER2- breast cancer patients. Methods All newly diagnosed ER+HER2- breast cancer patients treated with primary surgery in 2005 were included from the Netherlands Cancer Registry with a ten-year follow-up. All patients were staged according to 8 th AJCC TNM (both anatomic and prognostic stage group) and the Bioscore staging system. Five- and 10-year RFS was compared using Kaplan-Meier analysis. The ability to discriminate groups was quantified by the concordance statistic (c-statistic). Results Five-year RFS ranged from 65.0-91.1% (anatomic) and from 40.9-91.8% (prognostic stage group). The Bioscore staging system ranged from 54.9-92.1%. Ten-year RFS rates were 52.9-84.9% (anatomic stage), 31.8-84.6% (prognostic stage) and 47.1-85.1% (Bioscore). All systems similarly discriminated groups with comparable c-statistic score (five- and 10-year 0.58-0.60). The prognostic stage group identified a group (IIIC) with very poor prognosis (31.8%) which could not be identified using the other staging systems (10-year RFS for 52.8% for anatomic IIIC and 47.1% for Bioscore 6). Conclusion All three staging systems similarly discriminated groups for ER+HER2- breast cancer patients with a five- and 10-year follow-up. However, the prognostic stage group showed a wider distribution of the 10-year RFS compared to anatomic stage group and Bioscore staging system.
Gender Stereotypes when Applying Bloom’s Taxonomy by Preservice Teacher's
Authors: Karama Muneer Jebreel 
Published: March 2022

Abstract
The aim of this research was to examine the gender stereotypes between preservice teachers (33 preservice teachers;4 male, 29 female) by applying Bloom’s Taxonomy in their educational course, “ Measurement & Evaluation.” Each student was assigned to formulate behavioral goals, according to Blooms six classification levels, and by the end of the course. The research questions for the study were: Do the verbs (actions) and nouns of Bloom’s Taxonomy which were written by preservice teachers connotative any gender stereotypes? Were there differences between females and males in their use of gender stereotypes? Were there differences between preservice teachers according to their academic field (13 applied biology, 13 applied mathematics, 6 applied physics, and 1applied chemistry) toward gender stereotypes? The analysis of the data showed that preservice teachers had gender stereotypes (more than 70% of them are masculine verbs and nouns) in writing verbs (actions), and nouns, during they are designing Bloom’s Taxonomy. Moreover, there are no are significant differences between females and males in their tendency toward apply gender stereotypes due to males, and their academic field. In light of these findings and results, the scholar powerfully endorses that the course needs to be used to develop a gender balance, and eliminate gender stereotypes.
Novel Method to Systematically Resolve Global Warming by Removing CO2 from the Air and Turning it Into Formic Acid
Authors: Köntös Zoltán 
Published: March 2022

Abstract
The CO2 concentration in the atmosphere is a major problem with global warming being one of the main effects of the increased CO2 concentration. The recapture of CO2 from the atmosphere represents one of the most revolutionary ways of dealing with the problem. This study proposes the removal of high CO2 concentration in the Earth’s atmosphere relying on a photocatalytic conversion of CO2 into formic acid. The use of readily available materials such as water and light makes the process easily adaptable. The study conducts an experiment on the photocatalytic conversion of CO2 into formic acid using a RK-X reactor. Experiments conducted by the study returned 2.6g/L of formic acid achieved through the photocatalytic CO2 conversion which can be easily restarted and adopted on a large scale basis with the right investment. The study proves that the conversion of CO2 into formic acid is very much possible and highlights the practical applications of the process through the benefits associated with formic acid. The formic acid produced could act as a hydrogen carrier due to the formic acid’s properties that make it one of the best hydrogen energy carriers hence allowing for energy from the sun to be converted and stored in chemical bonds.
Z-RNA and the flipside of the SARS Nsp13 helicase
Authors: Herbert Alan , Shein Alex , Poptsova Maria 
Published: March 2022

