bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of DRGs-based inpatient service management on the performance of regional inpatient services in Shanghai, China: an interrupted time series study, 2013-2019
Authors: feng lvfan , Tian Yuan , He Mei , Tang Jie , Peng Ying , Dong Chenjie , Xu Wenzhong , Wang Tao , He Jiangjiang 
Published: October 2020

Abstract
Background: The asymmetry of information brings difficulty for government to manage public hospitals. Therefore, Jiading District of Shanghai has been establishing DRGs-based inpatient service management system (ISMS) to effectively compare the output of different hospitals through DRGs, reward desired hospital performance and enhance inpatient service capacity. However, the impact of the implementation of DRGs-based inpatient service management (ISM) policy in Jiading district is still unknow. We therefore conducted this study to evaluate the impact of DRGs-based ISM policy on the performance of inpatient service since its implementation in Jiading District, Shanghai, China in 2017.Methods: Using an interrupted time series design, we analyzed quarterly data of seven DRGs-based performance measures from the ISMS which covered all five public hospitals in Jiading District from 2013 to 2019. We utilized the segmented linear regression model to assess the change of level and trend of performance indicators before and after ISM policy. Dickey–Fuller test was used to examine the stationary of the data. Durbin-Watson test was performed to check the series autocorrelation of indicators.Results: Significant changes in the following indicators were observed since the implementation of ISM policy. The case-mix index (CMI) level decreased by 0.103 (P < 0.05), the trend increased by 0.008 (P < 0.05). The total weight level decreased by 3719.05 (P < 0.05), and the trend increased by 250.13 (P < 0.05). The time efficiency index (TEI) level increased by 0.12 (P < 0.05), and the trend decreased by 0.01 (P < 0.05). The cost efficiency index (CEI) level increased by 0.31 (P < 0.05), and the trend decreased by 0.02 (P < 0.05). No significant difference was found in the change of DRGs number, inpatient mortality of low-risk group cases (IMLRG) and inpatient mortality of medium-to-low risk group cases (IMMLRG).Conclusions: Findings highlight the role of ISM policy in improving the capacity and efficiency of regional inpatient service. Three prerequisites, including a good information system, high-quality EMR data, and a management team, are needed for other countries to implement their own ISM policy to help government manage public hospitals and improve the performance of regional inpatient service.
The Genome of Medicinal Leech (Whitmania pigra) and comparative genomic study for Exploration of Bioactive Ingredients
Authors: Tong Lei , Dai Shao-Xing , Kong De-Jun , Yang Peng-Peng , Tong Xin , Tong Xiang-Rong , Bi Xiao-Xu , Su Yuan , Zhao Yu-Qi , Liu Zi-Chao 
Published: October 2020

Abstract
BackgroundLeeches are classic annelids that have a huge diversity and closely related to people, especially medicinal leeches. Medicinal leeches have been widely utilized in medicine based on the pharmacological activities of their bioactive ingredients. Comparative genomic study of these leeches enables us to understand the difference among medicinal leeches and other leeches and facilitates the discovery of bioactive ingredients.ResultsIn this study, we reported the genome of Whitmania pigra and compared it with Hirudo medicinalis and Helobdella robusta. The assembled genome size of W. pigra is 177 Mbp, close to the estimated genome. Approximately about 23% of the genome was repetitive. A total of 26,743 protein-coding genes were subsequently predicted. W. pigra have 12346 (46%) and 10295 (38%) orthologous genes with H. medicinalis and H. robusta, respectively. About 20% and 24% genes in W. pigra showed syntenic arrangement with H. medicinalis and H. robusta, respectively, revealed by gene synteny analysis. Furthermore, W. pigra, H. medicinalis and H. robusta expanded different gene families enriched in different biological processes. By inspecting genome distribution and gene structure of hirudin, we identified a new hirudin gene g17108 (hirudin_2) with different cysteine pattern. Finally, we systematically explored and compared the active substances in the genomes of three leeches. The results showed that W. pigra and H. medicinalis exceed H. robusta in both kinds and gene number of active molecules.ConclusionsThis study reported the genome of W. pigra and compared it with other two leeches, which provides an important genome resource and new insight into the exploration and development of bioactive molecules of medicinal leeches.
Candidate Genes and Stable QTL for Grain Yield and Seed Size in Durum Wheat
Authors: Mangini Giacomo , Blanco Antonio , Nigro Domenica , Signorile Massimo Antonio , Simeone Rosanna 
Published: October 2020

