bluuebunny/crossref_metadata_2025_split huggingface dataset:
External Validation of Stroke Mimic Prediction Scales in the Emergency Department
Authors: Tu Tian Ming , Tan Guan Zhong , Saffari Seyed Ehsan , Wee Chee Keong , Chee David Jeremiah Ming Siang , Tan Camlyn , Lim Hoon Chin 
Published: April 2020

Abstract
Background
Acute ischemic stroke is a time-sensitive emergency where accurate diagnosis is required promptly. Due to time pressures, stroke mimics, whom present with similar signs and symptoms as acute ischemic stroke, pose a diagnostic challenge to the emergency physician. With limited access to investigative tools, clinical prediction tools, based only on clinical features, may be useful to identify stroke mimics. We aim to externally validate the performance of 4 stroke mimic prediction scales and aim to derive a novel decision tree, to improve identification of stroke mimics.
Methods
We performed a retrospective cross-sectional study at a primary stroke centre, served by a telestroke hub. We included consecutive patients whom were administered intravenous thrombolysis for suspected acute ischemic stroke from January 2015 to October 2017. Four stroke mimic prediction tools (FABS, simplified FABS, Telestroke Mimic Score and Khan Score) were rated simultaneously, using only clinical information prior to administration of thrombolysis. The final diagnosis was ascertained by an independent stroke neurologist. Area under receiver operating curve (AUROC) analysis was performed. A classification tree analysis was also conducted using variables which were found to be significant in the univariate analysis.
Results
Telestroke Mimic Score had the highest discrimination for stroke mimics among the 4 scores tested (AUROC = 0.75, 95% CI = 0.63–0.87), although it was not statistically significantly better. Telestroke Mimic Score had the highest sensitivity (91.3%), while Khan score had the highest specificity (88.2%). All 4 scores had high positive predictive value (88.1–97.5%) and low negative predictive values (4.7–32.3%). A novel decision tree, using only age, presence of migraine and psychiatric history, had a higher prediction performance (AUROC = 0.80).
Conclusion
Four tested stroke mimic prediction scales performed similarly well to identify stroke mimics in the emergency setting. A novel decision tree may improve the identification of stroke mimics.
Survival Analysis of Traditional Chinese Herbal Medicine Spleen-invigorating Compound in Patients with Pancreatic cancer
Authors: Li Xin , Chen Ling , Gu Xiaoqiang , Xu Jiahua , Li Hongwei , Yang Jinzu , Qian Jianxin 
Published: April 2020

Abstract
Background

Traditional Chinese herbal medicine (TCHM) is widely used in the treatment of pancreatic cancer in China. In this retrospective study, the authors mainly analyzed the effect of TCHM on the survival time of patients with pancreatic cancer.
Methods

From 2011 to 2018, 121 pancreatic cancer patients were enrolled in this study. All patients were divided into either the TCHM group or non-TCHM group based on received TCHM or not. TCHM group received three months or more of TCHM treatment on the basis of comprehensive treatment. Kaplan-Meier method was used to assess the difference in survival time, and Cox proportional hazards regression analysis was performed to identify independent prognostic factors.
Results

The overall survival was different between all patients with and without TCHM (P = 0.000), COX analysis showed the clinical staging (P = 0.050), surgery (P = 0.000), chemotherapy (P = 0.000) and TCHM (P = 0.000) were independent prognostic factors. In a stratification analysis of stage for patients who received chemotherapy, there was a significant increase in median overall survival from 10.7 (non-TCHM group) to 19.5 (TCHM group) months (hazard ratio [HR] = 3.197, 95% confidence interval [CI] 1.989–5.137, P = 0.000). Patients who did not receive chemotherapy, but best supportive care, there was a significant increase in median overall survival from 4.3 (non-TCHM group) to 15.1 (TCHM group) months (HR = 0.041, 95% CI = 0.005–0.329, P = 0.003).
Conclusions

TCHM was an important independent prognostic factor of pancreatic cancer and have an effect on improving the prognosis of pancreatic cancer patients.
Clinical Analysis of small Acoustic neuromas With Initial Neurological Symptoms
Authors: Chen Ke-Yang , Zhu Juan-Juan , Fang Jun-Hao , Cheng Li-Jun , Chen Si , Chen Bo-Bei 
Published: April 2020

Abstract
Background

Initial neurological manifestations involved with Acoustic neuromas (ANs) are easily misdiagnosed due to nonspecific symptoms. The objective is to investigate and describe the clinical features of small ANs presenting with initial neurological manifestations, to allow earlier diagnosis and more well-timed interference for patients with this disease.
Methods

