bluuebunny/crossref_metadata_2025 huggingface dataset:
Application of Novel Tumor-free Techniques in Laparoscopic Radical Hysterectomy for Early Cervical Cancer.
Authors: Jing Huining , Zhou Junying , Ran Xuting , Min Wenjiao , Li Zhengyu
Published: February 2021

Objective: Minimally invasive radical hysterectomy has been historically considered oncologically equivalent to open radical hysterectomy for patients with early cervical cancer. However, it was recently reported to be significantly inferior in long-term outcomes of the minimally invasive approach to open approach. The underlying causes of this finding arouse great concern and remain controversial. Here we would like to share some initial experience of tumor-free techniques in laparoscopic procedures for early cervical cancer, including uterine manipulator-free manipulation and enclosed colpotomy. Methods: Between December 2019 and May 2020, we performed manipulator-free laparoscopic radical hysterectomy in 26 cases with early cervical cancer. The modified tumor-free techniques, including uterine manipulator-free manipulation and enclosed colpotomy, was described in detail with illustrations.Results: The procedures went well in all patients. In our initial experience, these modifications do not increase the difficulty of surgical techniques, and can be well performed by the experienced surgeons.Conclusions: These techniques are safe and feasible, and the effects on oncological outcomes deserve follow-up and further clinical studies.
WITHDRAWN: Nutrient removal effectivity of seaweeds as biofilter and water pollution control in hybrid grouper aquaculture wastewater at low salinity
Authors: Adharini Ratih Ida , Murwantoko Murwantoko , Probosunu Namastra , Setiawan Riza Yuliratno , Satriyo Tony Budi
Published: February 2021

This research aims to determine the performance and nutrient removal effectivity of seaweeds species, namely Ulva fasciata., Sargassum illicifolium, Gelidium sp., and Dictyota sp. as a biofilter in hybrid grouper aquaculture wastewater at low salinity (14-17 ppt). This study used a Completely Randomized Design with 3 replications. The statistical analysis was carried out by Analysis of Variance continued with the Least Significance Difference test, and the Kruskal-Walis test with the Mann-Whitney analysis, and T-test with a confidence level of 95%. The concentrations of ammonia, nitrate, phosphate, and water quality parameters were observed every 4 days. The seaweeds removal of N and P in water, and Specific Growth Rate were also observed. The results showed that U. fasciata was able to remove or reduce ammonia by 75.95% and nitrate by 79.53%, which were the highest compared to other treatments, while Dictyota sp. was able to reduce the highest phosphate by 87.5% for 20 days. The highest SGR was achieved by U. fasciata at 1.91 %day -1 . The highest N content uptake by seaweeds was 104.4%, and the total P of 182.3% occurred in U. fasciata . Overall, U. fasciata has the highest performance and effectiveness as a biofilter that is able to reduce nutrient waste in low-salinity from grouper aquaculture, for re-circulation or before being discharged into the environment to reduce eutrophication and Harmful Algal Blooms (HABs) in open water system. The highest growth rate of U. fasciata can be used as food with highly nutritional and economical value.
Keywords : seaweeds, biofilter, hybrid grouper, wastewater, nutrient removal
A case of thyroid storm caused by Graves' disease misdiagnosed as panic attack due to panic disorder
Authors: Yasuda Manabu , Kumakura Jun , Kiyonori Oka , Fukuda Kazuhito
Published: February 2021

Background Graves' disease is characterized by hyperthyroidism and the symptoms of Graves' disease often overlap with those of panic disorder, which may make it difficult to distinguish between the two conditions.In this report, we describe how proper diagnosis of thyroid disease in patients with mental illness can lead to appropriate treatment.Case presentation We encountered a 34-year-old woman in whom thyroid crisis from Graves’ disease was misdiagnosed as panic attack. The patient was being managed as a case of panic disorder and bipolar disorder in a psychiatric outpatient setting. About 6 months before presentation, she had lost about 16 kg in weight, and a month before presentation, she developed several unpleasant symptoms as her condition worsened. Several weeks before, she had severe palpitations, tachycardia, and discomfort in her throat. She became unable to eat solids and ate only yogurt and gelatin and felt difficult to take psychiatric drugs.A day on the Sunday morning, she visited our department of emergency outpatient with severe nausea. Examination revealed proptosis, and so thyroid function tests were requested in addition to routine blood tests. There was no improvement in her condition, and she returned to hospital in the early hours of the next morning. Based on her symptoms, she was diagnosed as having panic attacks due to panic disorder and was given diazepam injection and allowed to go home. There was no suspicion of Graves' disease.Later that day, the thyroid function test results became available and thyroid storm was suspected. The endocrinology department was consulted immediately and she was referred and hospitalized the next day. During hospitalization, she was treated with steroid and radioisotope therapy, and was discharged from hospital in three weeks. Conclusion Psychiatrists and doctors engaged in psychosomatic medicine need to consider the possibility of thyroid disease as a differential diagnosis of panic disorder. It is necessary to check thyroid function at the initial examination when a patient presents with symptoms of severe panic attack.
Seasonal variability of ocean circulation near the Dotson Ice Shelf, Antarctica
Authors: Yang Hee Won , Kim Tae-Wan , Dutrieux Pierre , Wahlin A. K. , Jenkins Adrian , Ha Ho Kyung , Kim Chang-Sin , Cho Kyoung-Ho , Park Taewook , Lee SangHoon , Cho Yang-Ki
Published: February 2021

