bluuebunny/crossref_metadata_2025_split huggingface dataset:
National Lockdown to Cope with COVID-19 Pandemic: Effects (Contradictory) on Public Health and (Negative) on Economic System
Authors: Coccia Mario 
Published: November 2020

Abstract
One of the policy responses to cope with effects of COVID-19 pandemic in society is the national lockdown applied by many countries worldwide. Literature lacks of studies that show whether the effects of this public policy on public health, environment and socioeconomic systems have been effective or not during the first wave of the COVID-19 pandemic. Empirical analysis of this study focuses on some European countries that have applied different containment measures based on national lockdown with longer period (more than a month) and a shorter period (of max 15 days). The evidence shows that longer period of national lockdown by governments seem to generate contradictory effects on public health, whereas on economic growth induces a negative impact given by high contraction of real GDP growth %. This result here can be helpful to policymakers for new policy choices directed to design appropriate measures of containment based on a shorter temporal duration and applied on selected areas and places at risk, rather than general and uniform interventions of lockdown and reduction of mobility. This new perspective of public policy to cope with pandemic crisis of the COVID-19 and future epidemics of similar viral agents can balance the likely positive effects on public health without to deteriorate the structural indicators of economic system.
Development of a multivariable model predicting COVID-19 mortality risk from comorbidities in an Italian cohort of 18,286 confirmed cases aged 40 years or older
Authors: Andreano Anita , Murtas Rossella , Tunesi Sara , Greco Maria Teresa , Consolazio David , Guido Davide , Gervasi Federico , Gattoni Maria Elena , Sandrini Monica , Riussi Antonio , Russo Antonio Giampiero 
Published: November 2020

Abstract
Background: large studies on the predictive role of chronic conditions on mortality from COVID‑19 are scarce. We developed a predictive model of death from COVID‑19 in an Italian cohort aged 40 years or older.Methods: we conducted a cohort study on prospectively collected data. The cohort included all (n=18,286) swab positive cases ≥40 year-old in patients registered with the Agency for Health Protection (AHP) of Milan up to 27/04/2020. Data on comorbidities were obtained from the chronic condition administrative database of the AHP. A multivariable logistic regression model, including age and gender and the selected conditions, was fitted to predict 30-day mortality risk and internally validated. External validation and recalibration were performed in a cohort of untested subjects with COVID-19 like symptoms. R software was used for the analysis.Results: chronic conditions having the largest model-adjusted odds ratio (OR) of dying within 30 days from COVID-19 infection were chronic heart failure (OR=1.9, 95%CI 1.5-2.5), tumors (OR=1.8, 95%CI 1.4-2.3), complicated diabetes (OR=1.6, 95%CI 1.1-2.2) and dialysis-dependent chronic kidney disease (OR=1.5, 95%CI 1.0-2.2). Bootstrap-validated c-index was 0.78. The model fitted on the validation cohort had a c-index of 0.93, but required recalibration. With this latter model, at a 10% risk of death threshold, 11% of the AHP population aged 40 years or older is considered at high risk.Conclusion: we identified a selected number of comorbidities predicting early risk of death in a large COVID-19 cohort aged 40 years or older. In a new epidemic wave, our results will help physicians and health systems to identify high-risk subject to target for prevention and therapy in this specific age group.
Biomechanical study on the stress distribution of the knee joint after distal femoral fracture malunion with residual varus-valgus deformity&nbsp;
Authors: Li Ming , Hu Pan , Ma Lijie , Zhang Di , Chang Wenli , Zhang Tao , Wei Ning , Chen Wei , Zhu Yanbin 
Published: November 2020

