bluuebunny/crossref_metadata_2025_split huggingface dataset:
Crucial Conversations for High Risk Populations Before Surgery: Advance Care Planning in a Preoperative Setting
Authors: Patel Roma Gautam , Torke Alexia , Nation Barb , Cottingham Ann , Hur Jennifer , Gruber Rachel , Sinha Shilpee 
Published: November 2020

Abstract
Background: High-risk patients undergoing elective surgery may experience life-threatening complications. Preoperative assessment clinics provide an opportunity to conduct Advance Care Planning but it is unknown how often this is accomplished or subsequently needed for goals of care discussions. Objective: 1) assess the relationship between advance directives with readmissions and mortality at one year 2) qualitatively examine clinical events that occurred for patients who died during follow-up.Design: This was an observational cohort study conducted via chart review. Patients were followed for one year.Participants: Four hundred patients who were undergoing preoperative evaluation for elective surgery at two academic hospitals. Main measures: The prevalence of advance directives at the time of surgery, prevalence of advance directives in the electronic medical record during the one year follow-up period, readmissions and mortality at one year. Key Results: Three hundred and ninety patients were included. There were 102 (26.4%) patients were readmitted, which was not associated with having an AD on file. Seventeen (4.4%) filed an AD during follow-up. Twelve of 19 (63%) patients who died had an AD on file at the time of death. There was a significant association between having an AD at any time with mortality (chi-square p-value <0.001). Total mortality for the cohort was 4.9%. Of the 19 patients who died, seven (37%) underwent resuscitation, four of whom had an AD on file. Conclusions: A minority of patients who die within a year after major surgery have an AD, highlighting the missed opportunity to conduct advance care planning in a preoperative clinic.
Determination of Critical Criterion of Tensile-shear Failure in Brazilian Disc Based on Theoretical Analysis and Meso-macro Numerical Simulation
Authors: Zhao Zenghui , Yang Peng , Chen Shaojie , Yin Dawei , Liu Hao , Chen Bosen 
Published: November 2020

Abstract
To define the critical criterion between tensile failure and shear failure of Brazilian disc is crucial for determination of tensile strength under combination of tensile and compressive stresses. Although Griffith's tensile failure criterion is consistent with theoretical solution of radial splitting disc, there are still some shortcomings in which the compression-tension ratio is regarded as a constant and the critical criterion only depend on single parameter of tensile strength. Therefore a critical criterion for tensile-shear failure including tensile truncation was proposed firstly based on Mohr-Coulomb criterion. Then, a new calculation method of shear strength parameters was deduced based on the critical state stress circle. Finally, effective diameter and range of compression-tension ratio of Brazilian disc under tensile failure are proposed, and failure process of Brazilian disc from meso to macro is carried out based on numerical simulation. The results show that the modified Mohr-Coulomb criterion can be determined by two indexes of compressive strength and tensile strength. The deduced compression-tension ratio is in good agreement with experiment results. The accuracy of tensile strength test results is closely related to this ratio. When the ratio is greater than 6, failure of rock can be regarded as ideal tensile failure. If the ratio is less than 6, wedge-shape failure in loading area is the main failure type. On this condition, even if radial crack occurs, it is still not considered to be caused by pure tension.
Distribution and Factors Associated With Urogenital Schistosomiasis in Tiko Health District, A Semi-urban Setting, South West Region, Cameroon
Authors: Green Adeline Enjema , Anchang-Kimbi Judith Kuoh , Wepnje Godlove Bunda , Ndassi Vicky Daonyle , Kimbi Helen Kuokuo 
Published: November 2020

