bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deep Brain Stimulation of the Nucleus Accumbens in Severe Enduring Anorexia Nervosa: A Pilot Study
Authors: Scaife Jessica C. , Eraifej John , Green Alexander L. , Petric Beth , Aziz Tipu Z. , Park Rebecca J. 
Published: April 2022

IntroductionAnorexia nervosa (AN) is one of the most debilitating psychiatric disorders, becoming severe and enduring in a third of cases; with few effective treatments. Deep brain stimulation is a reversible, adjustable neurosurgical procedure that has been gaining ground in psychiatry as a treatment for depression and obsessive–compulsive disorder, yet few studies have investigated AN. Abnormal eating behavior and the compulsive pursuit of thinness in AN is, in part, a consequence of dysfunction in reward circuitry and the nucleus accumbens (NAcc) is central to reward processing.MethodsPhase 1 prospective open-label pilot study of seven individuals with severe enduring AN. Electrodes were implanted bilaterally into the NAcc with stimulation at the anterior limb of the internal capsule using rechargeable implantable pulse generators. The protocol of 15 months included 12 months of deep brain stimulation incorporating two consecutive, randomized blind on-off fortnights 9 months after stimulation onset. The primary objectives were to investigate safety and feasibility, together with changes in eating disorder psychopathology.ResultsFeasibility and safety was demonstrated with no serious adverse events due to deep brain stimulation. Three patients responded to treatment [defined as &gt; 35% reduction in Eating Disorders Examination (EDE) score at 12 months] and four patients were non-responders. Responders had a statistically significant mean reduction in EDE scores (50.3% reduction; 95% CI 2.6–98.2%), Clinical Impairment Assessment (45.6% reduction; 95% CI 7.4–83.7%). Responders also had a statistically significant mean reduction in Hamilton Depression Scale, Hamilton Anxiety Scale and Snaith-Hamilton pleasure scale. There were no statistically significant changes in Body Mass Index, Yale-Brown-Cornell Eating Disorder Scale, Yale-Brown Obsessive–Compulsive Scale and World Health Organization Quality of Life Psychological subscale.ConclusionThis study provides some preliminary indication that deep brain stimulation to the NAcc. Might potentially improve some key features of enduring AN. In this small study, the three responders had comorbid obsessive-compulsive disorder which predated AN diagnosis. Future studies should aim to further elucidate predictors of outcome.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [Project ID 128658].
Fiscal Reform in Costa Rica: Price Elasticities of Major Food Categories to Inform Decision-Making
Authors: Dal Eléonore , Rivera Rodrigo , Morales Opazo Cristian , Madrigal Mariela 
Published: April 2022

In the context of fiscal reform in Costa Rica (value added tax revision), the definition of a new basic tax basket, “canasta básica tributaria” (CBT) in Spanish, incorporating nutritional criteria is underway in the country. In this study, price elasticities of major food categories were analyzed using a Quadratic Almost Ideal Demand System (QUAIDS) model. Data from the 2018 National Survey of Household Income and Expenditures was used. Measuring price elasticities is essential because it allows: knowing the extent to which food demand reacts to price changes, anticipating changes in the quantities demanded as a result of fiscal policy changes, measuring potential substitution and complementary effects between food groups, and potential nutritional effects of fiscal policies. As a result, it helps providing recommendations on the content of a CBT with nutritional criteria. Results show that the food categories with the most elastic demand are “Bread and cereals,” soft drinks and “Milk, cheese and eggs.” Substitution effects exist between the following groups: “Fruits” and “Oils and fats,” “Fruits” and “Bread and cereals,” and between “Milk, cheese and eggs” and “Oils and fats.” For this last food category and for the one which includes sweets and chocolates, the consumption decreases when the price of “Bread and cereals” increases. They are complementary goods. These relations between food groups need to be taken into account when defining a national CBT with nutritional criteria and with the objective of promoting the consumption of healthier food groups while disincentivizing the consumption of the unhealthy ones. Lastly, it is important that the consumption of the healthiest foods within each food group be fiscally promoted.Clinical Trial RegistrationJEL codes: D12, H3, I18.
Hypofractionated Radiotherapy for Palliation of Main Portal Vein Tumor Thrombosis
Authors: Fang Fang , Qiu Bin , Zhen Peng , Wang Junjie 
Published: April 2022

