bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clover-Style Fasciocutaneous Perforator Flap for Reconstruction of Massive Sacral Pressure Sores
Authors: Cheng Jian , Zhang Qi , Feng Shiming , Wu Xiaodong , Huo Weiling , Ma Yong , Cai Jianping , Liu Mingming 
Published: June 2020

Background
As a common complication of the long-term bedridden patients, pressure sore is a great challenge for surgeons. The purpose of this study was to explore the surgical method of using a clover-style fasciocutaneous perforator flap raised on the buttocks for the treatment of massive sacral pressure sores and report the clinical outcomes.

Methods
The study included 15 patients from January 2015 to June 2017 with an average age of 52.87 years (range, 32–73 years). The size of the sacral pressure sores ranged from 10 cm × 13 cm to 18 cm × 20 cm. The defects were reconstructed using a fasciocutaneous perforator flap raised on the buttocks after debridement and vacuum sealing drainage treatment for 1 to 2 weeks. All the donor areas were sutured directly.

Results
All flaps survived completely; 13 patients achieved healing by primary intention, and the other 2 patients achieved healing by secondary intention. At the mean follow-up period of 20.8 months (range, 12–46 months), the appearance of the flap, including its texture and color, in all patients was satisfactory. No patients had deep infection, necrosis, or shrinkage of the flap during the follow-up period. One patient had a recurrent bedsore during the 2-year follow-up.

Conclusions
The clover-style fasciocutaneous perforator flap is ideal for the reconstruction of massive sacral pressure sores because it is a relatively simple procedure and results in good appearance and function, few complications, and a low recurrence rate.
Molecular Patterns in Acute Pancreatitis Reflect Generalizable Endotypes of the Host Response to Systemic Injury in Humans
Authors: Neyton Lucile P. A. , Zheng Xiaozhong , Skouras Christos , Doeschl-Wilson Andrea , Gutmann Michael U. , Uings Iain , Rao Francesco V. , Nicolas Armel , Marshall Craig , Wilson Lisa-Marie , Baillie J. Kenneth , Mole Damian J. 
Published: June 2020

Objective:
Acute Pancreatitis (AP) is sudden onset pancreas inflammation that causes systemic injury with a wide and markedly heterogeneous range of clinical consequences. Here, we hypothesized that this observed clinical diversity corresponds to diversity in molecular subtypes that can be identified in clinical and multiomics data.

Summary Background Data:
Observational cohort study. n = 57 for the discovery cohort (clinical, transcriptomics, proteomics, and metabolomics data) and n = 312 for the validation cohort (clinical and metabolomics data).

Methods:
We integrated coincident transcriptomics, proteomics, and metabolomics data at serial time points between admission to hospital and up to 48 hours after recruitment from a cohort of patients presenting with acute pancreatitis. We systematically evaluated 4 different metrics for patient similarity using unbiased mathematical, biological, and clinical measures of internal and external validity.
We next compared the AP molecular endotypes with previous descriptions of endotypes in a critically ill population with acute respiratory distress syndrome (ARDS).

Results:
Our results identify 4 distinct and stable AP molecular endotypes. We validated our findings in a second independent cohort of patients with AP.
We observed that 2 endotypes in AP recapitulate disease endotypes previously reported in ARDS.

Conclusions:
Our results show that molecular endotypes exist in AP and reflect biological patterns that are also present in ARDS, suggesting that generalizable patterns exist in diverse presentations of critical illness.
Application and Value of Endoscopic Ultrasonography Guided Biliary Interventional Therapy in Patients With Biliary Obstruction and Surgically Altered Anatomy
Authors: Huang Ping , Zhang Hao , Zhang Xiao-Feng , Lv Wen , Fan Zhen 
Published: June 2020

Aim:
The aim of this study was to evaluate the efficacy and safety of endoscopic ultrasound-guided biliary drainage (EUS-BD) in patients with biliary obstruction and surgically altered anatomy.

Patients and Methods:
This was a retrospective study. We collected data from 60 patients with biliary obstruction and surgically altered anatomies who undergone EUS-BD (group A, 33 cases) and percutaneous transhepatic biliary drainage (PTBD) (group B, 27 cases) after unsuccessful endoscopic retrograde cholangiopancreatography from January 2016 to January 2018. The operation success rate, the clinical success rate, complications, hospital stay were observed.

