bluuebunny/crossref_metadata_2025_split huggingface dataset:
An analysis of perioperative hidden blood loss in femoral intertrochanteric fractures: Bone density is an important influencing factor
Authors: Cui Haidong , Chen Kai , Lv Shujun , Yuan Chaoqun , Wang Youhua 
Published: November 2020

Abstract
Background To explore the influencing factors of perioperative hidden blood loss of intertrochanteric fractures.Method We undertook a retrospective analysis from January 2016 to October 2019. Clinical data of 118 patients with intertrochanteric fractures was included in. Hidden blood loss was calculated from the hematocrit changes before and after surgery, using the Gross equation, based on height, weight, and hematocrit (HCT) changes before and after surgery. Patients’ gender, age, presence of underlying diseases (hypertension and diabetes), fracture types, anesthesia methods, time from injury to surgery, whether to take antiplatelet drugs within 6 months before surgery, use of anticoagulant drugs after surgery, bone density were statistically analyzed. The factors with statistical significance were screened out. And then the hidden blood loss was used as the dependent variable and each influencing factor was the independent variable. Multivariate linear regression analysis was used to analyze the related risk factors that affect the hidden blood loss during the perioperative period of intertrochanteric fractures. Result The apparent blood loss during operation was (203.81 ±105. 51) ml, and the hidden blood loss was (517.55±191.47) ml. There were significant differences in the hidden blood loss of patients with different fracture types, anesthesia methods, antiplatelet or postoperative anticoagulant drugs, and different bone density(P＜0. 05). Multiple linear regression analysis showed that internal fixation, age, fracture type, anesthesia method, anticoagulant application, and bone density were related risk factors that affected hidden blood loss during surgical treatment of intertrochanteric fracture. Conclusion Hidden blood loss is the main cause of perioperative blood loss in intertrochanteric fractures, and the risk factors for hidden blood loss include internal fixation, fracture type, anesthesia, use of anticoagulant drugs. Specially, we found bone density was a risk factor for hidden blood loss. It is not reliable to use the apparent blood loss as the basis for fluid replacement and transfusion. We must fully consider the existence of hidden blood loss and intervene as soon as possible to prevent complications.
Intraoperative three-dimensional imaging in ankle syndesmotic reduction.
Authors: Beck Markus , Brunk Manuela , Wichelhaus Alice , Mittlmeier Thomas , Rotter Robert 
Published: November 2020

Abstract
Background: Injuries of the distal syndesmosis in ankle fractures are traditionally treated with a temporary adjusting screw fixation. Conventional fluoroscopic and X-ray examinations cannot reliably diagnose malpositions of the fixed tibiofibular syndesmosis. Postoperative computer tomography allows a reliable control of the transfixed region.The aim of the retrospective single-study was to clarify whether an intraoperative 3D image intensifier examination can detect malpositions of the syndesmosis already intraoperatively and whether the examination has an influence on the postoperative revision rate. Methods: In 200 patients with tibiofibular syndesmosis injuries, an intraoperative 3D scan was performed after reduction of the distal tibiofibular syndesmosis and placement of the adjusting screw. Postoperative computer tomography of both ankle joints was performed in all patients. Results: 15% of all intraoperative 3D scans (30 patients) showed a finding requiring correction in the area of the ankle joint. In 7% of the cases, a malposition of the fibula in the tibial incisura requiring correction was found. Further corrections were necessary due to the extent and position of the osteosynthesis material (7%) and for the removal of joint bodies (1%). Postoperative computer tomographies of the ankle joints showed no deformities requiring revision. Conclusion: An intraoperative 3D scan allows a reliable assessment of the injured ankle region and reduces the postoperative revision rate. This makes a postoperative routine CT examination of the ankle joint dispensable.
Association of serum 25-Hydroxyvitamin D with Vitamin D Intervention and outdoor activity among children in North China: an observational study
Authors: Zhang Xuguang , Chen Yanping , Jin Shanshan , Bi Xinxin , Chen Dongkai , Zhang Dongmei , Liu Li , Jing Hong , Na Lixin 
Published: November 2020