Abstract
Background: In wheat grain yield is expressed as the product of different components. Among these, thousand kernels weight (TKW) reflects the combination of several grain related traits including grain length (GL), grain width (GW) and area. Grain weight is also affected by phenological traits, such as heading time (HT) and plant height (PH). To detect stable QTL and candidate genes involved in phenotypic control of grain yield, a recombinant inbred line (RIL) population derived from two elite durum wheat cultivars (Liberdur and Anco Marzio) was evaluated for yield components and grain related traits for three growing seasons in southern Italy. The mapping population was genotyped with a 90K SNP array and a high-density genetic linkage map with 5134 markers was obtained.Results: A total of 30 QTL were detected on the durum RIL population including 9 stable QTL for TKW (2 QTL), GL, GW (2 QTL), AREA, HT and PH (2 QTL) distributed on 1B, 2A, 3A and 6B chromosomes. Interestingly, a QTL cluster mapped on 2A included a major QTL for HT explaining at least 70% of phenotypic variance and co-located with a QTL for YLD, TKW, GL and GW and AREA, respectively. In the physical position of this QTL cluster a photoperiod sensitivity gene (Ppd-A1) was found. Serine carboxypeptidase, Big Grain 1 and β-fructofuranosidase candidate genes were mapped in clusters containing stable QTL. Candidate genes involved in auxin metabolism were also found in QTL clusters in which a QTL for AREA was declared.Conclusions: This study showed that yield components and phenological traits had higher inheritances than grain yield, allowing an accurate stable QTL cluster detection. This was a powerful requisite to physically map QTL on the reference durum wheat genome and to identify candidate genes strongly affecting the genetic grain yield network.
27-Gauge trocar-assisted sutureless intraocular lens fixation.
Authors: Jujo Tatsuya , Kogo Jiro , Sasaki Hiroki , Sekine Reio , Sato Keiji , Ebisutani Sakura , Toyoda Yasuhiro , Kitaoka Yasushi , Takagi Hitoshi 
Published: October 2020

Abstract
Backgrounds: However there have been numerous investigations of intrascleral intraocular lens (IOL) fixation techniques, there is room for improvement in terms of simplifying complicated techniques and reducing the high levels of skill required. This study aimed to report a novel technique for sutureless intrascleral fixation of the IOL using retinal forceps with a 27-gauge trocar. Methods: Nineteen eyes of 18 patients underwent intrascleral fixation of the IOL from July 2018 to September 2019 were enrolled in this study. A 27-gauge trocar formed 3-mm scleral tunnels positioned at 4 and 10 o’clock, 2 mm from the corneal limbus. We used a 3-piece IOL haptic grasped by a 27-gauge retinal forceps and pulled from the 27-gauge trocar. The IOL was fixed by making a flange. Main outcome measures were visual acuity, corneal endothelial cell density, IOL tilt, decentration, predicted error of refraction and complications. Results: The 19 eyes were followed up for 1 month. The mean pre- and postoperative logMAR uncorrected visual acuity (UCVA) was 1.06 ± 0.63 and 0.40 ± 0.26, respectively (p<0.01), while the mean pre- and postoperative logMAR best corrected visual acuity (BCVA) was 0.27 ± 0.51 and 0.06 ± 0.15, respectively (p=0.09). The mean corneal endothelial cell density was 2406 ± 625 to 2004 ± 759 cells/mm 2 at 1 month (p=0.13). The mean IOL tilt was 3.52 ± 3.00°, and the mean IOL decentration was 0.39 ± 0.39 mm. There was no correlation among IOL tilt, decentration and BCVA (p>0.05). The mean prediction error of the target refraction was –0.03 ± 0.93 D. The complications were vitreous hemorrhage (3 eyes), hyphema (1 eye), IOP elevation (1 eye), iris capture of the IOL (1 eye) and hypotony (2 eyes). No IOL dislocation occurred.Conclusions: IOL intrascleral fixation with a flange achieved good IOL fixation and visual outcome in the scleral tunnels created with the 27-gauge trocar.
Illicit Drug Use by Adolescents: A Public Perception of Influencing Factors in Owerri, Nigeria
Authors: Ogu Udochukwu Ugochukwu , Ezumah Nkoli , Odii Aloysius 
Published: October 2020

