bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical application of artificial intelligence-assisted diagnosis using anteroposterior pelvic radiographs in children with developmental dysplasia of the hip
Authors: Zhang Si-Cheng , Sun Jun , Liu Chuan-Bin , Fang Ji-Hong , Xie Hong-Tao , Ning Bo 
Published: November 2020

Aims The diagnosis of developmental dysplasia of the hip (DDH) is challenging owing to extensive variation in paediatric pelvic anatomy. Artificial intelligence (AI) may represent an effective diagnostic tool for DDH. Here, we aimed to develop an anteroposterior pelvic radiograph deep learning system for diagnosing DDH in children and analyze the feasibility of its application. Methods In total, 10,219 anteroposterior pelvic radiographs were retrospectively collected from April 2014 to December 2018. Clinicians labelled each radiograph using a uniform standard method. Radiographs were grouped according to age and into ‘dislocation’ (dislocation and subluxation) and ‘non-dislocation’ (normal cases and those with dysplasia of the acetabulum) groups based on clinical diagnosis. The deep learning system was trained and optimized using 9,081 radiographs; 1,138 test radiographs were then used to compare the diagnoses made by deep learning system and clinicians. The accuracy of the deep learning system was determined using a receiver operating characteristic curve, and the consistency of acetabular index measurements was evaluated using Bland-Altman plots. Results In all, 1,138 patients (242 males; 896 females; mean age 1.5 years (SD 1.79; 0 to 10) were included in this study. The area under the receiver operating characteristic curve, sensitivity, and specificity of the deep learning system for diagnosing hip dislocation were 0.975, 276/289 (95.5%), and 1,978/1,987 (99.5%), respectively. Compared with clinical diagnoses, the Bland-Altman 95% limits of agreement for acetabular index, as determined by the deep learning system from the radiographs of non-dislocated and dislocated hips, were -3.27° - 2.94° and -7.36° - 5.36°, respectively (p < 0.001). Conclusion The deep learning system was highly consistent, more convenient, and more effective for diagnosing DDH compared with clinician-led diagnoses. Deep learning systems should be considered for analysis of anteroposterior pelvic radiographs when diagnosing DDH. The deep learning system will improve the current artificially complicated screening referral process. Cite this article: Bone Joint J 2020;102-B(11):1574–1581.
Der Einfluss von IoT-, Big-Data- und Mobile-Health-Lösungen auf die Wertschöpfung in Krankenhäusern: Gap-Analyse und Handlungsempfehlungen
Authors: Neft Florian , Kappler Karolin Eva , Smolnik Stefan 
Published: November 2020

ZusammenfassungDeutsche Krankenhäuser sehen sich heutzutage mit Herausforderungen wie der Globalisierung, dem demographischen Wandel, nachhaltiger Entwicklung und den Folgen des Corona-Virus konfrontiert. Um in diesen Zeiten die Versorgungsqualität zu verbessern, profitabel zu wirtschaften und die Resilienz gegenüber diesen allgemeinen und spezifischen Risiken zu erhöhen, ist in Krankenhäusern ein Optimierungsbedarf erkennbar. Daher werden in dieser Arbeit Mängel im Leistungsspektrum deutscher Krankenhäuser untersucht, um darauf aufbauend aktuelle Lösungsansätze zu diskutieren. Die hierfür interviewten Krankenhausleiter erkennen in der Kommunikation, der Reaktionsfähigkeit bei Patientenanstiegen, der Verwaltung sowie der IT-Ausstattung Verbesserungspotenziale. Die Antworten zu den verwendeten IT-Systemen weisen darauf hin, dass die Krankenhäuser bereits diverse Technologien einsetzen, diese allerdings häufig veraltet sind, zu wenige Schnittstellen besitzen und somit die Anforderungen des Personals und der Patienten nicht erfüllen. In der Evaluierung zeigen sich durch die Verwendung von Informations- und Kommunikationstechnologien wie Mobile Health, Big Data und dem Internet of Things langfristig Potenziale, die Leistungs- und Nachhaltigkeitsdefizite zu lösen. Weiterhin tragen sie zur Verbesserung vieler Wertschöpfungsprozesse bei. Auch für andere Technologien wie Robotik, Virtual und Augmented Reality sowie RFID bestehen zahlreiche Nutzungspotenziale. Dennoch bindet die Digitalisierung personelle und finanzielle Mittel, dient aber durch verbesserte Planungsmöglichkeiten der Ressourceneinsparung und somit der Nachhaltigkeit.
Urine metabolomics of rats with chronic atrophic gastritis
Authors: Zu Guo-Xiu , Sun Qian-Qian , Chen Jian , Liu Xi-Jian , Sun Ke-Yun , Zhang Liang-Kun , Li Ling , Han Tao , Huang Hai-Liang 
Published: November 2020

