bluuebunny/crossref_metadata_2025_split huggingface dataset:
Geometry of the fusiform excision for skin lesions
Authors: Rouzier Roman , Rocher Gregoire 
Published: August 2020

Abstract
Objective

The fusiform excision technique is commonly used by surgeons to remove round skin lesions to minimize "dog-ears" at the ends of the incision. We propose a geometric analysis to easily design the fusiform incision and consequently standardize the surgical procedure.
Background

The classic ellipse is formed by tracing 2 arcs of a circle on the skin. The arcs, which are symmetrical with respect to the midline axis separating them, intersect at their ends to form a convex shape and classically result in a 1:3 width-length ratio between the short and long axes of the ellipse.
Methods

Using basic geometry rules, namely Pythagorean theorem and the ratios of the angles of right triangles, we first calculated the ratio between the radius of the lesion and the radius of the arcs of the circle of the fusiform incision and then the distance between the center of the lesion and the intersection between the line perpendicular to the axis of the fusiform excision and the tangent to the arcs of the circle.
Results

The ratio between the radius of the lesion and the radius of the arcs of the circle of the fusiform incision is 5 and the distance between the center of the lesion and the intersection between the vertical axis and the tangent is 2.25 for a fusiform incision with a width-length ratio of 1:3. We then generalized the formulas.
Conclusions

Our approach provides an introduction to the geometry of dermatologic surgery to students in order to standardize the surgical procedure.
Prevalence of Gingivitis in Second Trimester of Pregnancy
Authors: Shrestha Rejina , Pradhan Shaili , Baral Gehanath 
Published: August 2020

Abstract
Background: There is rare documentation on the prevalence of gingivitis in pregnancy in the least developed countries. The aim of the study is to evaluate the prevalence of gingivitis in the second trimester of pregnancy and assess its relationship with age, parity, education, occupation, gravidity, oral hygiene habit and frequency of brushing.Methods: An observational descriptive study was conducted among 384 pregnant females in their second trimester in Kathmandu, Nepal. Demographic variables and general information including those related to oral hygiene practices and habits were collected during an interview. Plaque index and Gingival Index was recorded among the patients through full mouth examination at four sites.Results: The prevalence of gingivitis in the second trimester of pregnancy was 76.3%. Statistically significant relationship was found between gingivitis and gravida and parity. A relation could not be established between gingivitis with age, education, occupation, oral hygiene habit and frequency of brushing.Conclusions: The prevalence of gingivitis is found to be high in Nepalese pregnant women. Special strategies should be introduced targetting the pregnant women of least developed countries to uplift their periodontal health.
Predictors of Anemia Among Pregnant Women of Under-privileged Ethnic Groups Attending Antenatal Care at Provincial Level Hospital of Province 2, Nepal
Authors: Yadav Umesh Kumar , Ghimire Prabesh , Amatya Archana , Lamichhane Ashish 
Published: August 2020

Abstract
Background: This study aims to determine the predictors of anemia among pregnant women of underprivileged ethnic groups attending antenatal care at provincial level hospital of Province 2.Methods: A hospital based cross-sectional study was carried out in Janakpur Provincial Hospital of Province 2, Southern Nepal. 287 pregnant women from underprivileged ethnic groups attending antenatal care were selected and interviewed. Face to face interviews using structured questionnaire was undertaken. Anemia status was assessed based on hemoglobin levels determined at the hospital’s laboratory. Bivariate and multiple logistic regression analyses were used to identify the predictors of anemia. Analyses were performed using IBM SPSS version 23 software.Results: The overall anemia prevalence in the study population was 66.9% (95% CI 61.1-72.3). The women from most under-privileged ethnic groups (Terai Dalit, Terai Janajati and Muslims) were twice more likely to be anemic than Madhesi women. Similarly, women having education lower than secondary level were about 3 times more likely to be anemic compared to those with secondary level or higher education. Women who had not completed four antenatal visits were twice more likely to be anemic than those completing all four visits. The odds of anemia were three times higher among pregnant women who had not taken deworming medication compared to their counterparts. Furthermore, women with inadequate dietary diversity were four times more likely to be anemic compared to women having adequate dietary diversity.Conclusions: The prevalence of anemia is a severe public health problem among the pregnant women of under-privileged ethnic groups in Province 2. Being Dalit, Janajati and Muslim, having lower education, less frequent antenatal visits, not receiving deworming medication and having inadequate dietary diversity are found to be the significant predictors. The present study highlights the need of improving the frequency of antenatal visits and coverage of deworming program in ethnic populations. Furthermore, promoting a dietary diversity at the household level would help lower the prevalence of anemia. The study findings also imply that the nutrition interventions to control anemia must target and reach pregnant women from most-marginalized ethnic groups and those with lower education.
Leaf δ15N, δ13C and Their Associations with Soil Fungal Biodiversity, Ectomycorrhizal and Plant Pathogenic Abundance in Forest Ecosystems of China
Authors: Song Wenchen 
Published: August 2020