BackgroundHypofractionated radiotherapy delivered for portal vein tumor thrombosis (PVTT) located in the main portal vein is rarely exploited. The study aimed to evaluate the efficacy and safety of hypofractionated radiotherapy as palliative treatment for PVTT in cirrhotic patients with hepatocellular carcinoma.MethodsFrom March 2016 to July 2020, 16 patients (mean age, 59.1 ± 6.3 years; 15 men) with hepatocellular carcinoma and hepatitis virus-related cirrhosis who underwent hypofractionated radiotherapy for PVTT (located in the main portal vein) in our institute were retrospectively reviewed.ResultsComplete response of the PVTT was observed in 4 cases (25%) with partial response in 7 cases (43.75%) and stable disease in 5 cases (31.25%). Symptom relief was observed in all 7 patients suffering from ventosity. The median time to progression was 6 months (interquartile range, IQR: 6–12 months). Eight patients (50%) failed due to primary cancer progression, 7 patients failed due to extrahepatic metastasis, and only 1 patient failed due to PVTT progression. The median overall survival was 17.4 months (IQR: 8–25 months). Grade I/II anorexia/nausea was observed in 14 patients (87.5%) and Grade I/II leukopenia was observed in 14 patients (87.5%). No complications ≥ Grade III were observed.ConclusionsHypofractionated radiotherapy as palliative treatment appears effective and safe for PVTT located in the main portal vein in cirrhotic patients with advanced hepatocellular carcinoma, yielding a high rate of tumor response. Further study is warranted.
Prognostic Nomogram Based on the Metastatic Lymph Node Ratio for T1-4N0-1M0 Pancreatic Neuroendocrine Tumors After Surgery
Authors: Shi Jingxiang , Liu Sifan , Cao Jisen , Shan Shigang , Ren Chaoyi , Zhang Jinjuan , Wang Yijun 
Published: April 2022

PurposeThis study aimed to investigate the prognostic significance of the metastatic lymph node ratio (LNR) in patients with pancreatic neuroendocrine tumors (pNETs) and to develop and validate nomograms to predict 5-, 7-, and 10-year overall survival (OS) and cancer-specific survival (CSS) rates for pNETs after surgical resection.MethodsThe demographics and clinicopathological information of T1-4N0-1M0 pNET patients between 2004 and 2018 were extracted from the Surveillance, Epidemiology and End Results database. X-tile software was used to determine the best cutoff value for the LNR. Patients were randomly divided into the training and the validation groups. A Cox regression model was used in the training group to obtain independent prognostic factors to develop nomograms for predicting OS and CSS. The concordance index (C-index), calibration curves, area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA) were used to assess the nomograms. Patients were divided into four groups according to the model scores, and their survival curves were generated by the Kaplan–Meier method.ResultsA total of 806 patients were included in this study. The best cutoff value for the LNR was 0.16. The LNR was negatively correlated with both OS and CSS. Age, sex, marital status, primary site, grade, the LNR and radiotherapy were used to construct OS and CSS nomograms. In the training group, the C-index was 0.771 for OS and 0.778 for CSS. In the validation group, the C-index was 0.737 for OS and 0.727 for CSS. The calibration curves and AUC also indicated their good predictability. DCA demonstrated that the nomograms displayed better performance than the American Joint Committee on Cancer (AJCC) TNM staging system (8th edition). Risk stratification indicated that patients with higher risk had a worse prognosis.ConclusionsThe LNR is an independent negative prognostic factor for pNETs. The nomograms we built can accurately predict long-term survival for pNETs after surgery.
Emergence and Persistence of Resistance-Associated Substitutions in HCV GT3 Patients Failing Direct-Acting Antivirals
Authors: Mushtaq Saima , Hashmi Asraf Hussain , Khan Amjad , Asad Raza Kazmi Syed Muhammad , Manzoor Sobia 
Published: April 2022

