bluuebunny/crossref_metadata_2025_split huggingface dataset:
WITHDRAWN: Prevalence, Types and Risk Factors of Congenital Anomalies (A Hospital Based Study)
Authors: Shalaby Amira M. , EL-Gazzar Amira F. 
Published: November 2020

Abstract
Background: Congenital anomalies (CA) are common causes of infant’s and childhood deaths and disability. Objectives: The aim of the study is to determine the prevalence, describe the types and risk factors of congenital anomalies among newborns admitted to Neonatal Intensive Care Unit (NICU) of a Children's Hospital. Study design: It is a prospective observational study(analytic cross sectional study) was performed and screening of the newborn admitted at NICU of a Children's Hospital during the period of 6 months from 1 to 12-2017 to the end of 5-2018. The sample was 346 newborns, 173 cases and 173 control. We collected data using a record checklist and an interviewing questionnaire.Results: There were a significant difference between cases and control concerning gestational age (P=0.001), single or multiple babies (P=0.002), residence (P=0.001), consanguineous marriage (P=0.01) and family history of unfavorable outcome (P=0.001). We also found that the most common type of congenital anomalies was gastrointestinal anomalies 63 cases (36.4%) with tracheoesophageal fistula 17 cases (27%) being the most common GIT anomalies. Then the musculoskeletal anomalies being the second common anomalies 14.5% with diaphragmatic hernia 10 cases being the most common in musculoskeletal anomalies followed by other anomalies (22 multiple +1Conjoined Twins 23 cases (13.3%) followed by circulatory anomalies 22 cases (12.7%), followed by CNS anomalies 18 cases (10%). Conclusion: The prevalence of congenital anomalies was 22.97%. The most common anomalies were gastrointestinal anomalies (GIT), musculoskeletal anomalies, multiple anomalies and circulatory system anomalies. The risk factors were consanguineous marriage, positive family history, urban areas, full-term and singleton pregnancies.
Predictors of Prolonged Mechanical Ventilation After Cardiopulmonary Bypass in Infants with Congenital Heart Disease Less than 3 Months Old
Authors: Wang Ruonan , Yu Di , Zou Liang , Shu Yaqin , Mo Xuming , Peng Wei 
Published: November 2020

Abstract
Objective: To identify the predictors of prolonged mechanical ventilation (PMV) after cardiopulmonary bypass (CPB) in infants with congenital heart disease (CHD) less than 3 months. Methods: From June 2017 to May 2020, a total of 165 infants less than 3 months old with CHD admitted to the Children's Hospital of Nanjing Medical University for CPB were enrolled in this study. The following data were collected including gender, age, weight, Risk Adjustment in Congenital Heart Surgery-1 (RACHS-1) score, preoperative levels of thyroid hormones, CPB time, aortic cross-clamping (ACC) time, mechanical ventilation time, ICU mortality and infection. The PMV was defined as the ventilator assisted time > 72h. PMV prediction was assessed by multivariate binary logistic regression analysis. Results: Compared with non-PMV group, PMV group was younger (44.74 ± 25.27 days vs. 35.44 ± 26.91 days, P= 0.001), and most were newborns (41/93 vs. 10/57, P=0.000), with a higher proportion of RACHS-1 (29/93 vs.6/57, P=0.000) and more cases of infection (47/93 vs. 17/57,P= 0.004).PMV group had significantly lower weight than non-PMV group (3.79 ± 0.83Kg vs. 4.28 ± 1.01Kg, P=0.001). In PMV group, CPB (133.74 ± 89.65 vs. 72.30 ± 44.82, P =0.000) and ACC time (52.02 ± 24.80 vs. 36.98 ± 16.63, P =0.000) were both longer. FT4 and TT4 were higher while FT3, TT3 and TSH were lower in PMV group, but only FT3 (4.99 ± 1.67 vs. 5.29 ± 1.23, P =0.017) and TT3 (1.91 ± 0.59 vs. 1.96 ± 0.49, P =0.050) showed significant differences between PMV group and non-PMV group. Conclusion: Multiple logistic regression analysis showed that weight, infection, FT3 and CPB time were independent predictors of PMV after CPB in infants with CHD.
Infection control Knowledge, Practices, and Perceived barriers towards COVID-19 among physicians in university hospitals, Cairo, Egypt.
Authors: Hussein Rasha Saad , Abdel-Salam Shimaa A. , Mohamed Asmaa F. Gebrel 
Published: November 2020