Abstract
Leaf δ15N and δ13C are important functional traits in biogeographic studies of forest ecosystems. However, little is known about their relationships with soil fungal biodiversity, ectomycorrhizal, and plant pathogen abundance at large scales. In this study, leaf and soil samples were collected from 33 forest reserves along a large range across China to explore the associations between leaf δ15N and δ13C and soil fungal biodiversity, ectomycorrhizal, and plant pathogen relative abundance using molecular and stable isotope techniques. We found large-scale biogeographic patterns for leaf δ15N, δ13C, soil fungal biodiversity, and ectomycorrhizal relative abundance. The soil-plant-microbial interaction may contribute to the variations in leaf δ15N, δ13C, and soil fungal communities across different types of forest ecosystems. Temperature and precipitation were the main factors affecting large-scale biogeographic patterns of latitude and longitude. Leaf δ15N was mainly affected by the relative abundance of ectomycorrhizal fungi and leaf δ13C was affected by the relative abundance of plant pathogens. Leaf δ15N and δ13C may be indicators reflecting soil fungal communities in forest ecosystems.
Rotational Thromboelastometry Predicts Care Level in COVID-19: A Prospective, Observational Study.
Authors: Almskog Lou M. , Wikman Agneta , Svensson Jonas , Wanecek Michael , Bottai Matteo , Linden Jan van der , Ågren Anna 
Published: August 2020

Abstract
BackgroundHigh prevalence of thrombotic events in severely ill COVID-19 patients have been reported. Pulmonary embolism as well as microembolization of vital organs may in these individuals be direct causes of death. The identification of patients at high risk of developing thrombosis may lead to targeted, more effective prophylactic treatment. The aim of this study was to test whether Rotational Thromboelastometry (ROTEM) indicates hypercoagulopathy in COVID-19 patients, and whether patients with severe disease have a more pronounced hypercoagulopathy compared with less severely ill patients. MethodsThe study was designed as a prospective observational study where COVID-19 patients over 18 years admitted to hospital were eligible for inclusion. Patients were divided into two groups depending on care level: 1) regular wards or 2) wards with specialized ventilation support. ROTEM was taken after admission and the data were compared with ROTEM in healthy controls.ResultsThe ROTEM variables Maximum Clot Firmness (EXTEM-/FIBTEM-MCF) were higher in COVID-19 patients compared with healthy controls (p<0.001) and higher in severely ill patients compared with patients at regular wards (p<0.05). Coagulation Time (EXTEM-CT) was longer and Clot Formation Time (EXTEM-CFT) shorter in COVID-19 patients compared with healthy controls. Our results suggest that hypercoagulopathy is present in hospitalized patients with mild to severe COVID-19 pneumonia. ConclusionsROTEM variables were significantly different in COVID-19 patients early after admission compared with healthy controls. This pattern was more pronounced in patients with increased disease severity, suggesting that ROTEM-analysis may be useful to predict thromboembolic complications in these patients.
Institutional Anticoagulation Protocol for Septic DIC is Associated with Differences in In-Hospital Mortality. J-SEPTIC DIC STUDY (A Nationwide Registry Study)
Authors: Tanaka Keiko , Matsumoto Hironori , Ohshita Muneaki , Annen Suguru , Nakabayashi Yuki , Aibiki Mayuki 
Published: August 2020