Background: The hepatitis C virus has a high mutation rate, which results in the emergence of resistance-associated substitutions (RASs). Despite direct-acting antivirals (DAAs) efforts to treat chronically infected HCV genotype 3 (GT3) patients, there are concerns about the emergence and persistence of RASs in DAA failures. The objective of this study was to determine the prevalence of clinically relevant RASs in HCV NS5A and NS5B regions before and after treatment to better understand the role of RASs in treatment failures.Methods: Viral RNA was extracted before and after treatment from serum samples. NS5A and NS5B regions of HCV were amplified by nested PCR, followed by Sanger sequencing. The nucleotide sequences were aligned against HCV GT3 reference sequences, and amino acid substitutions were analyzed using the geno2pheno [hcv] webserver.Results: A total of 76 patients failing DAA therapy were stratified from the cohort of 1388. RASs were detected at the baseline in 15/76 patients and at relapse in 20/76 patients with cirrhosis and previously treated with interferons. The most prevalent NS5A RAS was Y93H found in all treatment-failing patients (14/54 in DCV vs. 6/22 in VEL), followed by A62S/T and A30K. No RASs were identified in NS5B. RASs that were present at the baseline persisted through the 24-week follow-up period and were enriched with emerging RASs during the treatment. The presence of RASs may be one of the causes of treatment failures in 26.3% of patients. Amino acid substitutions were present at the baseline in most of the patients with RASs against NS5A inhibitors. Patients with the baseline Y93H and/or A30K relapse more frequently than patients harboring A62S/T.Conclusion: Treatment-failing patients harbored NS5A RASs, and the most frequent were A30K (5/20), A62S/T (20/20), and Y93H (20/20). Direct resistance testing is recommended for optimizing re-treatment strategies in treatment-failing patients.
The Public's Preferences for Psychological Interventions During the COVID-19 Pandemic: A Discrete Choice Experiment
Authors: Li Hui-qin , Liu Shu-xiang , Xue Hui , Yuan Hua , Zhang Xiu-ying 
Published: April 2022

AimsTo explore the public's preference for psychological interventions through a discrete choice experiment and to provide references for formulating psychological intervention policies and establishing psychological intervention procedures in response to public health emergencies.MethodsThis study is a discrete choice experiment. Attributes and levels were identified through literature reviews, in-depth interviews, focus group discussions, and expert consultations. Experimental design principles were applied to generate choice sets containing different attribute levels and develop a survey instrument. Convenience sampling was conducted nationwide, and 1,045 participants were investigated. A mixed logit model was used to evaluate the public's preferences.ResultsAll attributes in our study were found to have a significant influence on the public's preferences for psychological interventions during the COVID-19 pandemic. The public's preferences for providers and duration were influenced by the public's levels of education and classifications. Furthermore, the most ideal scenario was found to be a one-on-one psychological intervention provided by family and friends through social network platforms, for which the frequency is twice per week, and the duration of each intervention is 0.5–1 h.ConclusionsThe public's preferences for psychological interventions during the COVID-19 pandemic are affected by the method, form, frequency, provider, and duration of interventions. Our findings provide references for the formulation of psychological intervention policies and the establishment of psychological intervention procedures in response to public health emergencies.
Relationship Between Time of Admission, Help-Seeking Behavior, and Psychiatric Outcomes: “From Dusk Till Dawn”
Authors: Knorr Marius , Hofmann Andreas B. , Miteva Dimitrina , Noboa Vanessa , Rauen Katrin , Frauenfelder Fritz , Seifritz Erich , Quednow Boris B. , Vetter Stefan , Egger Stephan T. 
Published: April 2022