Background/aim
To use liquid chromatography-mass spectrometry (LC-MS) to identify endogenous differential metabolites in the urine of rats with chronic atrophic gastritis (CAG).

Materials and methods
Methylnitronitrosoguanidine (MNNG) was used to produce a CAG model in Wistar rats, and HE staining was used to determine the pathological model. LC-MS was used to detect the differential metabolic profiles in rat urine. Diversified analysis was performed by the statistical method.

Results
Compared with the control group, the model group had 68 differential metabolites, 25 that were upregulated and 43 that were downregulated. The main metabolic pathways were D-glutamine and D-glutamic acid metabolism, histidine metabolism and purine metabolism.

Conclusion
By searching for differential metabolites and metabolic pathways in the urine of CAG rats, this study provides effective experimental data for the pathogenesis and clinical diagnosis of CAG.
Organizing pneumonia of COVID-19: Time-dependent evolution and outcome in CT findings
Authors: Wang Yan , Jin Chao , Wu Carol C. , Zhao Huifang , Liang Ting , Liu Zhe , Jian Zhijie , Li Runqing , Wang Zekun , Li Fen , Zhou Jie , Cai Shubo , Liu Yang , Li Hao , Liang Yukun , Tian Cong , Yang Jian 
Published: November 2020

Background
As a pandemic, a most-common pattern resembled organizing pneumonia (OP) has been identified by CT findings in novel coronavirus disease (COVID-19). We aimed to delineate the evolution of CT findings and outcome in OP of COVID-19.

Materials and methods
106 COVID-19 patients with OP based on CT findings were retrospectively included and categorized into non-severe (mild/common) and severe (severe/critical) groups. CT features including lobar distribution, presence of ground glass opacities (GGO), consolidation, linear opacities and total severity CT score were evaluated at three time intervals from symptom-onset to CT scan (day 0–7, day 8–14, day > 14). Discharge or adverse outcome (admission to ICU or death), and pulmonary sequelae (complete absorption or lesion residuals) on CT after discharge were analyzed based on the CT features at different time interval.

Results
79 (74.5%) patients were non-severe and 103 (97.2%) were discharged at median day 25 (range, day 8–50) after symptom-onset. Of 67 patients with revisit CT at 2–4 weeks after discharge, 20 (29.9%) had complete absorption of lesions at median day 38 (range, day 30–53) after symptom-onset. Significant differences between complete absorption and residuals groups were found in percentages of consolidation (1.5% vs. 13.8%, P = 0.010), number of involved lobe > 3 (40.0% vs. 72.5%, P = 0.030), CT score > 4 (20.0% vs. 65.0%, P = 0.010) at day 8–14.

Conclusion
Most OP cases had good prognosis. Approximately one-third of cases had complete absorption of lesions during 1–2 months after symptom-onset while those with increased frequency of consolidation, number of involved lobe > 3, and CT score > 4 at week 2 after symptom-onset may indicate lesion residuals on CT.
Increased malaria parasitaemia among adults living with HIV who have discontinued cotrimoxazole prophylaxis in Kitgum district, Uganda
Authors: Orishaba Philip , Kalyango Joan N. , Byakika-Kibwika Pauline , Arinaitwe Emmanuel , Wandera Bonnie , Katairo Thomas , Muzeyi Wani , Nansikombi Hildah Tendo , Nakato Alice , Mutabazi Tobius , Kamya Moses R. , Dorsey Grant , Nankabirwa Joaniter I. 
Published: November 2020