Abstract
Background: Illicit drug use among adolescents has become a public health concern which cuts across all social strata. This study explored the public perception of factors that influence illicit drug use among adolescents in Owerri, Nigeria.Methods: A descriptive cross-sectional research design was used for the study. The study adopted a mixed-method approach comprising quantitative and qualitative methods and was carried out in Owerri metropolis of Imo State, Nigeria. The research instruments used for data collection were questionnaires and in-depth interview guide. The target population comprised adults 18 years and above residing in the area of interest at the time of the study. For the qualitative method, a total of 10 communities were selected randomly by balloting and availability sampling was employed in the selection of respondents. Respondents for the qualitative method were purposively selected.Results: Our quantitative study found that 50.7% of the respondents, from across the three areas in Owerri metropolis, asserted that peer influence, emotional problems, relationship problems, wanting to feel ‘high’ are factors influencing adolescent consumption of illicit drugs whereas the qualitative study found family background, unique experience such as the death of a loved one, affliction or misfortune as factors influencing adolescents’ illicit drug use. The quantitative results showed that persons with a higher level of education are more likely than those with a lower level of education to perceive a significant difference in drug use between in – school and out – of – school adolescents.Conclusions: Peer influence, emotional problems, relationship problems, the influence of media (especially the social media), among several other identified reasons are perceived by the public as factors that influence adolescents’ use of illicit drugs. As a means to curb some of these factors, the communities, schools and universities should formulate contextual policies policies to prevent drug use and should also hold seminars for parents and families to alert them early to the symptoms of drug use in their children.
Bioequivalence of levamlodipine besylate tablets in healthy Chinese subjects: A single-dose and two-period crossover randomized study
Authors: Xin Li , Wang Chenjing , Li Ting , Liu Yanping , Liu Shuqin , Tao Ye , Ma Yaping , Gao Xiaomeng , Cao Yu 
Published: October 2020

Abstract
Background: Levamlodipine, a calcium channel blocker, has been show act as a cardiovascular drug. To compare the pharmacokinetic parameters between levamlodipine (test formulation) at a single dose of 5 mg and amlodipine (reference formulation) at a single dose of 10 mg, the bioequivalence study was carried out.Methods: A single-dose randomized, open-label, two-period crossover study was designed in healthy Chinese subjects. 48 subjects were divided into fasted and fed groups equally. The subjects randomly received the test or reference formulations at the rate of 1:1. Following a 21-day washout period, the alternative formulations were received. The blood samples were collected at 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 14, 24, 36, 48, 72, 96, 120, 144, 168 hours later. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was applied to determine the plasma concentrations of levamlodipine. Adverse events were recorded.Results: The 90% confidence intervals (CIs) of the ratio of geometric means (GMRs) of Cmax, AUC0-t, and AUC0-∞ under both fasted and fed conditions were within the prespecified bioequivalence limits between 80~125%. Under fasted conditions, 24 subjects were enrolled and completed the study. The mean Cmax was (2.70±0.49) ng/mL, AUC0-t was (141.32±36.24) ng×h/mL and AUC0-∞ was (157.14±45.65) ng×h/mL after a single dose of 5 mg levamlodipine. The mean Cmax was (2.83±0.52) ng/mL, AUC0-t was (153.62±33.96) ng×h/mL and AUC0-∞ was (173.05±41.78) ng×h/mL after a single dose of 10 mg amlodipine. Under fed conditions, 24 subjects were enrolled and completed the study. The mean Cmax was (2.73±0.55) ng/mL, AUC0-t was (166.93±49.96) ng×h/mL and AUC0-∞ was (190.99±70.89) ng×h/mL after a single dose of 5 mg levamlodipine. The mean Cmax was (2.87±0.81) ng/mL AUC0-t was (165.46±43.58) ng×h/mL and AUC0-∞ was (189.51±64.70) ng×h/mL after a single dose of 10 mg amlodipine. Serious adverse event was not observed.Conclusion: The trial confirmed that levamlodipine at a single dose of 5 mg and amlodipine at a single dose of 10 mg were bioequivalent under both fasted condition and fed condition.Trial registration: Cinicaltrials, NCT04411875. Registered 3 June 2020 - Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009W1Q&selectaction=Edit&uid=U00050YQ&ts=3&cx=-6iqkm8
Utility of oxygen insufflation through working channel during fiberoptic intubation in apneic patients: a prospective randomized controlled study
Authors: Roh Go Un , Kang Joon Gwon , Han Jung Youn , Chang Chul Ho 
Published: October 2020

