bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparative study for the rate of adverse outcomes in unilateral and bilateral abdominal flap breast reconstruction
Authors: Cao Zheming , Cao Jiri , Pang Xiaoyang , Du Wei , Wu Panfeng 
Published: September 2020

Abstract

Background:
Adverse outcomes after unilateral vs bilateral breast reconstruction involve an unknown level of risk that warrants thorough investigation.

Methods:
To address this research need, PubMed, Ovid, Medline, EMBASE, and Scopus databases were searched through systematically from January 1, 1990, to January 1, 2019 to retrieve the relevant studies on the risk of postoperative complications after unilateral vs bilateral abdominal flap breast reconstruction. According to the pre-designed inclusion criteria, available data were extracted from the relevant studies, and then analyzed comparatively in order to identify the relative risk (RR) and 95% confidence intervals (CI) applying either a random or a fixed effects model.

Results:
Eventually, 20 studies involving 8122 female subjects met the inclusion criteria. It was found that unilateral reconstruction involved a significantly higher risk of flap loss (RR: 1.56, 95% CI: 1.21–2.00; P < .05) and fat necrosis (RR: 1.60, 95% CI: 1.23–2.09; P < .05) compared to bilateral reconstruction, while bilateral reconstruction involved a greater risk of abdominal hernia/bulge (RR: 1.67, 95% CI: 1.25–2.24; P < .05). The risk was found to be higher following bilateral free transverse rectus abdominis myocutaneous (fTRAM) flaps in comparison with deep inferior epigastric perforator (DIEP) flaps (RR: 2.62, 95% CI: 1.33–5.15; P < .05).

Conclusion:
The risk of postoperative flap complications in unilateral breast reconstruction is significantly higher than that in bilateral reconstruction. Contrarily, the abdominal complications were significantly higher in the bilateral group vs the unilateral group. Meanwhile, the risk of abdominal hernia/bulge complication after bilateral breast reconstruction was significantly higher with fTRAM vs DIEP. Therefore, DIEP flaps are recommended in priority for bilateral breast reconstruction, unless specifically contraindicated.
Evaluating the efficacy and safety of bromhexine hydrochloride tablets in treating pediatric COVID-19
Authors: Wang Yuying , Zhang Yinghua , Chen Xia , Xue Kun , Zhang Tianjing , Ren Xiaohong 
Published: September 2020

Abstract

Background:
Bromhexine hydrochloride tablets may be effective in the treatment of Coronavirus disease 2019 (COVID-19) in children. This study will further evaluate the efficacy and safety of bromhexine hydrochloride tablets in the treatment of COVID-19 in children.

Methods:
The following electronic databases will be searched, with all relevant randomized controlled trials (RCTs) up to August 2020 to be included: PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), the Chongqing VIP China Science and Technology Database (VIP), Wanfang, the Technology Periodical Database, and the Chinese Biomedical Literature Database (CBM). As well as the above, Baidu, the International Clinical Trials Registry Platform (ICTRP), Google Scholar, and the Chinese Clinical Trial Registry (ChiCTR) will also be searched to obtain more comprehensive data. Besides, the references of the included literature will also be traced to supplement our search results and to obtain all relevant literature.

Results:
This systematic review will evaluate the current status of bromhexine hydrochloride in the treatment of COVID-19 in children, to evaluate its efficacy and safety.

Conclusion:
This study will provide the latest evidence for evaluating the efficacy and safety of bromhexine hydrochloride in the treatment of COVID-19 in children.

PROSPERO Registration number:
CRD42020199805.

Ethics and dissemination:
The private information of individuals will not be published. This systematic review will also not involve endangering participant rights. Ethical approval is not available. The results may be published in peer-reviewed journals or disseminated at relevant conferences.
Efficacy and safety of acupuncture for posterior circulation ischemic vertigo
Authors: Li Bo-xuan , Li Chen , Du Yu-zheng , Meng Xiang-gang 
Published: September 2020

Abstract

Background:
Posterior circulation ischemic vertigo (PCIV) is one of the most complaint symptoms in clinical, and is associated with high risk of recurrence. Current studies show that acupuncture has therapeutic effect on releasing symptom as well as improving the blood flow of posterior circulation. In this review, we aim to assess the efficacy and safety of acupuncture for PCIV.