Abstract
Background: We analyzed data from Japanese nationwide registry study of severe sepsis/septic shock to determine the influence of institutional treatment protocol, which has not been evaluated, on in-hospital mortality rate in septic DIC. Methods: From among all sepsis patients (n=3193), we selected those (n=1856) diagnosed with DIC according to the JAAM criteria, then divided them into three groups depending on DIC treatment protocol: patients admitted to hospitals providing basically no anti-coagulation therapy (NO-TX group: n=287); those admitted to hospitals routinely providing such treatment (anti-thrombin concentrate and/or rh-thrombomodulin or other anti-coagulants such as heparin/heparinoids: DO-TX group: n=1202); and those admitted to hospitals providing treatment at the discretion of the physician-in-charge (DEP-TX group: n=446). Results: In DIC patients only, in-hospital mortality was much higher in the NO-TX group (46.2%) than in the DO-TX group (34.1%) despite comparable APACHE II scores. The hazard ratio (HR) of mortality was much lower in the DO-TX group (0.76, 95% CI: 0.61-0.96) than in the NO-TX group (set at 1.0). When non-DIC subjects whose records contained complete information on JAAM and ISTH scores were also included (n=2513), however, different treatment protocols were no longer associated with differences in HR. Nevertheless, in-hospital mortality rates still differed among the three groups even after non-DIC patients were included. Conclusions: Thus, the present results support the use of anti-coagulation treatments for septic DIC and suggest that outcomes are affected by other institutional factors besides anti-coagulation protocol, such as an institutional approach to sepsis. The mechanisms underlying this effect should be clarified.
Early Critical Care Transthoracic Echocardiography Improves the Mortality of Patients Undergoing Mechanical Ventilation: Observational Data From Two Large Databases.
Authors: Yu Xueshu , Jiang Hao , Chen Wenjing , Pan Lingling , Fang Zhendong , Zhang Xianwei , Chen Zhiqiang , Shu Jie , Ye Yincai , pan jingye 
Published: August 2020

Abstract
Background: Critical care transthoracic echocardiography (TTE) can quickly and accurately assess haemodynamic changes in ICU patients. However, it is not clear whether transthoracic echocardiography improves the prognosis of mechanically ventilated patients. In this study, we hypothesized that early critical care transthoracic echocardiography independently contributes to improvements in mortality in mechanically ventilated patients in the ICU.Methods: This was a retrospective study based on the Medical Information Mart for Intensive Care III (MIMIC-III) database and the eICU Collaborative Research Database (eICU-CRD). Patients undergoing mechanical ventilation for more than 48 hours were selected. The exposure of interest was early TTE. The primary outcome was in-hospital mortality. We used propensity score matching to analyse the association between early TTE and in-hospital mortality and sensitivity analysis, including the inverse probability weighting model and covariate balancing propensity score model, to ensure the robustness of our findings.Results: A total of 8862 patients undergoing mechanical ventilation were enrolled. The adjusted OR showed a favourable effect between the early TTE group and in-hospital mortality [MIMIC: OR 0.77, 95% CI (0.63–0.94), (P=0.01); eICU-CRD: OR 0.78, 95% CI (0.68–0.89), (P<0.01) ]. Furthermore, TTE was also associated with 30-day mortality in the MIMIC database [OR 0.74, 95% CI (0.6-0.92), P=0.01].Conclusions: Early application of critical care transthoracic echocardiography during mechanical ventilation is beneficial for improving in-hospital mortality. Further investigation with prospectively collected data is required to validate this relationship.
Maternity Waiting Home and Maternal Mortality Ratio in EI Salvador
Authors: Yoon Heesang , Kim Chong-sup 
Published: August 2020