This was a retrospective cross-sectional study that included 22 patients. The detailed clinical information with initial symptoms of neurological manifestations caused by small ANs between January 2010 and May 2020 were retrospectively analyzed. The collected data included symptoms, signs, neuroimaging results, and pathologic diagnoses.
Results

There were 9 males and 13 females, and their ages ranged from 22 to 74 years. Dizziness/vertigo was the most common initial presenting symptom in 9 of the 22 patients. Headache was the second most frequent initial presenting symptom in 8 of 22. Neuro-physical examination found that the facial nerve and auditory nerve were the most involved cranial nerves, with remaining positive signs involving abnormalities of the optic nerve, trigeminal nerve and abducens nerve as well as ataxia and nystagmus. More than half of the patients underwent microsurgery and had postoperative clinical symptom improvement. The patients who chose the observation method showed no change in tumor size at follow-up.
Conclusions

Dizziness/vertigo and headache are the most common initial neurological symptoms of small ANs and should be considered in the differential diagnosis of patients. The results suggest that MRI is the best tool in diagnosis for small ANs. Observation and microsurgery are safe and common methods for the treatment.
The functional limits of the aneurysmal aortic root. A unique pressure testing apparatus.
Authors: Surman Timothy Luke , Abrahams John Matthew , O'Rourke Dermot , Reynolds Karen , Edwards James , Worthington Michael George , Beltrame John 
Published: April 2020

Abstract
Background The aortic root has unique embryological development and is a highly sophisticated and complex structure. In studies that report on the biomechanical characteristics of the thoracic aorta, distinction between the aortic root and ascending aorta regions is nonexistent. Our objective is to determine the maximal pressures at which dissection occurs or tissue failure occurs in the aortic root compared to that of the ascending aorta in the presence of aortic aneurysms. This may help guide preoperative monitoring, diagnosis and the decision for operative intervention for aortic root aneurysms in the normal and susceptible populations. Methods We developed a simple aortic root and ascending aorta pressure testing unit in series. Ten fresh porcine hearts were obtained from the local abattoir (n=5 aortic root and n=5 ascending aorta for comparison). Using a saline filled needle and syringe, artificial fluid-filled aneurysms were created between the intima and medial layers of the aortic root. The aorta lumen was then progressively filled with saline solution. Pressure measurement was taken at time of loss of tissue integrity, obvious tissue dissection or aneurysm rupture, and the tissue structure was then visually examined.Results In the aortic root, mean maximal pressure (mmHg) at tissue failure was 208mmHg. Macroscopic examination revealed luminal tears around the coronary ostia in 2/5 specimens, and in all specimens, there was propagation of the dissection in the aortic root in a circumferential direction. In all ascending aorta specimens, the maximal aortic pressures exceeded 300mmHg without tissue failure or dissection, and eventual apparatus failure. Conclusion Our results indicate that the aneurysmal aortic root tissues are at greater risk of rupture and dissection propagation at lower aortic pressure. With further analysis, this could guide clinical and surgical management.
Enhanced aging and thermal shock performance of Mn1.95-xCo0.21Ni0.84SrxO4 NTC ceramics
Authors: Li Haibing , Zhang H.M. , Thayil Islla P Ley , Chang Aimin , Sang Xu , Ma Xiuhua 
Published: April 2020

Abstract
Herein, the Mn1.95-xCo0.21Ni0.84SrxO4 (MCNS) (0 ≤ x ≤ 0.15) negative temperature coefficient (NTC) materials are prepared by co-precipitation method. The replacement of Mn by Sr plays a critical role in controlling the lattice parameter, relative density, microstructure and electrical properties. The lattice parameter and relatively density increase with the increase of Sr content. Moreover, a small amount of Sr retards the grain growth and increases the bulk density. Moreover, the ρ25, B25/50, Ea and α values of MCNS ceramics are influenced by the Sr content and ranged from 1535.0-2024.1 Ω•cm, 3654–3709 K, 0.3149–0.3197 eV and 4.111–4.173%, respectively. The XPS results explain the transformation of MCNS ceramics from n- to p-type semiconductors. Moreover, the aging coefficient (△R/R) of MCNS ceramics is found to be < 0.2%, which indicates the stable distribution of cations in the spinel. Finally, the MCNS ceramics demonstrate excellent thermal durability with < 1.3% of resistance shift after 100 thermal shock cycles.
Public-Private Partnership Policy in Primary Health Care: A Scoping Review Protocol
Authors: Gharaee Hojatolah , Aghdash Saber Azami , Tabrizi Jafar Sadegh 
Published: April 2020