Methods:
Literature of clinical randomized control trials regarding acupuncture for PCIV published before August of 2020 will be searched in databases, including 5 English databases and 4 Chinese databases. For the included studies, methodological quality will be assessed according to Cochrane Risk of Bias Tool, and evidence quality will be evaluated with Grading of Recommendations Assessment, Development and Evaluation guidelines. Data analysis will be performed using Review Manager Software.

Results:
The primary outcomes involve changes of PCIV symptoms and blood flow velocity of vertebrobasilar. The secondary outcomes include Barthel Index, National Institute of Health Stroke Scale, clinical effectiveness, and adverse reactions.

Conclusion:
Based on current clinical studies, this systematic review and meta-analysis will provide evidence-based basis for the efficacy and safety of acupuncture in treating PCIV.

Trial registration:
The protocol for this review has been registered in the INPLASY network (Registration number: INPLASY202070116).
Late outcomes of endovascular aortic stent graft therapy in patients with chronic kidney disease
Authors: Wu Chung-Cheng , Chou An-Hsun , Lin Yu-Sheng , Wu Victor Chien-Chia , Chang Shang-Hung , Chu Pao-Hsien , Cheng Yu-Ting , Ko Po-Jen , Liu Kuo-Sheng , Chen Shao-Wei 
Published: September 2020

Abstract
Endovascular aneurysm repair (EVAR) and thoracic endovascular aortic repair (TEVAR) are effective and minimally invasive treatment options for high-risk surgical candidates. Nevertheless, knowledge about the management of aortic stent graft therapy in chronic kidney disease (CKD) is scarce. This study aimed to examine outcomes after EVAR and TEVAR in patients with CKD.
Utilizing data from the Taiwan National Health Insurance Research Database, we retrospectively assessed patients who underwent EVAR and TEVAR therapy between January 1, 2006, and December 31, 2013. Patients were divided into CKD and non-CKD groups. Outcomes were in-hospital mortality, all-cause mortality, readmission, heart failure, and major adverse cardiac and cerebrovascular events.
There were 1019 patients in either group after matching. The CKD group had a higher in-hospital mortality rate than the non-CKD group (15.2% vs 8.3%, respectively; odds ratio, 1.92; 95% confidence interval [CI], 1.46–2.54). Patients with CKD had higher risks of all-cause mortality including in-hospital death (46.1% vs 33.1%; hazard ratio [HR], 1.61; 95% CI, 1.35–1.92), readmission rate (62.6% vs 55.0%; subdistribution HR [SHR], 1.61; 95% CI, 1.32–1.69), redo stent (7.8% vs 6.2%; SHR, 1.50; 95% CI, 1.09–2.07), and major adverse cardiac and cerebrovascular events (13.3% vs 8.8%; SHR, 1.50; 95% CI, 1.15–1.95). The subgroup analysis did not demonstrate a variation in mortality between the TEVAR and EVAR cohorts (P for interaction = .725). The dialysis group had higher risks of all-cause mortality and readmission than the CKD without dialysis and non-CKD groups.
Among EVAR/TEVAR recipients, CKD was independently associated with higher in-hospital mortality, postoperative complication, and all-cause mortality rates. Patients with end-stage renal disease on dialysis had worse outcomes than those in the CKD non-dialysis and non-CKD groups.
Protective effects of different doses of human milk on neonatal necrotizing enterocolitis
Authors: Zhang Baoquan , Xiu Wenlong , Dai Yue , Yang Changyi 
Published: September 2020