Abstract
Background: Airway management is a part of routine anesthetic procedures; however, serious complications, including hypoxia and death, are known to occur in cases of difficult airways. Therefore, alternative techniques such as fiberoptic bronchoscope-assisted intubation (FOBI) should be considered, although this method requires more time and offers a limited visual field than does intubation with a direct laryngoscope. Oxygen insufflation through the working channel during FOBI could minimize the risk of desaturation and improve the visual field. Therefore, the aim of this prospective randomized controlled study was to evaluate the utility and safety of oxygen insufflation through the working channel during FOBI in apneic patients. Methods: Thirty-six patients were randomly allocated to an N group (no oxygen insufflation) or an O group (oxygen insufflation). After preoxygenation, FOBI was performed with (O group) or without (N group) oxygen insufflation in apneic patients. The primary outcome was the velocity of decrease in the partial pressure of oxygen (PaO2) during FOBI (VPaO2, mmHg/sec) defined as the difference of PaO2 before and after intubation divided by the time to intubation. The secondary outcomes included the success rate for FOBI, time to intubation, visual field during FOBI, findings of arterial blood gas analysis, and occurrence of FOBI-related complications. Results: We found that VPaO2 was significantly greater in the N group than in the O group (1.01 ± 0.39 vs. 0.42 ± 0.42; p < 0.001), while the visual field was similar between groups. There were no significant intergroup differences in the secondary outcomes. Conclusions: These findings suggest that oxygen insufflation through the working channel during FOBI aids in extending the apneic window during the procedure.Trial registration: ClinicalTrials.gov, NCT02625194, registered at December 9, 2015
Multiparametric MRI and 18F-DCFPyL PET/CT for detection of locally recurrent prostate cancer after low dose rate brachytherapy
Authors: Walker Stephanie M. , Fernandez Martina , Roy Soumyajit , Mena Esther , Sackett Jonathan , Mease Ronnie , Merino Maria , Pomper Martin , Salerno Kilian , Schott Erica , Wood Bradford , Pinto Peter , Lindenberg Liza , Choyke Peter , Citrin Deborah , Turkbey Baris 
Published: October 2020

Abstract
Background and purpose: Both multiparametric magnetic resonance imaging (mpMRI) and prostate specific membrane antigen (PSMA)-targeting positron emission tomography (PET) imaging have shown promise in early localization of prostate cancer (PCa) recurrence after primary external beam radiotherapy. Detecting recurrence after brachytherapy for PCa using MRI is significantly hampered by susceptibility artifacts secondary to brachy seeds. Here, we compare the efficacy of 18F-DCFPyL (2-(3-{1-carboxy-5-[(6-18F-fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid) PET/CT versus mpMRI for detecting sites of local recurrence after low dose rate (LDR) brachytherapy for prostate cancer.Materials and methods: A total of 155 patients with a history of recurrent PCa who underwent mpMRI at 3 Tesla and 18F-DCFPyL PET/CT were retrospectively reviewed. Patients who underwent LDR brachytherapy for PCa and had subsequent biochemical recurrence (BCR) followed by mpMRI and 18F-DCFPyL PET/CT were included in this study. mpMRI was performed on a 3T scanner with endorectal and surface coils and images were prospectively read by a single expert radiologist. The 18F-DCFPyL PET/CT scan was prospectively interpreted by one of two nuclear medicine physicians. Patients underwent targeted biopsy when deemed clinically necessary and specimens were interpreted by an expert GU pathologist. Positivity rates (PR) from mpMRI and 18F-DCFPyL PET/CT were compared, and pathology results were used to calculate the positive predictive value (PPV) of each imaging modality for detecting PCa recurrence.Results: 15 patients who underwent LDR brachytherapy and had subsequent biochemical failure were imaged with mpMRI and 18F-DCFPyL PET/CT. 18 non-lymph node lesions were identified on at least one imaging modality. The PR for detection of intraprostatic lesions was 60% (9/15) for both PET/CT and mpMRI, with 3 prostate lesions detected by only one modality. 18F-DCFPyL PET/CT identified pelvic and extra-pelvic lymph nodes in 8 (53%) patients, while mpMRI noted positive lymph node findings in only 2 (13%) patients. A total of 15 lesions corresponding to 9 patients were targeted for biopsy. The PPV of 18F-DCFPyL PET/CT and mpMRI for the detection of local recurrence were 84.6% and 71.4%, respectively. For the detection of intraprostatic lesions, 18F-DCFPyL PET/CT and mpMRI had a PPV of 87.5% and 71.4%, respectively. Conclusion: This case series analysis suggests that 18F-DCFPyL PET/CT may detect local and regional recurrent PCa after LDR brachytherapy at a higher rate than mpMRI and that it has the potential to detect suspicious pelvic lymph nodes at a much higher rate. Further studies are needed to validate these findings in larger cohorts.
Risk Factors and Incidence of Suction Loss during Small Incision Lenticule Extraction (SMILE) in 8493 eyes
Authors: Huang Tian-Ze , Shen Ling , Yu Xiao-Ning , Jin Hong-Ying 
Published: October 2020