Abstract
Background: To investigate the effect of residual varus and valgus deformity on the stress distribution of knee joint after distal femoral fracture malunion. Methods: Fourteen adult cadaver specimens with formalin were selected to establish the femoral fractures models, which were fixed subsequently at neutral position (anatomical reduction) and malunion positions (at 3 degrees, 7 degrees, 10 degrees valgus positions and 3 degrees, 7 degrees, and 10 degrees varus positions). The stress distribution on the medial and lateral plateau of the tibia was quantitatively measured using ultra-low pressure sensitive film technology. The change of stress distribution of knee joint after femoral fracture malunion and the relationship between stress value and residual varus varus or valgus deformity were analyzed.Results: Under 400 N vertical load, the stress values on the medial and lateral plateau of the tibia at the neutral position were 1.162±0.114 MPa and 1.103±0.144 MPa, respectively. When compared with the stress values measured at the neutral position, the stress on the medial plateau of tibia were significantly higher at varus deformities and lower at valgus deformities, and the stress on the lateral plateau was significantly higher at valgus deformity and lower at varus deformities (all P<0.05). The stress values on the medial plateau of tibia were significantly higher than the corresponding data on the lateral plateau at neutral and 3 degrees, 7 degrees, 10 degrees varus deformities, respectively (all P<0.05), and significantly lower than the corresponding data on the lateral plateau at 3 degrees, 7 degrees, 10 degrees valgus deformities, respectively (all P<0.05). Conclusions: Residual varus and valgus deformity after femoral fracture malunion can cause obvious changes of the stress distribution of knee joint. Therefore, the distal femoral fracture should be anatomically reduced and rigidly fixed to avoid residual varus-valgus deformity and malalignment of lower limbs.
Analysis of gastroscopy results among healthy people undergoing a medical checkup: A retrospective study
Authors: Huang Haosu , Rong Yanting , Wang Meng , Guo Zimeng , Yu Yanghua , Long Zhenpu , Chen Xiaoxiao , Wang Hanyue , Ding Junjie , Yan Lu , Peng Jie 
Published: November 2020

Abstract
Background: The association of upper gastrointestinal endoscopic findings with sex, age, and Helicobacter pylori infection in asymptomatic healthy people is unclear. The aim of this study was to retrospectively determine the associations of upper gastrointestinal endoscopic findings in asymptomatic healthy people with sex, age, and H. pylori infection.Methods: A retrospective study was conducted on 2923 patients from a health examination center in Xiangya Hospital between September 2015 and September 2019. Data on sex, age, H. pylori infection, and gastroscopy results were collected.Results: Among 2923 asymptomatic patients who underwent gastroscopy, 2911 (99.59%) had abnormal results. The top three results were chronic gastritis (95.11%), peptic ulcer (17.45%), and duodenitis (9.17%). Inflammation of the gastric mucosa in chronic gastritis was more severe in the H. pylori-positive group. The incidence of peptic ulcer decreased with increasing age and was higher in men, patients aged <30 years, and H. pylori-positive patients. The incidence of polyps was higher in women (9.54%) than in men (5.94%), and the incidence in individuals aged ≥60 years (11.63%) was higher than that in those aged <60 years (6.83%). The pathological results of gastric polyps depended on the location of the lesion.Conclusion: The incidence of abnormal upper gastrointestinal endoscopic results is high in asymptomatic healthy people undergoing a check-up and is associated with sex, age, and H. pylori infection. Gastroscopy should be considered part of a routine health check.
Influence of diabetes on short-term outcome after major hepatectomy – an underestimated risk?
Authors: Fischer Alexander , Fuchs Juri , Stravodimos Christos , Hinz Ulf , Billeter Adrian , Büchler Markus W. , Mehrabi Arianeb , Hoffmann Katrin 
Published: November 2020

Abstract
BackgroundPatient-related risk factors such as diabetes mellitus and obesity are increasing in western countries. At the same time the indications for liver resection in both benign and malignant diseases have been significantly extended in recent years. Major liver resection is performed more frequently in a patient population of old age, comorbidity and high rates of neoadjuvant chemotherapy. The aim of this study was to evaluate whether diabetes mellitus, obesity and overweight are risk factors for the short-term post-operative outcome after major liver resection.MethodsFour hundred seventeen major liver resections (≥3 segments) were selected from a prospective database. Exclusion criteria were prior liver resection in patient’s history and synchronous major intra-abdominal procedures. Overweight was defined as BMI ≥ 25 kg/m 2 and < 30 kg/m 2 and obesity as BMI ≥ 30 kg/m 2 . Primary end point was 90-day mortality and logistic regression was used for multivariate analysis. Secondary end points included morbidity, complications according to Clavien-Dindo classification, unplanned readmission, bile leakage, and liver failure. Morbidity was defined as occurrence of a post-operative complication during hospital stay or within 90 days postoperatively.ResultsFifty-nine patients had diabetes mellitus (14.1%), 48 were obese (11.6%) and 147 were overweight (35.5%). There were no statistically significant differences in mortality rates between the groups. In the multivariate analysis, diabetes was an independent predictor of morbidity (OR = 2.44, p = 0.02), Clavien-Dindo grade IV complications (OR = 3.6, p = 0.004), unplanned readmission (OR = 2.44, p = 0.04) and bile leakage (OR = 2.06, p = 0.046). Obese and overweight patients did not have an impaired post-operative outcome compared patients with normal weight.ConclusionsDiabetes has direct influence on the short-term postoperative outcome with an increased risk of morbidity but not mortality. Preoperative identification of high-risk patients will potentially decrease complication rates and allow for individual patient counseling as part of a shared decision-making process. For obese and overweight patients, major liver resection is a safe procedure.
Business models for primary health care delivery in low and middle income countries: a scoping study of nine social entrepreneurs
Authors: Lokman Lutfi , Chahine Teresa 
Published: November 2020

