bluuebunny/crossref_metadata_2025_split huggingface dataset:
Timing for Closed Reduction Procedure for Developmental Dysplasia of the Hip and its Failure Analysis
Authors: Zhang Zhiqiang , Li Hao , Li Hai , Zhang Ziming 
Published: September 2020

Abstract
Background It remains controversial whether the older age to perform closed reduction (CR) procedure for developmental dysplasia of the hip (DDH), the higher incidence of complications. The aim of this study is to evaluate the midterm outcome of CR for DDH among difference age groups, and to analyze and identify risk factors for the failure of this procedure. Methods Clinical data of 107 DDH patients, who received CR, were retrospectively reviewed. Data were divided into three groups according to initial treatment age (Group I: younger than 12 months; Group II: 12 months to less or equal to18 months; Group III: older than 18 months). The presence of avascular necrosis (AVN), residual acetabular dysplasia (RAD), re-dislocation, and further surgeries (FS) were observed. The risk factors were identified for those outcomes aforementioned using univariable logistic regression models. For identified risk factor age, pre-op acetabular index (AI) and post-op AI, their prediction of CR failure were evaluated by receiver operating characteristics curve (ROC).Results A total of 107 patients (156 hips) undergoing CR procedure were evaluated with a median age at initial reduction of 13.0±5.4 months (range, 4 to 28 mo). Mean follow-up time in this study was 6.7±0.8 years (range, 3-8 years). The incidence of AVN, RAD and re-dislocation was 15.4% (24/156), 17.3% (27/156) and 14.7% (23/156) respectively. For AVN, RAD and re-dislocation, the significant risk factors are pre-op IHDI IV (p=0.033), age≥18 months (p=0.012), and pre-op IHDI IV (p=0.004) and walking (p=0.011), respectively. The areas under the ROC curve of each type of failures were 0.841 (post-op AI), 0.688 (pre-op AI) and 0.650 (age).Conclusions Severe DDH patients older than 18 months with CR procedure may result in a high risk of RAD complication. Re-dislocation is significantly associated with pre-op IHDI IV and walking. Patients, who are older than 12.5 months or have a pre-op AI of 38.7° or a post-op AI of 26.4°, are also more likely to fail of CR procedure.
High NEMO score values in nailfold videocapillaroscopy are associated with the subsequent development of ischemic digital ulcers in patients with systemic sclerosis.
Authors: Papa Nicoletta Del , Pignataro Francesca , Maglione Wanda , Minniti Antonina , Sambataro Domenico , Sambataro Gianluca , Valentini Gabriele , Caporali Roberto , Vitali Claudio 
Published: September 2020

Abstract
Background Nailfold videocapillaroscopy (NVC) is a feasible method that allows the observation of the microvascular changes that mark the course of systemic sclerosis (SSc). In previous studies we demonstrated that the NEMO score, i.e., the cumulative number of microhaemorrhages and microthromboses, is a good indicator of the steady state level and overtime changes of disease activity (DA) in SSc.Objectives To verify whether high NEMO scores, which mirror a very active microvascular derangement in the fingers, may be associated with the subsequent development of ischemic digital ulcers (IDUs).Methods The NEMO score was assessed at baseline (T0) in 98 patients with SSc, all classified according to the ACR-EULAR criteria. Of them, 90 were females, 48 had the limited and 50 the diffuse cutaneous variant of SSc. Afterwards, the patients were closely followed up for two years, and the appearance of new IDUs recorded at any time of the follow up.The T0-NEMO score values of patients who developed IDUs were compared to those of patients who did not. A receiver operating curve (ROC) was constructed, and the area under the curve (AUC) calculated by plotting the sensitivity and 1-specificity of the different NEMO score values in predicting the subsequent development of IDUs.Results During the follow-up 38 out of 98 patients developed one or more IDUs. The NEMO score at T0 was significantly higher in those who developed IDUs with respect to those who did not [median 14.5 (95%CI 11.0-21.5), and 4.5 (95%CI 4.0-6.0), respectively, p<.0001]. The ROC curve derived from different T0-NEMO score values had an AUC of 0.79 (95%CI 0.69-0.86, p<0.0001)]. A NEMO score of ≥12 had a sensitivity of 83.3% (95%CI 71.5-91.7), and a specificity of 63.2% (95%CI 46.0-78.2), with positive (P) and negative (N) predictive (PV) values of 58.9% (95%CI 44.7-72.2), and 85.6% (71.8-94.4), respectively. A NEMO score of ≥16 had a sensitivity of 95.0% (95%CI 86.1-99.0), and a NPV of 93.4% (77.5-99.2).Conclusions Being a valid tool to measure DA levels in SSc, the NEMO score also appears to be closely related to the subsequent development of IDUs in this disease.
Analysis of clinicopathological and molecular features of crawling-type gastric adenocarcinoma
Authors: Fujita Yasuko , Uesugi Noriyuki , Sugimoto Ryo , Eizuka Makoto , Toya Yosuke , Akasaka Risaburou , Matsumoto Takayuki , Sugai Tamotsu 
Published: September 2020