Abstract
Background: Living at high latitudes is one of the risk factors for vitamin D deficiency in children. However, evidence on vitamin D improvement for this pediatric population to date is limited. This study aims at evaluating the association of different vitamin D intervention methods and outdoor activity on the vitamin D status of children in North China. Methods: In this observational study, a total of 55,925 children aged 1 month to 18 years old were recruited from pediatric outpatient departments from July 2016 to June 2017. Data on demographics, anthropometric measurements, vitamin D intervention (either prescribed by physicians or given by parents) and outdoor activity were recorded. The serum levels of 25-hydroxycholecalciferol (25(OH)D) were determined by high performance liquid chromatography tandem–mass spectrometry. Logistic regression analysis was performed to assess the association of vitamin D intervention or outdoor activity with blood vitamin D status, adjusted for age, gender, BMI for age, and seasons.Results: The overall rate of hypovitaminosis D was 65.60%. Of the children’s outdoor activity, 35.63%, 31.95%, and 32.42% were below 30min/d, 30-60 min/d and over 60min/d, respectively. Furthermore, the proportion of therapeutic intervention, supplementation intervention and no vitamin D intervention among the children was 16.48%, 32.87%, and 50.65%, respectively. After adjusted for confounding factors, vitamin D intervention was associated with a lower risk of hypovitaminosis D, with OR (95% CI) of 0.191 (0.180, 0.202) in children with therapeutic doses and 0.423 (0.404, 0.443) in those with supplementation doses, compared with children without vitamin D intervention. In addition, longer outdoor time was associated with a lower risk of hypovitaminosis D [0.479 (0.456, 0.504) for 60 min/d, 0.737 (0.701, 0.776) for 30–60 min/d], independent of vitamin D intervention. Conclusions: High prevalence of vitamin D deficiency was found in children living at high latitudes. Vitamin D intervention and outdoor activity are all negatively associated with children’s vitamin D deficiency. Routine vitamin D intervention combined with increased outdoor time might be an effective approach to prevent hypovitaminosis D among children, especially those at school, living at high latitudes.
Retrospective cohort study on radial head arthroplasty comparing long-term outcomes between valgus type injury and fracture dislocation
Authors: Chen Alvin Chao-Yu , Weng Chun-Jui , Chiu Chih-Hao , Chang Shih-Sheng , Cheng Chun-Ying , Chan Yi-Sheng 
Published: November 2020

Abstract
Background: Radial head arthroplasty (RHA) has been commonly adopted for irreparable radial head fractures while little information is addressed on valgus type injury. The purpose of this study is to report long-term outcomes and radiographic analysis in RHA for valgus type injury with comparison to fracture dislocation injury.Methods: A retrospective cohort study was conducted in patients receiving unilateral RHA with loose-fit, modular metal prosthesis for irreparable radial head fractures between 2004 and 2012. Totally, 33 patients with a mean follow up of nine years (range, 7 to 15 years) were enrolled and divided into two groups including 14 valgus injuries and 19 fracture-dislocations. Demographics of the patients, injury details, clinical and radiographic outcomes, and correlation analysis were investigated and compared between two groups.Results: In patient demographics, significant difference was noted in sex distribution (p = 0.001), lateral collateral ligament involvement (p = 0.000) and time from injury to RHA (p = 0.031) between two groups. No patient underwent subsequent removal or revision of prosthesis. Good to excellent results according to Mayo Elbow Performance Score (MEPS) was achieved in 13 and 14 patients in group A and B respectively. Final motion range and Disabilities of the Arm, Shoulder, and Hand score was significantly better in valgus injury group. Radiographic analysis demonstrated fewer patients in valgus injury group presented periprosthetic osteolysis with weak to moderate negative correlation between radiolucency score and MEPS.Conclusions: With an average of nine years follow-up, RHA using loose-fit, modular metal prosthesis achieves encouraging outcomes for both valgus injury and fracture dislocation. In valgus type injury, better motion range, lower disability score and lower incidence of periprosthetic osteolysis is noted while correlation analysis of radiolucency score suggests extended, long-term investigation.
Clinical characteristics of Epstein–Barrvirus infection in the pediatric nervous system
Authors: Cheng Huan , Chen Doudou , Peng XiaoLing , wu Peng , Jang Li , Hu Yue 
Published: November 2020