Results:
In group A, 31 cases of 33 patients were successfully operated and placed stents or drainage tube by endoscopic ultrasound puncture [endoscopic ultrasonography (EUS) guided rendezvous 8, EUS-guided hepaticogastrostomy 14, EUS-guided choledochoduodenostomy 11], 28 had a significant decrease in jaundice. The complications rate was 9.1% (biliary bleeding 2; acute cholangitis 1). There was statistically significant difference in the complications [9.09% (3/33) vs. 33.33% (9/27), χ2=5.45, P<0.05] and length of hospital stay (14.45±5.78 vs. 18.52±8.64 d, t=10.03, P<0.01) between group A and group B. There was not statistical significance in the technical and clinical success rate between 2 groups [93.94% (31/33) vs. 92.60% (25/27), 84.85% (28/33) vs. 85.19% (23/27), χ2
1=0.10, χ2
2=0.11, P>0.05].

Conclusion:
EUS-BD may be the first choice for patients with biliary obstruction and surgically altered anatomy after a failed endoscopic retrograde cholangiography in centers with expertise in EUS-BD procedures.
Donor Hepatectomy and Implantation Time Are Associated With Early Complications After Liver Transplantation: A Single-center Retrospective Study
Authors: Gilbo Nicholas , Fieuws Steffen , Meurisse Nicolas , Nevens Frederik , van der Merwe Schalk , Laleman Wim , Verslype Chris , Cassiman David , van Malenstein Hannah , Roskams Tania , Sainz-Barriga Mauricio , Pirenne Jacques , Jochmans Ina , Monbaliu Diethard 
Published: June 2020

Background.
Donor hepatectomy and liver implantation time reduce long-term graft and patient survival after liver transplantation. It is not known whether these surgical times influence early outcomes after liver transplantation.

Methods.
This single-center study evaluated the effect of donor hepatectomy and implantation time on the risk of nonanastomotic biliary strictures (NAS) occurring within 1 year and of early allograft dysfunction (EAD) after deceased-donor solitary liver transplantation, adjusting for other donors, recipient, and surgical factors.

Results.
Of 917 transplants performed between January 2000 and December 2016, 106 (11.56%) developed NAS and 247 (27%) developed EAD. Donor hepatectomy time (median 35 min, IQR: 26–46) was an independent risk factor of NAS [adjusted hazard ratio, 1.19; 95% CI, 1.04-1.35; P = 0.01]. Implantation time (median 80 min, IQR: 69–95) was independently associated with EAD [adjusted odds ratio (OR), 1.15; 95% CI,1.07-1.23; P < 0.0001). The risk of EAD was increased by anastomosis time of both portal vein (adjusted OR, 1.26; 95% CI, 1.12-14.42; P = 0.0001) and hepatic artery (adjusted OR, 1.13; 95% CI, 1.04-1.22; P = 0.005). The magnitude of these effects was similar in donation after circulatory death liver grafts.

Conclusions.
Donor hepatectomy and implantation time negatively affect short-term outcomes.
EEG Synchronization—Parameters in Patients With Subcortical Arteriosclerotic Encephalopathy and Gait Disorder
Authors: Yazdani Babak , Yücel Gökhan , Landwehr Ralf 
Published: June 2020

Purpose:
Subcortical arteriosclerotic encephalopathy (SAE) is characterized by extensive white matter lesions in the MRI. Clinical symptoms are cognitive impairment, ranging from mild deficits to vascular dementia, impaired executive functioning, and gait disorders. In the EEG of SAE patients with vascular dementia, the lower frequencies are increased. However, it is unclear whether EEG changes also exist in SAE patients with gait disorders but without vascular dementia.

Methods:
The authors analyzed the EEGs of 50 nondemented patients with SAE and gait disorders and 50 healthy controls applying pointwise transinformation as a measure of synchronization.

Results:
Hundred seconds of waking EEG that appeared unaltered in visual analysis were sufficient to prove changes in synchronization. The authors found a decrease in the mean level of synchronization, combined with an elongation of synchronization time in all examined brain areas. These effects correlated slightly with the extent of subcortical lesions.