Abstract
Background: Social enterprises are organizations created to address social problems that use business models to sustain themselves financially. Social enterprises can help increase access to primary health care in low resource settings. Research on social enterprises in health care have focused either on high-income countries, or on secondary and tertiary care in low- and middle-income countries, where common business models include differential pricing to cross-subsidize low income populations. This is the first study to examine social enterprises providing primary health care in low- and middle-income countries using primary data. The purpose is to determine whether social enterprise is a viable model in this setting and to identify common patterns and characteristics that could inform the work of social entrepreneurs, funders, and researchers in this area.Methods: We identify social entrepreneurs working to deliver primary care in low- and middle-income countries who have been vetted by international organizations dedicated to supporting social entrepreneurship. Through in-depth interviews, we collect information on medical processes, business processes, social impact, and organizational impact according to the Battacharyya et al framework. We then conducted qualitative analysis to identify common patterns emerging within these four categories.Results: Common characteristics in the business models of primary health care social enterprises include flat rate rather than differential pricing; cross-subsidizing across services rather than patients. Subscription packages and in-house IT systems were utilized to generate revenue and increase reach through telemedicine, franchising, and mobile units. In some cases, alternate revenue streams are employed to help break even. About half of the social enterprises interviewed were for-profit, and about half non-profit. The majority faced challenges in engaging with the public sector. This is still a nascent field, with most organizations being under ten years old.Conclusions: Social enterprise has been demonstrated as a feasible model for providing primary care in low resource settings, with key characteristics differing from the previously commonly studied social enterprises in tertiary care. There are opportunities to complement existing public health systems, but most organizations face challenges in doing so. More research and attention is needed by researchers, governments and funders to support social entrepreneurs and avoid parallel systems.
Localization of recurrent lesions following ileocolic resection for Crohn's disease
Authors: Ikeuchi Hiroki , Uchino Motoi , Bando Toshihiro , Horio Yuki , Kuwahara Ryuichi , Minagawa Tomohiro , Goto Yoshiko , Kusunoki Kurando , Ikeda Masataka , Beppu Naohito , Takesue Yoshio 
Published: November 2020

Abstract
Background Crohn’s disease (CD) recurrence can occur not only at the site of anastomosis but also elsewhere in the bowel following an ileocolic resection (ICR) procedure. The aims of the present study were to assess long-term outcomes of a primary ICR procedure for CD in consecutive patients and examine the location of the reoperation causative lesion.Methods We examined cases of surgery with ICR initially performed at our institution. Those with simultaneous multiple bowel resection or bowel resection with strictureplasty were excluded. Results A total of 169 patients who underwent ICR due to CD were enrolled. The median follow-up period was 12.6 years (range 4-27 years). A reoperation was needed in 45 (26.6%), of whom 14 had lesions causative of the reoperation at other than the anastomotic site. The most common causative lesion location was in the colon rather than the oral side of the small intestine. Furthermore, we investigated the relationship between presence of residual lesions following the initial surgery and lesions causative of reoperation. In the group without residual disease (n=31), 29.0% (n=9) had non-anastomotic lesions involved in indications for reoperation, while that was 35.7% (n=5) in the group with residual disease (n=14).Conclusions Anastomotic site lesion is not the only causative factor for reoperation following ICR. Regular examinations and applicable treatment with awareness that the cause of reoperation is not limited to the site of anastomosis are important in these cases.
Intraoperative hypotension is not associated with adverse short-term postoperative outcomes after esophagectomy in esophageal cancer patients
Authors: Yeheyis Ephraim Teffera , Kassa Seyoum , Yeshitila Hiwot , Bekele Abebe 
Published: November 2020