Abstract
Background: Crawling-type adenocarcinoma (CRA) is an important gastric cancer (GC) subtype that exhibits a specific histological pattern and has characteristic clinicopathological findings. Despite its characteristic histology, little is known about the molecular characteristics of CRA. Methods: We examined 254 GC cases, including 51 cases of CRA and 126 cases having conventional differentiated adenocarcinomas (CDAs). Results for immunohistochemistry (mucin phenotype; Muc5AC, Muc6, Muc2 and CD10, CDX-2, MLH-1, p53 and β-catenin), mutation analysis (TP53, KRAS and BRAF), microsatellite instability (BAT25, BAT26, D2S123, D5S346 and D17S250), DNA methylation status by a two-panel method (RUNX3, MINT31, LOX, NEUROG1, ELMO1 and THBD), MLH-1 promoter methylation, and allelic imbalance (AI; 1p, 3p, 4p, 5q, 8p, 9p, 13q, TP53, 18q and 22q) were examined. Results: CRAs were more likely to occur in the middle third of the stomach, in younger patients and to be macroscopically depressed. Nuclear accumulation of β-catenin and loss of MLH-1 expression were less frequent among CRA cases compared to CDA cases. At a molecular level, CRA is often characterized by the deletion mutation c.529_546 (18-base pair deletion at codon 177-182 in exon 5) in the TP53 gene (10 cases). Although the low methylation epigenotype was significantly more frequent for CRAs compared to CDAs, multiple AIs were more often seen in CRAs relative to CDAs. Conclusions: The results demonstrated that TP53 mutations, particularly c.529_546del, and multiple AIs are closely associated with CRA carcinogenesis. Our results suggest that CRA is an independent entity of GC in terms of clinicopathologic and molecular findings.
Monocyte Platelet Aggregates in Children with Kawasaki Disease- a Preliminary Study from a Tertiary Care Centre in North-West India
Authors: Vignesh Pandiarajan , Rawat Amit , Shandilya Jitendra Kumar , Sachdeva Man Updesh Singh , Ahluwalia Jasmina , Singh Surjit 
Published: September 2020

Abstract
Background: Platelet activation is an integral part of pathogenesis of Kawasaki disease (KD). However, there is paucity of literature on flow-cytometry based assessment of platelet activation in KD. We aimed to analyse monocyte-platelet aggregates (MPAs), one of the sensitive markers for platelet activation, by flow cytometry in children with KD.Findings: In this single-centre prospective study, we have enrolled 14 children with KD and results were compared with age-matched febrile (n=15) and healthy (n=13) controls. After gating monocytes in side-scatter plot, MPAs were identified based on CD14 and CD41 expression. Two (2) ml of blood samples for children with KD were collected at 3 phases of illness- acute stage before start of intravenous immunoglobulin or aspirin, 24 hours after completion of IVIg infusion, and 3 months after acute episode of KD. Children with KD had a significantly higher MPA% values [Median (IQR)- 41.3% (26.6, 52.7)] when compared with febrile [Median (IQR)- 5.98% (2.98-9.72)] and normal [Median (IQR)- 4.48% (2.57-5.59)] controls, p<0.01. On follow-up, the MPA% showed a gradual decline in children with KD, but even at 3 months, the value [Median (IQR)- 7.55% (4.15-14.6)] was higher compared to healthy controls [Median (IQR)- 4.48% (2.57-5.59)].Conclusions: Our results suggest that MPA% was significantly elevated in acute stages in children with KD and activated platelets may continue to persist even after systemic inflammation has subsided. Future studies are warranted whether objective evidence of platelet activation may guide the use of immunomodulatory and anti-platelet therapy in KD.
Role of Liver Enzymes in Patients with Blunt Abdominal Trauma to Diagnose Liver Injury
Authors: Shrestha Anup , Neupane Harish Chandra , Tamrakar Kishor Kumar , Bhattarai Abhishek , Katwal Gaurav 
Published: September 2020