Abstract
Background: El Salvador is recognized as a country which could effectively reduce the maternal mortality ratio (MMR). In El Salvador, there was an improvement in health indicators, such as fertility rate, adolescent fertility rate, skilled birth attendance, health expenditures, but this improvement was not extraordinary compared with other developing countries. The reason El Salvador could achieve an outstanding decrease in MMR in spite of a not so special improvement in health or non-health indicators, deserves a deep research.Methods: We used quantitative as well as qualitative methods to show that the reason El Salvador could reduce maternal mortality ratio more than expected is the health policy that not only aimed at reducing the (adolescent) fertility rate, but also provided a safe birth service to pregnant women through maternity waiting home. As quantitative methods we ran regressions using maternal mortality ratio as dependent variable, health and non-health factors as independent variables. As qualitative methods, we carried out a case study of maternal waiting home in El Salvador.Results: El Salvador could reduce maternal mortality ratio through the improvement of health factors, such as fertility rate, skilled birth attendance, and non-health factors, such as GDP per capita and woman empowerment. However, even considering these factors, maternal mortality ratio of El Salvador decreased more than expected. We confirmed this by analyzing the residuals of the regression model. This improvement in MMR, which is more than expected from the regression results, can be attributed partly to the government measures, such as maternity waiting home.Conclusions: The reason of the unexplained reduction in El Salvador’s maternal mortality ratio seems to be attributable to the health policy that not only aimed at reducing the fertility rate, but also provided a safe birth service to pregnant women through maternity waiting home.
Risk Factors for the Environmental Spread of Different Multi-Drug-Resistant-Organisms (MDRO)
Authors: Saliba Rindala , Ghelfenstein-Ferreira Théo , Lomont Alexandra , Pilmis Benoît , Carbonnelle Etienne , Seytre Delphine , Ayoub Eliane Nasser , Zahar Jean Ralph , Sarkis Dolla Karam 
Published: August 2020

Abstract
BackgroundSubstantial scientific evidence has accumulated that the contamination of environmental surfaces in hospitals plays an important role in the transmission of MDRO. To date, all studies have failed to identify the risk factors associated with environmental contamination. In this work, we aimed to evaluate, compare and identify factors associated with environmental contamination around carriers of different MDRO.MethodsWe conducted a prospective cohort study from May 2018 to February 2020. We included 125 patients admitted to Avicenne Hospital and Hotel Dieu de France de Beyrouth Hospital, fecal carriers of MDRO (ESBL-PE, CPE, VRE). For each patient, we did a quantification of MDRO in stool, a qualitative evaluation of presence of MDRO in 6 different environmental sites and collected several clinical data.ResultsESBL-PE represented 34% of the carried MDRO, CPE 45% and VRE 21%. The most frequent MDRO species was E.coli . Contamination of at least one environmental site was observed for 22 (18%) patients. Only carriage of VanA was associated with a significantly higher risk of dissemination. Having a urinary catheter, carriage of OXA48 and E.coli were protective factors against environmental contamination. We didn’t find any statistically significant difference in environmental contamination between E.coli and other Enterobacteriaceae carriers, also between ESBL-PE and CPE carriers.ConclusionsIn conclusion, our results showed that hospital environmental contamination rates are substantially higher for patients with VRE, compared to the low environment dissemination rates around ESBL-PE and CPE. Further studies on a larger scale are needed to confirm the validity of our findings.
Efficacy and Safety of Tocilizumab in the Treatment of SARS-CoV-2: A Systematic Review and Meta-analysis
Authors: Singh Surjit , Khera Daisy , Chugh Ankita , Mittal Niti , Mittal Rakesh , Chugh Vinay Kumar 
Published: August 2020