Abstract
Background Achieving universal health coverage requires health systems oriented to primary health care (PHC). The private sector may be a crucial resource for countries’ work on universal health coverage. One of the most effective ways to engage the private sector in health system is Public-Private Partnership (PPP). Since, published experiences about PPP implementation in PHC in different countries have provided various and sometimes contradictory results, there is a need to examine the results of using PPP in PHC worldwide. Thus, the main objective of this scoping review is to perform an inclusive search for studies that report the experiences of implementation PPP in PHC worldwide. Methods This scoping review study will be conducted using the framework proposed by Arkesy and O'Malley. An extensive search of the literature will be done in five databases including PubMed, Embase, Scopus, Web of Science and Science Direct, and two Persian databases using a comprehensive search strategy to identify studies on PPP implementation in PHC. The search will be done from January 2000 to the end of 2019, completed by reference tracking, author tracking and expert consultation. Any study, which focuses on the results of PPP in PHC, will be included in the study. Two reviewers will screen the articles based on the title, abstract and full text, and extract data. Potential disagreements will be resolved by consulting a third author. Discussion Given the problems and shortcomings in the providing PHC services in different countries, specially low and middle income countries, the use of private sector capacities and capabilities in the form of PPP, can be effective and useful solution. The results along with recommendations will be published in order to the authorities of the health system in different countries, especially low and middle income countries, use it to make better evidence-based decisions about using PPP in PHC in the future.
Prevalence of Short Stature and Malnutrition among Egyptian Primary School Children and their Coexistence with Anemia
Authors: Shafie Ali M. El , Kasemy Zeinab A. , omar Zein A. , Alkalash Safa H. , salama Amal A. , mahrous kerollos s. , bahbah Wael A. 
Published: April 2020

Abstract
Background
Under nutrition and overweight typically occur during nutritional transition periods in developing countries including Egypt. Short stature and anemia are public health concern due to its strong link with malnutrition which is a preventable risk factor.
Objectives
to estimate the prevalence of overweight, obesity, underweight and short stature and its concurrence with anemia, also to determine the etiological profile of short stature among primary school children in Egypt.
Methods
A cross-sectional study was carried out on 33150 Egyptian children aged 6–11 years old from January 2018 to January 2020, allocated in 59 primary schools from diverse geographical districts in Egypt. Complete anthropometric measurements were conducted and applied according to WHO growth charts. Hemoglobin level was measured. Systematic approach to detect the etiology of short stature was applied randomly to a sample of 380 stunted children.
Results
The prevalence of underweight was 8.2%, while obesity and overweight represented 21.8% (9.6% and 12.2% respectively). Overall short stature constituted 17%. The main etiologies of short stature were familial (40.8%) and constitutional (24.2%). Anemia was diagnosed in 26% of children; while concurrent anemia and stunting was reported in 9.9%. Regarding anemia and anemia with stunting were more common among girls (30.0% (OR = 1.50, CI95%: 1.43–1.58) and 11.4% (OR = 1.39, CI95%:1.29–1.49) respectively), who were living in rural areas (33.4% (OR = 1.96, CI 95%:1.87–2.06) &12.7% (OR = 1.72, CI 95%:1.60–1.85)) and those who had low socioeconomic status )34.6% (OR = 2.54, CI 95%:2.29–2.82) & 40.4% (OR = 18.46, CI 95%:15.40-22.12() respectively. Anemia with stunting was significantly higher among children aged ≥ 9 years old representing 12% (OR = 1.40, CI 95%:1.30–1.51).
Conclusion
Prevalence of short stature, obesity and anemia was high among primary school children in Egypt with a strong concurrence between anemia and stunting. Intensive parental health education and in-depth nutritional assessment are required.
Utility of ferritin, procalcitonin, and C-reactive protein in severe patients with coronavirus disease 2019
Authors: Zhou Bo , She Jianqing , Wang Yadan , Ma Xiancang 
Published: April 2020