Abstract
Background: The liver is the second most injured organ following blunt abdominal trauma (BAT) after spleen. Although the computed tomography (CT) scan is considered as the gold standard for diagnosing liver injury in BAT, it is not readily available in every hospital. This study was performed to evaluate the role of aspartate transaminase (AST) and alanine transaminase (ALT) in patients with BAT and its significance in predicting the diagnosis and severity of the liver injury. Method: The study was conducted in Chitwan Medical College Teaching Hospital (CMCTH) from February 2019 to May 2020. During that period 96 patients with BAT presented to the emergency department(ED) of CMCTH. Results: Among the 96 patients admitted with BAT, 38 patients had liver injury and 58 patients had no liver injury. The median length of the intensive care unit (ICU) stay of patients with liver injury was higher than without liver injury. There was a significant difference in the median level of AST and ALT (<0.001) between patients with liver injury and no liver injury. The median of AST and ALT of patients requiring blood transfusion was more than that of the patient not requiring blood transfusion(p<0.05). The area under the ROC curve of AST was 0.89(95% Confidence Interval 0.86-0.98) and of ALT was 0.92(95% Confidence Interval 0.83-0.97). The area under the curve demonstrated that the test was a good predictor for the identification of liver injury and also the severity of liver enzymes. The cut-off values for the liver injury were 106 U/l and 80 U/l for AST and ALT respectively. Based on these values, AST ≥ 106 U/l had a sensitivity of 71.7 %, a specificity of 90 %, a positive predictive value of 86.8 %, and a negative predictive value of 77.6 %. The corresponding values for ALT ≥ 80 U/l were 77.8 %, 94.1%, 92.1% and 82.8 %, respectively. Conclusion: In conclusion, we report the optimal cut-off value of AST and ALT for liver injury in BAT as ≥ 106 U/l and 80 U/l respectively. The elevated level of AST and ALT might assist the emergency physicians and surgeons to timely refer the suspected patients with the liver injury to a tertiary center.
Application of nano-carbon and titanium clip combined labeling in robot-assisted laparoscopic transverse colon cancer surgery
Authors: Lin Nan , Qiu Jiandong , Song Junchuan , Yu Changwei , Fang Yongchao , Wu Weihang , Yang Weijin , Wang Yu 
Published: September 2020

Abstract
Background: Robot-assisted laparoscopic transverse colon tumor surgery requires precise tumor localization. The purpose of this study was to evaluate the safety and efficacy of nano-carbon and titanium clip combination labeling methods in robot-assisted transverse colon tumor surgery.Methods: From January 2018 to January 2019, the clinical data of 16 patients who underwent preoperative nano-carbon and titanium clip combined with robot-assisted laparoscopic transverse colon cancer surgery were retrospectively analyzed.Results: Of the 16 patients, no signs of abdominal pain, fever, or diarrhea were observed after colonoscopy. Two titanium clips were seen on all of the 16 patients' abdominal plain films. Nano-carbon staining sites were observed during the operation, and no staining disappeared or abdominal cavity contamination. All patients underwent R0 resection. The average number of lymph nodes harvsted was 18.23±5.04 (range, 9-32). The average time to locate the lesion under the laparoscopic was 3.03±1.26 min(range, 1-6min), and the average operation time was 321.43±49.23 min (range, 240-400min). All were consistent with the surgical plan, and there was no intraoperative change of surgical procedure or conversion to open surgery.Conclusion: Preoperative colonoscopy combined with nano-carbon and titanium clip is safe and effective in robot-assisted transverse colon cancer surgery. A At the same time, the labeling method shows potential in shortening the operation time, ensuring sufficient safety margin and reducing complications.
Established fibrous peritoneal metastasis in an immunocompetent mouse model similar to clinical immune microenvironment of gastric cancer
Authors: Fujimori Daisuke , Kinoshita Jun , Yamaguchi Takahisa , Nakamura Yusuke , Gunjigake Katsuya , Ohama Takashi , Sato Koichi , Yamamoto Masami , Tsukamoto Tetsuya , Nomura Sachiyo , Ohta Tetsuo , Fushida Sachio 
Published: September 2020