Abstract
Background: WHO declared COVID-19 a global pandemic on 11th March 2020. Due to the lack of adequate treatment and approved vaccines, proper infection control practices are the only effective tools for prevention and control of COVID-19 infection among the health care facilities. Objectives: This study aimed to assess the infection control knowledge, practices, and perceived barriers towards COVID-19 among physicians working at Ain Shams University hospitals. Methods: Cross-sectional was carried out among a sample of physicians working at Ain Shams university hospitals, Cairo, Egypt, by using an online questionnaire. The design of the questionnaire was based mainly on the WHO guidance for infection prevention and control during health care when novel coronavirus infection is suspected and CDC guidance for COVID-19. Results: A total of 318 physicians with different job titles and specialties participated in this study, results showed average infection control knowledge (the mean correct answer rate was 57.1%+ 15.9%) and practices (infection control practices score was 78.76% + 12.17%) among our studied group. Patients overload and improper design of the working places were perceived as barriers to infection control practices by the majority (90%) of our participants. Conclusion: Our study results showed average infection control knowledge and practices towards COVID-19. There are defects in certain aspects related to infection control knowledge and practices that needed more practical training and properly designed working places to improve it.
Improved Tumor Discrimination and Shortened Administration-to-Imaging Times in Fluorescence Guided Surgery Through Paired-Agent Protocols
Authors: Wang Cheng , Folaron Margaret , Gunn Jason , Hodge Sassan , Chen Eunice , Hoopes P. Jack , Tichauer Kenneth , Samkoe Kimberley 
Published: November 2020

Abstract
Background: The goal of fluorescence guided surgery (FGS) in oncology is to improve the surgical therapeutic index by enhancing contrast between cancerous and healthy tissue. However, optimal discrimination between these tissues is complicated by the non-specific uptake and retention of molecular targeted agents and the heterogeneity of fluorescence signal. Paired-agent imaging (PAI) employs co-administration of an untargeted imaging agent with a molecular targeted agent, providing a normalization factor to minimize nonspecific and heterogeneous signals. The resulting measured binding potential is quantitative and equivalent to in vivo immunohistochemistry of the target protein. This study demonstrates that PAI improves the accuracy of tumor-to-healthy tissue discrimination compared to single agent imaging for in vivo FGS. Methods: PAI using a fluorescent anti-EGFR affibody molecule (ABY-029, eIND 122681) with untargeted IRDye 700DX carboxylate was compared to ABY-029 alone in an oral squamous cell carcinoma xenograft mouse model at 3 hours (n = 30). Results: PAI significantly enhanced tumor discrimination, as compared to ABY-029 alone (diagnostic accuracy - 0.94 vs 0.86, ROC curve AUC - 0.991 vs. 0.925, respectively). Additionally, the AUC of the ROC curve for PAI was stable as patient cohort number was increased from n = 1 to 20, while ABY-029 decreased as n increased, indicating a potential for universal FGS image thresholds to determine surgical margins. In addition, PAI reduced the administration-to-imaging time from 3 hours to 30 minutes and exhibited a statistically stronger correlation to EGFR expression heterogeneity (r = 0.58 compared to r = 0.47, p = 9B10-8). Conclusion: The quantitative receptor delineation of PAI promises to improve the surgical therapeutic index of cancer resection in a clinically relevant timeline.
Development of key quality indicators for appropriate antibiotic use in the Republic of Korea: results of a modified Delphi survey
Authors: Kim Bongyoung , Kim Myung Jin , Park Se Yoon , Moon Song Mi , Song Kyoung-Ho , Kim Tae Hyong , Kim Eu Suk , Kim Hong Bin 
Published: November 2020

Abstract
Background: An effective antibiotic stewardship program relies on the measurement of appropriate antibiotic use, on which there is a lack of consensus. We aimed to develop a set of key quality indicators (QIs) for nationwide point surveillance in the Republic of Korea.Methods: A systematic literature search of PubMed, EMBASE, and Cochrane Library (publications until 20th November 2019) was conducted. Potential key QIs were retrieved from the search and then evaluated by a multidisciplinary expert panel using a RAND-modified Delphi procedure comprising two online surveys and a face-to-face meeting. Results: The 23 potential key QIs identified from 21 studies were submitted to 25 multidisciplinary expert panels, and 17 key QIs were retained, with a high level of agreement (13 QIs for inpatients, 7 for outpatients, and 3 for surgical prophylaxis). After adding up the importance score and applicability, six key QIs [6 QIs (Q 1–6) for inpatients and 3 (Q 1, 2, and 5) for outpatients] were selected: (1) prescribe empirical antibiotic therapy according to guideline, (2) change empirical antibiotics to pathogen-directed therapy, (3) obtain culture samples from suspected infection sites, (4) obtain two blood cultures, (5) adapt antibiotic dosage to renal function, and (6) document antibiotic plan. In surgical prophylaxis, the QI to prescribe antibiotics according to the guideline and initiate antibiotic therapy 1 h before incision was selected.Conclusions: We identified key QIs to measure the appropriateness of antibiotic therapy for the identification of targets for improvement and to evaluate effects of antibiotic stewardship intervention.
MiR-21-3p promotes hepatocellular carcinoma progression through regulating Smad7/Yap1.
Authors: Hong Yinghui , Ye Mingliang , Wang Dan , Wang Chun , Luo Jie , Liu Jialiang , Liu Jing , Zhao Qiu , Chang Ying 
Published: November 2020

