bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Cost-effectiveness of screening tools used in the diagnosis of fetal alcohol spectrum disorder: A modeled analysis
Authors: Berrigan Patrick , Andrew Gail , Reynolds James N , Zwicker Jennifer D 
Published: December 2019

Abstract

Background Fetal Alcohol Spectrum Disorder (FASD) is characterized by physical and neurological abnormalities resulting from prenatal alcohol exposure. Though diagnosis may help improve patient outcomes, the diagnostic process can be costly. Subsequently, screening children suspected of FASD prior to diagnostic testing has been suggested, to avoid administering testing to children who are unlikely to receive a diagnosis. The present study set out to assess the cost-effectiveness of currently recommended FASD screening tools. Methods The screenings tools evaluated were chosen from Children’s Healthcare Canada’s National Screening Toolkit for Children and Youth Identified and Potentially Affected by FASD and include meconium testing of fatty acid ethyl esters (meconium testing) and the neurobehavioral screening tool (NST). An economic model was constructed to assess cost-effectiveness. One-way and probabilistic sensitivity analyses were conducted to assess the robustness of findings. Costs reflect 2017 Canadian dollars and the perspective is the public healthcare system. Results Both screening tools evaluated resulted in reduced costs and fewer diagnosed years of life than a no screening strategy in which all children suspected of FASD receive diagnostic testing. The model predicts that screening newborns with meconium testing results in a reduced cost of $89,186 per 100 individuals screened and 38 fewer diagnosed years of life by age 18, corresponding to an incremental cost-effectiveness ratio (ICER) of $2,359. Screening children with the NST resulted in a reduced cost of $183,895 per 100 individuals screened and 77 fewer diagnosed years of life by age 18, corresponding to an ICER of $2,390. Conclusion Findings suggest that screening is associated with less use of healthcare recourses but also fewer years of life with an FASD diagnosis over a no screening strategy. Since diagnosis can be key to children receiving timely and appropriate health and educational services, cost-savings must be weighed against the fewer years of life with a diagnosis associated with screening.
Shortening Antibiotic Duration in the Treatment of Acute Cholangitis. Rationale and Study Protocol for an Open Label Randomized Controlled Trial.
Authors: Iwata Kentaro , Doi Asako , Oba Yuichiro , Matsuo Hiroo , Ebisawa Kei , Nagata Manabu , Nishimura Sho , Yoshimura Kenichi , Masuda Atsuhiro , Shiomi Hideyuki , Kodama Yuzo 
Published: December 2019

Abstract
Background: Antimicrobial therapy with appropriate biliary drainage is considered the standard of care for acute cholangitis, but the optimal duration of antimicrobial therapy remains unknown. Seven to 10 days of antimicrobial therapy is common for the treatment of acute cholangitis, but a recent retrospective cohort study suggested a shorter duration might be effective . A shorter duration of antimicrobial therapy can be beneficial in decreasing the length of hospital stay, improving patients’ quality of life, decreasing adverse effects, and even contributing to a decrease in the occurrence of antimicrobial resistance. Methods/design: We will conduct a multi-center, open-label, randomized, non-inferiority trial to compare short course therapy (SCT) with conventional long course therapy (LCT) in treating patients with acute cholangitis. SCT consists of 5-day intravenous antimicrobial therapy if the patients had clinical improvement, while at least 7 days of intravenous antibiotics will be provided to the LCT group. The primary outcome is clinical cure at 30 days after onset. Patients will be randomly assigned in an open label fashion. A total sample size of 150 was estimated to provide a power of 80% with a one-sided alpha level of 2.5% and a non-inferiority margin of 10%. Discussion: This trial is expected to reveal whether SCT is non-inferior to conventional LCT or not, and may provide evidence that one can shorten the treatment duration for acute cholangitis for the benefit of patients.
The Impact of HIV Knowledge and Attitudes on HIV Testing Acceptance among Patients in an Emergency Department in the Eastern Cape, South Africa
Authors: Ryan Sofia , Hahn Elizabeth , Rao Aditi , Mwinnyaa George , Black John , Maharaj Roshen , Mvandaba Nomzamo , Nyanisa Yandisa , Quinn Thomas C. , Hansoti Bhakti 
Published: December 2019