Abstract
Background Peritoneal metastasis (PM) in gastric cancer (GC) is characterized by diffusely infiltrating and proliferating cancer cells accompanied by extensive stromal fibrosis in the peritoneal space. The prognosis of GC with PM is still poor regardless of the various current treatments. In order to elucidate the cause of difficulties in PM treatment, we compared the tumor immune microenvironment (TME) in primary and PM lesions in GC. In addition, a PM model with fibrous stroma was constructed using immunocompetent mice to determine whether its TME was similar to that in patients. Methods Immuno-histochemical analyses of infiltrating immune cells were performed in paired primary and PM lesions from 28 patients with GC. A C57BL/6J mouse model with PM was established using the mouse GC cell line YTN16 either with or without co-inoculation of mouse myofibroblast cell line LmcMF with a-SMA expression. The resected PM from each mouse model was analyzed the immunocompetent cells using immunohistochemistry.Results The number of CD8+ cells was significantly lower in PM lesions than in primary lesions (P<0.01). Conversely, the number of CD163+ cells (M2 macrophages) was significantly higher in PM lesions than in primary lesions (P=0.016). Azan staining revealed that YTN16 and LmcMF co-inoculated tumors were more fibrous than tumor with YTN16 alone (P<0.05). Co-inoculated fibrous tumor also showed an invasive growth pattern and higher progression than tumor with YTN16 alone (P=0.045). Additionally, YTN16 and LmcMF co-inoculated tumors showed lower infiltration of CD8+ cells and higher infiltration of M2 macrophages than tumors with YTN16 alone (P<0.05, P<0.05). These results indicate that LmcMF plays as cancer-associated fibroblasts (CAFs) by crosstalk with YTN16 and CAFs contribute tumor progression, invasion, fibrosis, and immune suppression.Conclusions This model is the first immunocompetent mouse model to accurately reflect the similar to TME of human clinical PM with fibrosis. By using this model, new treatment strategies for PM, such as anti-CAFs therapies, may be developed.
Intelligent prediction of RBC demand in trauma patients using decision tree methods
Authors: Feng Yannan , Xu Zhenhua , Liu Junting , Sun Xiaolin , Wang Deqing , Yu Yang 
Published: September 2020

Abstract
Background: The vital signs of trauma patients are complex and changeable, and the prediction of blood transfusion demand mainly depends on doctors' experience and trauma scoring system; therefore, it cannot be accurately predicted. In this study, a machine learning decision tree algorithm (classification and regression tree, CRT and eXtreme gradient boosting, XGBoost) was proposed for the demand prediction of traumatic blood transfusion to provide technical support for doctors. Methods: A total of 1,371 trauma patients who were diverted to the emergency department from January 2014 to January 2018 were collected from an emergency trauma database. The vital signs, laboratory examination parameters and blood transfusion volume were used as variables, and the non-invasive parameters and all (non-invasive + invasive) parameters were used to construct an intelligent prediction model for RBC demand by logistic regression (LR), CRT and XGBoost. The prediction accuracy of the model was compared with the area under the curve (AUC).Results: The studies we performed showed that non-invasive parameters were used to predict blood transfusion. The LR method was the best, with an AUC of 0.72 (95% confidence interval [CI] 0.657-0.775), which was higher than the CRT AUC of 0.69 (95% CI 0.633-0.751) and the XGBoost AUC of 0.71 (95% CI 0.654-0.756) (P<0.05). The trauma site and shock index are important prediction parameters. For all the prediction parameters, XGBoost was the best, with an AUC of 0.94 (95% CI 0.893-0.981), which was higher than the LR AUC of 0.80 (95% CI 0.744-0.850) and the CRT AUC of 0.82 (95% CI 0.779-0.853) (P<0.05). Haematocrit/Haemoglobin is an important prediction parameter. Conclusions: The classification performance of the intelligent prediction model constructed by the decision tree algorithm is not inferior to that of the traditional LR method. With the increase in the data quantity, the accuracy of the model improved in the iteration process, and the prediction performance continuously improved, which is conducive to clinical application and wide promotion.
The microbiota of the surface, dermis and subcutaneous tissue of dog skin
Authors: García-Fonticoba Rocío , Ferrer Lluis , Francino Olga , Cusco Anna 
Published: September 2020