Abstract
Background Hepatocellular carcinoma (HCC) remains the global burden due to its high prevalence and mortality. Emerging evidence confirms that microRNAs (miRNAs) play a vital role in cancer initiation and progression. MiRNAs are widely involved in the regulation of signaling pathways by targeting downstream genes. MiR-21-3p as a liver-enriched miRNA has not been fully investigated. Abnormal activation of TGF-β transduction pathway promoted by deletion of Smad7 matters since HCC occurrence. While the relation between miR-21-3p and Smad7 has not yet been confirmed. We aimed to explore the influence of miR-21-3p on HCC initiation and progression by targeting Smad7 and further facilitating the expression of Yap1. Methods MicroRNA (miRNA) microarray analysis was performed for miRNA screening. Dual-luciferase assay was adopted for target verifying. The expressions of miRNA and related genes were quantified by qRT-PCR, western blotting, and immunohistochemical staining. Flow cytometry and transwell assay were used to discover cell apoptosis, invasion and metastasis abilities. Rat models were established to explore the axis's role in hepatocarcinogenesis. Bioinformatics analysis was performed for analyzing clinical significance. Results ­ MiR-21-3p was significantly increased in HCC, indicating a poor overall survival (OS) rate. High miR-21-3p was associated with advanced stages (P=0.029), especially T stages (P=0.026). Low Smad7/high Yap1 was verified in HCCs and rat models. Smad7 was proved to be the direct target of miR-21-3p. MiR-21-3p's effect on tumor malignant phenotypes and promotion of Yap1 could be partly reversed through transfecting Smad7. Overexpressed Yap1 promoted the downstream effector connective tissue growth factor (CTGF). Co-survival analysis indicated that lower miR-21-3p/higher Smad7 (P=0.0494) and lower miR-21-3p/lower Yap1 group (P=0.0379) patients had better OS rates. GSVA analysis of miR-21-3p and Smad7 related gene sets displayed strong relation with TGF-β signaling pathway in HCC. Conclusions MiR-21-3p promotes HCC migration and invasion via directly inhibiting Smad7 and further improving the expression of Yap1.
Obesity as a Predictor for Adverse Outcomes Among COVID-19 Patients: A Meta-Analysis
Authors: Das Pranta , Samad Nandeeta , Seidu Abdul-Aziz , Aboagye Richard Gyan , Tetteh Justice Kanor , Ahinkorah Bright Opoku 
Published: November 2020

Abstract
Background: The 2019 Severe Acute Respiratory Syndrome Coronavirus (COVID-19) is an unexpected pandemic causing mortalities across all ages. However, the severity of its health implications is mostly reported in persons with chronic health conditions with obesity being identified as one of the leading predisposing factors in acquiring the novel virus and developing its adverse complications. This meta-analysis sought to determine the estimated association between obesity and adverse outcomes among COVID-19 patients. Methods: We followed the recommended PRISMA guidelines in executing this study. A systematic literature search was conducted in PubMed, Google Scholar, and ScienceDirect for published literature between December 1, 2019, and October 2, 2020. The data for the study were pooled from studies that contained the search terms "Obesity" AND (COVID-19 or 2019-nCoV or Coronavirus or SARS-CoV-2) AND ("ICU admission" OR "Hospitalization" OR "Disease severity" OR "Invasive mechanical ventilator" OR "Death" OR "Mortality"). All the online searches were supplemented by reference screening of retrieved studies for additional literature. The pooled odds ratio (OR) and confidence intervals (CI) from the retrieved studies were calculated using the random effect model (Inverse-Variance method). Findings: A total of five (5) studies with a combined sample size of 335,192 patients were included in the meta-analysis. The pooled OR from the final analysis showed that patients who are severely obese were more likely to experience adverse outcome (death or ICU admission or needing IMV or hospitalization) compared to the normal patients [OR = 2.81, 95% CI = 2.33 – 3.40, I2 = 29%].Conclusion: Severe obesity is a risk factor in developing adverse outcomes among COVID-19 patients. The finding of the study signifies promotive, preventive, and curative attention to be accorded patients diagnosed with severe obesity and COVID-19.
Changing Paradigms in the Initial Treatment of Ectopic Pregnancy at a University Hospital in Brazil
Authors: Tavares Bárbara Virginia Gonçalves , Delfino Letícia Sathler , Ignarro Isabella Silvestre , Baccaro Luiz 
Published: November 2020

