bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®) database to identify factors associated with postoperative mortality after elective non-cardiac surgery
Authors: Malviya Amit K. , Bruceta Melanio , Singh Preet M. , Bonavia Anthony , Karamchandani Kunal 
Published: July 2020

Abstract
Background Various surgical risk assessment tools, including the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®) risk calculator have been devised to predict post-operative mortality. However, the role of individual factors on mortality is unclear. We sought to identify patient characteristics from the database that were associated with postoperative mortality in patients undergoing elective, non-cardiac surgery.Methods Data from the ACS NSQIP® database at a tertiary care academic medical center was analyzed from January 2011 to September 2016. Relevant patient related variables were extracted from the database and univariable logistic regression was used to assess the association of each potential risk factor with 30-day mortality. A multivariable logistic regression model was then used to assess the adjusted effect of each potential risk factor on the outcome.Results 5,254 database patient records were identified and among the analyzed variables, American Society of Anesthesiologists (ASA) physical status III and IV (odds ratio and 95%CI : 16.75 [2.29, 122.69] ), poor preoperative functional health status (Odds ratio and 95%CI : 38.52 [2.46, 604.12] ), and low serum albumin (Odds ratio and 95%CI : 3.76 [1.35, 10.44]) were significant predictors of 30-day postoperative mortality.Conclusions In a comprehensive analysis of the ACS NSQIP®database, spreading across multiple surgical specialties, we found an association between ASA physical status, preoperative albumin levels, and functional health status with 30-day mortality after elective non-cardiac surgery.
Patients &gt;40 years with a glenohumeral dislocation have a lower incidence of Symptomatic Rotator Cuff Tear than previously reported and can be managed safely without routine advanced imaging
Authors: Manafa Chibuzo , Barakat Ahmed , Auld Felicity , Phadnis Joideep 
Published: July 2020

Abstract
Background Incidence of rotator cuff tears (RCT) following primary anterior glenohumeral dislocation in patients over 40 years is thought to be high. Current guidelines recommend specialist clinic review and advanced imaging for all patients. The aim of this study was to report the incidence of symptomatic RCT in a large cohort of patients and to assess the safety and efficacy of a physiotherapy led virtual protocol where patients were selectively investigated and treated based on symptoms. Methods 238 consecutive patients over 40 years of age with a primary anterior glenohumeral dislocation were identified between January 2015 and June 2018 (42 months). All patients were managed initially through a physiotherapy led virtual clinic with selective referral of patients with red flag symptoms to a specialist shoulder clinic. Advanced imaging (MRI or USS) was performed at the discretion of the shoulder specialist following patient assessment. The incidence of symptomatic RCT was assessed and compared between two groups (Group 1: 40-70 years, Group 2: >70 years). All surgical interventions were recorded. Patients were assessed at a mean of 22 months (range 10-54) using the Oxford shoulder score; patient satisfaction and return to pre-injury functional level. Cost analysis was performed to compare management using this protocol versus published guidelines.Results A total of 238 patients were identified with mean age of 65 years (range 40-96). 69% (n=164/238) were symptomatic and were referred to specialist clinic. The other 31% (n=74/238) were asymptomatic and were discharged to physiotherapy. Of those referred to a specialist clinic, only 46% (n=75/164) were sent for advanced imaging following clinical examination. The incidence of symptomatic RCTs was 31% (n=51/164) in this group and only 22% (n=11/51) of those underwent subsequent surgical repair of their rotator cuff. Of those patients discharged to physiotherapy, 62% (n=47/74) responded to the questionnaire with 89% fully satisfied, 85% returned to pre-injury level and mean Oxford score was 42 (33-38, SD 3.2) indicating excellent shoulder function. With all patients pooled excluding those lost to follow-up (n=27), the incidence of symptomatic RCTs was 24% (51/211). The incidence in group 1 was 16% (n=22/137) and was significantly lower than in group 2 which was 39% (n=29/74) (p<0.05). Cost analysis demonstrated 49% cost reduction using this protocol.Conclusion Incidence of symptomatic cuff tears following a primary glenohumeral dislocation in patients over 40 years was lower than previously reported. A protocol based on selective referral and investigation for symptomatic patients was cost effective and safe.
Can Natural Language Processing Help Differentiate Inflammatory Intestinal Diseases in China? Models Applying Random Forest and Convolutional Neural Network Approaches
Authors: Tong Yuanren , Lu Keming , Yang Yingyun , Li Ji , Lin Yucong , Wu Dong , Yang Aiming , li yue , Yu Sheng , Qian Jiaming 
Published: July 2020