Abstract
We present evidence that the severe acute respiratory syndrome coronavirus (SARS) non-structural protein 13 (Nsp13) modulates the Z-RNA dependent regulated cell death pathway of necroptosis (1). We show that Z-prone sequences (called flipons (2)) exist in coronavirus and provide a signature that enables identification of the animal viruses which have become human pathogens. We also identify a potential RHIM in Nsp13. These two observations allow us to suggest a model in which Nsp13 may regulate Z-RNA-initiated RHIM-dependent cell death outcomes at two steps. The first step involves possible new ATP-independent Z-flipon helicase activity in Nsp13, which is distinct from the activity of the canonical A-RNA helicase. This activity unwinds/quenches nascent Z-RNAs, preventing their sensing by ZBP1. The second step involves RHIM-dependent inhibition of ZBP1, RIPK3 and/or RIPK1, preventing cell death downstream of Z-RNA sensing. Together the RHIM and Z-flipon helicase have the potential to alter the host response to the virus and the effectiveness of drugs targeting the NSP13 helicase.
Morphological characteristics of the infrapatellar fat pad
Authors: Edama Mutsuaki , Otsuki Tomofumi , Yokota Hirotake , Hirabayashi Ryo , Sekine Chie , Maruyama Sae , kageyama Ikuo 
Published: March 2022

Abstract
The purpose of this study was to clarify the morphological characteristics of the infrapatellar fat pad (IFP) in Japanese cadavers and to elucidate the relationship between morphological characteristics of the IFP and degeneration of the patellofemoral joint. This investigation examined 41 legs from 25 Japanese cadavers. Morphological measurement was performed by one examiner, and the proximal IFP, IFP body length, width, and IFP volume were measured. The morphological characteristics of IFP proximal were used to categorize three types of IFP: Type I, IFP proximal located on medial and lateral sides of the patella; Type II, IFP proximal only located medially; and Type III, absence of IFP proximal medially and laterally. Articular surfaces were graded as macroscopically intact or mildly altered (Grade I), moderately altered (if fissuring or fibrillation was observed; Grade II), or severely altered (if eburnation was present; Grade III). Type I was identified in 36.6%, Type II in 48.8%, and Type III in 14.6%. IFP medial proximal was seen in 85%, IFP lateral proximal in 36.6%, and loop type was 2.4%. Grade II was significantly more frequent than Grades I or III in Type II, and Grade III was significantly more frequent than Grades I or II in Type III. In addition, IFP volume was significantly larger in Type I than in Types II or III. Causal relationships remain unclear, but the deformation of patellofemoral joint may be related to decreased IFP volume (atrophy).
Investigation of optical properties of Er3+-doped Ga1As39S60 glasses quenched in salt batch media
Authors: rezvani mohammad , Dizaj Amin Yousefi , Ahmadi Pouya 
Published: March 2022

Abstract
Er3+ - doped (0.5-2%wt) Ga1As39S60 glasses were synthesized by melting appropriate amounts of Ga, As, S as starting materials in rotating furnace and consequently quenching in salt batch media (NaNO3 + KNO3) with the temperature of 130\(℃\). X-ray diffraction spectra and FESEM micrograph showed the amorphous nature and homogeneous structure of the prepared samples with no clusters. The glass transition temperature of samples was increased from 183\(℃\) to 206\(℃\) by increasing Er3+ amount from 0.5 to 2%wt. The effects of Er3+ on absorption coefficient\(\left(\alpha \right)\), Fermi energy level(EF), direct and indirect forbidden bands, and Urbach energy were investigated and later ones were increased from 1.75 to 1.77ev, from 1.80 to 1.84 ev, from 2.05 to 2.08 ev and from 0.10 to 0.11 ev, respectively with increasing Er3+ ions (0.5-2%wt) which confirmed the modifying role of Er3+ ions in Ga-As-S system.
Evaluating a ten years training course in child psychiatry in Jimma, South-West Ethiopia
Authors: Abera Mubarek , Hailu Yohannes , Kerebih Habtamu , Gruber-Frank Christine , Frank Reiner 
Published: March 2022

Abstract
Background: In Ethiopia, as many other low-and middle income-countries, health professionals, particularly of mental health workers are scarce. The purpose of this paper is therefore to describe the process of developing, establishing and evaluating a training course for child psychiatry within this program.Method: Cooperation between local and foreign institutions and instructors used to offer the course in child psychiatry between 2010 and 2019. The core elements of the course were to train mental state description from locally produced video examples, make decisions on possible disorders, do occupational activities and design psychosocial interventions. Patient-oriented method of teaching was implemented. The basic structures of course development were a phase of preparation, a focus on case presentations during the course, mutual feedback and evaluation, and a workup after the course. The concept in the method of teaching was adapted in an iterative process according to the needs of patients and evaluations of participants and teachers overtime. Results: From 2010 to 2019 eight courses were organized. A total of 71 trainees took part in the courses successfully. The initial step was to establish collaboration with guest lecturers and implementation of the teaching program. Each course contributed to expand the course materials subsequently. Main modifications were to elaborate on the mental state description successively to get a feeling for children's’ problems by age and severity. The second period was a phase of transition from guest lecturers to local trainers. At the request of graduates, a refresher course was held in 2017. Relying on an OSCE format, clinical abilities could be updated within one weekend. Capacity building was a major aim of the program. Three graduates developed to be trainers in child mental health and they subsequently continued the course on their own. Alongside the teaching program, an outpatient clinical service for children established by the lead author is now running at Jimma University.Conclusion: The establishment of the training program was time consuming. The long-term commitment of local and guest teachers enabled them to develop culturally appropriate solutions for the local context. A similar approach could be applied to other settings.
KEUNGGULAN KOMPETITIF YANG DALAM MENCIPTAKAN INOVASI UNTUK KEWIRAUSAHAAN STRATEGIS
Authors: Bilgies Ana Fitriyatul 
Published: March 2022