Abstract
Background: Increased risk of schistosomiasis in peri-urban and urban towns is not uncommon. An epidemiological survey was carried out in the Tiko Health District (THD), an unmapped transmission focus for urogenital schistosomiasis (UGS), to assess the distribution, intensity and risk factors associated with the occurrence of UGS in the District. Methods: In this cross-sectional survey, 1029 individuals were enrolled from twelve communities purposively selected from four health areas (Likomba, Holforth, Holforth-Likomba and Mutengene) between June and August 2018. A semi-structured questionnaire was used to collect information on sociodemographic and water contact behaviour. Urine samples were examined for S. haematobium infection using test strip, filtration and microscopy methods. Bivariate and binary logistic regression analyses were used to identify predictors of infection. Results: The overall prevalence of UGS in the Likomba, Holforth-Likomba and Holforth was 31.5% (95% CI: 28.3 – 34.8). Schistosoma haematobium infection was not found in Mutengene HA. Infection was unevenly distributed among the HAs, Holforth-Likomba and Holforth being the most and least affected, respectively. The prevalence of infection varied (p < 0.001) among the affected communities, ranging from 0 – 56.9%. Infection status of the community related positively (p < 0.001) with proximity to stream (< 100m), the degree of contact (II) with water and number of improved water sources. Younger age group (5 – 14 years) (aOR = 3.6, 95% CI: 1.1 – 12.0) and intense water contact (Degree II) (aOR = 5.2, 95% CI: 3.4 – 8.1) were associated with increased risk of infection as well as higher worm egg load excretion. Conclusion: Generally, THD is a moderate risk endemic focus for UGS but prevalence higher than 50% was observed in some communities. These findings warrant immediate mass chemotherapy with praziquantel to reduce morbidity. Provision of portable water and health education are proposed measures to reduce and eventually eliminate transmission in the area.
Geospatial Epidemiology of Leprosy in Northwest Bangladesh: A 20-year Retrospective Observational Study
Authors: Bulstra Caroline , Blok David J. , Alam Khorshed , Butlin C. Ruth , Roy Johan Chandra , Bowers Bob , Nicholls Peter , de Vlas Sake J. , Richardus Jan Hendrik 
Published: November 2020

Abstract
Background: Leprosy is known to be unevenly distributed between and within countries. High risk areas or ‘hotspots’ are potential targets for preventive interventions, but the underlying epidemiologic mechanisms of these areas remain not fully understood. In this study, we identified and characterized leprosy hotspots in Bangladesh, a high endemic country. Methods: Data were used from four high-endemic districts in ﻿northwest Bangladesh, including 20,623 registered cases (among ~7 million population) between January 2000 and April 2019. Incidences per union were calculated using geospatial population density estimates. A geospatial Poisson model was used to detect incidence hotspots over three (overlapping) 10-year timeframes: 2000-2009, 2005-2014 and 2010-2019. Ordinal regression models were used to assess whether patient characteristics were significantly different for cases outside hotspots, as compared to cases within weak (i.e. relative risk (RR) of one to two), medium (i.e. RR of two to three), and strong (i.e. RR higher than three) hotspots.Results: New case detection rates dropped from 44/100,000 in 2000 to 10/100,000 in 2019. Statistically significant hotspots were identified during all timeframes, and were often located at areas with high population densities. The RR for leprosy was up to 12 times higher for inhabitants of hotspots than for people living outside hotspots. Within strong hotspots (1,930 cases among less than 1% of the population), significantly more child cases (i.e. below 15 years of age) were detected, indicating recent transmission. Cases in hotspots were not significantly more likely to be detected actively. Conclusions: Leprosy showed a heterogeneous distribution with clear hotspots in northwest Bangladesh throughout a 20-year period of decreasing incidence. Findings confirm that hotspots have higher active transmission and are not solely the result of active case finding strategies.
Prevention and Emergency Management in Cardiac Intensive Care Units After Effective Control of the COVID-19: A Chinese Tertiary Hospital Experience
Authors: Wu Zhijian , Li Muzheng , Chen mingxian , Liu Yanxia , Tudahun Ilyas , Peng Zengjin , Hu Qingdan , Qi Nenghua , Chen Yaqin , Tang Jianjun 
Published: November 2020

Abstract
ObjectiveAfter effective control of the 2019 Coronavirus Disease (COVID-19) in China, how to reopen the hospital and avoid the outbreak in the hospital is a problem that needs to be carefully considered. The aim of this descriptive study is to share the experience of prevention and emergency management in our hospital and cardiac intensive care units (CCU) when medical services were reopened after COVID-19 was under control.Methods and ResultsWe conducted a retrospective, descriptive and single-centre study. Management strategy and data were collected from the Second Xiangya Hospital of Central South University, Hunan and CCU. We have implemented some strategies to prevent the prevalence of covid-19 in hospitals while ensuring that more critical cardiac patients can be admitted to CCU. These measures are summarized as follows: 1. gradually expanding medical services; 2. risk classification and routine strict screening of patients admitted to CCU; 3. strengthening the management of hospitalized patients, accompanying person and medical staffs; 4. strengthening screening and isolation of suspected cases of inpatients; 5. other measures such as strengthening training of medical workers, protective equipment and environmental management, and so on.ConclusionWe share the experience of prevention and emergency management in our hospital and CCU when medical services were reopened after effective control of the COVID-19 epidemic and hope it will be helpful for cardiologist or critical care physician all around the world to continue to provide critical care in a safe and orderly manner.
Computational Flow Cytometric Analysis to Detect Epidermal Subpopulations In Human Skin
Authors: Zhang Lidan , Cen Ying , Huang Qiaorong , Li Huifang , Mo Xianming , Meng Wentong , Chen Junjie 
Published: November 2020