Abstract
Background. Studies using highly sensitive molecular techniques have detected bacterial communities below the human epidermis. Depending on their abundance and composition, this finding could be clinically relevant. The aim of this study was to determine if bacteria can be detected in the dermis and subcutaneous tissue of dogs without cutaneous disease using two different approaches: traditional cultures and DNA sequencing of the V4 region of bacterial 16S rRNA gene using next-generation sequencing (NGS).Results. Seven healthy dogs were included in the study, and two sets of samples were collected from each subject. Sample sets were composed of a 6-mm abdominal skin biopsy, including epidermis, dermis, and subcutis, a skin surface swab, and an environmental blank sample for contamination control. One set of samples from each dog was submitted for bacterial culture and the other one for bacterial DNA amplification and sequencing. Five different bacterial genera (Staphylococcus, Bacillus, Corynebacterium, Streptococcus, and Enterococcus) were isolated in five out of the seven skin surface swab samples with aerobic microbiological culture methods, while no growth was obtained from the other two samples. Although some DNA could be amplified from epidermal, dermal, and subcutaneous tissue samples, the results of the NGS were similar to those of the blanks.Conclusion. When investigated with aerobic microbiological culture methods, the dermis and subcutaneous tissue of dogs are sterile. NGS techniques lead to the detection of some bacterial DNA, similar to the signal detected in blanks, which does not support the presence of a microbiota in dermis or subcutaneous tissue.
Risk assessment of acute kidney injury following cardiopulmonary bypass
Authors: Wittlinger Thomas , Maus Martin , Kutschka Ingo , Baraki Hassina , Friedrich Martin 
Published: September 2020

Abstract
Background: Acute kidney injury (AKI) is a frequent and serious complication of cardiac surgery, associated with a high incidence of morbidity and mortality. Although the RIFLE criteria serve as a prominent tool to identify patients at high risk of AKI, an optimized diagnosis model in clinical practice is desired.Methods: Based on the SOP-criteria, 365 patients (10%) developed AKI following surgery and were subjected to RRT. In contrast, the incidence of AKI, defined according to the RIFLE criteria, was only 7% (n=251 patients). Prominent risk factors identified by SOP were patients’ sex, valve and combined valve and bypass surgery, deep hypothermia, use of intra-aortic balloon pump (IABP) and previous coronary interventions. Ischemia, reperfusion, blood loss and surgery time also served as significant risk factors for patient evaluated by SOP.Results: Risk assessment by RIFLE differed in as much as most patients with normothermia and those receiving only cardiovascular bypass developed AKI. However, patients’ sex and valve surgery did not serve as a risk factor.Conclusion: Evaluation of patients by the RIFLE versus SOP criteria yielded different results with more AKI patients detected by SOP. Based on the present data, it is concluded that patients may not prone to AKI when surgery and ischemia time will be kept short, when blood loss is mitigated to a minimum and when surgery is performed under non-hypothermic conditions
Extracardiac Imaging Findings in COVID-19 Associated Multisystem Inflammatory Syndrome in Children
Authors: Fenlon Edward Patrick , Chen Susie , Ruzal-Shapiro Carrie , Jaramillo  , Maddocks Alexis B.R. 
Published: September 2020

Abstract
Background – COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) is an emerging disease that presents with inflammation of multiple organs. The extracardiac radiographic manifestations of this syndrome are not well understood.Objective – We reviewed the radiologic findings of MIS-C in a cohort of children with a confirmed diagnosis of the syndrome.Materials and methods – In a retrospective study from 4/1/2020 to 5/22/2020, we reviewed imaging studies of 38 children with MIS-C, 21 females (55%) and 17 males (45%), with an average age of 9.2 years (range 1.3 – 20 years). Thirty six had chest radiographs, 6 had abdominal radiographs, 12 had abdominal sonograms or MRI, 2 had neck sonograms, and 3 had brain MRI.Results – 28 patients had pulmonary disease, with 24 (86%) having bilateral opacities, mostly diffuse (n=16, 57%). The most common abnormalities were peribronchial thickening (n=19, 68%), ground glass opacities (n=15, 54%) and consolidation (n=5, 18%). Pleural effusions were only present in children 10 years of age and under, and ground glass opacities were seen more often in older patients (59% vs. 26%, P<0.05). On abdominal imaging, small volume ascites was the most common finding (n=6, 50%). Other findings included right lower quadrant bowel wall thickening (n=3, 25%), gallbladder wall thickening (n=3, 25%), and cervical (n=2) or abdominal (n=2) lymphadenophathy. Of 3 patients with brain MRI, one had bilateral parietooccipital abnormalities and another papilledema.Conclusion – COVID-19 associated MIS-C causes a constellation of findings in the chest and abdomen, most often showing bilateral diffuse pulmonary abnormalities and small volume ascites.