Recent rapid thinning of West Antarctic ice shelves are believed to be caused by intrusions of warm deep water that induce basal melting and seaward meltwater export. Dotson Ice Shelf has a high basal melt rate due to southward ocean heat transport in the Dotson-Getz Trough. We deployed three bottom-moored instrument arrays along the ice shelf calving front, obtaining continuous records of temperature, salinity, and current velocity throughout 2014 and 2015. Southward deep water velocities were highest along the eastern channel slope, while northward outflows of freshened ice shelf meltwater spread at intermediate depth above the western slope. Inflow warm water along the eastern slope into the sub-Dotson cavity reached a maximum of 182 MW m− 1 in Summer, 3.5 times larger than the autumn/winter values of 51 MW m− 1. The inflow correlated with the local ocean surface stress curl. At the western slope meltwater outflows were strongest during autumn and weakest in spring, following the warm influx along the eastern slope with a ~ 2–3 months delay. Ocean circulation near Dotson Ice Shelf, affected by sea ice distribution and wind, appears to be a significant control on the inflow of warm water and subsequent ice shelf melting on seasonal time-scales.
Identification of Two-Dimensional Layered Dielectrics from
First Principles
Authors: Osanloo Mehrdad Rostami , de Put Maarten Van , Saadat Ali , Vandenberghe William
Published: February 2021

Two-dimensional (2D) van der Waals (vdW) materials promise ideal electrostatic control of charge carrier flow in a channel free of surface roughness or defects. To realize this ideal, good vdW dielectrics are needed in addition to the well explored channel materials. We study the dielectric properties of 32 easily exfoliable vdW materials using first principles methods. Specifically, we calculate the static and optical dielectric response of the monolayer and bulk form. In monolayers, we discover a strong out-of-plane response in GeClF (10.99), LaOBr (13.20), LaOCl (55.80) and PbClF (15.17), while the in-plane dielectric response is strong in BiOCl, PbClF, and TlF, ranging from 64.86 to 98.37. To assess their potential as gate dielectrics, we calculate the bandgap and electron affinity, and estimate the leakage current through the dielectric. We discover seven monolayer 2D dielectrics that promise to outperform bulk HfO2: LaOBr, LaOCl, CaHI, SrBrF, SrHBr, SrHI, and TlF with lower leakage currents at a significantly reduced equivalent oxide thickness. Of these, LaOBr and LaOCl are the most promising and our findings motivate the growth and exfoliation of rare-earth oxyhalides for their use as vdW dielectrics on vdW transistor channel materials.
First-aid Fast Track Channel in Rescuing Critically Ill Children With Airway Foreign Body: Our Clinical Experience
Authors: Chen Yong-chao , Xian Zhi-xiong , Han Sai-hong , Li Lan , Teng Yi-shu
Published: February 2021

Objective To explore the role of First-aid Fast Track channel in rescuing children with airway foreign body, and to analyze and summarize the experience and lessons of First-aid Fast Track channel in rescuing airway foreign body in critical condition. Methods Clinical data of 21 cases of First-aid Fast Track channel rescue admitted to our hospital from January 2017 to December 2020were retrospectively collected, including 12 males and 9 females, aged 9-18 months, with an average age of 15 months and a history of 1-72 hours. Follow-up medical history showed that all 21 children had a history of significant foreign body cough. Results 21 cases of airway foreign body were successfully removed without second operation. Twenty-one critically ill children were intubated into PICU after surgery. Two of the children had a history of asphyxia rescue in a foreign hospital. After endotracheal intubation and cardiopulmonary resuscitation, the ambulance was sent to our hospital. Although the foreign body was removed, the patient's family gave up the treatment because the brain hypoxia lasted too long and the deep coma could not be recovered. Conclusion First-aid Fast Track channel of airway foreign body is the cooperation of otolaryngology, anesthesiology, ICU, emergency room and other departments, which has won valuable time for rescue, highlighted the purpose of rescue, improved the success rate of rescue and the quality of life of children, and is of great value for the treatment of critical tracheal foreign body.
DNA Hypermethylation of a panel of genes as an urinary biomarker for bladder cancer diagnosis
Authors: Georgopoulos Petros , Papaioannou Maria , Markopoulou Soultana , Fragou Aikaterini , Kouvatseas George , Apostolidis Apostolos
Published: February 2021

PurposeThe aim of this study was to explore the diagnostic potential of a panel of five hypermethylated gene promoters in bladder cancer. Individuals with primary BCa and control individuals matching the gender, age and smoking status of the cancer patients were recruited. DNA methylation was assessed for the gene promoters of RASSF1, RARβ, DAPK, hTERT and APC in urine samples collected by spontaneous urination. Fifty patients and 35 healthy controls were recruited, with average age of 70.26 years and average smoking status of 44.78 pack-years. In the BCa group, DNA methylation was detected in 27(61.4%) samples. RASSF1 was methylated in 52.2% of samples. Only 3(13.6%) samples from the control group were methylated, all in the RASSF1 gene promoter. The specificity and sensitivity of this panel of genes to diagnose BCa was 86% and 61% respectively. The RASSF1 gene could diagnose BCa with specificity 86.4% and sensitivity 52.3%. Promoter DNA methylation of this panel of five genes could be further investigated as urine biomarker for the diagnosis of BCa. The RASSF1 could be a single candidate biomarker for predicting BCa patients versus controls. Studies are required in order to develop a geographically adjusted diagnostic biomarker for BCa.Trial registration: ACTRN12620000258954
Risk Factors for Overweight and Obesity Among Women of Reproductive Age in Dar Es Salaam, Tanzania
Authors: Mosha Dominic , Paulo Heavenlight A , Mwanyika-Sando Mary , Mboya Innocent B , Madzorera Isabel , Leyna Germana , Msuya Sia Emmanuel , Bärnighausen Till , Killewo Japhet , Fawzi Wafaie
Published: February 2021