Abstract
BackgroundThe detection and dissection of epidermal subgroups could lead to an improved understanding of skin homeostasis and wound healing. Flow cytometric analysis provides an effective method to detect the surface markers of epidermal cells while producing high-dimensional data files.MethodsA 9-color flow cytometric panel was optimized to reveal the heterogeneous subgroups in the epidermis of human skin. The subsets of epidermal cells were characterized using automated methods based on dimensional reduction approaches (viSNE) and clustering with Spanning-tree Progression Analysis of Density-normalized Events (SPADE).ResultsThe manual analysis revealed differences in epidermal distribution between body sites based on a series biaxial gating starting with the expression of CD49f and CD29. The computational analysis divided the whole epidermal cell population into 25 clusters according to the surface marker phenotype with SPADE. This automatic analysis delineated the differences between body sites. The consistency of the results was confirmed with PhenoGraph.ConclusionA multicolor flow cytometry panel with a streamlined computational analysis pipeline is a feasible approach to delineate the heterogeneity of the epidermis in human skin.
Integrated Analysis of Methylation-driven Genes and Pretreatment Prognostic Factors in Patients with Hepatocellular Carcinoma
Authors: He Dongsheng , Cai Lifang , Huang Weiming , Xie Xuehua , You Mengxing , Liao Shengyin 
Published: November 2020

Abstract
Background: The potential reversibility of aberrant DNA methylation indicates an opportunity for oncotherapy. This study aimed to integrate methylation-driven genes and pretreatment prognostic factors and then construct a new individual prognostic model in hepatocellular carcinoma (HCC) patients.Methods: The gene methylation, gene expression dataset and clinical information of HCC patients were downloaded from The Cancer Genome Atlas (TCGA) database. Methylation-driven genes were screened with a Pearson’s correlation coefficient less than -0.3 and a P value less than 0.05. Univariable and multivariable Cox regression analyses were performed to construct a risk score model and identify independent prognostic factors from the clinical parameters of HCC patients. The least absolute shrinkage and selection operator (LASSO) technique was used to construct a nomogram that might act to predict an individual’s OS, and then C-index, ROC curve and calibration plot were used to test the practicability. The correlation between clinical parameters and core methylation-driven genes of HCC patients was explored with Student’s t-test.Results: In this study, 44 methylation-driven genes were discovered, and three prognostic signatures (LCAT, RPS6KA6, and C5orf58) were screened to construct a prognostic risk model of HCC patients. Five clinical factors, including T stage, risk score, cancer status, surgical method and new tumor events, were identified from 13 clinical parameters as pretreatment-independent prognostic factors. To avoid overfitting, LASSO analysis was used to construct a nomogram that could be used to calculate the OS in HCC patients. The C-index was superior to that from previous studies (0.75 vs 0.717, 0.676). Furthermore, LCAT was found to be correlated with T stage and new tumor events, and RPS6KA6 was found to be correlated with T stage.Conclusion: We identified novel therapeutic targets and constructed an individual prognostic model that can be used to guide personalized treatment in HCC patients.
Release Characteristics of Enoxaparin Sodium Loaded Polymethylmethacrylate Bone Cement
Authors: Sun Hui , Ma Xinzhe , Li Zhiyong , Liu Jianning , Wang Wei , Qi Xiangbei 
Published: November 2020