Abstract
Background: Cytokine storm is the main cause of mortality in COVID-19. Tocilizumab, an IL-6 inhibitor, is being tested for its therapeutic potential in this condition. To evaluate the efficacy and safety of Tocilizumab in comparison to Standard therapy in the treatment of COVID-19 in adult patients. Methods: Using Medline (via PubMed), The Cochrane Central Register of Controlled Trials, preprint server (medRxiv) and clinicaltrials.gov, a final search was conducted on 26th June 2020. All types of clinical studies (prospective or retrospective cohort studies, observational case-control studies, clinical trials) aiming to evaluate the role of Tocilizumab in the treatment of patients with COVID-19 were considered eligible for this systematic review. Tocilizumab was considered as the intervention group and standard of care or drugs other than tocilizumab as control group. Meta-analysis was performed by Cochrane review manager 5 (RevMan) version 5.3. For quality assessment, ROBINS-I (The Risk Of Bias In Non-randomised studies – of Interventions) assessment tool for observational studies was used. The overall quality of evidence for each of the outcomes was assessed using the GRADE Pro GDT. Results: Out of 362 records identified, 13 studies were included in qualitative and quantitative analysis. Tocilizumab treatment was associated with 46% decrease in probability of mortality rate [Adjusted HR = 0.54 (95% CI = 0.44-0.68), p<0.00001; I2=74%] and 66% odds decrease in progression of disease [OR = 0.34 (95% CI = 0.21 – 0.55), p<0.0001; I2=76%] compared to control. However, there was no difference in hospital discharge [OR = 1.35 (95% CI = 0.84 – 2.18), p=0.22; I2=22%] and clinical improvement [OR = 1.02 (95% CI = 0.61 – 1.69), p=0.95; I2=84%] with tocilizumab. There was statistically significant increase in risk of secondary bacteraemia [OR = 2.75 (95% CI = 1.86 – 4.06), p< 0.00001] and superinfections [OR = 2.93 (95% CI = 1.92 – 4.46), p< 0.00001].Conclusions: With current evidence on efficacy and safety of tocilizumab, we recommend use of tocilizumab treatment for moderate to severe COVID-19 patients caused by SARS-CoV-2, along with caution for superinfections.Systematic review registration: PROSPERO registration number: CRD42020189517
Heteronormativity in schools is associated with unhealthy weight-control behaviors in Lesbian, Gay, and Bisexual youth: A multilevel analysis.
Authors: Santos Carolina da Franca Bandeira Ferreira , Godoy Fabiana , Menezes Valdenice , Colares Viviane , Zarzar Patrícia , Ferreira Raquel , Kawachi Ichiro 
Published: August 2020

Abstract
Background Previous studies found that a school climate of more heteronormativity is associated with adverse effects on the mental health of LGB students. Accordingly, our aim was to assess the association between low LGB visibility in schools and unhealthy weight-control behaviors among LGB youth. Methods Cross-sectional, multilevel study based in public high schools in the city of Olinda, Northeast Brazil. A multilevel logistic regression was performed, including 2,500 adolescents enrolled in 27 schools. The contextual variable was the prevalence of LGB youth in each school (as a proxy for heteronormativity in schools) while the outcome was unhealthy weight-control behaviors (fasting, purging, and taking diet pills). We controlled for socioeconomic characteristics (age, gender, receiving a family allowance), obesity, and self-reported happiness. Results Low LGB visibility in schools was associated with higher odds of engaging in unhealthy weight-control behaviors (OR: 1.5, 95%CI: 1.0, 2.2) among all youth, regardless of sexual orientation. Among LGB youth, there was some suggestion that the association between LGB visibility and unhealthy weight control behaviors was mediated by experiences of victimization and self-perceptions of unhappiness. Conclusion A school environment of low LGB visibility was associated with unhealthy weight-control behaviors in youth.
Fasting and non-fasting lipid profile for cardiovascular risk assessments using China ASCVD risk estimator and Europe SCORE risk charts in Chinese participants
Authors: Zhang Shi-Lan , Du Xiao , Xu Jin , Xiang Qun-yan , Liu Ling 
Published: August 2020

Abstract
Background Previous studies have shown that non-fasting lipids have similar values in cardiovascular risk estimation as fasting, but it is not clear whether this could also be applicable to Chinese participants.Methods A total of 127 (76 men, 51 women) participants without atherosclerotic cardiovascular diseases (ASCVD) were enrolled in the study. Serum levels of blood lipids were monitored at 0 h, 2 h and 4 h after a daily breakfast. Ten-year cardiovascular disease (CVD) risk was estimated with China ASCVD risk estimator and Europe SCORE risk charts. Kappa statistic was used to determine agreement among estimators.Results there was substantial agreement between China ASCVD risk estimator based on fasting and non-fasting lipid profiles (Kappa = 0.731 or 0.718, P < 0.001), but poorly agreement between China ASCVD risk estimator and SCORE low- or high-risk chart (Kappa = 0.339 or 0.300, P < 0.001).Conclusions Promoting use of non-fasting blood lipids in diagnosis, evaluation, and prediction of CVD are feasible. Furthermore, non-fasting blood lipids could be used in China ASCVD risk estimator to evaluate assess 10-year risk of ASCVD among Chinese general participants.