Abstract
Background: To investigate the clinical characteristics of Epstein–Barr virus (EBV) infection in the pediatric nervous system (NS).Methods: We retrospectively analyzed the clinical data and follow-up results of 89 children with neurological damage caused by EBV who were hospitalized in the children's hospital of Chongqing Medical University from January 2008 to April 2019.Results: EBV infection of the NS can occur at any time of the year. The highest incidence was seen in the age group of 0–4 years. Fever is the main clinical feature (74/89, 83.1%). The main clinical types were encephalitis/meningoencephalitis (64/89, 71.9%), acute myelitis (2/89, 2.2%), acute disseminated encephalomyelitis (ADEM) (3/89, 3.4%), Guillain–Barré Syndrome (GBS) (15/89, 16.9%), neurological damage caused by EBV-hemophagocytic lymphohistiocytosis (EBV-HLH) (4/89, 4.5%), and NS-post-transplant lymphoproliferative disorder (NS-PTLD) (1/89, 1.1%). Anti-N-methyl-D-aspartate receptor encephalitis was found during the convalescence of EBV encephalitis. EBV encephalitis/meningitis showed no symptoms of tonsillitis, lymph node enlargement, skin rash, hepatosplenomegaly. Acute motor axonal neuropathy is the chief complication in GBS caused by EBV.Conclusion: There were significant differences in neurological complications caused by EBV. The prognosis of EBV infection in the NS is generally good. These illnesses are often self-limiting. A few cases may show residual sequelae.
Altered Metabolism of Mothers of Young Children with Autism Spectrum Disorder: A Case Control Study
Authors: Hollowood-Jones Kathryn , Adams James B. , Coleman Devon M. , Ramamoorthy Sivapriya , Melnyk Stephan , James S. Jill , Woodruff Bryan K. , Pollard Elena L. , Snozek Christine L. , Kruger Uwe , Chuah Joshua , Hahn Juergen 
Published: November 2020

Abstract
Background: Previous research studies have demonstrated abnormalities in the metabolism of mothers of young children with autism.Method: Metabolic analysis was performed on blood samples from 30 mothers of young children with Autism Spectrum Disorder (ASD-M) and from 29 mothers of young typically-developing children (TD-M). Targeted metabolic analysis focusing on the folate one-carbon metabolism (FOCM) and the transsulfuration pathway (TS) as well as broad metabolic analysis were performed. Statistical analysis of the data involved both univariate and multivariate statistical methods.Results: Univariate analysis revealed significant differences in 5 metabolites from the folate one-carbon metabolism and the transsulfuration pathway and differences in an additional 48 metabolites identified by broad metabolic analysis, including lower levels of many carnitine-conjugated molecules. Multivariate analysis with leave-one-out cross-validation allowed classification of samples as belonging to one of the two groups of mothers with 93% sensitivity and 97% specificity with five metabolites. Furthermore, each of these five metabolites correlated with 8-15 other metabolites indicating that there are five clusters of correlated metabolites. In fact, all but 5 of the 50 metabolites with the highest area under the receiver operating characteristic curve were associated with the five identified groups. Many of the abnormalities appear linked to low levels of folate, vitamin B12, and carnitine-conjugated molecules.Conclusions: Mothers of children with ASD have many significantly different metabolite levels compared to mothers of typically developing children at 2-5 years after birth.
Transmission potential and forecasting of the number of Coronavirus disease 2019 cases in Hubei Province, China
Authors: Wang Ke-wei , Gao Jie , Wang Hua , Wu Xiao-long , Yuan Qin-fang , Cheng Yang 
Published: November 2020