Abstract
Background: This study aimed to prepare the polymethylmethacrylate (PMMA) bone cement release system with different concentrations of enoxaparin sodium (ES) and to investigate the release characteristics of ES after loading into the PMMA bone cement. Methods: In the experimental group, 40g Palacos®R PMMA bone cement was loaded with various amount of ES 4000, 8000, 12000, 16000, 20000, and 24000 AXaIU, respectively. The control group was not loaded with ES. Scanning electron microscopy (SEM) was used to observe the surface microstructure of the bone cement in the two groups. In the experiment group, the mold was extracted continuously with pH7.4 Tris-HCL buffer for 10 days. The extract solution was collected every day and the anti-FXa potency was measured. The experiment design and statistical analysis were conducted using a quantitative response parallel line method. Results: Under the SEM, it was observed that ES was filled in the pores of PMMA bone cement polymer structure and released from the pores after extraction. There was a burst effect of the release. The release amount of ES on the first day was 0.415, 0.858, 1.110, 1.564, 1.952 and 2.513 respectively from the six groups with various ES loading amount of 4000, 8000, 12000, 16000, 20000 and 24000 AXaIU, all reaching the peak of release on the first day. The release decreased rapidly on the next day and entered the plateau phase on the fourth day. Conclusion: PMMA bone cement can be used as a carrier to effectively release enoxaparin sodium within a short term.
pUDK-HGF Gene Therapy to Relieve CLI Rest Pain and Ulcers: A Phase II, Double-Blind, Randomized Placebo-Controlled Trial
Authors: Gu Yongquan , Cui Shijun , Liu Changjian , Zhao Jichun , Li Ming , Li Yiqing , Yang Xinglong , Lv Bonan , Li Mingzhang , Zhao Wenguang , Guo Wei , Huang Jianhua , Huang Wen , Qiu Zhenming , Zhao Jun , Yin Ping , Qiu Tingting , zhu Dan , Sun Wenjie , Lu Yuxin , Cheng Xiaochen , Du Li , Zhang Qinglin , Wu Zuze 
Published: November 2020

Abstract
BackgroundCritical limb ischemia (CLI) has become a global problem. Less invasive therapy is needed. Hepatocyte growth factor (HGF) is one of the most potent angiogenic protein and the plasmid encoding human hepatocyte growth factor (HGF) is considered to be the most promising gene therapy for CLI.MethodsWe conducted a randomised, double-blind, placebo-controlled trial to assess the efficacy and safety of intramuscular injection of plasmid pUDK-HGF expressing HGF. Pain-at-rest patients and ulcer patients were enrolled as two cohorts and randomized to receive intramuscular injection of placebo or pUDK-HGF. Efficacy assessments included pain scale, ulcer size, TBI, ABI, and TcPO2 over 180 day. Safety analysis was based on the occurrence of adverse events. ResultsIn the pain-at-rest cohort, the proportion of patients with complete pain relief after receiving pUDK-HGF injections was significantly higher than that of the placebo group on day 180 (p = 0.0148). More responders with >50% pain reduction were also observed in the pUDK-HGF groups than in the placebo groups (p = 0.0168). In the ulcer cohort of patients, pUDK-HGF treatment tended to be superior to the placebo in the percentage of patients with both complete ulcer healing and >50% ulcer healing. No significant differences in the incidence of adverse events or serious adverse events were observed among the groups. ConclusionIntramuscular injection of pUDK-HGF is safe and can significantly reduce pain-at-rest and possibly promotes ulcer healing in CLI patients. The mid dose pUDK-HGF (6 mg) was the most efficacious, and is an appropriate dose for phase III clinical trial. Clinical Trial RegistrationChina Food and Drug Administration number: 2013L00637, Data: 2013/03/15. China Clinical Trial Registry URL: http://www. chinadrugtrials.org.cn. Unique Identifier: 20130378)
Low Surgical Morbidity and Mortality After Fast-Track Liver Surgery for Colorectal Liver Metastases: A Study of Complications in a High-Volume Centre
Authors: Egeland Charlotte , Rostved Andreas Arendtsen , Schultz Nicolai Aagaard , Pommergaard Hans-Christian , Daugaard Thomas Røjkjær , Thøfner Line Buch , Hillingsø Jens G. , Rasmussen Allan 
Published: November 2020