Background: Overweight and obesity have increased considerably in low- and middle-income countries over the past few decades, particularly among women of reproductive age. This study assessed the role of physical activity and nutrient intake in overweight and obesity among women in Dar es Salaam, Tanzania.Methods: We conducted a cross-sectional survey among 1,004 women aged 15 - 49 years in the Dar es Salaam Urban Cohort Study (DUCS) from September 2018. Dietary intake was assessed using a food frequency questionnaire (FFQ). Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ) using metabolic equivalent tasks (MET). Modified poison regression models were used to evaluate associations between physical activity and nutrient intake with overweight/obesity in women, controlling for energy and other factors.Results: The mean (±SD) age of study women was 30.2 (±8.1) years. Prevalence of overweight and obesity was high (50.4%), and underweight was 8.6%. Risk of overweight/obesity was higher among older women (35 – 49 vs. 15 – 24 years: PR 1.59; 95% CI: 1.30 – 1.95); women of higher wealth status (PR 1.24; 95% CI: 1.07–1.43); and informally employed and married women. Attaining moderate to high physical activity (≥600 MET) was inversely associated with overweight/obesity (PR 0.79; 95% CI: 0.63 – 0.99). Dietary sugar intake (PR 1.27; 95% CI: 1.03 – 1.58) was associated with increased risk, and fish and poultry consumption (PR 0.78; 95% CI: 0.61 – 0.99) with lower risk of overweight/obesity.Conclusion: Lifestyle (low physical activity and high sugar intake), and socio-demographic (age, wealth status, informal employment and married status) factors were associated with increased risk, and, fish/poultry consumption with lower risk of overweight/obesity. Given its potential for increasing diet-related chronic diseases and poor maternal and child nutrition outcomes, overweight/obesity among Tanzanian women should be addressed through feasible, and effective physical activity and dietary interventions.
Disorganization of Intercalated Discs in Dilated Cardiomyopathy
Authors: Ito Yukinobu , Yoshida Makoto , Masuda Hirotake , Maeda Daichi , Kudo-Asabe Yukitsugu , Umakoshi Michinobu , Nanjo Hiroshi , Goto Akiteru
Published: February 2021

Dilated cardiomyopathy (DCM) is a primary myocardial disease, the pathology of which is left ventricular or biventricular dilation and impaired myocardial contractility. The clinical and pathological diagnosis of DCM is difficult, and other cardiac diseases must be ruled out. Several studies have reported pathological findings that are characteristic of DCM, including cardiomyocyte atrophy, nuclear pleomorphism, and interstitial fibrosis, but none of these findings are DCM-specific. In this study, we examined the morphological differences in ICDs between three groups of patients, a DCM group, a chronic heart failure group, and a control group. A total of 21 autopsy cases, including five DCM cases, eight CHF cases and eight control cases, were retrieved from the archives of the Department of Pathology at Akita University, Japan. The morphological differences were examined using multiple methods: macroscopic examination, light microscopy, immunohistochemistry, electron microscopy, and gene expression analyses. We observed disorganized intercalated discs (ICDs), clearly illustrated by N-cadherin immunostaining in the DCM group. “Reduction of N-cadherin immunostaining intensity” and “ICD scattering” was DCM-specific. The results suggest that disorganized ICDs contribute to the development of DCM, and that N-cadherin immunostaining is useful for determining the presence of disorganized ICDs and for the pathological diagnosis of DCM.
Glomerular Function in Relation to Fine Airborne Particulate Matter in a Representative Population Sample
Authors: Feng Yingmei , Thijs Lutgarde , Zhang Zhen-Yu , Bijnens Esmee M. , Yang Wen-Yi , Wei Fang-Fei , Janssen Bram G. , Nawrot Tim S , Staessen Jan A.
Published: February 2021

Whereas the adverse impact of fine particulate matter on coronary heart disease and respiratory disorders has been clarified, its influence on glomerular function is not well defined in population studies. Serum creatinine levels were quantified in 820 randomly recruited people (50.7% women; mean age 51.1 years). Among them, 653 participants were followed up for a median of 4.8 years. Using multivariable-adjusted mixed model, eGFR (or serum creatinine) both at baseline and follow-up were regressed against long term residential black carbon (BC) or PM2.5 (particles with an aerodynamic diameter ≤2.5 µm). In longitudinal analysis, the percent change in eGFR was regressed against long term residential exposure to BC or PM2.5. eGFR averaged 80.9 (SD 16.4) mL/min/1.73m2 and median long term PM2.5 and black carbon amounted 13.1 (SD 0.92) and 1.10 (SD 0.19) µg/m³, respectively. In multivariable-adjusted cross-sectional analyses, eGFR was unrelated to BC and PM2.5 (P ≥ 0.59). During follow-up, eGFR decreased on average by 1.9 mL/min/1.73m2 (95% confidence interval: 1.0-2.8). The percentage decline in eGFR was not significantly associated with either BC or PM2.5 (P ≥ 0.75). In conclusion, long-term residential exposure to PM2.5 and black carbon is not associated with eGFR decline in predominantly healthy people drawn from a general semirural population.
The Effect of National Weekly COVID-19 Screening Testing of All Workers in Long-Term Care Facilities: a Decrease in Mortality
Authors: Maimon Nimrod , Maimon Michal , Hassan Lior , Grotto Itamar , Abu-Fraiha Yasmeen , Robinson-Geva Shahar , Uzan Limor Gortzak , Goldin Sivam , Novack Victor
Published: February 2021