Abstract
Background: Coronavirus disease 2019 (COVID-19) was first reported in Wuhan, Hubei Province, China. We aimed to describe the temporal and spatial distribution and the transmission dynamics of COVID-19 and to assess whether a hybrid model can forecast the trend of COVID-19 in Hubei Province.Method: The data of COVID-19 cases were obtained from the website of the Chinese Center for Disease Control and Prevention, whereas the data on the resident population were obtained from the website of the Hubei Provincial Bureau of Statistics. The temporal and spatial distribution and the transmission dynamics of COVID-19 were described. A combination of an autoregressive integrated moving average (ARIMA) and a support vector machine (SVM) was constructed to forecast the trend of COVID-19.Results: A total of 56,062 confirmed COVID-19 cases, which were mainly concentrated in Wuhan, were reported from 16 January to 16 March 2020 in Hubei Province. The daily number of confirmed cases exponentially increased to 3,156 before 4 February 2020, fluctuated on an upward trend to 4,823 before 13 February 2020, and then markedly decreased to one case after 16 March 2020. The highest mean reproduction number R(t) of 9.48 was recorded on 16 January 2020, after which it decreased to 2.15 on 2 February 2020 and further dropped to less than one on 13 February 2020. In the modelling stage, the mean square error, mean absolute error and mean absolute percentage error of the hybrid ARIMA–SVM model decreased by 98.59%, 89.19% and 89.68%, and those of SVM decreased by 98.58%, 87.71% and 88.94% compared with the ARIMA model. Similar results were obtained in the forecasting stage.Conclusion: Public health interventions resulted in the terminal phase of COVID-19 in Hubei Province. The hybrid ARIMA–SVM model may be a reliable tool for forecasting the trend of the COVID-19 epidemic.
Survival Benefit of Ixazomib, Lenalidomide and Dexamethasone (IRD) over Lenalidomide and Dexamethasone (Rd) in Relapsed and Refractory Multiple Myeloma Patients in Routine Clinical Practice
Authors: Minarik Jiri , Pika Tomas , Radocha Jakub , Jungova Alexandra , Straub Jan , Jelinek Tomas , Pour Ludek , Pavlicek Petr , Mistrik Martin , Brozova Lucie , Krhovska Petra , Machalkova Katerina , Jindra Pavel , Spicka Ivan , Plonkova Hana , Stork Martin , Bacovsky Jaroslav , Capkova Lenka , Sykora Michal , Kessler Petr , Stejskal Lukas , Heindorfer Adriana , Ullrychova Jana , Skacel Tomas , Maisnar Vladimir , Hajek Roman 
Published: November 2020

Abstract
Background: We have performed a head to head comparison of all-oral triplet combination of ixazomib, lenalidomide and dexamethasone (IRD) versus lenalidomide and dexamethasone (RD) in patients with relapsed and refractory multiple myeloma (RRMM) in the routine clinical practice. Methods: A total of 344 patients treated with IRD (N=127) or RD (N=217) were selected for analysis from the Czech Registry of Monoclonal Gammopathies (RMG). Descriptive statistics were used to assess patient’s characteristics associated with the respective therapy. The primary endpoint was progression free survival (PFS), secondary end points included response rates and overall survival (OS). Survival endpoints were plotted using Kaplan-Meier methodology at 95% Greenwood confidence interval. Univariable and multivariable Cox proportional hazards models were used to evaluate the effect of treatment regimens and the significance of uneven variables. Statistical tests were performed at significance level 0.05.Results: In the whole cohort, median PFS for IRD was 17.5 and for RD was 11.5 months favoring the all-oral triplet, p = 0.005; in patients within relapse 1-3, the median PFS was 23.1 vs 11.6 months, p = 0.001. The hazard ratio for PFS was 0.67 (95% confidence interval [CI] 0.51 – 0.89, p = 0.006). The PFS advantage translated into improved OS for patients treated with IRD, median 36.6 months vs 26.0 months (p = 0.008). The overall response rate (ORR) was 73.0 % in the IRD group vs 66.2 % in the RD group with a complete response rate (CR) of 11.1 % vs 8.8 %, and very good partial response (VGPR) 22.2 % vs 13.9 %, IRD vs RD respectively. The IRD regimen was most beneficial in patients ≤75 years with ISS I, II, and in the first and second relapse. Patients with the presence of extramedullary disease did not benefit from IRD treatment (median PFS 6.5 months). Both regimens were well tolerated, and the incidence of total as well as grade 3/4 toxicities was comparable. Conclusions: Our analysis confirms the results of the TOURMALINE-MM1 study and shows benefit of all-oral triplet IRD treatment versus RD doublet. It demonstrates that the addition of ixazomib to RD improves key survival endpoints in patients with RRMM in a routine clinical setting.
Addressing the quality of paediatric primary care: Health worker and caregiver perspectives from a process evaluation of PACK Child, a health systems intervention in South Africa
Authors: Curran Robyn Leigh , Murdoch Jamie , Bachmann Max , Bateman Eric , Cornick Ruth , Picken Sandy , Simelane Makhosazana Lungile , Fairall Lara 
Published: November 2020