Abstract
We aim to summarize the evidence focusing on the effects of various doses of human milk on the risk of neonatal necrotizing enterocolitis (NEC). The eligible articles in the study were those investigating the association between human milk and NEC published before June 26, 2019, in the PubMed, EMBASE, the Cochrane Library, VIP database, CNKI database, and Wangfang database. The included criteria were as follows: premature infants of <37 weeks; randomly controlled trials (RCTs); those fed by mother's own milk or donor human milk; studies focused on the comparison of human milk and formula milk, involving various breast milk doses; and NEC-related studies. Compared with the exclusive formula, the incidence of NEC in the infants fed by exclusive human milk was significantly lower. The incidence of NEC in the infants fed by exclusive human milk was significantly lower than that of partial human milk [risk ratio (RR) = 0.54, 95% confidence interval (95% CI): 0.36–0.79, P < .05]. The incidence of NEC in the infants fed mainly by human milk was significantly lower than that of mainly fed by formula. Incidence of NEC in the infants fed by exclusive human milk was significantly lower than that of any formula (RR = 0.49, 95% CI: 0.34–0.71, P < .05). In summary, this meta-analysis was based on the RCTs involving the prevention of NEC using human milk. Exclusive human milk and partial human milk reduced the incidence of NEC in premature infants, especially in the those fed by high proportion of human milk. In addition, more RCTs are needed to further validate such conclusion.
The prognostic value of geriatric nutritional risk index in elderly patients with severe community-acquired pneumonia
Authors: Wei Lishuang , Xie Hailun , Li Junkang , Li Rui , Chen Weijian , Huang Lanfang , Li Xialin , Yan Ping 
Published: September 2020

Abstract
The geriatric nutritional risk index (GNRI) is associated with the prognosis of many diseases. However, the association between the GNRI and the prognosis of patients aged ≥65 years with severe community-acquired pneumonia (SCAP) has not been studied. We aimed to evaluate the prognostic value of GNRI in elderly SCAP patients.
This study retrospectively analyzed the clinical data of 346 patients aged ≥65 years with SCAP from December 2013 to September 2019. Patients were divided into 4 groups by the GNRI. The chi-square test or student's t test was used to compare the differences between the groups. Logistic regression analysis was used to evaluate the factors that affect prognosis. The receiver operating characteristic curve was used to compare the prognostic performance of the GNRI with other indicators. A GNRI-based nomogram was established based on the result of the multivariate analysis.
Two hundred nine (60.4%) patients had a poor prognosis. GNRI scores were significantly lower in the poor prognosis group than in the group with a good prognosis. In the multivariate analysis, gender, mean arterial pressure, neutrophil counts, and the GNRI were independently correlated with the prognosis of elderly patients. The GNRI was a significantly better predictor for poor prognosis than other indicators. The GNRI-based nomogram had excellent prediction capabilities.
GNRI is a simple and effective prognostic indicator for elderly patients with SCAP, and a GNRI-based nomogram can aid in developing individualized treatment plans for elderly patients with SCAP.
Endoscopic Pancreatic Function Testing (ePFT) in Children
Authors: Patel Nishant , Sellers Zachary M. , Grover Amit , Liu Quin Y. , Maqbool Asim , Morinville Veronique D. , Abu‐El‐Haija Maisam , Husain Sohail Z. 
Published: September 2020

ABSTRACTEndoscopic pancreatic function testing (ePFT) is one of the few ways to directly diagnose exocrine pancreatic insufficiency, and considerable confusion regarding indications, utility, and interpretation of the test remains. This position paper of the Pancreas Committee of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition reviews the history and indications for ePFT in children. We compare various methods in current practice and determine their strengths and limitations, and based on data from children and adults we provide guidance on a protocol on how to perform ePFT in children. Lastly, we pose areas in need of further research relating to ePFT in children.
Unusual Clinical Course for Untreated Malformative Biliary Atresia Infant
Authors: Di Dato Fabiola , Ranucci Giulia , de Ville de Goyet Jean , Alberti Daniele , Iorio Raffaele 
Published: September 2020

ABSTRACTIn biliary atresia, infants left untreated, and in those with unsuccessful porto‐enterostomy, hepatic condition and function worsen rapidly towards cirrhosis, malnutrition, portal hypertension with ascites, and variceal haemorrhage; many die within the first 3 years of life unless they benefit from liver replacement. We describe a girl with biliary atresia splenic malformation syndrome, who had portal vein cavernoma and microsplenia; she did not undergo porto‐enterostomy. She survived with her native liver over the age of 3 years. Remarkably, she remained in satisfactory condition in absence of ascites or severe hepatic dysfunction, when 4 other similar patients—managed during the same period of time—all had the usual clinical deterioration and ascites, with the need for liver replacement. To our knowledge, there is no similar report in literature. Possible pathogenetic mechanisms and the role of portal hypertension as important factors are discussed.
Clinical Performance of the BD CTGCTV2 Assay for the BD MAX System for Detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis Infections
Authors: Van Der Pol Barbara , Torres-Chavolla Edith , Kodsi Salma , Cooper Charles K. , Davis Thomas E. , Fife Kenneth H. , Taylor Stephanie N. , Augenbraun Michael H. , Gaydos Charlotte A. 
Published: September 2020

Background
Diagnostic options to combat the increasing rates of sexually transmitted infections recorded throughout the world increasingly include multiplex assays. Here we describe the estimated sensitivity and specificity of a triplex molecular assay that simultaneously detects Chlamydia trachomatis (CT), Neisseria gonorrhoeae (or gonococci [GC]), and Trichomonas vaginalis (TV).