Abstract
Background: Differentiating between ulcerative colitis (UC), Crohn’s disease (CD) and intestinal tuberculosis (ITB) using endoscopy is challenging. We aimed to realize automatic differential diagnosis among these diseases through machine learning algorithms. Methods: A total of 6399 consecutive patients (5128 UC, 875 CD and 396 ITB) who had undergone colonoscopy examinations in the Peking Union Medical College Hospital from January 2008 to November 2018 were enrolled. The input was the description of the endoscopic image in the form of free text. Word segmentation and key word filtering were conducted as data preprocessing. Random forest (RF) and convolutional neural network (CNN) approaches were applied to different disease entities. Three two-class classifiers (UC and CD, UC and ITB, and CD and ITB) and a three-class classifier (UC, CD and ITB) were built.Results: The classifiers built in this research performed well, and the CNN had better performance in general. The RF sensitivities/specificities of UC-CD, UC-ITB, and CD-ITB were 0.89/0.84, 0.83/0.82, and 0.72/0.77, respectively, while the values for the CNN of CD-ITB were 0.90/0.77. The precisions/recalls of UC-CD-ITB when employing RF were 0.97/0.97, 0.65/0.53, and 0.68/0.76, respectively, and when employing the CNN were 0.99/0.97, 0.87/0.83, and 0.52/0.81, respectively.Conclusions: Classifiers built by RF and CNN approaches had excellent performance when classifying UC with CD or ITB. For the differentiation of CD and ITB, high specificity and sensitivity were achieved as well. Artificial intelligence through machine learning is very promising in helping unexperienced endoscopists differentiate inflammatory intestinal diseases.
Prognostic Value of the Creatinine-Albumin Ratio in Acute Pancreatitis Debridement
Authors: ZHAO Zhifeng , YU Yeping , XIE Rongli , YANG Kaige , XU Dan , LI Li , LIN Jiayun , ZHENG Lei , ZHANG Chihao , XU Xin , CHEN Ying , XU Zhiwei , CHEN Erchen , LUO Meng , FEI Jian 
Published: July 2020

Abstract
Background Increases in the levels of serum C-reactive protein (CRP) and creatinine (Cr) and decreases in those of albumin (Alb) are commonly observed in acute pancreatitis (AP). We aimed to evaluate the efficacy of the Cr/Alb and CRP/Alb ratios in the prediction of surgical treatment effect in AP patients. Methods This study retrospectively analyzed clinical data obtained from 140 AP patients who underwent debridement from January 2008 to November 2018 in Shanghai Ruijin Hospital. The Cr/Alb and CRP/Alb ratios at admission and before surgery were assessed in the analysis of clinical statistics, prediction of prognoses, and logistic regression analysis. Results The admission Cr/Alb had the best predictive value of the four ratios. This value was significantly higher in patients with re-operation and those who died (P < 0.05) and was correlated with the Acute Physiology and Chronic Health Evaluation (APACHE II) score, admission CRP/Alb, preoperative Cr/Alb, and post-operative complications. The admission Cr/Alb could predict the risk of AP-related re-operation and mortality with sensitivities, specificities and areas under the curve of 86.3%, 61.7% and 0.824, and 73.4%, 81.3% and 0.794, respectively. At a cut-off value of 3.43, admission Cr/Alb values were indicative of a worse clinical state, including impaired laboratory test values, APACHE II scores, rates of post-operative complications and re-operation, and mortality (P < 0.05). In the logistic regression analysis, admission Cr/Alb values were independently related to the APACHE II score, post-operative renal failure, and mortality. Conclusion Cr/Alb is a novel but promising, easy-to-measure, reproducible, non-invasive prognostic score for the prediction of the effect of debridement in AP patients.
Evaluation of a training program for soft skill education and financial literacy to community health workers in India: a quasi-experimental study
Authors: Sharma Shantanu , Arora Kanishtha , Chandrashekhar Chandrashekhar , Sinha Rajesh Kumar , Akhtar Faiyaz , Mehra Sunil 
Published: July 2020