Background Outbreaks of Coronavirus 2019 (COVID-19) in Long-Term Care Facilities (LTCFs) have resulted mainly from disease transmission by asymptomatic health care workers (HCW's). It is not known whether routine COVID-19 screening tests carried out on HCW's would reduce mortality of LTCF residents. Since mid-July 2020, the Israeli national LTCF defense program – "Senior Shield" - has used weekly COVID-19 PCR tests on all LTCF employees.Methods A nationwide, government funded, screening program on all LTCF personnel for four months during the second COVID-19 wave. We evaluated differences between the two waves in the national LTCF's system with regard to hospitalizations and mortality. Estimation of national health system predicted outcomes, in the absence of this weekly screening plan, was calculated.Results COVID-19 tests were taken weekly in all 1,107 LTCFs which includes 62,159 HCWs and 100,046 residents. A median of 55,282 (range – 16,249) tests were performed each week. Turnaround time from sampling to result was less than 24 hours in 95% of tests. Compared to the first wave, in which 45.3% of national mortality was attributed to the LTCF's, the second wave saw a 33.8% reduction in this mortality ratio. Estimation of national health system outcomes during the second wave showed that the activation of the screening program reduced hospital load by 35% and prevented 30% of national mortality from COVID-19.Conclusions Routine weekly COVID-19 PCR testing of all LTCF employees may reduce national hospitalizations and mortality.
Pregnancy Outcomes in Women Affected by Fetal Alpha-thalassemia: A Case Control Study
Authors: Li Jiangheng , Yan Jingli , Huang Yongquan , Wei Jinlu , Xie Bingyan , Jiang Wu , Zhu Maoling
Published: February 2021

To evaluate the possible associations between fetal α-thalassemia and risk of adverse pregnancy outcomes using a provincial woman-child health service information database in China. This was a case control study (N=438,747) in which we compared all singleton pregnancies of women with or without the α-thalassemia trait from May 2016 to May 2020, and where women with the trait were further allocated to a normal fetal group, a group of fetuses with the α-thalassemia trait, and a fetal group with hemoglobin H (HbH) disease according to the results of fetal DNA analysis. With thalassemic women whose fetuses were normal as the reference, fetuses in the HbH disease group showed a higher increase in the odds of Apgar scores being <7 at 1 minute (adjusted odds ratio [aOR], 2.79; 1.03–7.59) and 5 minutes (aOR, 4.56; 1.07–19.40). With non-thalassemic women as the reference, these trends were more obvious (aOR, 4.83; 2.55–9.16; aOR, 6.24; 2.75–14.18, respectively); whereas the normal fetal group was more likely to be diagnosed with postpartum hemorrhage (aOR, 1.66; 1.10–2.50). In addition, fetal HbH disease and gestational age were two independent factors influencing low Apgar scores, and their combination reflected medium accuracy in Apgar predictions.
What Is the Impact of Distraction Osteogenesis on the Upper Airway of Hemifacial Microsomia Patient With OSA: a Case Report
Authors: Wang Rongyang , Xu Shixing , Yang Ruimei
Published: February 2021

Background: Current researches about hemifacial microsomia (HFM) patients after distraction osteogenesis (DO) most emphasize the morphologic changes. This case report shows the outcome of DO on the upper airway of a HFM patient with obstructive sleep apnea (OSA) based on the use of computational fluid dynamics (CFD).Case presentation: A boy of 11-year-old was diagnosed as HFM with OSA, and underwent unilateral DO. Polysomnography and CT scans were performed before and six months after treatment. After DO, lowest blood oxygen saturation increased from 81% to 95% and apnea and hypopnea index decreased from 6.4 events/hour to 1.2 events/hour. The oropharynx and nasopharynx were obviously expanded. We observed apparently increased average pressure, decreased average velocity and pressure drop in all cross-sections, and largely decreased airflow resistance and maximum velocity entirely in the airway.Conclusions: The results suggest that DO might be effective for the treament of OSA by expanding the upper airway and reducing the resistance of inspiration.
Budget Impact Analysis of Surfactant Therapy for Bronchiolitis In Critically Ill Infants: The Colombian National Health System Perspective
Authors: buendia jefferson , Patiño Diana Guerrero
Published: February 2021