BackgroundAlthough WHO recommends cotrimoxazole (CTX) discontinuation among HIV patients who have undergone immune recovery and are living in areas of low prevalence of malaria, some countries including Uganda recommend CTX discontinuation despite having a high malaria burden. We estimated the prevalence and factors associated with malaria parasitaemia among adults living with HIV attending hospital outpatient clinic before and after discontinuation of CTX prophylaxis.MethodsBetween March and April 2019, 599 participants aged 18 years and above, and attending Kitgum hospital HIV clinic in Uganda were enrolled in a cross study. A standardized questionnaire was administered and physical examination conducted. A finger-prick blood sample was collected for identification of malaria parasites by microscopy. The prevalence of parasitaemia was estimated and compared among participants on and those who had discontinued CTX prophylaxis, and factors associated with malaria parasitaemia assessed.ResultsOf the enrolled participants, 27 (4.5%) had malaria parasites and 452 (75.5%) had stopped CTX prophylaxis. Prevalence of malaria parasitaemia was significantly higher in participants who had stopped CTX prophylaxis (5.5% versus 1.4% p = 0.03) and increased with increasing duration since the discontinuation of prophylaxis. Compared to participants taking CTX, those who discontinued prophylaxis for 3–5 months and >5 months were more likely to have malaria parasites (adjusted prevalence ratio (aPR) = 1.64, 95% CI 0.37–7.29, p = 0.51, and aPR = 6.06, 95% CI 1.34–27.3, P = 0.02). Low CD4 count (< 250cells/mm3) was also associated with increased risk of having parasites (aPR = 4.31, 95% CI 2.13–8.73, p <0.001).ConclusionPeople from malaria endemic settings living with HIV have a higher prevalence of malaria parasitaemia following discontinuation of CTX compared to those still on prophylaxis. The risk increased with increasing duration since discontinuation of the prophylaxis. HIV patients should not discontinue CTX prophylaxis in areas of Uganda where the burden of malaria remains high. Other proven malaria control interventions may also be encouraged in HIV patients following discontinuation of CTX prophylaxis.
The cost of cancer – A comparative analysis of the direct medical costs of cancer and other major chronic diseases in Europe
Authors: Schlueter Max , Chan Katie , Lasry Romain , Price Martin 
Published: November 2020

Background
Cancer poses a significant mortality, morbidity, economic and humanistic burden to patients and health systems. This study aims to better understand healthcare expenditure on cancer relative to other major chronic diseases across France, Germany, Italy, Spain and the United Kingdom, whilst also considering the burden of illness posed by these conditions.

Methods
A targeted literature review was performed to identify and extract relevant demographic, epidemiological and economic data. A health care payer perspective was adopted for the analysis, with a focus on direct healthcare costs.

Results
Between 2006–2015, the cancer-related disability-adjusted life year (DALY) disease burden decreased by 9.3% despite a 6.5% increase in prevalence. Whilst the per patient drug costs increased by a compound annual growth rate (CAGR) of 5.1%, the overall per patient cancer costs decreased over the 10-year study period (CAGR of -1.4%). Compared to cardiovascular disease, neurological/mental disorders and diabetes, cancer was associated with the highest disease burden (20.8% of DALYs across all diseases) but the second-lowest healthcare expenditure levels (4.8% of total healthcare expenditure) among the studied major chronic diseases.

Conclusions
Our study suggests that the costs associated with treating cancer account for a low proportion of total healthcare expenditure relative to the burden of the disease and compared to other major chronic diseases across the countries included in the analysis.
Novel measurement tool and model for aberrant urinary stream in 3D printed urethras derived from human tissue
Authors: Cohen Andrew J. , Patino German , Mirramezani Mehran , Srirangapatanam Sudarshan , Tresh Anas , Cheema Bhagat , Tai Jenny , Romero Dylan , Enriquez Anthony , Baskin Laurence S. , Shadden Shawn C. , Breyer Benjamin N. 
Published: November 2020

Background
An estimated 10% of male adults have split or dribbled stream leading to poor hygiene, embarrassment, and inconvenience. There is no current metric that measures male stream deviation.