Abstract
Objectives It is of clinical significance to evaluate the disease severity and investigate possible biomarkers of COVID-19. In this study, we aim to describe the clinical characteristics of infection makers in severe and very severe patients with COVID-19.Methods This is a single center, observational analysis. We enrolled 48 in-hospital severe patients with COVID-19 admitted to the West District of Union Hospital of Tongji Medical College and analyzed infection biomarkers in 20 patients who had been tested for ferritin, PCT, CRP, etc.Results We noted significantly increased CRP (1.48mg/L [IQR: 16.69-2.74] vs. 57.98mg/L [IQR: 38.335-77.565], P<0.05), PCT(0.05ng/ml [IQR: 0.03-0.06] vs. 0.21ng/ml [IQR: 0.11-0.42], P<0.05) and ferritin (291.13ng/ml [IQR: 102.1-648.42] vs. 1006.16ng/ml [IQR: 408.265-1988.25]) in severe COVID-19. For blood count, significant increase was noticed in neutrophil count (3.75*10^9/L [IQR: 3.42-4.93] vs. 8.11*10^9/L [IQR: 5.675-8.905], P<0.05); and decrease was seen in lymphocyte count (1.62*10^9/L [IQR: 0.7-1.73] vs. 0.68*10^9/L [IQR: 0.385-1.04], P<0.05), and platelet count (214*10^9/L [IQR: 184-247] vs. 147*10^9/L [IQR: 126-202.5], P<0.05) in severe COVID-19.Conclusions The serum levels of CRP, PCT and ferritin are markedly increased in very severe compared with severe COVID-19. Increased CRP, PCT and ferritin level might correlate to secondary bacterial infection and associated with poor clinical prognosis.
Fractal signature of coronaviruses related to severe acute respiratory syndrome
Authors: Fernandes Thiago de Salazar e , Filho Jonas Sérgio de Oliveira , Lopes Isvania Maria Serafim da Silva 
Published: April 2020

Abstract
Coronavirus is the agent which causes the severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), emergent infections such as the present Pandemic of COVID-19. Understanding its genome pattern is important for developing new and faster ways of testing for identifying the genome of the virus, and also for better understanding of its origin and evolution. The aim of this work was to investigate the genome of SARS-CoV, MERS-CoV and SARS-CoV-2 by the paradigm of chaos theory and fractal geometry. For that, it was calculated the alpha coefficient by detrended fluctuation analysis (DFA) for the sequences of these genomes converted to binary numbers in order to determine if it is a chaotic or a random series of data. Also, it was applied the random walking for obtaining a fractal map of the whole genome, and calculated the fractal dimension (FD) by box-counting of this map by two different softwares. With this, it was found that the alpha coefficient of the first SARS viruses was > 0.5, indicating that the series is chaotic or fractal, and has a persistent long-range memory or self-similarity along its sequence. This is not the case for MERS virus, which showed to have a completely random sequence (alpha < 0.5). For the fractal dimension, SARS viruses presented a FD around 1.5, and for MERS the fractal dimension decreases (FD < 1.5). The images generated by random walking of the entire RNA genome are by itself a fractal signature of the virus, which may be applied for studying its origin and for faster diagnostic of COVID-19.
Potential biomarkers for predicting of depression in diabetes mellitus
Authors: Song Xiuli , Zheng Qiang , Zhang Rui , Wang Miye , Deng Wei , Wang Qiang , Guo Wanjun , Li Tao , ma xiaohong 
Published: April 2020

Abstract
Background To identify the potential biomarkers for predicting depression in diabetes mellitus using the support vector machine technique to analyze routine biochemical tests and vital signs between two groups: subjects with both diabetes mellitus and depression, and subjects with diabetes mellitus alone. Methods Electronic medical records upon admission and biochemical tests and vital signs of 135 patients with both diabetes mellitus and depression and 178 patients with diabetes mellitus alone were identified for this retrospective study. After the covariate regression analysis on age and sex, the two groups were classified by the recursive feature elimination-based support vector machine and the biomarkers were also identified by 10-fold cross validation. Specifically, the training data, evaluation data, and testing data were split for ranking the parameters, determine the optimal parameters, and assess classification performance. Results The experimental results identified 12 predictive biomarkers with classification accuracy of 74%. The 12 biomarkers are hydroxybutyrate, magnesium, hydroxybutyrate dehydrogenase, creatine kinase, total protein, high-density lipoprotein cholesterol, cholesterol, absolute value of the lymphocyte, blood urea nitrogen, chlorine, platelet count, and glutamyltranspeptidase. Receiver operating characteristic curve analysis was also used with area under the curve being 0.79. Conclusions Some biochemical parameters may be potential biomarkers to predict depression among the subjects with diabetes mellitus.
A deeper look at COVID-19 CFR: health care impact and roots of discrepancy
Authors: Dehkordi Amirhoshang Hoseinpour , Nemati Reza , Tavousi Pouya 
Published: April 2020