Abstract
Background: The soft skills of community health workers (Accredited Social Health Activists, ASHA) are known to be effective in negotiating behaviour change in the community; however, there has been a meagre focus towards improving them. Considering this gap, we adopted a comprehensive training program, known as Personal Advancement and Career Enhancement (P.A.C.E.), to empower ASHAs on soft skills and financial literacy. The present study intends to assess the training program in two districts of Uttar Pradesh, India, by examining changes in knowledge, perceptions, and practices of ASHAs about soft skills and financial literacy.Methods: We conducted a quasi-experimental, non-randomized, controlled study with pre- and post-test assessments. Data were collected on socio-demographic characteristics, knowledge, and practices related to soft skills (communication skills, self-confidence, problem–solving and decision-making skills, time and stress management skills) and financial literacy. Additionally, perceptions regarding changes in practices related to gender issues, soft skills, and savings at the personal, community, and workplace levels were obtained from the intervention group. Factor analysis was performed to obtain the change patterns by assessing the degree to which the four domains of soft skills, financial literacy, and domains of perceptions of change in practices were correlated to each other. A general linear regression model was performed to assess associations among change pattern scores and socio-demographic variables.Results: The data of 171 ASHAs were analyzed (intervention group:86 and control group:85). There was a significant improvement in the average post-test scores of all the soft skills and financial literacy in the intervention group (p<0.001). Three distinct change patterns were found post-training in the intervention group. Factor 1 (high loadings for perceptions related to change in practices) was positively associated with ASHAs aged 38 years and above and with experience of ≤12 years. On the contrary, the change in financial literacy and self-confidence scores was common among ASHAs with more than 12 years of experience.Conclusions: The P.A.C.E training program was found effective in improving the soft skills and financial literacy of ASHAs in India.
A Systems Biology Workflow for Drug and Vaccine Repurposing: Identifying Small-molecule BCG Mimics to Prevent COVID-19 Mortality
Authors: Hajjo Rima , Tropsha Alexander 
Published: July 2020

Abstract
Purpose: Coronavirus disease 2019 (COVID-19) is expected to continue to cause worldwide fatalities until the World population develops ‘herd immunity’, or until a vaccine is developed and used as a prevention. However, the vaccine may prove ineffective due to rapid changes in viral antigenic determinants. Bacillus Calmette–Guérin (BCG) vaccine has been recognized for its off-target beneficial effects on the immune system, therefore, can be exploited to boast immunity and protect from emerging novel viruses.Methods: We developed a systems biology workflow capable of identifying small-molecule antiviral drugs and vaccines that can boast immunity and impact a wide variety of viral disease pathways to protect from the fatal consequences of emerging viruses. Results: We show that BCG affect the production and maturation of naïve T cells, which results in enhanced long-lasting trained innate immune responses to tackle novel viruses. Our workflow identified small-molecule BCG mimics, including antiviral drugs such as raltegravir and lopinavir as high confidence hits. Strikingly, top hits emetine and lopinavir were validated to inhibit the growth of SARS-CoV-2 in vitro.Conclusions: Our results provide systems biology support for using BCG and small-molecule BCG mimics as a protection measure from the lethal consequences of emergent viruses including SARS-CoV-2.
The feasibility of transfer learning for differentiation H1N1 Influenza from COVID-19 on chest CT
Authors: Sotoudeh Houman , Tasorian Baharak , Tabatabaei Seyed Mohsen , Sotoudeh Ehsan , Moini Abdollatif 
Published: July 2020