Abstract
BackgroundFor colorectal liver metastases, surgery is a high-risk procedure due to perioperative morbidity. The objective was to assess complications after fast-track liver surgery for colorectal liver metastases.MethodsAll patients were treated according to the same fast-track programme. Complications were graded according to the Clavien-Dindo classification for patients undergoing surgery from 2013 to 2015. Correlation between complications and length of stay was analysed by multivariate linear regression.Results564 patient cases were included of which three patients died within 3 months (0.53%, 95% CI: 0.17-1.64%). Complications were common with Grade 2 in 167 patients (30%) and ≥Grade 3a in 93 (16%). Patients without complications had a mean length of stay of 4.1 days, which increased with complications: 1.4 days (95% CI: 1.3 – 1.5) for Grade 2, 1.7 days (1.5 – 2.0) for Grade 3a, 2.3 days (1.7 – 3.0) for Grade 3b, 2.6 days (1.6 – 4.2) for Grade 4a, and 2.9 days (2.8 – 3.1) for Grade 4b. Following were associated with increased length of stay: complication severity grade, liver insufficiency, ascites, and biliary, cardiopulmonary, and infectious complications. Conclusions﻿Complications after liver surgery for colorectal liver metastases, in a high-volume centre, were associated with low mortality, few severe complications, and short but increased length of stay.
Short Uncemented Femoral Component for Hip Revision: Prognosis and Risk Factors Associated With Failure
Authors: Liu Zeming , Liu Bo , Zhang Bingshi , Ma WenHui , Wu Tao , Huo Jia , Liu Sikai , Han Yongtai 
Published: November 2020

Abstract
BackgroundThe application of short uncemented femoral stem is partially restricted in revision surgery. In some patients with mild to moderate bone deficiency, short uncemented stem is certainly a choice. This study will demonstrate the therapeutic effect and unsuitable situation for short uncemented stem revision.MethodsPatients who undergone hip revision from January 2005 to December 2015 were retrospectively analyzed in this study. Preoperative radiological images were evaluated to help estimating the bone deficiency around hip joint. Mann-Whitney U test was performed for comparison between continuous variables. Chi-square test was performed for comparison between categorical variables. Cox regression analysis was used to assess the association between potential risk factors and failure of revision surgery.ResultsA total of 381 patients were retrospectively reviewed. The mean follow-up time was 71.05±16.54 months. The mean time from primary revision surgery to secondary revision surgery was 16.41±17.47 months. According to the survival status of femoral component at final follow-up, patients were divided into two groups. Cox regression analysis revealed that the risk for revision failure approximately increased by 5.6% for every year of age increase (HR=1.056, 95%CI=1.012–1.102). Osteoporosis was another independent risk factor for revision failure (HR=2.802, 95%CI=1.097–7.157). The strongest risk factor was intraoperative periprosthetic femoral fracture during revision surgery in this study (HR=5.477, 95%CI=2.156–13.913).Conclusion﻿Three risk factors for failure are identified, such as aging, osteoporosis and intraoperative periprosthetic femoral fracture during revision surgery. Therefore, short uncemented femoral stem should be implanted in these patients with additional caution.
Association of Monocytes and the Monocyte/high-density Lipoprotein Ratio With Intracranial and Extracranial Atherosclerotic Stenosis
Authors: Liu Zhu , Fan Qingli , Wu Shizheng , Lei Yancheng , Yang Wenfang 
Published: November 2020

Abstract
Background and aims: Although the monocyte/high-density lipoprotein ratio (MHR) has been shown to be a potential inflammatory marker of cardiovascular and cerebrovascular diseases, there are few studies on the relationship between intracranial and extracranial atherosclerotic stenosis degree and its distribution.Methods: A total of 271 patients were admitted for digital subtraction angiography (DSA) examination. (1) The non-stenosis group and the stenosis group were compared, and the artery was grouped according to the degree of intracranial and extracranial atherosclerotic stenosis (if ≥2 branches were stenotic, the artery with the most severe stenosis was used). (2) According to the locations of the intracranial and extracranial artery stenosis groups.clinical baseline data and laboratory indexes of each group of patients were collected.Results: (1) MHR (odds ratio (OR)=1.119, P<0.001), age (OR=1.057, P=0.007), and lymphocyte (OR=0.273, P=0.002) could significantly affect cerebral atherosclerotic stenosis, the AUC (area under the ROC curve) of MHR was 0.82, and the optimal diagnostic value was 0.486. Further analysis of the mild, moderate, and severe stenosis groups showed that MHR (OR=1.07, P<0.001) significantly affected the severity of stenosis in patients. (2) According to the analysis of stenosis at different sites, the rate of extracranial artery stenosis in patients who smoked (OR=3.86, P=0.023) and had a reduced lymphocyte level (OR=0.202, P=0.001) was significantly higher than that in patients who smoked (OR=3.86, P=0.023). With increasing age, the rate of extracranial and extracranial artery stenosis increased significantly. With the increase in MHR level, the stenosis rate of each group was significantly higher than that of the non-stenosis group.Conclusion: MHR has predictive value for the diagnosis of intracranial and extracranial atherosclerotic stenosis and is correlated with the degree and distribution of stenosis.