Conclusions:
Changes in EEG synchronization in patients with SAE and gait disorders seem to occur independently of cognitive function. The causal relationship of the changes in EEG synchronization and gait disorders remains to be clarified. The results of this study might point to a decrease in coupling efficiency in these patients, with the increase in synchronization duration as a possible compensatory mechanism. Because a time-efficient signal transmission particularly during gait execution is crucial, reduced efficiency might contribute to an impairment of postural stabilization. The study results might indicate a neuronal network for planning and execution of motor activity and particularly gait, extending from the frontal over the central to the parietal cortex.
Completeness of intervention reporting in neurology randomized controlled trials: a retrospective, cross-sectional study
Authors: Roberts William , Beavers Craig , Jellison Samuel , Vassar Matt 
Published: June 2020

ABSTRACT

Aim:
Incomplete reporting of interventions in randomized controlled trials (RCTs) may hinder the replicability of studies and thus lead to adverse clinical outcomes for patients. Currently, little is known about the completeness of intervention reporting in neurology clinical trials. This study's primary objective was to determine the completeness of intervention reporting in neurology RCTs, as measured by the Template for Intervention Description and Replication (TIDieR) checklist. The secondary objectives of this study were to compare the completeness of intervention reporting before and after TIDieR publication and to evaluate factors associated with intervention reporting.

Methods:
We conducted a cross-sectional, pilot-tested, double-blind investigation of 141 neurology RCTs to determine the completeness of intervention reporting in neurology.

Results:
Overall, the average number of TIDieR checklist items that reached completion per study was 7.4 out of 12 (61.7%). We found no increase in intervention reporting following the publication of TIDieR (P = 0.35). Our generalized estimating equation analysis found that poorer TIDieR adherence was associated with trials lacking a trial registration (P = 0.03).

Conclusion:
Our findings showed that on average, authors reported only 61.7% of items on the TIDieR checklist. These findings have significant implications, because incomplete reporting may hinder the replicability of studies and thus negatively affect clinical outcomes for patients.
Extensive layer clouds in the global electric circuit: their effects on vertical charge distribution and storage
Authors: Harrison R. Giles , Nicoll Keri A. , Mareev Evgeny , Slyunyaev Nikolay , Rycroft Michael J. 
Published: June 2020

A fair-weather electric field has been observed near the Earth's surface for over two centuries. The field is sustained by charge generation in distant disturbed weather regions, through current flow in the global electric circuit. Conventionally, the fair-weather part of the global circuit has disregarded clouds, but extensive layer clouds, important to climate, are widespread globally. Such clouds are not electrically inert, becoming charged at their upper and lower horizontal boundaries from vertical current flow, in a new electrical regime—neither fair nor disturbed weather; hence it is described here as
semi-fair weather
. Calculations and measurements show the upper cloud boundary charge is usually positive, the cloud interior positive and the lower cloud boundary negative, with the upper charge density larger, but of the same magnitude (∼nC m
−2
) as cloud base. Globally, the total positive charge stored by layer clouds is approximately 10
5
C, which, combined with the positive charge in the atmospheric column above the cloud up to the ionosphere, balances the total negative surface charge of the fair-weather regions. Extensive layer clouds are, therefore, an intrinsic aspect of the global circuit, and the resulting natural charging of their cloud droplets is a fundamental atmospheric feature.
The Risk of Lifting COVID-19 Confinement in Mexico
Authors: Ricardo Cristy Leonor Azanza , Hernandez-Vargas Esteban A. 
Published: June 2020

ABSTRACTThe novel coronavirus SARS-CoV-2 has paralysed our societies, leading to self isolation and quarantine for several days. As the 10th most populated country in the world, Mexico is on a major threat by COVID-19 due to the limitations of intensive care capacities, and a total of about 1.5 hospital beds for every 1000 citizens. In this paper, we projected different scenarios to evaluate sharp or gradual quarantine lifting strategies, however, even in the hypothetical scenario that Mexico would continue with full confinement, hospitals would be reaching the maximum capacity of hospital bed occupancy. Mexican government is planning to relax the strict social distancing regulations on 1 June 2020, however, epidemic rebound risks are latent.Our results suggest that lifting social confinement needs to be gradually sparse while maintaining a decentralized region strategy among the Mexican states. To substantially lower the number of infections, predictions highlight that the elderly should remain in social confinement (approximately 11.3% of the population); the confined working class (roughly 27% of the population) must gradually return in at least four parts in consecutive months; and to the last the return of students to schools (about 21.7%). As the epidemic progresses, de-confinement strategies need to be continuously re-adjusting with the new pandemic data. Assuming the most optimistic scenario by our predictions, the smallest number of new COVID-19 cases, Mexico would require at least a 3 fold increase in hospital capacities dedicated for COVID-19. Furthermore, to observe the real dimension of the epidemic, Mexico would need to increase to at least 18 samples per 1000 people, currently is only 0.6 per 1000.All mathematical models, including ours, are only a possibility of many of the future, however, the different scenarios that were developed here highlight that a gradual decentralized region de-confinement with a significant increase in healthcare capacities is paramount to avoid a high death toll in Mexico.
Uncertainty Quantification in Epidemiological Models for COVID-19 Pandemic
Authors: Taghizadeh Leila , Karimi Ahmad , Heitzinger Clemens 
Published: June 2020