At the moment in the environment of competitive advantage use for companyneeds to be very agile and adaptive. While often unable to make a certainlevel of performance based on technology on existing progress, the company isalso came often to login of in the new technology emerging. How to addressentrepreneurship strategically as a way which the company simultaneouslyexploit competitive advantage they are now while explore for opportunitiesfor the future . On this Reaching based on balance between exploration andexploitation of consists of more than just allocated of resources in comparable between the two the process. And so as be discussed, For the exploration to the exploitation of is process that it should be, structure and culturally distinct.
Soft Anticholinergics
Authors: Kumar Gondi N. , Bodor Nicholas 
Published: March 2022

Abstract:
The soft drug (pharmacologically active compounds which undergo predictable, preferably one-step, deactivation to a nontoxic moiety, after achieving the desired pharmacological effect) approach was applied to design and evaluate soft anticholinergics based on several known anticholinergics (propantheline, atropine and scopolamine. These compounds are intended for selective local action with decreased potential for systemic side effects. The new compounds synthesized were found to
be potent anticholinergics both in vitro and in vivo. A propantheline soft analog was equipotent with propantheline in inhibiting indomethacin-induced gastric ulceration in rats and exhibited a shorter duration of systemic anticholinergic action in rabbits than propantheline. The methatropine and methscopolamine soft analogs were potent anticholinergics with very short duration of mydriatic action in rabbits compared to their hard analogs. In contrast to their hard analogs, they exhibited no systemic anticholinergic activity on topical administration into the rabbit eye. The potent anticholinergic activity combined with increased metabolic lability of the compounds described in this article fulfill the design requirements of ideal soft drugs.
Diagnostic Accuracy of MR Mammography in Comparison with Digital Mammography and Sonomammography
Authors: Sedguli Sreenidhi , Gowda Raghu Srinivasa , Ranganathan Rupa , Kumar B Senthil 
Published: March 2022

Background. Even though the sensitivity of contrast-enhanced breast magnetic resonance mammography (CE-MRM) is consistently high in the range of 94-100%, conventionally, digital mammography and sonomammography continue as standard imaging modalities for the detection and evaluation of breast disease.
The objective of the study was to detect additional lesions that go undetected by routine digital mammography and sonomammography using CE-MRM.
Materials and Methods. In a prospective study, 68 patients who came for screening diagnostic mammogram and had breast lesions of Breast Imaging-Reporting and Data System category 3-6 were evaluated. All patients underwent bilateral digital mammography and targeted high-frequency sonomammography of the primary lesion. Those patients who were thought to possibly have breast cancer and to be candidates for surgical management were offered bilateral CE-MRM.
Results. In this prospective study, we included 68 patients (mean age - 50.6 years, range - 30-73 years). A total of 74 lesions were evaluated. In detecting these lesions, digital mammography had a sensitivity of 40.0%, specificity of 100% and diagnostic accuracy of 63.5%. CE-MRM sensitivity was found to be 71.7%, specificity - 96.6% and diagnostic accuracy - 83.7%. Among the 27 additional lesions detected by CE-MRM, histopathological evaluation confirmed only 19, indicating the sensitivity of 100%, specificity of 85.4%, positive predictive value of 67.8%, negative predictive value of 100%, diagnostic accuracy of 89.2%.
Conclusions. The diagnostic accuracy of CE-MRM was found to be 83.7%, with a specificity of 96.6%. CE-MRM detected 19 additional lesions that were undetected by either digital mammography or ultrasonography. CE-MRM is sensitive in detecting additional malignant lesions which are not detected by other imaging modalities.