Abstract
Background: The WHO’s Integrated Management of Childhood Illness (IMCI) has resulted in progress in addressing infant and child mortality. However, unmet needs of children continue to present a burden upon primary healthcare services. The capacity of services and quality of care offered require greater support to address these needs by extending and integrating curative and preventive care for the child with a long-term health condition and the child older than 5, not prioritised in IMCI. In response to these needs, the PACK Child intervention was developed and piloted in 2017-2019 in the Western Cape Province of South Africa,. We report health worker and caregiver perspectives of the existing paediatric primary care context as well as the extent to which PACK Child functions to address perceived problems within the current local healthcare system. Methods: This process evaluation involved 52 individual interviews with caregivers, 10 focus group discussions with health workers, 3 individual interviews with trainers, and 31 training observations. Interviews and focus groups explored participants’ experiences of paediatric primary care, perspectives of the PACK Child intervention, and tensions with implementation in each context. Inductive thematic analysis was used to analyse verbatim interview and discussion transcripts.Results: Perspectives of caregivers and health workers suggest an institutionalised focus of paediatric primary care to treating children’s symptoms as acute episodic conditions. Health workers’ reports imply that this focus is perpetuated by interactions between contextual features such as, IMCI policy, documentation-driven consultations, overcrowded clinics and verticalised care. Whilst these contextual conditions constrained health workers’ ability to translate skills developed within PACK Child training into practice, the intervention initiated expanded care of children 0-13 years and those with long-term health conditions, enhanced professional competence, improved teamwork and referrals, streamlined triaging, and facilitated probing for psychosocial risk.Conclusion: PACK Child appears to be catalysing paediatric primary care to address the broader needs of children, including long-term health conditions and the identification of psychosocial problems. However, to maximise this requires primary care to re-orientate from risk minimisation on the day of attendance towards a view of the child beyond the day of presentation at clinics.
Out-of-sample Predictability of Economic Efficiency Measures of U.S. Banks: Evidence of capital adequacy requirements
Authors: Sakouvogui Kekoura 
Published: November 2020

Abstract
This paper contributes to the sparse debate on the effect of capital adequacy requirements on banks' economic efficiency measures. Precisely, we evaluate the out-of-sample predictability of capital adequacy requirements on banks' economic efficiency measures using Support Vector Regression (SVR) model with Linear, Polynomial and Radial Basis Function kernels and ordinary least squares (OLS) model. This analysis is important because a prediction of economic efficiency measures allows for an untangle view of bank's progress that is useful for management as it gains a high degree of transparency in the evaluation of future events. Our framework adapts optimization of h-block cross-validation to account for serial correlation of economic variables to produce robust sets of tuning parameters for SVR model. Using a total of 10,380 December quarterly observations of U.S Commercial and Domestic banks spanning from 2008 through 2019, empirical results show that SVR model provides better benchmarking in-sights in the evaluation of economic efficiency measures compared to the OLS model. Furthermore, in contrast to previous approaches identifying a single "best" model among competing models, the results of Model Confidence Test suggests that the out-of-sample forecasting confidently identifies superior predictive accuracy of SVR model-based forecasts over OLS model.
Adenovirus Viremia Predicts Adenovirus Pneumonia Severity in Immunocompetent Children
Authors: Zhang Ruimu , Wang Hongmei , Tian Shufeng , Deng Jikui 
Published: November 2020

Abstract
Background: Previous studies have demonstrated an association between adenovirus viremia and disease severity in immunocompromised children. However, few studies focused on the use of this approach in immunocompetent children. This study explored the association between adenovirus viremia and adenovirus pneumonia severity in immunocompetent children. Methods: We did a retrospective, observational study of immunocompetent children with adenovirus pneumonia admitted in Shenzhen Children’s hospital in Shenzhen, China. Pneumonia was classified as severe or mild, based on the Chinese guideline of pneumonia severity classification. The serum of all the children in the study was tested for adenovirus DNA with quantitative polymerase chain reaction (PCR). Clinical manifestations, laboratory examinations, and disease severity were compared between these two groups. Results: A total of 111 immunocompetent children with adenovirus pneumonia (60 severe, 51 mild) were included. The median age was 40 months and 64 patients were male. Five patients were admitted to intensive care unit and two were endotracheal intubated. All the patients were discharged with recovery or improvement. Univariate analysis and binary logistic regression analysis showed leukocytosis (OR = 1.1; 95% CI: 1.0 to 1.2; P = 0.033), co-infection of mycoplasma pneumoniae (OR = 5.0; 95% CI: 2.1 to 12.3; P < 0.001), and high blood viral load (OR = 1.5; 95% CI: 1.2 to 2.0; P = 0.001) were risk factors for severe adenovirus pneumonia. Conclusions: Leukocytosis, co-infection of mycoplasma pneumoniae, and high blood viral load are risk factors for severe adenovirus pneumonia in immunocompetent children. Blood viral load predicts pneumonia severity.