AbstractThe main goal of this paper is to develop the forward and inverse modeling of the Coronavirus (COVID-19) pandemic using novel computational methodologies in order to accurately estimate and predict the pandemic. This leads to governmental decisions support in implementing effective protective measures and prevention of new outbreaks. To this end, we use the logistic equation and the SIR system of ordinary differential equations to model the spread of the COVID-19 pandemic. For the inverse modeling, we propose Bayesian inversion techniques, which are robust and reliable approaches, in order to estimate the unknown parameters of the epidemiological models. We use an adaptive Markov-chain Monte-Carlo (MCMC) algorithm for the estimation of a posteriori probability distribution and confidence intervals for the unknown model parameters as well as for the reproduction number. Furthermore, we present a fatality analysis for COVID-19 in Austria, which is also of importance for governmental protective decision making. We perform our analyses on the publicly available data for Austria to estimate the main epidemiological model parameters and to study the effectiveness of the protective measures by the Austrian government. The estimated parameters and the analysis of fatalities provide useful information for decision makers and makes it possible to perform more realistic forecasts of future outbreaks.
Classification of schizophrenia spectrum disorder using machine learning and functional connectivity: reconsidering the clinical application
Authors: Li Chao , Wang Fei , Jiang Xiaowei , Chen Ji , Duan Jia , Han Shaoqiang , Yan Hao , Tang Yanqing , Xu Ke 
Published: June 2020

AbstractAn accurate identification of schizophrenia spectrum disorder (SSD) at early stage could potentially allow for treating SSD with appropriate intervention to potentially prevent future deterioration. Despite mounting studies found neuroimaging combined with machine learning can identify chronic medicated SSD, whether or not the classification model identified the trait biomarker of SSD that can be used to identify early stage SSD is largely unknown. The present study aimed to investigate whether or not the classification model trained using chronic medicated SSD identified the trait biomarker of SSD that whether or not the model can be generalized to early stage SSD, by using functional connectivity (FC) combined with support vector machine (SVM) using a large sample from 4 independent sites (n = 1077). We found that the classification model trained using chronic medicated SSD from three sites(dataset 2, 3 and 4) classified SSD from HCs in another site (dataset 1) with 69% accuracy (P = 2.86e-13). Subgroup analysis indicated that this model can identify chronic medicated SSD in dataset 1 with 71% sensitivity (P = 4.63e-05), but cannot be generalized to first episode unmedicated SSD (sensitivity = 48%, P = 0.68) and first episode medicated SSD (sensitivity = 59%, P = 0.10). Univariable analysis showed that medication usage had significant effect on FC, but disease duration had no significant effect on FC. These findings suggest that the classification model trained using chronic medicated SSD may mainly identified the pattern of chronic medication usage state, rather than the trait biomarker of SSD. Therefore, we should reconsider the current machine learning studies in chronic medicated SSD more cautiously in term of the clinical application.
Exhaled breath is a significant source of SARS-CoV-2 emission
Authors: Ma Jianxin , Qi Xiao , Chen Haoxuan , Li Xinyue , Zhang Zheng , Wang Haibin , Sun Lingli , Zhang Lu , Guo Jiazhen , Morawska Lidia , Grinshpun Sergey A. , Biswas Pratim , Flagan Richard C. , Yao Maosheng 
Published: June 2020

AbstractDespite notable efforts in airborne SARS-CoV-2 detection, no clear evidence has emerged to show how SARS-CoV-2 is emitted into the environments. Here, 35 COVID-19 subjects were recruited; exhaled breath condensate (EBC), air samples and surface swabs were collected and analyzed for SARS-CoV-2 using reverse transcription-polymerase chain reaction (RT-PCR). EBC samples had the highest positive rate (16.7%, n = 30), followed by surface swabs(5.4%, n = 242), and air samples (3.8%, n = 26). COVID-19 patients were shown to exhale SARSCoV-2 into the air at an estimated rate of 103-105 RNA copies/min; while toilet and floor surfaces represented two important SARS-CoV-2 reservoirs. Our results imply that airborne transmission of SARS-CoV-2 plays a major role in COVID-19 spread, especially during the early stages of the disease.One Sentence SummaryCOVID-19 patient exhales millions of SARS-CoV-2 particles per hour
The mechanism of analgesia in NaV1.7 null mutants
Authors: MacDonald Donald Iain , Sikandar Shafaq , Weiss Jan , Pyrski Martina , Luiz Ana P. , Millet Queensta , Emery Edward C. , Mancini Flavia , Iannetti Gian D. , Alles Sascha R.A. , Zhao Jing , Cox James J , Brownstone Robert M. , Zufall Frank , Wood John N. 
Published: June 2020