Objective
To develop a novel method to measure spray in normal and abnormal anatomical conformations.

Design, setting, and participants
We developed a novel platform to reliably describe spray. We used cadaveric tissues and 3D Printed models to study the impact of meatal shape on the urinary stream. Cadaveric penile tissue and 3D printed models were affixed to a fluid pump and used to simulate micturition. Dye captured on fabric allowed for spray detection.

Outcome measurements and statistical analysis
Spray pattern area, deviation from normal location, and flowrates were recorded. Computational fluid dynamic models were created to study fluid vorticity.

Results and limitations
Obstructions at the penile tip worsened spray dynamics and reduced flow. Ventral meatotomy improved flowrate (p<0.05) and reduced spray (p<0.05) compared to tips obstructed ventrally, dorsally or in the fossa navicularis. 3D models do not fully reproduce parameters of their parent cadaver material. The average flowrate from 3D model was 10ml/sec less than that of the penis from which it was derived (p = 0.03). Nonetheless, as in cadavers, increasing obstruction in 3D models leads to the same pattern of reduced flowrate and worse spray. Dynamic modeling revealed increasing distal obstruction was correlated to higher relative vorticity observed at the urethral tip.

Conclusions
We developed a robust method to measure urine spray in a research setting. Dynamic 3D printed models hold promise as a methodology to study common pathologies in the urethra and corrective surgeries on the urine stream that would not be feasible in patients. These novel methods require further validation, but offer promise as a research and clinical tool.
The association of Medicaid expansion and racial/ethnic inequities in access, treatment, and outcomes for patients with acute myocardial infarction
Authors: Valdovinos Erica M. , Niedzwiecki Matthew J. , Guo Joanna , Hsia Renee Y. 
Published: November 2020

IntroductionAfter having an acute myocardial infarction (AMI), racial and ethnic minorities have less access to care, decreased rates of invasive treatments such as percutaneous coronary intervention (PCI), and worse outcomes compared with white patients. The objective of this study was to determine whether the Affordable Care Act’s expansion of Medicaid eligibility was associated with changes in racial disparities in access, treatments, and outcomes after AMI.MethodsQuasi-experimental, difference-in-differences-in-differences analysis of non-Hispanic white and minority patients with acute myocardial infarction in California and Florida from 2010–2015, using linear regression models to estimate the difference-in-differences. This population-based sample included all Medicaid and uninsured patients ages 18–64 hospitalized with acute myocardial infarction in California, which expanded Medicaid through the Affordable Care Act beginning as early as July 2011 in certain counties, and Florida, which did not expand Medicaid. The main outcomes included rates of admission to hospitals capable of performing PCI, rates of transfer for patients who first presented to hospitals that did not perform PCI, rates of PCI during hospitalization and rates of early (within 48 hours of admission) PCI, rates of readmission to the hospital within 30 days, and rates of in-hospital mortality.ResultsA total of 55,991 hospital admissions met inclusion criteria, 32,540 of which were in California and 23,451 were in Florida. Among patients with AMI who initially presented to a non-PCI hospital, the likelihood of being transferred increased by 12 percentage points (95% CI 2 to 21) for minority patients relative to white patients after the Medicaid expansion. The likelihood of undergoing PCI increased by 3 percentage points (95% CI 0 to 5) for minority patients relative to white patients after the Medicaid expansion. We did not find an association between the Medicaid expansion and racial disparities in overall likelihood of admission to a PCI hospital, hospital readmissions, or in-hospital mortality.ConclusionsThe Medicaid expansion was associated with a decrease in racial disparities in transfers and rates of PCI after AMI. We did not find an association between the Medicaid expansion and admission to a PCI hospital, readmissions, and in-hospital mortality. Additional factors outside of insurance coverage likely continue to contribute to disparities in outcomes after AMI. These findings are crucial for policy makers seeking to reduce racial disparities in access, treatment and outcomes in AMI.
Location but Not Severity of Endoscopic Lesions Influences Endoscopic Remission Rates in Crohn's Disease: A Post Hoc Analysis of TAILORIX
Authors: Rivière Pauline , D'Haens Geert , Peyrin-Biroulet Laurent , Baert Filip , Lambrecht Guy , Pariente Benjamin , Bossuyt Peter , Buisson Anthony , Oldenburg Bas , Vermeire Séverine , Laharie David 
Published: November 2020