Abstract
Background The effect of low systolic blood pressure and its subsequent postoperative outcome during esophagectomy for esophageal cancer is not well studied.MethodsA prospective study was conducted and data were collected on patients who underwent esophagectomy and esophagogastrostomy for esophageal cancer. Intraoperative Hypotension (IOH), defined as Systolic Blood Pressure (SBP) < 90 mm Hg lasting more than 5 minutes, was recorded. Patients’ 30 days post-operative composite outcome of mortality, anastomotic leak, and prolonged hospital stay were analyzed as outcome variables.ResultA total of 54 patients underwent esophagectomy for esophageal cancer during the study period. The mean age was 54 years. The mean duration of the surgery was 208 minutes. Intraoperative mean low SBP was 80mmHg while the lowest record was 55 mmHg. IOH occurred in 51 % (n=29) of patients. Anastomotic leak occurred in 7% (n=4) (OR 1.2, 95% CI 0.26-6.3; p=0.76). In-hospital mortality was 5 % (n=3) (OR 1.44, 95% CI 0.22- 9.3; p=0.7) and 33 % (n=18) had prolonged hospital stay (OR 0.53, 95% CI 0.14- 1.9; p=0.34).The overall anastomotic leak rate was 13% (n=7). The 30 days operative mortality was 9% and 55 % (30) of patients had prolonged hospital stay. Multivariate analysis (logistic regression model) showed SBP < 90mmHg for more than 5 minutes was not significantly associated either with individual or composite outcomes of mortality, anastomotic leak, and prolonged hospital stay (AOR 1.06, 95% CI 0.98-1.14; p=0.16)ConclusionIn patients undergoing esophagectomy for esophageal cancer, a systolic blood pressure < 90 mm Hg for greater than 5 min during surgery has no significant statistical association with composite adverse outcomes of mortality, anastomotic leak, and prolonged hospital stay.
A novel nomogram for predicting liver metastasis in patients with gastrointestinal stromal tumor: A SEER-based study
Authors: Zhou Guowei , Xiao Keshuai , Gong Guanwen , Wu Jiabao , Zhang Ya , Liu Xinxin , Jiang Zhiwei , Ma Chaoqun 
Published: November 2020

Abstract
Background: Liver metastasis (LIM) of gastrointestinal stromal tumor (GIST) is associated with poor prognosis. The present study aimed at developing and validating nomogram to predict LIM in patients with GIST, thus helping clinical diagnosis and treatment. Methods: The data of GIST patients derived from Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2016, which were then screened by univariate and multivariate logistic regression for the construction of LIM nomogram. The model discrimination of LIM nomogram was evaluated by concordance index (C-index) and calibration plots, while the predictive accuracy and clinical values were measured by decision curve analysis (DCA) and clinical impact plot. Furthermore, we validated predictive nomogram in the internal testing set. Results: A total of 3797 patients were enrolled and divided randomly into training and validating groups in a 3-to-1 ratio. After logistic regression, the significant variables were sex, tumor location, tumor size, N stage and mitotic rate. The calibration curves showed the perfect agreement between nomogram predictions and actual observations, while the DCA and clinical impact plot showed the clinical utility of LIM nomogram. C-index of the nomogram was 0.812. What’s more, receiver operating characteristic curves (ROC) also showed good discrimination and calibration in the training set (AUC=0.794, 95% CI: 0.778 to 0.808) and the testing set (AUC=0.775, 95% CI: 0.748 to 0.802). Conclusion: The nomogram for patients with GIST can effectively predict the individualized risk of liver metastasis and provide insightful information to clinicians to optimize therapeutic regimens.
Predictors and One-year Outcomes of Patients with Delayed Graft Function after Deceased Donor Kidney Transplantation
Authors: Chen Rao , Wang Haifeng , Song Lei , Hou Jianfei , Peng Jiawei , Dai Helong , Peng Longkai 
Published: November 2020