BACKGROUND: Exogen surfactant in mechanically ventilated infants decreased duration of stay in the intensive care unit and had favorable effects on oxygenation and carbon dioxide removal. This study aimed to evaluate the budget impact of surfactant therapy for bronchiolitis in critically ill infants in Colombia.METHODS: Budget impact analysis was performed to estimate the economic impact of surfactant therapy (ST) for the treatment of infants with a diagnosis of bronchiolitis, requiring mechanical ventilation. The analysis considered a 4-year time horizon and Colombian National Health System perspective. The model estimated drug costs associated with current scenario using humidified oxygen or adrenaline nebulization , and new scenario adding exogen surfactant. The size of the target population was calculated using epidemiological national data. Univariate one-way sensitivity analyses and scenario analyses were performed.RESULTS: In the base-case analysis the 4-year costs associated to ST and no-ST were estimated to be US$ 55.188.132 and US$ 55.972.082 respectively, indicating savings for Colombian National Health equal to US% 783.950 if ST is adopted for the routine management of patients with bronchiolitis requiring mechanical ventilation. Results were consistent at variation of most of the model’s parameters; only in case of increases of drug cost of surfactant and daily cost or length of stay in pediatric intensive unit , the savings are reducedCONCLUSION: ST was cost-saving in emergency settings for treating infants with severe bronchiolitis requiring mechanical ventilation. This shift in treatment approach proved to be economically favorable in the Colombian context.
Health-Related Quality of Life in Children with Kaposiform Hemangioendothelioma : A Case Control Study
Authors: Dai Shiyi , Yang Kaiying , Qiu Tong , Zhou Jiangyuan , Zhang Xuepeng , Chen Siyuan , Li Li Zhi , Ji Yi
Published: February 2021

Background and objective: Kaposiform hemangioendothelioma (KHE) is a rare, aggressive and borderline vascular tumor mainly occurring in infants and children. The aim of this study was to determine the health-related quality of life (HRQOL) in children with KHE. Methods: A total of 91 children with KHE participated in this cross-sectional study. The HRQOL was assessed by the age-specific Pediatric Quality of Life Inventory Version 4.0 (PedsQL™ 4.0) Infant Scales, Family Information Form (FIF), Family Impact Module (FIM) and Generic Core Scales (GCS). For comparison, demographically matched healthy children were recruited as a control group. The main outcome measure of HRQOL was analyzed in the two groups. We determined related factors that influenced the HRQOL in children with KHE and their parents by using a stepwise multiple regression analysis. Results: Except for social and cognitive functioning, we found significant differences in the PedsQL™ 4.0 Infant Scales subscales between the patient group and healthy group (P<0.05). In the PedsQL™ 4.0 GCS, all the subscales were significantly different between the patient group and the healthy group (P<0.05). Additionally, in the ≤24 month age group, there were significant differences in the HRQOL between patients with and without Kasabach-Merritt phenomenon (KMP) in physical, physical symptoms, emotional and cognitive functioning (P<0.05). In the >24 month age group, physical, emotional and social functioning were significantly different between the patients with and without activity dysfunction (P<0.05). Conclusions: The findings presented here suggest that patients with KHE have a poor HRQOL. KMP and activity dysfunction are risk factors for poor HRQOL in patients with KHE. However, lesion size, lesion location and education level of the mother and father were not related to the HRQOL.
TFCrowd: A Blockchain-based Crowdsourcing Framework with Enhanced Trustworthiness and Fairness
Authors: Li Chunxiao , Qu Xidi , Guo Yu
Published: February 2021

Blockchain technology has attracted considerable attention due to the boom of cryptocurrencies and decentralized applications. Among them, the emerging blockchain-based crowdsourcing is a typical paradigm, which gets rid of centralized cloud-servers and leverages smart contracts to realize task recommendation and reward distribution. However, there are still two critical issues yet to be solved urgently. First, malicious evaluation from crowdsourcing requesters will result in honest workers not getting the rewards they deserve even providing valuable solutions. Second, unfair evaluation and reward distribution can lead to workers’ reluctance to work actively. Therefore, the above problems will seriously hinder the development of blockchain-based crowdsourcing platforms. In this paper, we propose a new blockchain-based crowdsourcing framework with enhanced trustworthiness and fairness, named TFCrowd. The core idea of TFCrowd is utilizing a smart contract of blockchain as a trusted authority to fairly evaluate contributions and allocate rewards. To this end, we devise a reputation-based evaluation mechanism to punish the requester who behaves as “false-reporting” and a Shapley value-based method to distribute rewards fairly. By using our proposed schemes, TFCrowd can prevent malicious requesters from making unfair comments and reward honest workers according to their contributions. Extensive simulations and the experiment results demonstrate that TFCrowd can protect the interests of workers and distribute rewards fairly.
WITHDRAWN: How Flushable Wet Wipes Are Causing Sewer Blockages – and An Approach to Prevent That
Authors: Harter Thomas , Bernt Ingo , Winkler Stefanie , Hirn Ulrich
Published: February 2021

Scientific publications and newsfeeds recently focused on flushable wet wipes and their role in sewage system blockages. It is stated that although products are marked as flushable, they do not disintegrate after being disposed of via the toilet. In this work it is shown that wetlaid hydroentangled wet wipes lose their initially good dispersive properties during their storage in wet condition. This behaviour is found for both, wet wipes from industrial production and wipes produced on pilot facilities. It is demonstrated that the deterioration of the wipe’s ability to disintegrate during wet storage is linked to the type of cellulosic fibres used. Only wipes made from a combination of band-shaped viscose fibres and unbleached softwood pulp fibres were preserving good disintegration during wet storage. The results are also suggesting to add tests after defined times of wet storage when assessing the flushability of wet wipes.
New Surgical Realities—Implementation of An Enhanced Recovery After Surgery Protocol for Gynecological Laparoscopy: A Prospective Study
Authors: Jimenez Jose Carlos Vilches , Serrano Beatriz Tripiana , Muñoz Emilia Villegas , Pérez Belinda Sanchez , Lopez Jesús S Jimenez
Published: February 2021