Abstract
Objectives: It is unlikely that by fall and winter of 2020, standard vaccine or treatment is available for COVID-19 infection. In this period, differentiation between COVID-19 and Influenza induced pneumonia will be critical for patient management. To develop an automated platform to perform this task, artificial intelligence models were developed by using the transfer learning techniques on chest CT.Methods: Chest CT images from known cases of COVID-19, H1N1 Influenza induced pneumonia (before December 2019), and normal chest CTs were collected. Different pre-trained Convolutional Neural Networks (CNN) models, including VGG 16, VGG 19, ResNet-50, Wide ResNet, InceptionV3, and SqueezNet were fine-tuned on this data set. 60% of the dataset was used for training, 20% for validation, and 20% for test the final models. Accuracy, Precision, Recall and F1 score of each model were calculated.Results: For differentiation of COVID-19 pneumonia versus H1N1 Influenza pneumonia versus normal CTs, the ResNet-50 (accuracy above 92%) outperformed other models followed by InceptionV3 and wide ResNet.Conclusions: The pre-trained image classification AI models are feasible to be fine-tuned and used for differentiation COVID-19 versus H1N1 Influenza pneumonia. In this context, ResNet-50 and then InceptionV3 architectures appear more promising and are suitable start points for further development. We share the source code and trained models in the supplement of this manuscript to be used by other researchers for further development.
Health and socioeconomic resource provision for older people in South Asian countries: Bangladesh, India, Nepal, Pakistan and Sri Lanka
Authors: Matthews Natasha Roya , Porter George James , Varghese Mathew , Sapkota Nidesh , Khan Murad Moosa , Lukose Ammu , Paddick Stella-Maria , Dissanayake Malathie , Khan Naila Zaman , Walker Richard 
Published: July 2020

Abstract
BackgroundThe global population is ageing rapidly, with low- and middle-income countries (LMICs) undergoing a fast demographic transition. This necessitates effective services to address the increasing physical and mental health needs of multimorbid and frail older people in LMICs. We review the current provision of health and socioeconomic resources for older people in South Asian countries: Bangladesh, India, Nepal, Pakistan and Sri Lanka, to identify gaps in available resources and assess areas for improvement. MethodsWe conducted a search of grey and published literature via Google Search and Compendex, EBSCO, JSTOR, Medline, Ovid, ProQuest databases, Scopus and Web of Science to extract data on population demographics, human resources, health funding and social security provision for older people. Local informants were consulted to supplement and verify the data. ResultsIn most study countries, care of the elderly is provided by general physicians or primary care doctors, nurses and community health workers, though in very low numbers per capita. The number of geriatricians and specialist allied health professionals were largely unknown, with minimal postgraduate programmes available for specific training in geriatric medicine or psychiatry. Total average healthcare expenditure as a percentage of GDP was between 2.5-5.5%, markedly below the global average of 10.0%, with between 48.1-72.0% of healthcare costs covered by out-of-pocket payments. All countries, except Pakistan, had a social pension offering a minimum level of protection against financial constraints, but with varying coverage of those eligible. Financial provision for people with dementia was only available in India and Nepal. A modest number of state and charity-run care homes were established in all countries, though numbers were disproportionate to the growing number of older adults requiring long term care.ConclusionsInadequate health funding, a lack of specific healthcare and training and insufficient government pension and social security schemes are a current threat to achieving universal health coverage in LMICs. Governing bodies must establish geriatrics and geriatric psychiatry as specialities and scale up training programmes for specific healthcare providers for the elderly. This needs to occur alongside increased social protection provision to improve access to those in need and prevent catastrophic health expenditure.
Effects of different PTSD modeling methods on fear and depressive behavior in rats: a protocol for systematic review and network meta analysis
Authors: Song Kai , Xiong Fanjie , Huang Ailing , Zhang Hong 
Published: July 2020

Abstract
Background: Posttraumatic stress disorder (PTSD) is a debilitating mental disorder that occurs after exposure to traumatic events. This disorder can result in a interference to personal and family functioning, causing great threat to people's life and public health. Animal models remain the effective tools to the pathophysiological study of PTSD, There are many model paradigms of PTSD, and the purpose of this study is to evaluate the effect of different model paradigms of PTSD on depression-like and fear-like behavior using systematic review and network meta-analysis (NMA).Methods: The authors will retrieve a total of seven electronic databases by April 2020. After a series of screening, the two researchers will use Aggregate Data Drug Information System (ADDIS) and Stata software to analyze the data extracted from randomized controlled animal studies in PTSD rats . Ultimately, the evidence grade of the results will be evaluated.Discussion: The results of this study will provide references for evaluating the influence of different rats models of PTSD on depression-like and fear-like behavior, and provide decision-making references for clinical practice. Systematic review registration: PROSPERO CRD42020182389.
A Comprehensive Analysis of the MAGE Family as Prognostic and Diagnostic Markers for Hepatocellular Carcinoma
Authors: Li Rong , Gong Jiao , Xiao Cuicui , Zhu Shuguang , Hu Zhongying , Liang Jinliang , Li Xuejiao , Yan Xijing , Zhang Xijian , Li Danyang , Liu Wei , Chong Yutian , Jie Yusheng 
Published: July 2020