Abstract
Background: to evaluate the use of different treatment options for ectopic pregnancy and the frequency of severe complications in a university hospital. Methods: observational study with women with ectopic pregnancy admitted at UNICAMP Women´s Hospital, Brazil, between 01/01/2000 and 12/31/2017. The outcome variables were the type of treatment (first choice) and the presence of severe complications. Independent variables were clinical and sociodemographic data. Statistical analysis was carried out by the Cochran–Armitage test, chi-square test, Mann–Whitney test and multiple Cox regression. Results: 673 women were included in the study. The mean age was 29.0 years (±6.1) and the mean gestational age was 7.7 (±2.5). The frequency of surgical treatment decreased significantly over time (z=-4.69; p<0.001). Conversely, there was a significant increase in the frequency of clinical treatment (z=4.73; p<0.001). Seventy-one women (10.5%) developed some type of severe complication. In the final statistical model, the prevalence of severe complications was higher in women who were diagnosed with a ruptured ectopic pregnancy at admission (PR=2.97; 95%CI: 1.61–5.46), did not present with vaginal bleeding (PR=2.45; 95%CI: 1.41–4.25), had never undergone laparotomy/laparoscopy (PR=6.69; 95%CI: 1.62–27.53), had a non-tubal ectopic pregnancy (PR=4.61; 95%CI: 1.98–10.74), and do not smoke (PR=2.41; 95%CI: 1.08–5.36). Conclusion: there was a change in the first treatment option for cases of ectopic pregnancy in the hospital during the period of analysis. Factors inherent to a disease that is more difficult to treat are related to a higher frequency of severe complications.
A Novel MSC-Based Immune Induction Strategy in ABO-Incompatible Liver Transplantation: A Phase I/II Randomized, Open-Labeled, Controlled Trial
Authors: Zhang Yingcai , Zhang Jiebin , Yi Huimin , Zheng Jun , Cai Jianye , Chen Wenjie , Lu Tongyu , Chen Liang , Du Cong , Liu Jianrong , Yao Jia , Zhao Hui , Wang Guoying , Fu Binsheng , Zhang Tong , Zhang Jian , Wang Genshu , Li Hua , Xiang Andy Peng , Chen Guihua , Yi Shuhong , Zhang Qi , Yang Yang 
Published: November 2020

Abstract
Background: ABO-incompatible liver transplantation (ABO-i LT) has become a rescue therapeutic option for severe hepatic failure patients. Although the use of rituximab greatly reduces the morbidity of antibody-mediated rejection (AMR), severe adverse effects, such as infection and biliary complications still seriously threatening the survival of the transplant recipients. The aim of this study is to evaluate the safety and feasibility of using mesenchymal stem cells (MSCs) to replace rituximab in ABO-i LT. Methods: 22 severe hepatic failure patients undergoing ABO-i LT were enrolled and randomly divided into two groups, including the MSC group and Rituximab group. The safety of the application of MSCs and the incidence of allograft rejection, including antibody-mediated rejection (AMR) and acute cellular rejection (ACR) were evaluated in both groups at 2-year follow-up period as primary endpoints. Recipients and graft survivals and other postoperative complications were compared as secondary endpoints. Results: No severe adverse effects occurred in the MSC group related to the MSC infusion. MSCs treatment obtained comparable, if not better, results to rituximab for decreasing the incidence of acute rejection, especially AMR (9.1% vs 27.3%). Inspiringly, compared to the Rituximab group, biliary complications (0% vs 45.5%) and infection (9.1% vs 81.8%), were significantly decreased in MSCs group. In addition, there were no significant difference in 2-year graft and recipient survivals in the two groups (81.8% vs 72.7%). Conclusions: Our data shows that MSCs transfusion is comparable to rituximab treatment for AMR prophylaxis following ABO-i LT. Additionally, the results indicate that MSC is more beneficial to the prevention of infection and biliary complications, which may be introduced as a novel immunosuppressive approach for ABO-i LT. Trial registration: Trial registration: chictr.org.cn, ChiCTR2000037732. Registered 31 August 2020- Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=57074.
Monocyte Distribution Widths for Early Sepsis Detection in Emergency Department and Comparison with C-reactive Protein and Procalcitonin
Authors: woo Ala , Oh Dong-Kyu , Park Chan Jung , Hong Sang-Bum 
Published: November 2020

