bluuebunny/crossref_metadata_2025_split huggingface dataset:
Novel Nomograms to&nbsp;Predict&nbsp;of Overall Survival and Cancer-Specific Survival of Patients of Metaplastic Breast cancer
Authors: Li Yongfeng , Chen Daobao , Xuan Haojun , Dragomir Mihnea P. , Calin George A. , Yang Hongjian , Chen Meng , Jin hongchuan 
Published: December 2020

Abstract
Background Metaplastic breast cancer (MBC) is a rare type of breast cancer with an increasing incidence, we aim to develop clinical nomograms to predict the overall survival and cancer-specific survival for patients with MBC.MethodsPatients data were collected from the SEER database between 1973 and 2015. All included patients were randomly assigned into the training and validation sets. Univariate and multivariate Cox analysis were performed to identify independent prognostic factors of MBC. These essential prognostic variables were combined to construct nomogram models to predict overall survival (OS) and cancer-specific survival (CSS) in patients with MBC. Model performance was evaluated by concordance index (C-index) and calibration plots.ResultsA total of 1129 patients were collected and divided into the training (753) and validation (376) groups. The multivariate Cox model identified age, stage_ajcc, T stage, chemotherapy and radiotherapy as independent covariates associated with OS, while age, race, stage_ajcc, T stage, and radiotherapy were independent prognostic factors of CSS. The nomogram constructed based on these covariates demonstrated excellent accuracy in estimating 3-, and 5-year OS and CSS, with a C-index of 0.744 (95% CI, 0.701-0.787) for OS and 0.746 (95% CI, 0.695-0.797) for CSS in the training cohort. In the validation cohort, the nomogram-predicted C-index was in OS and 0.818 for OS (95% CI, 0.775-0.861) and 0.800 (95% CI, 0.747-0.853) for CSS. All calibration curves exhibited good consistency between predicted and actual survival.ConclusionsThese nomogram models established in this study can help to enhance the accuracy of prognostic prediction, which may thereby improve individualized assessment of survival risks and facilitate to provide constructive therapeutic suggestions.
Pre-operative External Ventricle Drainage Improves Neurological Outcomes for Patients with Traumatic Intracerebellar Hematomas
Authors: Wang Bao , Ge Shun-nan , Guo Hao , Gao Fei , Shi Ying-wu , Cui Wen-xing , Li zhi-hong , Qu Yan 
Published: December 2020

Abstract
Background: Traumatic intracerebellar hematoma (TICH) is a very rare entity but with high morbidity and mortality rate, and there is no consensus on its optimal surgical management. In particular, whether and when to place external ventricle drainage in TICH patients without acute hydrocephalus pre-operation is still controversial.Methods: A single-institutional, retrospective analysis of total 47 TICH patients with craniectomy hematoma evacuation in a tertiary medical center from January 2009 to October 2020 was performed. Primary outcomes were mortality in hospital and neurological function evaluated by GOS at discharge and 6 months after the ictus. The special attention was paid to the significance of external ventricular drainage (EVD) in TICH patients without acute hydrocephalus on admission.Results: Analysis of the clinical characteristics of the TICH patients revealed that the odds use of EVD was seen in patients with IVH (p=0.03), fourth ventricle compression (p=0.02), and acute hydrocephalus (p<0.01). Placement of EVD at the bedside can significantly improve the GCS score before craniotomy (p=0.02), as well as the neurological score at discharge (p=0.045) and 6 months (p=0.04). Compared with the only hematoma evacuation (HE) group, there is a trend that EVD can reduce hospital mortality (27.6% vs. 38.9%) and decrease the occurrence of delayed hydrocephalus (4.8% vs. 18.2%), although the difference is not statistically significant. In addition, EVD can reduce the average NICU stay time (p=0.04, 4.9 ± 5.1 vs. 9.4 ± 6.3), but has no effect on the total length of stay. Moreover, our data showed that EVD did not increased the risk of associated bleeding and intracranial infection. Interestingly, in terms of neurological function at discharge and 6-month after the ictus (p=0.01), even though without acute hydrocephalus on admission, the TICH patients can still benefit from EVD insertion. Conclusion: For TICH patients, EVD is safe and can significantly improve neurological prognosis. Especially for patients whose GCS dropped by more than 2 points before operation, EVD can significantly improve the patient's GCS score, reduce the risk of herniation, and gain more time for surgical preparation. Even for TICH patients without acute hydrocephalus on admission CT scan, EVD placement still has positive clinical significance. However, future studies with larger sample size are warranted to confirm whether EVD can reduce in-hospital mortality and the risk of delayed hydrocephalus in TICH.
WITHDRAWN: Factors Defining the Development of Severe Illness in Patients with COVID-19: A Single-Center, Retrospective, Observational Study
Authors: Yibai Xiong , Yaxin Tian , Bin Liu , Lianguo Ruan , Cheng Lu , Luqi Huang 
Published: December 2020