Abstract
Background: Transmission of HIV in South Africa continues to be high due to a large proportion of individuals living with undiagnosed HIV. Uptake of HIV testing is influenced by a multitude of factors including the patient’s knowledge and beliefs about HIV. Methods: This study sought to quantify the impact of knowledge and attitudes on HIV testing acceptance in an emergency department by co-administering a validated HIV knowledge and attitudes survey to patients who were subsequently offered HIV testing. Results: During the study period 223 patients were interviewed and offered HIV testing. Individuals reporting more negative overall attitudes (p = 0.006), higher levels of stigma to HIV testing (p<0.001), and individuals who believed their test was confidential (p<0.001) were more likely to accept an HIV test. Conclusions: Interventions focused on improving patient perceptions around testing confidentiality will likely have the greatest impact on testing acceptance in the emergency department.
Establishment and Validation of a Nomogram with Intratumoral Heterogeneity Derived from 18F-FDG PET/CT for Predicting Individual Conditional Risk of 5-Year Recurrence before Initial Treatment of Nasopharyngeal Carcinoma
Authors: Gu Bingxin , Ma Guang , Song Shaoli , Shi Liqun , Zhang Yingjian , Zhang JianPing , Yang Zhongyi 
Published: December 2019

Abstract
Objectives

Intratumoral heterogeneity has an enormous effect on patient treatment and outcome. The purpose of the current study was to establish and validate a nomogram with intratumoral heterogeneity derived from 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for prognosis of 5-Year progression-free survival (PFS) of patients with nasopharyngeal carcinoma (NPC).Methods

A total of 171 NPC patients who underwent pretreatment 18F-FDG PET/CT were retrospectively enrolled. Data was randomly divided into training cohort (n=101) and validation cohort (n=70). The clinicopathologic parameters and the following PET parameters were analyzed: maximum and mean standardized uptake value (SUVmax, SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and heterogeneity index (HI, SUVmax/SUVmean) for primary tumor and maximal neck lymph node. Cox analyses were performed on PFS in the training cohort. A prognostic nomogram based on this model was developed and validated.Results

For the primary tumor, MTV-2.5, TLG-2.5, MTV-70%, and TLG-70% were significantly correlated with PFS. For the maximal neck lymph node, short diameter and HI were significantly correlated with PFS. Among the clinicopathologic parameters, M stage was a significant prognostic factor for recurrence. In multivariate analysis, M stage (P=0.006), TLG-T-70% (P=0.002), and HI-N (P=0.018) were independent predictors. Based on this prognostic model, a nomogram was generated. The C-index of this model was 0.74 (95% CI: 0.63-0.85). For the cross validation, the C-index for the model was 0.73 (95% CI: 0.62-0.83) with the validation cohort. Patients with a risk score of ≥111 had poorer survival outcomes than those with a risk score of 0-76 and 77-110.Conclusions

Intratumoral heterogeneity derived from 18F-FDG PET/CT could predict long-term outcome in patients with primary NPC. A combination of PET parameters and the TNM stage enables better stratification of patients into subgroups with different PFS rates.
Nasogastric tube feeding versus assisted hand feeding in-home healthcare older adults with severe dementia in Taiwan: a prognosis comparison
Authors: Chou Hsiao-Hui , Tsou Meng-Ting , Hwang Lee-Ching 
Published: December 2019

Abstract
Backgrounds:
All individuals with severe dementia should be offered careful hand feeding. However, under certain circumstances, people with severe dementia have a feeding tube placed. In Taiwan, tube feeding rate in demented elderly home care residents is increasing；however, the benefits of tube feeding in this population remain unknown. We compared the clinical prognosis and mortality of elderly patients with severe dementia receiving nasogastric tube feeding (NGF) or assisted hand feeding (AHF).

Methods:
This retrospective longitudinal study enrolled 169 participants over 60 years of age in the setting of in-home healthcare between January 1 and December 31, 2017. All subjects with documented severe dementia and complete functional dependence suffered from difficulty in oral intake and required either AHF or NGF. Data were collected from both groups to analyze pneumonia, hospitalization, and mortality rates.