Background
Multimodal rehabilitation allows optimization of functional recovery in surgery patients by reducing the post-operative stress and hospital stay duration, without increasing the morbidity and mortality. It is reportedly successful in other surgical disciplines, and guidelines for its application to gynecological surgery are available; however, most evidence for these guidelines is derived from observational and/or retrospective studies. Therefore, this study aimed to investigate the applicability of an enhanced recovery after surgery (ERAS) protocol in laparoscopic gynecological surgery and its influence on the postoperative stay, morbidity, mortality and readmission, through a prospective approach.
Methods
This prospective cohort study was performed on 90 patients who underwent laparoscopic hysterectomy for benign causes from October 2017 to October 2019. Patients in whom the ERAS (ERAS group, n = 30) and traditional (control group, n = 60) protocols were implemented were compared. All patients were followed for six months.
Results
The groups were homogeneous and did not differ significantly with respect to the demographic characteristics (age, ASA score, body mass index), surgical indications, and surgery types. Adherence to the ERAS protocol was over 99%. The postoperative hospital-stay durations were 1.73 days (r = 1–3) and 2.97 days (r = 2–6) in the ERAS and control groups (p = 0.000). No significant intergroup differences were observed in the rates of complications and readmissions.
Conclusions
The ERAS protocol is applicable in laparoscopic gynecological surgery and can be implemented with good adherence. This can allow optimization of patient recovery by reducing the hospital stay duration, without increasing the rates of morbidity, mortality, or readmission.
Dexmedetomidine Attenuates Hemodynamic and Proinflammatory Responses During Craniotomy for Traumatic Brain Injury: A Randomized Controlled Trial Study
Authors: Hou Junde , Cheng Yanxin , Wei Hongfang , Wang Xiaowei , Chi Xiaohui , Zhao Guangping , Zhao Senming , Chen Yongxue
Published: February 2021

The authors have requested that this preprint be removed from Research Square.
Hundred Most Cited Articles in Perioperative Neurocognitive Disorder: A Bibliometric Analysis
Authors: Mi Xinning , Wang Xiaoxiao , Yang Ning , Han Yongzheng , Li Yue , Liu Taotao , Han Dengyang , Yuan Yi , Cao Yiyun , Shi Chengmei , Guo Xiangyang , Zhou Yang , Li Zhengqian
Published: February 2021

Background: In line with aging populations and increased application of anesthesia and surgery, perioperative neurocognitive disorder (PND) has received growing attention worldwide. Considerable research into PND is being conducted; however, the quantity and quality of such research have not been reported. Through a retrospective bibliometric analysis, this study aimed to identify and characterize the top 100 cited publications on PND. Methods: We searched the Web of Science database to find the top 100 cited articles focusing on PND. We collected bibliographic information, including year of publication, country of origin, article type, published journal, citation count, and authorship. To determine changes with time, we compared older and newer articles. Results: The top 100 cited articles were published between 1955 and 2016; the number of citations ranged from 111 to 1248. The United States had the most published papers; clinical trials were the most common article type. The specialty journals of Anesthesiology and Anesthesia & Analgesia were the two most cited journals. Newer papers had a comparable number of citations to older articles, but the former had higher citation rates, greater funding disclosures, more focus on basic research, and more open access publications. Conclusions: This study provides a comprehensive overview of the most cited articles and highlights the increasing attention on PND. High-quality clinical trials with a greater journal impact factor received more citations. However, there has been growth in the number of basic science studies as an area of research with respect to the pathogenesis of PND.
Allogeneic Red Blood Cell Transfusion Rate and Risk Factors in Elderly Patients with Femoral Neck Fracture After Hemiarthroplasty
Authors: Yue Rui , Yang Minghui , Deng Xiaohui , Zhang Ping
Published: February 2021

Objective: To determine the rate and risk factors of allogeneic red blood cell transfusions (ABT) in elderly patients with femoral neck fracture (FNF) after hemiarthroplasty (HA). Methods: We conducted a study on elderly patients (≥65 years old) who were admitted to the geriatric trauma orthopedics ward of Beijing Jishuitan Hospital for HA treatment from March 2018 to February 2019 due to FNF. The perioperative data were collected retrospectively, and univariate and multivariate stepwise logistic regression analysis were performed to determine the postoperative ABT rate and its risk factors. Results: 445 patients were included in the study, of which 177 (39.8%) received ABT after surgery. Multivariate stepwise logistic regression analysis showed that preoperative low hemoglobin (Hb), high intraoperative blood loss (IBL), advanced age, and low body mass index (BMI) are independent risk factors of ABT after HA in elderly FNF patients. Conclusion: ABT after HA is a common phenomenon in elderly patients with FNF. Their postoperative ABT needs are related to preoperative low Hb, high IBL, advanced age, and low BMI. Therefore, ABT can be reduced from the above aspects.
The General Relativistic Perspective
Authors: Taylor David
Published: February 2021

This paper formulates additional General Relativistic [GR] equations that do not contradict the originals. They rephrase Dr. Einstein's equations from a Relativistically distorted Perspective. The equations reason the distorted Escape velocity of a GR object, determining its real Escape velocity after the distortions of Relativity slow Bosons||Gravitons. In contrast to the variables in the Classical equations of Relativity, variables are more specific in their respect and relationship to Escape Velocity and Graviton distortion, not just the Time distortion.
Treatment and Pregnancy Outcomes of Pregnant Women Exposed to Second-line Anti-tuberculosis Drugs in South Africa
Authors: Mokhele Idah , Jinga Nelly , Berhanu Rebecca , Dlamini Thandi , Long Lawrence , Evans Denise
Published: February 2021