Abstract
Objective Early triage of patients with coronavirus disease 2019 (COVID-19) is pivotal in managing the disease. However, data on the risk factors for the development of severe disease remains scant. Here, we report a clinical risk score system for severe illness and highlight possible protective factors, which might inform proper treatment strategies.Methods We conducted a retrospective, single-center, observational study at the JinYinTan Hospital from January 24,2020 to March 31, 2020. We evaluated the demographic, clinical, and laboratory data and performed a 3-fold cross-validation to split the data into training set and validation set. We then screened the prognostic factors for severe illness using the Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression, and finally conducted a risk score to estimate the probability of critical illness in the training set. Data from the validation set were used to validate the score. Furthermore, the clinical factors of those patients who recovered were compared with those who did not recover from the rapidly worsened illness. We then employed logistic regression tools to delineate the possible protective factors.Results A total of 302 patients were included. From 47 potential risk factors, 6 variables were measured as the risk score: sex(female) (OR, 0.372; 95%CI, 0.211-0.655), Chest Computed Tomography abnormality (OR, 1.90; 95%CI, 1.36-2.66), neutrophil value (OR, 1.33; 95%CI, 1.18-1.50), neutrophil to lymphocyte ratio (OR, 1.23; 95%CI, 1.14-1.34), lactate dehydrogenase (OR, 1.01; 95%CI, 1.006-1.012), albumin (OR, 0.77; 95%CI, 0.71-0.84). The mean AUC of development cohort was 0.82 (95% CI, 0.81-0.92) and the AUC of validation cohort was 0.894 (95% CI, 0.78-0.95). Our comparison data from patients who rapidly worsened but recovered with those who did not showed that 4 variables were predictive factors: Prealbumin (OR, 1.028; 95%CI, 1.010-1.057), percentage of lymphocytes (OR, 1.213; 95%CI, 1.062-1.385), lactate dehydrogenase (OR, 0.984; 95%CI, 0.973-0.996), Prothrombin ativity (OR, 1.065; 95%CI, 1.018-1.115).Conclusion and Relevance In this study, we developed a predictive risk score and highlight 4 factors that might predict recovery from suddenly worsened illness. This report may help define the potential of developing critical illness and recovery prospects in patients with rapidly worsened condition.
Body Weight Variability and the Risk of Cardiovascular Outcomes in Patients with Nonalcoholic Fatty Liver Disease A Nationwide Cohort Study
Authors: Kim Mi Na , Han Kyungdo , Yoo Juhwan , Ha Yeonjung , Chon Young Eun , Lee Ju Ho , Simon Tracey G. , Chan Andrew T. , Hwang Seong Gyu 
Published: December 2020

Abstract
Background: Body weight variability is thought to be an indicator of poor health outcomes, including cardiovascular disease (CVD) and mortality. Given that the vast majority of NAFLD patients have difficulty maintaining weight loss and CVD is closely associated with NAFLD, the investigation of the influence of body weight variability on CVD and mortality in NAFLD patients is crucial to prevent the deleterious consequences of NAFLD. We investigated the association between body weight variability and the risks of CVD and mortality in patients with NAFLD using large-scale, nationwide cohort data. Methods: We included 726,736 individuals with NAFLD who underwent a health examination provided by the Korean National Health Insurance System between 2009 and 2010, with follow-up through the end of 2017. NAFLD was defined as a fatty liver index ≥60, after excluding excess alcohol intake, viral hepatitis, and alcoholic cirrhosis. Significant liver fibrosis was defined as a BARD score ≥2. Body weight variability was assessed using four indices, including variability independent of the mean (VIM). A multivariate-adjusted Cox proportional hazards regression analysis was performed. Results: During a median 8.1-year follow-up , we documented 11,358, 14,714, and 22,164 cases of myocardial infarction (MI), stroke, and all-cause mortality, respectively. Body weight variability was associated with an increased risk of MI, stroke, and mortality after adjusting for confounding variables. The hazard ratios (HRs) (95% confidence intervals) for the highest quartile, compared with the lowest quartile, of VIM for body weight were 1.15 (1.10–1.20), 1.22 (1.18–1.26), and 1.56 (1.53–1.62) for MI, stroke, and all-cause mortality, respectively. When examined jointly, the risk of outcomes was highest among NAFLD patients with both significant liver fibrosis and the highest VIM for body weight.Conclusions: Body weight variability was associated with increased risks of MI, stroke, and all-cause mortality in NAFLD patients. Appropriate interventions to maintain a stable weight could positively affect health outcomes in NAFLD patients.
Intersection between ageing-related Genes and SARS-CoV-2 Interactome: Is it higher than expected?
Authors: Guzzi Pietro Hiram , Pedace Elisabetta , Giorgi Federico Manuel 
Published: December 2020

Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (coronavirus disease, 2019; COVID-19) is associated with adverse outcomes in patients. It has been observed that lethality seems to be related to the age of patients. Moreover, it has been demonstrated that ageing causes some modifications at a molecular level.Objective The study aims to investigate a possible link between the increased COVID-19 lethality and the molecular changes that occur in elderly people.Methods We considered publicly available datasets on ageing-related genes and SARS-CoV-2 interactors. Then, for each SARS-CoV-2 protein interactor, we tested for the enrichment of ageing-related proteins. Finally, we performed a network-based analysis to identify which molecular mechanisms could play a role in the SARS-CoV-2 molecular aetiology and ultimately affect COVID-19 outcome.Results We observed a significant intersection between some SARS-CoV-2 interactors and ageing-related genes. Our analysis evidenced that virus infection particularly affects ageing molecular mechanisms centred around proteins EEF2, NPM1, HMGA1, HMGA2, APEX1, CHEK1, PRKDC, and GPX4.Conclusion Our study generated a mechanistic framework aiming at explaining the correlation between COVID-19 incidence in elderly patients and molecular mechanisms of ageing. This will provide testable hypotheses for future investigation on the mechanism of action of coronaviruses and pharmacological solutions tailored on specific age ranges.
Salutary factors and hospital work environments: A qualitative descriptive study of nurses in Sweden.
Authors: Nunstedt Håkan , Eriksson Monica , Obeid Ayman , Hillström Lisbeth , Truong Anh , Pennbrant Sandra 
Published: December 2020

Abstract
Background: Extensive research describes how nurses experience their work environment. The conditions are described as stressful and dissatisfying with nurses intending to leave their workplace. Knowledge about the personal perception regarding why nurses consider leaving the hospital workplace is limited. The purpose of this study was to understand why hospital nurses remain in their workplace, which facilitates their continuation in the profession.Objective: The objective was to explore and describe factors explaining why hospital nurses remain in the workplace.Methods: This was a descriptive qualitative study with a purposive sample of hospital nurses in Sweden. The salutogenic theory was the basis for the interview guide and the semi-structured questions. Individual interviews were conducted in a hospital in western Sweden. Content analysis was performed to organize the coded data according to the sense of coherence.Results: Data saturation was achieved with 12 interviews. Within the three themes of coherence (comprehensibility, manageability, and meaningfulness), ten subthemes were categorized from the data as follows: job satisfaction and fun at work, acknowledgement and productivity, togetherness and team security, manageable workload, variable work and challenging situations, workplace and personal space balance, collaboration and supportive leadership, valued role and good work, commitment and involvement, and pride in the professional role.Conclusions: The main findings of this study have shown the critical importance of being in a meaningful, comprehensible and manageable work context that supports nurses in maintaining their professional identity.
Evaluation of the risk factors of dental caries in children with very low birth weight and normal birth weight
Authors: Koberova Romana , Radochova Vladimira , Zemankova Jana , Ryskova Lenka , Broukal Zdeněk , Merglova Vlasta 
Published: December 2020