Results:
A total of 169 subjects (56 males and 113 females, aged 85.9 ± 7.5 years) were analyzed. Of note, 39 required AHF and 130 NGF. All subjects were in a bedridden status；129 (76.3%) showed Barthel index < 10. Pneumonia risk was higher in the NGF group (47.7%) than in the AHF group (25.6%, p = 0.015). After adjusting for multiple factors in the regression model, the risk of pneumonia showed no significant difference in both groups (aOR = 2.20, 95% CI 0.92–5.30). One-year mortality rates in the AHF and NGF groups were 7.7% and 14.6%, respectively, and no significant difference was observed after adjustment with logistic regression (aOR = 2.38, 95% CI 0.58–9.70). There were no significant differences in hospitalization rate and duration.

Conclusions:
For elderly patients with dementia requiring in-home healthcare, NGF is not associated with a significantly lower risk of pneumonia than AHF. Additionally, neither mortality nor hospitalization rates decreased with NGF. However, aORs with the trend of increasing risk of in the NGF group were observed in measured outcomes. Therefore, the benefits of NGF are debatable in elderly patients with severe dementia requiring in-home healthcare. Continued careful hand feeding could be an alternative to NG feeding in patients with severe dementia. Furthermore, large-scale studies on home healthcare would be required to support these results.
Well-being in high-risk pregnancy: an integrative review
Authors: mirzakhani kobra , Ebadi Abbas , Faridhosseini Farhad , Khadivzadeh Talaat 
Published: December 2019

Abstract
Background: A prerequisite to the interventions for well-being improvement in high-risk pregnancy (HRP) is to make the concept clear, objective, and measurable. Despite the wealth of studies into the concept of well-being in high-risk pregnancy, there is no clear definition for it. This study aimed to explore the concept of well-being in high-risk pregnancy.
Methods: This integrative review was conducted using the Whittemore and Knafl’s approach. A literature search was done without any data limitation in dictionaries, thesauruses, encyclopedias, well-being-related textbooks, midwifery, psychology, and mental health journals, and Iranian and international databases. The most primary inclusion criterion was relevance well-being in high-risk pregnancy. The full-texts of all articles were assessed using the checklists of the Joanna Briggs Institute (JBI). Data were analyzed through the constant comparison method and were managed using the MAXQDA 10 software. Meaning units were identified and coded. The codes were grouped into subcategories and categories according to the attributes, antecedents, and consequences of well-being in high-risk pregnancy.
Results: Thirty articles were included in the review, from which 540 codes were extracted. The codes were grouped into seven main attributes, eight main antecedents, and five main consequences of well-being in HRP. Findings showed that the four dimensions of well-being in high-risk pregnancy concept were physical, mental-emotional, social, and spiritual well-being.
Conclusion: As a complex and multidimensional concept, well-being in high-risk pregnancy refers to the pregnant woman’s evaluation of her life during high-risk pregnancy. It includes physical, hedonic, and eudaimonic components. The assessment of well-being in HRP should include all these components.
Keywords: Well-being, Pregnancy, High-risk pregnancy
Rapid direct identification of positive paediatric blood cultures by MALDI-TOF MS technology and its clinical impact in the paediatric hospital setting.
Authors: Samaranayake Waniganeththi Arachchige Manori Piyumal , Dempsey Suzanne , Howard-Jones Annaleise R , Outhred Alexander Conrad , Kesson Alison Margaret 
Published: December 2019