INTRODUCTION:
The impact of severity and location of Crohn's disease (CD) endoscopic ulcers on endoscopic remission in patients treated with antitumor necrosis factor is poorly known. We aimed to describe the endoscopic evolution of CD lesions in a prospective cohort of patients treated with infliximab (IFX) in combo therapy.

METHODS:
We conducted a post hoc analysis of the TAILORIX randomized controlled trial, which studied biologic-naïve patients with active CD and endoscopic ulcers receiving IFX combo therapy. Ileocolonoscopies were performed at week 0, 12, and 54. Endoscopic healing was defined as the absence of ulcers and complete endoscopic remission as CD Endoscopic Index of Severity (CDEIS) <3. Ileocolonic segments were scored separately for remission by blinded readers.

RESULTS:
A total of 122 (median disease duration: 7 months) patients were included, corresponding with 379 diseased segments. The median (IQR) CDEIS scores at week 0, 12, and 54 were 9.9 (6.1–14.4), 2.4 (0.2–4.6), and 0.2 (0.0–3.7), respectively. At weeks 12 and 54, the rates of endoscopic healing and complete endoscopic remission were 41% and 61% and 61% and 73%, respectively. Median CDEIS scores were similar among patients with deep ulcers at baseline and those with only superficial ulcers at week 12 and 54. Segmental remission rates were lower both at week 12 and 54 in the ileum compared with colonic segments (P < 0.01 all comparisons) and in the rectum (P = 0.02 and P = 0.03).

DISCUSSION:
In biologic-naive patients with CD treated with IFX combo therapy, the severity of endoscopic lesions at the baseline did not influence healing rates. Endoscopic remission occurs less frequently in the ileum compared with the colon.
Ni de aquí ni de alla: A Mythohistoriography of Growing Up In-Between
Authors: López Andrés C. 
Published: November 2020

AbstractUsing Aurora Levins Morales’ concept of “medicinal histories,” and Audre Lorde’s “biomythography,” this mythohistoriography weaves together multiple histories of the Guatemalan Civil War, Indigenous stories of resistance in Guatemala, queer and trans presences and erasures, the author’s family stories during this time, and the author’s upbringing as this armed conflict was supposedly ending. Through a Two-Spirit critique this layering project calls for different types of historicizing practices and methodologies for queer and trans studies to focus on in order to do responsible decolonial work. Ultimately, this project is part of a healing praxis meant to deal with generational traumas forged through forcefully forgotten and erased historias and memories of queer and trans Indigenous Guatemalans.
Perverse Politics, Postsocialist Radicality: Queer Marxism in China
Authors: Tian Ian Liujia 
Published: November 2020

Abstract
This article offers a queer postsocialist lens to theoretical contestations around neoliberalism, socialist legacies, capitalist reform, and the Chinese state. I foreground a queer Marxist position by situating Chinese capitalist developmentalism in global racial capitalism. I examine a recent GLBTQ hiring event in Shanghai alongside publications and personal involvement with the socialist organization “Queer Workers.” Based on this analysis, I contend that, rather than taking the Chinese state’s leftist legacies for granted, queer Marxism should be read as critical Marxism in the global postsocialist present. In the Marxist perspective, the sexual politics of queer liberation is inherently anti-statist and anti-capitalist. Further, queer Marxism in China, while remaining tied to postsocialism and the afterlife of the Cold War, should be situated within the broader struggle against racial capitalism. Groups like Queer Workers should be taken seriously as they are actively making space for historically and geographically grounded postsocialist radicality on their own terms.