Abstract
Background Health problems of premature infants can affect both general and oral health. The enamel defects, poor dietary and oral hygiene habits may predispose these children to dental caries. This study was conducted to assess the impact of very low birth weight and prematurity on caries risk in early childhood.Methods The study cohort consists of 189 of one year old infants. Anamnestic data were obtained from hospital records, feeding practice, bed-time sugar drinks and oral hygiene onset from questionnaires. Saliva samples of children and their mothers were collected for the detection of cariogenic pathogens.Results VLBW newborns had significantly shorter gestation age (29.6 vs. 38.8)) and lower mean birthweight (1124g vs 3315g) compared to NBW ones (p<0.0001). Statistical significance has been found in the presence of early morbidity (p<0.0001) and regular medication intake (p=0.007). VLBW children got more frequently sweetened drinks during the day and night (p=0.007). Regular oral hygiene practice was more frequent in full term group (p=0.002). There was statistical difference in the presence of enamel hypoplasia in VLBW children (p=0.033) but no statistical difference in the presence of hypomineralization (p=0.0736) in comparison to NBW individuals. Proportional representation and count of S. mutans did not reveal statistical difference neither in both groups of children (p=0.484) nor in both groups of mothers (p=0.385).Conclusions The study confirmed anamnestic and medical differences between both groups. The proportional representation and count of S. mutans did not reveal statistical difference neither in VLBW and NBW children, nor in their mothers.
Ambulatory end-stage liver disease in Ghana; patient profile and utility of alpha fetoprotein and aspartate aminotransferase - platelet ratio index.
Authors: Nartey Yvonne Ayerki , Awuku Yaw Asante , Agyei-Nkansah Adwoa , Duah Amoako , Bampoh Sally Afua , Ayawin Joshua , Asibey Shadrack Osei , Björkström Niklas , Ye Weimin , Afihene Mary Yeboah , Roberts Lewis Rowland , Plymoth Amelie 
Published: December 2020

Abstract
Background: End-stage liver disease (ESLD) is a major burden on public health, particularly in sub-Saharan Africa, where hepatitis B virus (HBV) is an important risk factor. We aimed to describe clinical characteristics of ESLD from cirrhosis or hepatocellular carcinoma (HCC) and the performance of aspartate aminotransferase (AST) - platelet ratio index (APRI) and alpha fetoprotein (AFP) in Ghana. Methods: We performed an observational cross-sectional study in outpatient hepatology clinics at three teaching hospitals in Ghana, West Africa. One hundred and forty-one HCC, 216 cirrhosis and 218 chronic HBV patients were recruited by convenience sampling. Sociodemographic, history and examination, laboratory, and disease staging information were shown using descriptive statistics. Performance of the APRI score in diagnosis of cirrhosis and AFP in the diagnosis of HCC was determined using AUROC analysis.Results: Median age at presentation was 44 years for HCC and 46 years for cirrhosis. HBV was found in 69.5% of HCC and 47.2% of cirrhosis cases, and HCV in 6.4% and 3.7% respectively. APRI cut-off of 2 had sensitivity of 45.4% and specificity of 95% in diagnosis of cirrhosis, and cut-off of 1 had sensitivity of 75.9% and specificity of 89%. AUC of AFP was 0.88 (95% CI 0.81-0.94) in diagnosis of HCC. Low monthly income was associated with lower odds of undertaking AFP. Thirty one percent of cirrhotic persons were Child-Pugh C, and 67.9% of HCC patients had advanced or terminal disease at presentation. Conclusions: Our findings emphasize the young age of ESLD patients in Ghana and the advanced nature at presentation. It highlights shortcomings in surveillance and the need for policies to address the burden and improve outcomes in Ghana.
Blinding in electric current stimulation in subacute neglect patients with current densities of 0.8 A/m²: A cross-over pilot study
Authors: Gorsler Anna , Grittner Ulrike , Külzow Nadine , Rackoll Torsten 
Published: December 2020

Abstract
Objective Neglect after stroke is a disabling disorder and its rehabilitation is a major challenge. Transcranial direct current stimulation (tDCS) seems to be a promising adjuvant technique to improve standard care neglect therapy. Since electric fields are influenced by age-related factors, higher current densities are probably needed for effective treatment in aged stroke patients. Validation of treatment efficacy requires sham-controlled experiments, but increased current densities might comprise blinding. Therefore, a pilot study was conducted to test sham adequacy when using current density of 0.8 A/m2. Whether especially neglect patients who mainly suffer from perceptual and attentional deficits are able to differentiate beyond chance active from sham tDCS was investigated in a randomized cross-over design (active/sham stimulation) in 12 early subacute patients with left-sided hemineglect. Stimulation (0.8 A/m²) was performed simultaneous to standard care neglect therapy. Results Odds ratio of correct guessing an atDCS condition compared to wrongly judge an atDCS condition as sham was 10.00 (95%CI: 0.65 - 154.40, p = 0.099). However, given the small sample size and high OR, although likely somewhat overestimated, results require careful interpretation and blinding success in neglect studies with current densities of 0.8 A/m² should be further confirmed.
Effect of capsular tension ring implantation on capsular stability after phacoemulsification in patients with weak zonules: a randomized controlled trial. CTR implantation in cataract patients with weak zonules
Authors: Yang Shangfei , Jiang Hui , Nie Kailai , Feng Liwen , Fan Wei 
Published: December 2020