Abstract
Background:Delayed graft function (DGF) is closely associated with the use of marginal donated kidneys due to deficits during transplantation and in recipients. We aimed to predict the incidence of DGF and evaluate its effect on graft survival.Methods:This retrospective study on kidney transplantation was conducted from January 1, 2018, to December 31, 2019, at the Second Xiangya Hospital of Central South University. We classified recipients whose operations were performed in different years into training and validation cohorts and used data from the training cohort to analyze predictors of DGF. A nomogram was then constructed to predict the likelihood of DGF based on these predictors.Results:The incidence rate of DGF was 16.92%. Binary logistic regression analysis showed correlations between the incidence of DGF and cold ischemic time (CIT), warm ischemic time (WIT), terminal serum creatine (Scr) concentration,, duration of pretransplant dialysis, primary cause of donor death, and usage of LifePort . The internal accuracy of the nomogram was 83.12%. One-year graft survival rates were 93.59% and 99.74%, respectively, for the groups with and without DGF (P<0.05).Conclusion:The nomogram established in this study showed good accuracy in predicting DGF after deceased donor kidney transplantation; additionally, DGF decreased one-year graft survival.
Visceral Adipose Tissue Promotes Pressure-Induced Heart Failure Associated with Circulating Fatty Acids
Authors: Shi Wenjiao , Peng Yuanzhi , Du Jianer , Weng Xiaojian 
Published: November 2020

Abstract
Visceral adipose tissue (VAT) is the main source of circulating fatty acids (FAs) that provides the energy substrate for the heart. Till now, studies have not shown a clear association between individual circulating FAs and heart failure (HF). In this study, we aimed to investigate the changes in circulating FAs in HF mice and their association with VAT by removing epididymal white adipose tissue (eWAT). Here, we found that the serum levels of four fatty acids, namely arachidic acid, behenic acid, lignoceric acid, and docosapentaenoic acid, were significantly decreased in pressure-induced HF mice via transverse aortic constriction (TAC) surgery accompanied with cardiac enlargement and fibrosis. Most importantly, removal of eWAT in mice led to a significant decrease in the levels of the above-mentioned fatty acids without any significant difference between the HF and sham groups. Accordingly, cardiac enlargement and fibrosis were significantly alleviated. We concluded that VAT excision alleviated TAC-induced cardiac failure by decreasing serum arachidic acid, behenic acid, lignoceric acid, and docosapentaenoic acid levels.
AMAMENTAÇÃO x COVID-19
Authors: Fernandes Elaine , Sousa Juliany , Silva Raissi , Serquiz Alexandre 
Published: November 2020

A Organização Mundial da Saúde declarou o surto da COVID-19 como pandemia, e até o momento não há documentação de transmissão vertical na amamentação. O objetivo foi elaborar um Procedimento Operacional Padronizado sobre a extração e armazenamento do leite de forma segura, em meio ao novo coronavírus, visando a continuidade do aleitamento exclusivo. Para o desenvolvimento do POP, foi realizada uma revisão bibliográfica dos últimos cinco anos e elencado opiniões seguras sobre o assunto abordado, destinado principalmente à empresas e instituições que têm como público-alvo puérpera e lactente. O produto deste trabalho é uma ferramenta de orientação sobre o manejo do aleitamento materno exclusivo diante da doença, tendo em vista que a opinião com maior respaldo científico é de que mães infectadas, com bom estado geral, devem manter a amamentação.
Palavras-chave: aleitamento materno; extração de leite; novo coronavírus.
EDUCAÇÃO POPULAR E SAÚDE DOS TRABALHADORES(AS) EM TEMPOS PANDEMIA
Authors: Maria Sousa de Castro Kamilla , Beatriz dos Santos Silva Milena , Gleice de Pontes Bezerra Jamile , Taurino Guedes Dimitri 
Published: November 2020

Este artigo relata a experiência da construção de uma rede de apoio a trabalhadores(as) informais e pequenos produtores rurais, no interior do RN, durante a pandemia do Covid-19. Parte da perspectiva teórica da educação popular, delineando caminhos cuja intencionalidade é fortalecer a economia local. Assim, problematizando a realidade, são construídas estratégias conjuntas de soluções para manutenção da saúde e luta pela dignidade. Na primeira etapa, o mapeamento dos serviços foi implantado com parcerias estabelecidas (instituições e associações de trabalhadores). Na segunda etapa, foram elaborados materiais de divulgação e de educação em saúde (podcasts, mídias para instagram e a revista eletrônica), divulgados em blogs, linhas de transmissão, rede social do projeto e rádio comunitária. Essa ação tem contribuído para fortalecimento da economia local e construção de uma rede colaborativa.