Abstract
Objective: Rapid diagnostic tools are imperative for timely clinical decision making, particularly in bacteraemic patients. This study evaluated the performance of a fast, inexpensive novel in house method for processing positive blood cultures for immediate identification of microorganisms by matrix-assisted laser desorption ionization-time of flight mass spectrometry (Vitek MS bioMérieux). We prospectively analyzed the clinical impact of such method on the management of pediatric patients.
Result: In total, 360 positive blood cultures were included. Among 318 mono-microbial cultures, in-house method achieved correct identification in 270 (85%) cultures to the species level, whilst 43 (13.5%) gave no identification, and 7 (2.2%) gave discordant identifications. Identification of Gram-negative organisms was accurate to both species and genus level in 99% of isolates, and for Gram positives accuracy was 84% to genus and 81% to species level overall, with accuracy of 100% for Staphylococcus aureus and Enterococcus to the species level. Assessment of the potential impact of direct identification in sixty sequential cases revealed a clear clinical benefit in 35.5% of cases. Benefits included timely antibiotic rationalization, change of medical intervention, and early confirmation of contamination. This study demonstrates a highly accurate in-house method with considerable potential clinical benefits for paediatric care.
The diagonal branches and outcomes in patients with anterior ST- elevation myocardial infarction
Authors: Zhang Shuning , Deng Xin , Yang Wenlong , Xia Liping , Yao Kang , Lu Hao , Ge Lei , Li Shen , Sun Aijun , Zou Yunzeng , Qian Juying , Ge Junbo 
Published: December 2019

Abstract
Background: To detect the impact of loss of main diagonal branch (D) flow on cardiac function and clinical outcomes in patients with anterior ST-segment elevation myocardial infarction (STEMI).Methods: Patients with anterior STEMI undergoing primary percutaneous coronary intervention (PCI)at our clinic between October 2015 and October 2018were reviewed. Anterior STEMI due to left anterior descending artery (LAD) occlusion with or without loss of the main D flow (TIMI grade 0-1 or 2-3) was enrolled in the analysis. The short- and long-term incidence of major adverse cardiac events (MACEs, a composite of all-cause death, target vessel revascularization and reinfarction) and left ventricular ejection fraction (LVEF) were analyzed.Results: A total of 392 patients (mean age of 63.9years) with anterior STEMI treated with primary PCI was enrolled in the study. They were divided into two groups, loss (TIMI grade 0-1, n=69) and no loss (TIMI grade2-3, n=323) of D flow, before primary PCI. Compared with the group without loss of D flow, the group with loss of D flow showed a lower LVEF post PCI (41.0% vs. 48.8%, p=0.003). Meanwhile, loss of D flow resulted in the higher in-hospital, one-month, and 18-month incidence of MACEs, especially in all-cause mortality (all p<0.05). Landmark analysis further indicated that the significant differences in 18-month outcomes between the two groups mainly resulted from the differences during the hospitalization. In addition, multivariate Cox proportional hazards analysis found that D flow loss before primary PCI was independent factor predicting short- and long-term outcomes in patients with anterior STEMI.Conclusion: Loss of the main D flow in anterior STEMI patients was independently associated with the higher in-hospital incidences of MACEs and all-cause death as well as the lower LVEF.
PSEN1, but not PSEN2, mutation in familial form of Alzheimer’s disease is associated with impaired barrier phenotype in a stem cell-based model of the blood-barrier
Authors: Patel Ronak , Raut Snehal , Al-Ahmad Abraham 
Published: December 2019

Abstract
Background: Alzheimer’s disease (AD) is the most common form of neurodegenerative disease. It is an irreversible condition marked by irreversible cognitive loss, commonly attributed by the loss of hippocampal neurons due to the formation of senile plaques and neurofibrillary tangles. Although the sporadic form is the most prevalent, the presence of familial form (involving several genes such as APP, PSEN1 and PSEN2) of the disease is commonly used as a model for understanding the pathophysiology of the disease. The aim of this study is to investigate the effect of mutation on PSEN1 and PSEN2 genes on the BBB function using induced pluripotent stem cells. Methods: iPSC lines from patients harboring mutations in PSEN1 or PSEN2 were used in this study and compared to a control iPSC line. Cells were differentiated into BMECs following existing protocols. Barrier function was assessed by measuring TEER and fluorescein permeability, drug transporters activity was assessed by uptake assay, glucose uptake and metabolism assessed by cell flux analyzer, mitochondrial potential by JC-1 and lysosomal acidification by acridine orange. Results: PSEN1-BMECs, but not PSEN2-BMECs, showed impaired barrier function compared to control group. Such impaired barrier function correlated with poor tight junction complexes and reduced drug efflux pump activity. In addition, both PSEN1 and PSEN2 displayed reduced glucose uptake and glycolysis, as well as impaired mitochondrial membrane potential and lysosomal acidification. Conclusion: Our study reports evidence that PSEN1 and PSEN2 mutations, two genes commonly associated with familial form of Alzheimer’s disease, can impair the development and the maintenance of the BBB, both by an impairment of the barrier function, vesicle trafficking and bioenergetics. Therefore, assessing the contribution of genetic mutations associated with Alzheimer’s disease will allow us to better understand the contribution of the BBB in dementia, but also in other neurodegenerative diseases.
Probiotic Effects on Sperm Parameters, Oxidative Stress index, Inflammatory Factors and Sex Hormones in Infertile Men
Authors: Helli Bijan , Kavianpour Maria , Ghaedi Ehsan , Dadfar Mohammadreza , haghighian Hossein Khadem 
Published: December 2019