Abstract
Background: The use of capsular tension ring (CTR) implantation to treat cataract patients with weak zonules is still controversial. The aim of this study was to examine the effects of CTR implantation on capsular stability after phacoemulsification in patients with weak zonules, especially patients who have undergone pars plana vitrectomy (PPV) or those who suffer from severe myopia.Methods: A total of 42 patients who underwent phacoemulsification and received an intraocular lens (IOL) were randomized to undergo CTR implantation or not. The control and CTR groups were compared in terms of uncorrected distant visual acuity (UDVA), best corrected distant visual acuity (BCDVA), refractive prediction error, the area of anterior capsulorhexis, and IOL inclination angle. Follow-up visits were conducted postoperatively at 1 day, 1 week, 1 month and 3 months. subgroup analyses were performed based on PPV and severe myopia. Results: Surgery significantly improved UDVA and BCDVA to similar extents in CTR and control patients, and refraction prediction error was similar between the two groups at all follow-up times. At 3 months after surgery, the area of anterior capsulorhexis was significantly larger in CTR patients than in controls (p = 0.0199). These differences were also significant between the subgroups of patients with severe myopia. Vertical IOL inclination was less within CTR groups at 3 months after surgery, especially in patients with severe myopia (p = 0.0286). At 1 week postoperatively, the proportion of individuals whose posterior lens capsule that had completely adhered to the posterior IOL surface was significantly higher among CTR patients (p = 0.023). No serious surgical complications were observed.Conclusion: CTR implantation can benefit cataract patients with weak zonules by maintaining the shape of the capsular bag, reducing capsule shrinkage and stabilizing IOL inclination.Trial registration: Chinese Clinical Trial Registry ChiCTR-INR-17011217, date of registration April 22, 2017, prospectively registered.
Effects of different acupuncture treatment methods on post-stroke cognitive impairment: study protocol for a multicenter randomized controlled trial
Authors: Su Kai-Qi , Liu Su-Tong , Li Jie-Ying , Li Rui-Qing , Feng Hui-Li , Xue Yang , Feng Xiao-Dong 
Published: December 2020

Abstract
Background: Cognitive impairment is a common dysfunction after stroke that seriously affects the overall recovery of patients. Cognitive rehabilitation training is currently the main treatment to improve cognitive function, but its curative effect is limited. Acupuncture is a core component of traditional Chinese medicine (TCM), and some previous clinical studies have shown that it might be effective in treating post-stroke cognitive impairment (PSCI), but further evidence from large-sample studies is needed. The overall objective of this trial is to obtain further data to develop an optimized acupuncture treatment for PSCI by comparing the effects of different acupuncture treatment methods on cognitive function in PSCI patients.Methods/Design: In this multicenter, prospective, randomized controlled trial, 206 eligible stroke inpatients who meet the trial criteria will be randomly assigned to 2 groups: an electroacupuncture (EA) plus needle retention (NR) group and an EA group. Both groups of patients will undergo the same routine cognitive rehabilitation treatments. All treatments will be given 5 times per week for 8 weeks. The primary outcomes will be assessed using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment scale (MOCA). The secondary outcome will be measured by the Barthel Index (BI). All outcomes will be evaluated at baseline, and week 4, week 8 and at the third and sixth month after the end of treatment.Discussion: Our aim is to evaluate the effects of two different acupuncture treatment methods for treating PSCI patients. This study is expected to provide data to be used in developing an optimized acupuncture treatment method for PSCI treatment.Trial registration: Chinese Clinical Trial Registry, ChiCTR1900027849. Registered on 30 November 2019, http://www.chictr.org.cn/showproj.aspx?proj=46316