Abstract
Background: Monocyte undergo morphological changes in response to infection. Monocyte distribution width (MDW) reflects the morphological changes and increase in septic conditions. Currently, it has been suggested that MDW can act as an early biomarker of sepsis, but there are few reports on the comparison with conventional biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT).Methods: Patients who visited the emergency department (ED) were screened and enrolled prospectively. Tests for complete blood count, MDW, CRP, and PCT were done. Diagnostic performance for sepsis was tested in terms of area under the curve (AUC) of receiver operating characteristic (ROC) curves, sensitivity, and specificity.Results: In total, 665 patients were screened, and 549 patients with validated laboratory test results were included for the analysis. The patients were categorized into three groups according to Sepsis-3 criteria: non-infection, infection, and sepsis. MDW was the highest in the sepsis group (median [Q1-Q3] 24.0 [20.8-27.8]). AUC [95%CI] for MDW, CRP, PCT, and white blood cells for sepsis were 0.71[0.67-0.75], 0.75[0.71-0.78], 0.76[0.72-0.79], and 0.61[0.57-0.65], respectively. With the optimal cut-off value from the cohort, the sensitivity was 85.6% with MDW (cut-off 19.8), 69.7% with CRP (4.0), and 76.6% with PCT (0.05). Combination of quick sequential organ failure score (qSOFA) with MDW and WBC improved the AUC (0.78[CI 0.74-0.82]) to a greater extent compared to qSOFA alone (0.67[CI 0.62-0.72]).Conclusions: MDW reflected comparable diagnostic performance with conventional diagnostic markers, implying that MDW could be an alternative biomarker and that the combination with qSOFA improves the diagnostic performance for early sepsis.
Clearance of&nbsp;Inflammatory Cytokines in Patients with Septic Acute Kidney Injury During Renal Replacement Therapy Using the EMiC2 Filter (Clic-AKI Study)
Authors: Lumlertgul Nuttha , Hall Anna , Camporota Luigi , Crichton Siobhan , Ostermann Marlies 
Published: November 2020

Abstract
BackgroundThe Ultraflux EMiC2 membrane is a high cutoff hemofilter (45 kiloDalton). Little is known regarding its efficacy in eliminating medium-sized cytokines in sepsis. This study aimed to explore the effects of continuous veno-venous hemodialysis (CVVHD) using the EMiC2 filter on cytokine clearance.MethodsThis was a prospective observational study conducted in critically ill patients with sepsis and acute kidney injury requiring kidney replacement therapy. We measured concentrations of 12 cytokines [Interleukin (IL) IL-1β, IL-1α, IL-2, IL-4, IL-6, IL-8, IL-10, interferon (IFN)-ƴ, tumor necrosis factor (TNF)-α, vascular endothelial growth factor (VEGF), monocyte chemoattractant protein (MCP)-1, epidermal growth factor (EGF)] in plasma at baseline (T0) and pre- and post-dialyzer at 1, 6, 24, and 48 hours after CVVHD initiation and in the effluent fluid at corresponding time points. Outcomes were the effluent and adsorptive clearance rates, sieving coefficients (SCs), mass balances, and changes in serial serum concentrations.ResultsTwelve patients were included in the final analysis. All cytokines except EGF concentrations declined over 48 hours (p<0.001). Apart from IL-4, IL-8 and MCP-1, the SCs of the cytokines were <0.6. The effluent clearance rates were variable and ranged from negligible values for IL-2, IFN-ƴ, IL-1α, IL-1β, and EGF, to 19.0 ml/min for TNF-α. Negative or minimal adsorption was observed. The effluent and adsorptive clearance rates remained steady over time. The percentage of cytokine removal was low for most cytokines throughout the 48-hour period. ConclusionEMiC2-CVVHD achieved modest removal of most cytokines by diffusion and demonstrated small to no adsorptive capacity despite a decline in plasma cytokine concentrations. This suggests that changes in plasma cytokine concentrations may not be solely influenced by extracorporeal removal.Trial registrationNCT03231748, registered on 27th July 2017