Background:Multi-drug resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) in pregnant women is a cause for concern globally; few data have described the safety of second-line anti-TB medications during pregnancy. We characterize maternal, and pregnancy outcomes for pregnant women receiving second-line anti-tuberculosis treatment for MDR/RR-TB.Methods: We conducted a retrospective record review of pregnant women (≥18 years) who received treatment for MDR/RR-TB between 01/2010–08/2016 at three outpatient treatment sites in Johannesburg, South Africa. Demographic, treatment and pregnancy outcome data were collected from available medical records. Preterm birth (<37 weeks), and miscarriage were categorized as adverse pregnancy outcomes.Results: Out of 720 women of child-bearing age who received MDR/RR-TB treatment at the three study sites, 35 (4.4%) pregnancies were identified. Overall, 68.7% (24/35) were HIV infected, 83.3% were on ART. Most women (88.6%) were pregnant at the time of MDR/RR-TB diagnosis and four women became pregnant during treatment. Pregnancy outcomes were available for 20/35 (57.1%) women, which included 15 live births (11 occurred prior to 37 weeks), 1 neonatal death, 1 miscarriage and 3 pregnancy terminations. Overall, 13/17 (76.5%) had an adverse pregnancy outcome. Of the 28 women with known TB treatment outcomes 17 (60.7%) completed treatment successfully (4 were cured and 13 completed treatment), 3 (10.7%) died and 8 (28.6%) were lost-to-follow-up.Conclusions:Pregnant women with MDR/RR-TB suffer from high rates of adverse pregnancy outcomes and about 60% achieve a successful TB treatment outcome. These vulnerable patients require close monitoring and coordinated obstetric, HIV and TB care.
Diagnostic Reasoning by Master Clinicians: What Distinguishes Them From Their Peers?  
Authors: Kumar Bharat , Ferguson Kristi , Swee Melissa L. , Suneja Manish
Published: February 2021

Introduction: Master clinicians are a group of physicians recognized in large part for their superior diagnostic reasoning abilities. However, their reasoning skills have not been rigorously and quantitatively compared to other clinicians using a validated instrument.Methods: We surveyed Internal Medicine physicians at the University of Iowa to identify the master clinicians. These master clinicians were administered the Diagnostic Thinking Inventory, along with an equivalent number of their peers in the general population of internists. Scores were tabulated for structure and thinking, as well as four previously identified elements of diagnostic reasoning (data acquisition, problem representation, hypothesis generation, and illness script search and selection). The 2-sample t-test was used to compare scores between the two groups.Results: 17 master clinicians were identified, of whom 17 (100%) completed the inventory. 19 out of 25 randomly-selected internists also completed the inventory (76%). Mean total scores were 187.2 and 175.8 for the Master Clinician (MC) and the Internist (IM) groups respectively. Thinking and structure subscores were 91.5 and 95.71 for MCs, compared to 85.5 and 90.3 for IMs (p-values: 0.0783 and 0.1199, respectively). The mean data acquisition, problem representation, hypothesis generation, and illness script selection subscores for MCs were 4.46, 4.57, 4.71, and 4.46, compared to 4.13, 4.38, 4.45, and 4.13 in the IM group (p-values: 0.2077, 0.4528, 0.095, and 0.029, respectively). Conclusions: Master Clinicians have greater proficiency in searching for and selecting illness scripts compared to their peers. There were no statistically significant differences between the other scores and subscores. These results will help to inform continuing medical education efforts to improve diagnostic reasoning.
Improved Trends in the Mortality-To-Incidence Ratios for Liver Cancer in Countries With High Development Index and Health Expenditures
Authors: Wang Chi-Chih , Chen Hsin-Hung , Sung Wen-Wei , Tsai Ming-Chang
Published: February 2021

Primary liver cancer is one of leading causes of death globally. Liver cancer has the uniqueness of geographical distribution as it predisposes viral infection etiologies and aging effects. We speculate if the human development index (HDI), current health expenditure (CHE) per capita, and current health expenditure on gross domestic product (CHE/GDP) can affect the incidence numbers, mortality numbers, or mortality-to-incidence ratios (MIRs) of liver cancer worldwide. Data was obtained from GLOBOCAN health data and statistics from the World Health Organization. MIRs and the changes in MIR over time (𝛿MIR) were used to evaluate the correlation of expenditures on healthcare and the HDI disparities via Spearman's rank correlation coefficient. The incidence and mortality of crude rate have significant associations with HDI, CHE per capita, and CHE/GDP. Specifically, there were significant associations between 𝛿MIR and HDI as well as between 𝛿MIR and CHE per capita. However, there were no significant associations between 𝛿MIR and CHE/GDP. We evidenced that favorable liver cancer 𝛿MIR was not associated with CHE/GDP, although it had significant association with HDI and CHE per capita. This result is worthy of the attention of the public health system all over the world.
The Effect of Paclitaxel on Apoptosis, Autophagy and Mitotic Catastrophe in AGS Cells
Authors: - Tin Myo Khing , Choi Won Seok , Kim Dong Min , - Wah Wah Po , - Wynn Thein , Shin Chang Yell , Sohn Uy Dong
Published: February 2021