IntroductionDay and time of admission influence treatment outcomes and prognosis in several medical specialties; this seems related to resources' ability. It is largely unknown whether this also applies to mental health services. We investigate the relationship between time of admission, patients' demographic and clinical profile, and treatment outcomes.MethodsDemographic and clinical profiles of admitted and discharged patients to a general psychiatric ward between January 1st, 2013 and December 31st, 2020, were analyzed. In addition, we used the last year (i.e., 2020) to monitor rehospitalization. Time of admission was defined as weekdays (working day, weekend) and dayshifts (daytime, dusk, and dawn).ResultsDuring the study period, 12,449 patient admissions occurred. The mean age of the sample was 48.05 ± 20.90 years, with 49.32% (n = 6,140) females. Most admissions (n = 10,542, 84%) occurred on working days. Two-fifths of admissions (39.7%, n = 4,950) were compulsory, with a higher rate outside daytime hours. Patients had slight differences in the clinical profile, resulting from evaluating the different items of the Health of Nation Outcome Scale (HoNOS). Patients admitted on night shifts, weekends, and holidays showed a shorter length of stay; patients compulsorily admitted during daytime (disregarding the day of the week) had a longer length of stay. All patient groups achieved a robust clinical improvement (i.e., an HoNOS score reduction of around 50%), with similar readmission rates.DiscussionThe main finding of our study is the relationship between “daytime hours” and fewer compulsory admissions, a result of the interplay between demographics, clinical characteristics, and out-of-clinic service availability (such as ambulatory psychiatric- psychological praxis; day-clinic; home-treatment). The differing clinical profile, in turn, determines differences in treatment selection, with patients admitted after office hours experiencing a higher rate of coercive measures. The shorter length of stay for out-of-office admissions might result from the hospitalization as an intervention. These results should encourage the implementation of outpatient crisis-intervention services, available from dusk till dawn.
Depression and Psychological Stress Among Health Workers in Remote Areas in Indonesia
Authors: Idaiani Sri , Waris Lukman 
Published: April 2022

BackgroundThe Indonesian government launched the Nusantara Sehat program in 2015, under which teams of health workers were assigned to community health care centers in remote, border, and island areas for 2 years. The deployment to remote areas is likely to affect their psychological condition if they are not equipped with facilities and strong motivation. This study aimed to describe the psychological condition of health workers in remote areas in Indonesia, focusing on the proportion of the prevalence of depression and psychological stress.Materials and MethodsThis cross-sectional study was conducted between April and December of 2018. Participants were 140 health workers placed in 26 community healthcare centers in 13 provinces. Interviews were conducted by enumerators using a questionnaire that included questions from the Mini International Neuropsychiatric Interview (MINI) and Self-Reporting Questionnaire-20 (SRQ-20).ResultsOf the participants, 7.1% experienced depression and 10.0% experienced psychological stress. Motivation was related to psychological stress in participants with an odds ratio of 0,218 (95% confidence interval = 0.065–0.729, p = 0.013). Health workers with high motivation tend not to experience psychological stress compared to individuals with lower motivation.ConclusionHealth workers with high motivation experience relatively low levels of psychological stress. To overcome stress, high motivation is needed to control psychological risk factors before and during placement.
Perception of University Students Towards National Efforts at Controlling COVID-19 Pandemics, the Practice of Prevention Measures and its Associated Factors During School Reopening
Authors: Tadese Mesfin , Tessema Saba Desta , Altaye Girma , Mulu Getaneh Baye 
Published: April 2022

BackgroundThe Coronavirus disease 2019 (COVID-19) pandemic has affected many communities including students. Even if restrictions are being lifted in some countries, i.e., Ethiopia, COVID-19 is not gone yet. Adjusting to the “new normal”, an emerging prevention response to the virus, can greatly recover public health and education. Thus, this study aimed to assess students' perception of national efforts at controlling the COVID-19 pandemic, including approaches to prevention measures, and associated factors during campus re-entry.Methods and MaterialsWe conducted a cross-sectional study among 682 Debre Berhan University (DBU) students from December 1 to 15, 2020, when students had just gone back to school. The data was entered into Epi-Data version 4.6 and exported to SPSS version 25.0 statistical software for analysis. The perception and practice of the participants were assessed using a scoring system. Binary logistic regression was run to identify the significant (p ≤ 0.05) predictors of COVID-19 prevention practice.ResultThe overall high perception and good practice of prevention behaviors were 32%, 95% CI (28.8–35.2), and 37.5%, 95% CI (33.7–41.2), respectively. Being female [AOR (CI) = 1.67 (1.17–2.37)], have a rural residence [AOR (CI) = 1.56 (1.07–2.29)], fathers' education [AOR (CI) = 1.94 (1.06–3.56)], having respiratory disease [AOR (CI) = 2.81 (1.32–5.95)], and information sources from YouTube [AOR (CI) = 1.87 (1.19–2.91)] were significant factors for COVID-19 prevention practice. Besides, a high perception of national efforts at controlling COVID-19 [AOR (CI) = 2.94 (2.04–4.25)] was positively associated with the practice of prevention measures.ConclusionDuring school reopening, most students had a low perception of national efforts at controlling COVID-19 and poor prevention practices. Socio-demographics, having a chronic illness, information sources, and perception of national efforts were factors of COVID-19 prevention practice. Thus, raising the perception of the national efforts, promoting precautionary measures, managing chronic illnesses, and disseminating information through YouTube are critical to preventing and controlling COVID-19 during campus re-entry.
Pretreatment Systemic Immune-Inflammation Index Can Predict Response to Neoadjuvant Chemotherapy in Cervical Cancer at Stages IB2-IIB
Authors: Liu Pingping , Jiang Yinan , Zheng Xiaojing , Pan Baoyue , Xiang Huiling , Zheng Min 
Published: April 2022