Methods
Participants (2547 women and 1159 men) were recruited from 12 clinics in the United States. BD CTGCTV2 for BD MAX System assay (CTGCTV2) results were obtained from vaginal and endocervical swabs, endocervical samples in cytology medium, and female and male urine. Results were compared with infection standards that were sample type and pathogen dependent.

Results
Female specimen sensitivity estimates ranged from 92.7% to 98.4%, 92.9% to 100%, and 86.6% to 100% for CT, GC and TV, respectively. Male urine sensitivity estimates were 96.7%, 99.2%, and 97.9% for CT, GC, and TV, respectively. Specificity estimates were >98.7% for all sample types.

Conclusions
BD CTGCTV2 performed well using a variety of sample types. As a true triplex assay, performed using a benchtop instrument, BD CTGCTV2 may be useful in settings where no testing is currently performed and in settings, such as reference laboratories, where testing turnaround time may be several days. Use of this assay at local laboratories may result in greater access to testing and a shorter time to result, which are important steps for improving our ability to combat sexually transmitted infections.
Self-reported Symptoms of Anxiety Predict Positive Suicide Risk Screening in Adolescents Presenting to the Emergency Department
Authors: Powell Daniel S. , Lanzillo Elizabeth C. , Jay Samantha Y. , Tanenbaum Mira , Bridge Jeffrey A. , Wharff Elizabeth A. , Ballard Elizabeth , Pao Maryland , Horowitz Lisa M. 
Published: September 2020

Objective
The objective of this study was to assess whether patient-reported anxiety symptoms are associated with suicide risk in pediatric emergency department (ED) patients. An additional objective was to examine differences between patients presenting for medical/surgical or psychiatric complaints.

Methods
Pediatric patients aged 10 to 21 years were recruited from 3 pediatric EDs. Participants completed self-report questionnaires assessing for suicidal ideation and behavior, in addition to questions of interest about recent feelings of unbearable anxiety and depression. Adjusted odds ratios were calculated to assess the relationship between endorsement of recent anxiety and screening positive for suicide risk.

Results
Data were analyzed from 522 participants, including 344 presenting with medical/surgical chief complaints and 178 presenting with psychiatric complaints. Overall, 28.9% of participants screened positive for suicide risk, 29.9% endorsed recent feelings of anxiety, and 24.3% endorsed recent feelings of depression. Patients who self-reported recent anxiety symptoms were 5 times more likely to screen positive for suicide risk (adjusted odds ratios = 5.18, 95% confidence interval = 3.06–8.76). Analysis of the 344 medical/surgical patients revealed that this subsample was also 5 times more likely to screen positive for suicide risk if they endorsed recent anxiety (adjusted odds ratios = 4.87, 95% confidence interval = 2.09–11.36).

Conclusions
Self-reported suicidal ideation and feelings of unbearable anxiety are prevalent among patients presenting to pediatric EDs. Patients who self-report recent feelings of unbearable anxiety are significantly more likely to screen positive for suicide risk, regardless of whether their presenting complaint is medical/surgical or psychiatric in nature.
Persistent Racial and Sex Disparities in Outcomes After Coronary Artery Bypass Surgery
Authors: Enumah Zachary Obinna , Canner Joseph K. , Alejo Diane , Warren Daniel S. , Zhou Xun , Yenokyan Gayane , Matthew Thomas , Lawton Jennifer S. , Higgins Robert S. D. 
Published: September 2020

Objective:
The purpose of this study was to assess the temporal trends in 30-day mortality by race group for patients undergoing coronary artery bypass grafting (CABG) between 2011 and 2018 and to investigate the effect of race and sex on postoperative outcomes after CABG.