SummaryDeletion ofSCN9Aencoding the voltage-gated sodium channel NaV1.7 in humans leads to profound pain insensitivity and anosmia. Conditional deletion of NaV1.7 in sensory neurons of mice also abolishes pain suggesting the locus of analgesia is the nociceptor. Here we demonstrate that NaV1.7 knockout mice have essentially normal nociceptor activity usingin vivocalcium imaging and extracellular recording. However, glutamate and substance P release from nociceptor central terminals in the spinal cord is greatly reduced by an opioid-dependent mechanism. Analgesia is also substantially reversed by central but not peripheral application of opioid antagonists. In contrast, the lack of neurotransmitter release from olfactory sensory neurons is opioid-independent. Male and female humans with NaV1.7 null mutations show naloxone reversible analgesia. Thus opioid-dependent inhibition of neurotransmitter release is the principal mechanism of NaV1.7 null analgesia in mice and humans.
A cohort study to evaluate the effect of combination Vitamin D, Magnesium and Vitamin B12 (DMB) on progression to severe outcome in older COVID-19 patients
Authors: Tan Chuen Wen , Ho Liam Pock , Kalimuddin Shirin , Cherng Benjamin Pei Zhi , Teh Yii Ean , Thien Siew Yee , Wong Hei Man , Tern Paul Jie Wen , Chandran Manju , Chay Jason Wai Mun , Nagarajan Chandramouli , Sultana Rehena , Low Jenny Guek Hong , Ng Heng Joo 
Published: June 2020

AbstractObjectiveTo determine the clinical outcomes of older COVID-19 patients who received DMB compared to those who did not. We hypothesized that fewer patients administered DMB would require oxygen therapy and/or intensive care support than those who did not.MethodologyCohort observational study of all consecutive hospitalized COVID-19 patients aged 50 and above in a tertiary academic hospital who received DMB compared to a recent cohort who did not. Patients were administered oral vitamin D3 1000 IU OD, magnesium 150mg OD and vitamin B12 500mcg OD (DMB) upon admission if they did not require oxygen therapy. Primary outcome was deterioration post-DMB administration leading to any form of oxygen therapy and/or intensive care support.ResultsBetween 15 January and 15 April 2020, 43 consecutive COVID-19 patients aged ≥50 were identified. 17 patients received DMB and 26 patients did not. Baseline demographic characteristics between the two groups was significantly different in age. In univariate analysis, age and hypertension showed significant influence on outcome while DMB retained protective significance after adjusting for age or hypertension separately in multivariate analysis. Fewer DMB patients than controls required initiation of oxygen therapy during their hospitalization (17.6% vs 61.5%, P=0.006). DMB exposure was associated with odds ratios of 0.13 (95% CI: 0.03 – 0.59) and 0.20 (95% CI: 0.04 – 0.93) for oxygen therapy and/or intensive care support on univariate and multivariate analyses respectively.ConclusionsDMB combination in older COVID-19 patients was associated with a significant reduction in proportion of patients with clinical deterioration requiring oxygen support and/or intensive care support. This study supports further larger randomized control trials to ascertain the full benefit of DMB in ameliorating COVID-19 severity.
System Dynamics Modeling of Within-Host Viral Kinetics of Coronavirus (SARS CoV-2)
Authors: Burgos Javier 
Published: June 2020

AbstractMathematical models are being used extensively in the study of SARS-CoV-2 transmission dynamics, becoming an essential tool for decision making concerning disease control. It is now required to understand the mechanisms involved in the interaction between the virus and the immune response effector cells, both innate and adaptive, in order to support lines of research related to the use of drugs, production of protective antibodies and of course, vaccines against SARS-CoV-2. The present study, using a system dynamic approach, hypothesizes over the conditions that characterize the fraction of the population which get infected by SARS-CoV-2 as the asymptomatic patients, the mild symptomatic, acute symptomatic, and also super-spreaders, in terms of innate immune response, the initial virus load, the virus burden with shedding events, and the cytokine levels.