Background: The systemic immune-inflammation index (SII) has been identified as a predictor of chemotherapy efficacy for a variety of cancers, and we aimed to determine its ability to predict the response to chemotherapy and its long-term prognosis for patients with cervical squamous cell carcinoma (CSCC) who have underwent platinum-based neoadjuvant chemotherapy (NACT).Methods: The date from 210 patients (133 in the training cohort and 77 in the validation cohort) with CSCC who received NACT were analyzed retrospectively. The association between SII and the pathological complete response (pCR) was determined using Pearson’s chi-square test, receiver operating characteristic (ROC) curve, and Logistic regression analysis. The Kaplan-Meier method and Cox proportional regression model were used to assess the relationship between SII and progression-free survival (PFS) or overall survival (OS).Results: The calculated optimal SII cutoff values for pCR and survival were 568.7051 and 600.5683, respectively, and patients were divided into two groups: a low SII group (≤568.7051 or ≤600.5683) and a high SII group (&gt;568.7051 or &gt;600.5683). A high SII was associated significantly with a lower pCR. Further analysis determined that SII was a more efficient predictor of pCR than the prognostic nutritional index, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio. Upon multivariate logistic analysis, SII proved to be an independent risk factor to predict the pCR of patients with CSCC. Kaplan-Meier analysis demonstrated that PFS and OS rates were significantly higher in the low-SII group compared with those in the high-SII group. Additional multivariate analysis indicated that the SII is an independent prognostic factor for patients with CSCC treated with NACT.Conclusion: The results confirmed that the pre-treatment SII is not only an independent predictor of pCR but also an independent prognostic factor of CSCC patients treated with platinum based NACT.
High Neutrophil-To-Lymphocyte Ratio (NLR) and Systemic Immune-Inflammation Index (SII) Are Markers of Longer Survival After Metastasectomy of Patients With Liver-Only Metastasis of Rectal Cancer
Authors: Polk Nándor , Budai Barna , Hitre Erika , Patócs Attila , Mersich Tamás 
Published: April 2022

Background: The literature data regarding colon cancer patients with liver-only metastases (CLM) show that NLR determined before metastasectomy is a prognostic marker of shorter relapse-free survival (RFS), but no results has been reported to date for rectal cancer patients with liver-only metastases (RLM). This study aimed to investigate the NLR and SII in CLM and RLM.Methods: Relapse-free (RFS) and overall survival (OS) were evaluated in 67 CLM and 103 RLM patients with a median follow-up of 46.5 and 59.8 months, respectively. Pre- and/or postoperative chemotherapy ± targeted treatment was applied in 96% and 87% of CLM and RLM patients, respectively. The cut-off level for hematologic parameters were determined by receiver operating characteristic (ROC) analysis. Univariate analysis was performed by Kaplan-Meier method and log rank test. For multivariate analysis Cox regression was applied.Results: In univariate analysis low NLR (cut-off 2) and SII (535) were predictors of longer RFS in case of CLM (p &lt; 0.01). In contrast, for RLM high NLR (2.42) and SII (792) were predictors of longer RFS (p &lt; 0.001). For RLM both NLR and SII proved to be independent markers of RFS (HR 0.66 (95% CI 0.52–0.84) and 0.73 (0.57–0.91), respectively) and OS (0.76 (0.58–0.99) and 0.66 (0.5–0.87), respectively). Only NLR (1.44 (1.04–1.99)) was independent marker of RFS for CLM. The preoperative treatment has not influenced the role of NLR or SII.Conclusion: In contrast to CLM, in RLM the high NLR or SII determined before metastasectomy proved to be independent prognostic factors of longer RFS and OS.