Summary Background Data:
Cardiovascular diseases remain a leading cause of death in the United States with studies demonstrating increased morbidity and mortality for black and female patients undergoing surgery. In the post drug-eluting stent era, studies of racial disparities CABG are outdated.

Methods:
We performed a retrospective analysis of the Society for Thoracic Surgeons database for patients undergoing CABG between 2011 and 2018. Primary outcome was 30-day mortality. Secondary outcomes included postoperative length of stay, surgical site infection, sepsis, pneumonia, stroke, reoperation, reintervention, early extubation, and readmission.

Results:
The study population was comprised of 1,042,506 patients who underwent isolated CABG between 2011 and 2018. Among all races, Black patients had higher rates of preoperative comorbidities. Compared with White patients, Black patients had higher overall mortality (2.76% vs 2.19%, P < 0.001). On univariable regression, Black patients had higher rates of death, infection, pneumonia, and postoperative stroke compared to White patients. On multivariable regression, Black patients had higher odds of 30-day mortality compared to white patients [odds ratio (OR) = 1.11, 95% confidence interval (CI) 1.05–1.18]. Similarly, female patients had higher odds of death compared to males (OR = 1.26, 95% CI 1.21–1.30).

Conclusions:
In the modern era, racial and sex disparities in mortality and postoperative morbidity after coronary bypass surgery persist with Black patients and female patients consistently experiencing worse outcomes than White male patients. Although there may be unknown or underappreciated biological mechanisms at play, future research should focus on socioeconomic, cultural, and multilevel factors.
A New Screening Method for COVID-19 based on Ocular Feature Recognition by Machine Learning Tools
Authors: Fu Yanwei , Li Feng , Wang Wenxuan , Tang Haicheng , Qian Xuelin , Gu Mengwei , Xue Xiangyang 
Published: September 2020

AbstractThe Coronavirus disease 2019 (COVID-19) has affected several million people. With the outbreak of the epidemic, many researchers are devoting themselves to the COVID-19 screening system. The standard practices for rapid risk screening of COVID-19 are the CT imaging or RT-PCR (real-time polymerase chain reaction). However, these methods demand professional efforts of the acquisition of CT images and saliva samples, a certain amount of waiting time, and most importantly prohibitive examination fee in some countries. Recently, some literatures have shown that the COVID-19 patients usually accompanied by ocular manifestations consistent with the conjunctivitis, including conjunctival hyperemia, chemosis, epiphora, or increased secretions. After more than four months study, we found that the confirmed cases of COVID-19 present the consistent ocular pathological symbols; and we propose a new screening method of analyzing the eye-region images, captured by common CCD and CMOS cameras, could reliably make a rapid risk screening of COVID-19 with very high accuracy. We believe a system implementing such an algorithm should assist the triage management or the clinical diagnosis. To further evaluate our algorithm and approved by the Ethics Committee of Shanghai public health clinic center of Fudan University, we conduct a study of analyzing the eye-region images of 303 patients (104 COVID-19, 131 pulmonary, and 68 ocular patients), as well as 136 healthy people. Remarkably, our results of COVID-19 patients in testing set consistently present similar ocular pathological symbols; and very high testing results have been achieved in terms of sensitivity and specificity. We hope this study can be inspiring and helpful for encouraging more researches in this topic.
Generalizable cursor click control using grasp-related neural transients
Authors: Dekleva Brian M , Weiss Jeffrey M , Boninger Michael L , Collinger Jennifer L 
Published: September 2020

AbstractIntracortical brain-computer interfaces (iBCI) have the potential to restore independence for individuals with significant motor or communication impairments. One of the most realistic avenues for clinical translation of iBCI technology is to enable control of a computer cursor—i.e. movement-related neural activity is interpreted (decoded) and used to drive cursor function. Both nonhuman primate and human studies have demonstrated high-level cursor translation control using attempted upper limb reaching movements. However, cursor click control—based on identifying attempted grasp—has only been successful in providing discrete click functionality; the ability to maintain click during translation does not yet exist. Here we present a novel decoding approach for cursor click based on identifying transient neural responses that emerge at the onset and offset of intended hand grasp. We demonstrate in a human participant, who used the BCI system independently in his home, that this transient-based approach provides high-functioning, generalized click control that can be used for both point-and-click and click-and-drag applications.