Abstract
Background: The Melanoma Antigen Gene (MAGE) family is a large, highly conserved group of proteins that share a common MAGE homology domain. Multiple MAGEs are aberrantly expressed in a variety of cancers. However, the function of distinct MAGE genes in hepatocellular carcinoma (HCC) is largely unclear. Our study aimed to comprehensively analyze the MAGE family as prognostic and diagnostic markers for HCC. Methods: In this research, all HCC data were obtained from NCBI GEO DataSets, The Cancer Genome Atlas (TCGA) and our clinical center. UALCAN was used to reveal the expression profile of distinct MAGEs in HCC and further evaluate the association between the expression of MAGEs and the clinicopathological characteristics of HCC patients, including clinical stage, tumor grade. Kaplan-Meier Plotter (KM-Plot) was used to evaluate the correlation between MAGEs expression and the overall survival (OS) of HCC patients. qRT-PCR was used to detection the expression levels of MAGEs in HCC samples. cBioPortal was used to analyze the genetic alterations in MAGEs and their associations with OS of HCC patients. Gene Set Variation Analysis (GSVA) algorithm was used to do functional enrichment analysis of MAGE genes in HCC to reveal the molecular mechanisms of MAGEs functioned in HCC. Results: Our research showed that many MAGE genes were dysregulated in HCC and most of them were highly expressed. Among them, MAGEA1、MAGEC2、MAGED1、MAGED2、MAGEF1 and MAGEL2 were significantly correlated with clinical stage and differentiation of HCC patients. MAGED1、MAGED2、MAGEA6、MAGEA12、MAGEA10、MAGEB4、MAGEL2 and MAGEC3 had significant correlation with HCC prognosis. Further functional enrichment analysis suggested the dysregulated MAGEs may play important roles in signal transduction. Conclusions: Taken together, our research revealed that multiple MAGEs were dysregulated in HCC and they might play important roles in the development of HCC and can be exploited as useful biomarkers for diagnosis and treatment for HCC.
CD45+ Erythroid Progenitor Cell Contribute to Antiangiogenic Drug Resistance Through Reactive Oxygen Species in Lymphoma.
Authors: Wei Xia , Yang Sainan , Pu Xin , He Silian , Yang Zailin , Sheng Xiaomin , Chen Wen , Zhang Yong 
Published: July 2020

Abstract
Background: More than half of lymphoma patients are complicated with anemia. Anemia often indicates a poor prognosis, but the mechanism is still unclear. Erythroid progenitor cells (EPCs) are precursors of erythrocytes and play an important role in maintaining the homeostasis of erythrocytes. Here we investigated the role and mechanism of EPCs in promoting lymphoma progression.Materials and methods: Ki-67, CD31, P-AMPK and CPT1A expression was detected by immunohistochemical staining. CD45+ EPCs were detected and sorted by flow cytometry. Animal experiments were used to detect the effect of CD45+ EPCs on lymphoma.Results: Our study found that the proportion of CD45+ EPCs in diffuse large B-cell lymphoma (DLBCL) patients with anemia was significantly higher, which is positively correlated with the expressions of P-AMPK and CPT1A in lymphoma tissues. Interestingly, we found that in hypoxic conditions, CD45+ EPCs regulated lipid metabolism and enhanced energy metabolism of lymphoma cells through AMPK-ACC-CPT1A pathway, further promoted cell proliferation and inhibited apoptosis of lymphoma cells. Animal experiments showed that CD45+ EPCs transplantation significantly increased the resistance of antiangiogenic drugs. Reactive oxygen species (ROS) played a key role in these processes. Conclusion: CD45+ EPCs contributed to antiangiogenic drug resistance through ROS in lymphoma.