Paclitaxel is an anti-microtubule agent that has been shown to induce cell death in gastric cancer. However, the detailed mechanism of action is unclear. In this study, we reveal that the paclitaxel-induced cell death mechanism involves mitotic catastrophe, autophagy and apoptosis in AGS cells. Paclitaxel induced intrinsic apoptosis by activating caspase-3, caspase-9 and PARP. In addition, the significant increase in autophagy marker LC3B-II, together with Atg5, class III PI3K and Beclin-1, and the down-regulation of p62 following paclitaxel treatment verified that paclitaxel induced autophagy. Further experiments showed that paclitaxel caused mitotic catastrophe, cell cycle arrest of the accumulated multinucleated giant cells at the G2/M phase and induction of cell death in 24 h. Within 48 h, the arrested multinucleated cells escaped mitosis by decreasing cell division regulatory proteins and triggered cell death. Cells treated with paclitaxel for 48 h were grown in fresh medium for 24 h and checked for CDC2, CDC25C and lamin B1 protein expressions. These proteins had decreased significantly, indicating that the remaining cells became senescent. In conclusion, it is suggested that paclitaxel-induced mitotic catastrophe is an integral part of the cell death mechanism, in addition to apoptosis and autophagy, in AGS cells.
Towards Safe Medication Use Among Geriatric Patients: A Combined Tool For Identification of Potential Drug-Related Problems
Authors: Bobrova Veera , Fialová Daniela , Desselle Shane , Heinämäki Jyrki , Volmer Daisy
Published: February 2021

Background: Drug-related problems (DRP), including potentially inappropriate medications (PIMs), are a common problem in older people with multi-morbidity and polypharmacy. It is important to identify appropriate tools, preferably adjusted to specific patient groups, to deal more effectively with potential or existing DRPs. Our hypothesis is that combining PIM identification tools enables to significantly enhance the determination of DRPs. The aim of this study was to develop a combined tool for identification of DRPs in geriatric multi-morbid and polypharmacy patients, using the EU(7)-PIM and EURO-FORTA lists, with a focus on high-risk medications. Methods: The combined PIM identification tool used the information on PIM active ingredients in both databases - the EU(7)-PIM and EURO-FORTA. PIMs were classified into four color groups based on risk profile: very significant PIMs (should be avoided in older patients) as red, significant PIMs (require dose and/or treatment duration adjustment) as yellow, non-significant PIMs/non-PIMs (low DRP risk) as green, and questionable PIMs (incomplete/missing information) as grey. Results: The summarized list of the red PIMs contains 34 active ingredients, including one combination of two medications and one medication class. According to the Anatomical Therapeutic Chemical classification, most of the red PIMs (n=27, 79.4%) belong to the A, C and N medication groups. Only 41.2% of the red PIMs have marketing authorization in Estonia. In 2019 more frequently used red PIMs in Estonia were sodium picosulfate, propafenone, ginkgo biloba, magnesium hydroxide, and dextromethorphan. The approximate number of the yellow and green PIMs is 248, but sub-classification of this category into one or another group depends mainly on an individual patient´s clinical characteristics. The complete list of the grey PIMs will be developed in the future Conclusions: The combined PIM tool based on the EU(7)-PIM and EURO-FORTA criteria was created to address the need for more efficient identification of DRP in geriatric multi-morbid patients. The combined PIM tool was developed with a focus on the high-risk medications for older adults and taking into consideration the availability of the PIMs in Estonia. The tool could potentially be applied as a screen to identify DRPs in different health care settings.
A Probability Formula Derived From Serum Indicators, Age and Comorbidities As An Early Predictor of Dementia For Elderly Chinese People
Authors: Gong Qing , Xie Lianhong , Bi Minghui , Yu Lina
Published: February 2021

Background: Blood-based indicators are potential economical and safe methods of population screening for dementia although their predictive values have not been confirmed. The present study proposes a dementia prediction formula based on serum indicators and patient characteristics.Methods: From Jan 2016 to Dec 2018 the data of elderly patients aged over 60 years admitted to the Department of Neurology and Geriatrics in our hospital were retrospectively reviewed. A multivariate logistic regression model was applied to verify the patients’ characteristics and serum indicators associated with the risk of dementia. After receiver operating characteristic curve (ROC) and area under the ROC curve (AUC) analysis, we propose a dementia prediction formula and cutoff values for predictive ability of early dementia.Results: 4,722 elderly patients were enrolled and the incidence of dementia was 12.0% (565). When patients had ≥ 8 comorbidities, their risk of developing dementia was 20 times higher than those without comorbidities. After multivariate regression analysis, age (OR: 1.086, P < 0.001) and homocysteine concentrations (HCY) (OR: 1.017, P = 0.003) were proven to be linked the risk of developing dementia, while total cholesterol (TC) (OR: 0.674, P = 0.005) was a protective factor for dementia. We developed a formula of age + LDL-C+ TC + HCY + number of comorbidities as a good predictor of dementia (AUC: 0.79), with a probability (cut-off) value of 0.112 (sensitivity 87.4%, specificity 55.8%, accuracy 60.5%).Conclusions: High serum HCY and low TC were risk factors for developing dementia. A cut-off value > 0.112 derived from the formula of age + LDL-C + TC + HCY + number of comorbidities was an excellent predictor for a high risk of dementia, which may be a potentially useful diagnostic tool for identifying at risk patients using this routine clinical test.