Abstract
Intensive care capacity and proper testing play a paramount role in the COVID-19 Case Fatality Rate (CFR). Nevertheless, the real impact of such important measures has not been appreciated due to the lack of proper metrics. In this work, we have proposed a method for estimating a lower bound for the number of positive cases by using the reported data on the oldest age group and the regions' population distributions. The proposed estimation method improved the expected similarity between the age-distribution of positive cases and regions' population. Further, we have provided a quantitative measure for the impact of intensive care on the critical cases by comparing the CFR among those who did and did not receive intensive care. Our findings showed that the chance of living among non-ICU receivers is less than half of ICU receivers (~24% vs ~60%).
Pharmacokinetics of Inter-Alpha Inhibitor Proteins and Effects on Hemostasis After Hypoxic-Ischemic Brain Injury in Neonatal Rats
Authors: Chen Xiaodi , Song Dawei , Nakada Sakura , Qiu Joseph , Iwamoto Karin , Chen Ray H. , Lim Yow-Pin , Jusko William J. , Stonestreet Barbara S. 
Published: April 2020

Background:
Hypoxic-ischemic (HI) brain injury is a leading cause of long-term neurodevelopmental
morbidities in neonates. Human plasma-derived Inter-Alpha Inhibitor Proteins (hIAIPs) are neuroprotective after
HI brain injury in neonatal rats. The light chain (bikunin) of hIAIPs inhibits proteases involved in the coagulation
of blood. Newborns exposed to HI can be at risk for significant bleeding in the brain and other organs.

Objective:
The objectives of the present study were to assess the pharmacokinetics (PK) and the duration of bleeding
after intraperitoneal (IP) administration of hIAIPs in HI-exposed male and female neonatal rats.

Methods:
HI was induced with the Rice-Vannucci method in postnatal (P) day-7 rats. After the right common
carotid artery ligation, rats were exposed to 90 min of 8% oxygen. hIAIPs (30 mg/kg, IP) were given immediately
after Sham or HI exposure in the PK study and serum was collected 1, 6, 12, 24, or 36 h after the injections.
Serum hIAIP concentrations were measured with a competitive ELISA. ADAPT5 software was used to fit the
pooled PK data considering first-order absorption and disposition. hIAIPs (60 mg/kg, IP) were given in the bleeding
time studies at 0, 24 and 48 h after HI with tail bleeding times measured 72 h after HI.

Results:
IP administration yielded significant systemic exposure to hIAIPs with PK being affected markedly
including primarily faster absorption and reduced elimination as a result of HI and modestly of sex-related differences.
hIAIP administration did not affect bleeding times after HI.

Conclusion:
These results will help to inform hIAIP dosing regimen schedules in studies of neuroprotection in
neonates exposed to HI.
Autumn Royal and Egnatia Grape Extracts Differently Modulate Cell Proliferation in Human Colorectal Cancer Cells
Authors: Gigante Isabella , Milella Rosa Anna , Tutino Valeria , Debiase Giambattista , Notarangelo Luciano , Giannandrea Maria Angela , De Nunzio Valentina , Orlando Antonella , D’Alessandro Rosalba , Caruso Maria Gabriella , Notarnicola Maria 
Published: April 2020

Objective:
Polyphenols extracted by table grape have been demonstrated to decrease cell
proliferation in vitro and to exert anti-atherosclerotic and antithrombotic activities, regulating cell functions.
A grape polyphenolic profile is affected by climate as well as a grape cultivar. This study was
aimed to characterize the berry skin polyphenolic composition, antioxidant activity and antiproliferative
properties of two black grape cultivars, Autumn Royal and Egnatia.

Methods:
The phenolic composition of Grape Skin Extracts (GSEs) was determined by HPLC analyses.
The antioxidant activity was determined using DPPH, ABTS and ORAC tests. Caco2, HT29 and
SW480 human colon cancer cell lines were used to test the effects of GSEs in vitro. Cell proliferation
and cell cycle were assessed with the MTT method and a Muse cell analyzer, respectively. qPCR and
Western Blotting analysis were used to evaluate gene and protein expression, respectively.

Results:
The total polyphenolic content and the total antioxidant capacity were significantly higher in
Autumn Royal than in Egnatia. However, table grape Egnatia showed greater ability to affect cell proliferation
and apoptosis, as well as to exert a growth arrest in the S phase of the cell cycle, particularly
in the Caco2 cell line.

Conclusion:
These data suggest that the new grape variety Egnatia is an interesting source of phenolic
compounds that could be of interest in the food and pharmaceutical industries.