Abstract
Background: To report the incidence and risk factors of suction loss during small incision lenticule extraction (SMILE). Methods: This retrospective comparative case control study included 8493 eyes of 4261 patients. Patients underwent SMILE surgery between January 2014 and September 2019 were included. Videos of suction loss were reviewed, and the direct causes of suction loss were noted. An independent samples t-test was used for comparisons between the suction loss group and the control group. A binary logistic regression model was used to determine the possible significant risk factors that might increase the likelihood of suction loss during SMILE surgery. Results: Suction loss occurred in 31 (0.37%) eyes of 30 patients; 23 (74.2%) cases occurred in the right eye (the first operative eye) and 8 (25.8%) cases occurred in the left eye. Among the 30 patients, 23 (76.7%) were male and 7 (23.3%) were female. The incidence in the six consecutive years were 0%, 2.13%, 0.34%, 0.24%, 0.22%, and 0.25%. Head and eye movements during surgery caused suction loss in 16 (51.6%) and 15 (48.4%) eyes, respectively. Comparison between the suction loss group and the control group showed that the first operative eye and male sex are at a significantly high risk for suction loss (p < 0.05). Conclusions: The risk factors of suction loss were first operative eye and male sex. Head and eye movements due to patient anxiety are the most common direct causes of suction loss. Surgeon’s experience may help to reduce the incidence of suction loss. Preoperative education and better communication during surgery needs to be emphasized.
Influence of measurement differences of anterior chamber depth and axial length on lens thickness evaluation in cataract patients: a comparison of two tests
Authors: Xu Jiayi , Li Chen , Wang Lijun , Li Caixin , Li Xin , Lu Peirong 
Published: October 2020

Abstract
Background: The purpose of this study was to investigate the agreement of lens thickness (LT) measurements made by contact A-scan ultrasonography and Lenstar LS900 as well as the influence of anterior chamber depth (ACD) and axial length (AL) measurement differences on LT measurement in cataract patients in the two techniques.Methods: 1247 cataract patients (1247 eyes) participated in this retrospective cross-sectional study. Ocular biometric measurements were performed with Lenstar LS900 and A-scan ultrasonography respectively, and the measured results of AL, ACD and LT were compared using Pearson correlation coefficients (r) and Bland-Altman analyses.Results: Bland-Altman analyses showed poor agreement between the A-scan ultrasonography and Lenstar LS900 in measuring AL and ACD. The average difference of LT was 0.01 mm; the consistency limit was -0.86 mm, 0.88 mm; and 95.27% of datapoints were within the 95% consistency limit. The consistency of LT measurements between the two techniques was poor for those subjects whose ACD or AL values were beyond the 95% consistency limit. Among the subjects whose AL or ACD values measured by A-scan ultrasonography were greater than those measured by Lenstar LS900, 93.33% of them were within the 95% consistency limit, suggesting that the consistency of LT measurement between the two techniques was poor. Of patients whose ACD or AL measured by A-scan ultrasonography were smaller than that of Lenstar LS900, 96.01% of them were within the 95% consistency limit.Conclusions: There was good agreement of the LT measurements between A-scan ultrasonography and Lenstar LS900, except for the axis deviating from the apparent axis during A-scan ultrasonography. If this error can be avoided, A-scan ultrasonography can replace Lenstar LS900 in LT measurement in cataract patients.