Abstract
Background: Impaired sperm production, decreased sperm motility, and increased oxidative stress levels are the main causes of male infertility. To evaluate effects of supplementation with probiotic on the spermatogram, seminal oxidative stress biomarkers, inflammatory factors and reproductive hormones.Methods: In this randomized, double-blind controlled clinical trial, 52 idiopathic asthenozoospermia men, attending urology clinic, were randomly assigned to one of intervention and placebo (n =26) groups. Participants in the intervention group took daily 500 mg Probiotic and those in the placebo group took daily placebo for 10 wk. Semen parameters, total antioxidant capacity, malondialdehyde, inflammatory factors, reproductive hormones, anthropometric and physical activity assessments were measured at the baseline and at the end of the study. Statistical analysis was performed using SPSS software.Results: Out of 52 who participated in this study, 25 men in the intervention group and 25 men in the control group completed the protocol of the study. After the intervention, ejaculate volume, number, concentration and the percentage of motile sperm, total antioxidant capacity of plasma significantly increased in the intervention group and the concentration of plasma malondialdehyde and inflammatory markers significantly decreased in the intervention group.Conclusion: Probiotic supplementation in infertile men, leading to significant increase in concentration and motility and significant reduce in oxidative stress and inflammatory markers. Possibly oral intake of probiotic has the potential to be one of the ways to deal with oxidative damage sperm of infertile men.
Short-chain fatty acid-Butyrate ameliorates hypoxia-induced pulmonary hypertension in rat
Authors: He Shixin , Zhu Tengteng , Zhu Zhaowei , Huang Yiyuan , Tai Shi , Tang Liang , Fang Zhenfei 
Published: December 2019

Abstract
Background: Gut Microbiome can produce numerous metabolites which may be absorbed into the circulation and play a critical role in the development of diseases. Our study wants to find out the roles of faecal microbiota and its metabolite in the development of pulmonary hypertension. Methods: SD rats were expose to either normoxia (Control, n=8) or chronic hypoxia (10% O2) (n=16). Rats in chronic hypoxia were randomly received sodium butyrate (500 mg/kg) (n=8) or volume-matched saline (n=8) once a day. Rats in normoxia condition also received volume-matched saline once a day. RVSP and lung vascular features were assessed after 3 week’s treatment. Rats’ fecal samples were collected and analyzed by GCMS and 6S/18S Amplicon Sequencing. Activation of HIF-1α, HMGB2, TLR4, TNF-α, HDAC5 and PCNA was assessed using Western blot analysis. The effect of sodium butyrate on proliferation of pulmonary artery smooth muscle cell, induced by PDGF or hypoxia (1% O2), was evaluated by CCK-8, EDU assay and wound healing assay. Results: Hypoxia significantly increased RVSP and induced a significant decrease in butyrate-producing bacteria, but a slight decrease of SCFAs without statistic difference. Administration of sodium butyrate remarkably attenuated the RVSP and improved lung vascular features. Decreased expression of HDAC5, PCNA, HIF-1α, HMGB2, TLR4, TNF-α and inhibited proliferation of PASMC were found in rats or cells with sodium butyrate. Conclusions: Decreased butyrate-producing bacteria may contribute to the development of PH, and sodium butyrate supplement can effectively attenuate hypoxia-induced PH in rats probably by inhibiting the proliferation and migration of PASMC.