bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of thromboelastography profile with severity of liver cirrhosis and portal venous system thrombosis
Authors: He Yanglan , Yuan Shanshan , Guo Xiaozhong , Yi Fangfang , Xu Xiangbo , An Yang , Xu Shixue , Ageno Walter , Qi Xingshun 
Published: June 2021

Abstract
Background and aim
Hemostasis profile is often complicated in liver cirrhosis. Thromboelastography is a global viscoelastic test recommended by the current practice guideline and consensus. This cross-sectional study aimed to evaluate the association of thromboelastography profile with severity of liver cirrhosis and presence of portal venous system thrombosis (PVST).

Methods
Overall, 116 and 50 cirrhotic patients were included in the Shenyang and Xi’an cohorts, respectively. Thromboelastography parameters were compared between cirrhotic patients with Child–Pugh class A and B/C, those with and without decompensated events, and those with and without PVST. Hypercoagulability would be considered if at least two of the following thromboelastography parameters were met: shortened reactive time (R), shortened coagulation time (K), increased angle, and increased maximum amplitude (MA).

Results
In the Shenyang cohort, 16 patients had shortened R, of whom seven (43.75%) had prolonged K and 11 (68.75%) decreased MA. In the Xi’an cohort, 24 patients had shortened R, of whom seven (29.17%) had prolonged K and 15 (62.50%) decreased MA. In the Shenyang cohort, the prevalence of hypercoagulability was not significantly different between cirrhotic patients with Child–Pugh class A and B/C (3.85% vs. 6.25%, P = 0.873), those with and without decompensated events (5.49% vs. 4.00%, P = 1.000), and those with and without PVST (4.17% vs. 5.88%, P = 1.000), which were similar to the results obtained in the Xi’an cohort.

Conclusion
There is a high rate of discordance between R and other thromboelastography parameters. In addition, hypercoagulability may not be related to more advanced stage of liver cirrhosis or presence of PVST.
Comparison of the operative outcomes and learning curves between laparoscopic and “Micro Hand S” robot-assisted total mesorectal excision for rectal cancer: a retrospective study
Authors: Wang Yanlei , Wang Guohui , Li Zheng , Ling Hao , Yi Bo , Zhu Shaihong 
Published: June 2021

AbstractBackgroundThe Micro Hand S robot is a new surgical tool that has been applied to total mesorectal excision (TME) surgery for rectal cancer in our center. In this study, we compared the operative outcomes, functional outcomes and learning curves of the Micro Hand S robot-assisted TME (RTME) with laparoscopic TME (LTME).MethodsA total of 40 patients who underwent RTME and 65 who underwent LTME performed by a single surgeon between July 2015 and November 2018 were included in this retrospective study. Clinicopathologic characteristics, operative and functional outcomes, and learning curves were compared between the two groups. The learning curve was analyzed using the cumulative sum method and two stages (Phase 1, Phase 2) were identified and analyzed. All patients were followed up for at least 12 months.ResultsThe clinicopathologic characteristics of the two groups were similar. The learning curve was 17 cases for RTME and 34 cases for LTME. Compared with LTME, RTME was associated with less blood loss (148.2 vs. 195.0 ml,p = 0.022), and shorter length of hospital stay (9.5 vs. 12.2 days,p = 0.017), even during the learning period. With the accumulation of experience, the operative time decreased significantly from Phase 1 to Phase 2 (RTME, 360.6 vs. 323.5 min,p = 0.009; LTME, 338.1 vs. 301.9 min,p = 0.005), whereas other outcomes did not differ significantly.ConclusionsMicro Hand S robot-assisted TME is safe and feasible even during the learning period, with outcomes comparable to laparoscopic surgery but superior in terms of blood loss, length of hospital stay, and learning curve.Trial registrationClinicaltrial.gov, NCT04836741, retrospectively registered on 5 April 2021.
An unexpected intracerebral lesion – case report of a superinfected aspergillosis mimicking a brain metastasis
Authors: Grüter Basil Erwin , Reuss Anna Maria , Rushing Elisabeth Jane , Pangalu Athina , Oertel Markus Florian 
Published: June 2021

Abstract
Background
Invasive aspergillosis of the central nervous system is a rare but increasingly prevalent disease. We present the unusual case of an immunosuppressed patient suffering from unexpected superinfected invasive aspergillosis with cerebral, pulmonal, and adrenal manifestations, mimicking a metastasized bronchial carcinoma. This report reveals the importance of including aspergillosis in the differential diagnosis of a cerebral mass lesion in the light of unspecific clinical findings.

Case presentation
A 58-year-old immunocompromised female presented to our emergency department with a single tonic-clonic seizure. Imaging showed a ring enhancing cerebral mass with perifocal edema and evidence of two smaller additional hemorrhagic cerebral lesions. In the setting of a mass lesion in the lung, and additional nodular lesions in the left adrenal gland the diagnosis of a metastasized bronchus carcinoma was suspected and the cerebral mass resected. However, histology did not reveal any evidence for a neoplastic lesion but septate hyphae consistent with aspergillus instead and microbiological cultures confirmed concomitant staphylococcal infection.

Conclusions
A high index of suspicion for aspergillus infection should be maintained in the setting of immunosuppression. Clinical and radiological findings are often unspecific and even misleading. Definite confirmation usually relies on tissue diagnosis with histochemical stains. Surgical resection is crucial for establishing the diagnosis and guiding therapy with targeted antifungal medications.
Web-based, rapid and contactless management of ambulatory patients for SARS-CoV-2-testing
Authors: Stemler Jannik , Cornely Oliver A. , Noack-Schönborn Torsten , Fohrholz Corinna , Schumacher Sofie , Poluschkin Leonard , Binder Bernd , Lehmann Clara , Langebartels Georg 
Published: June 2021

Abstract
Background
During the SARS-CoV-2 pandemic a mass casualty incident of ambulatory patients occurred at the COVID-19 rapid response infrastructure (CRRI) facility at the University Hospital of Cologne (UHC). We report the development of a patient-centred mobile-device solution to support efficient management of the facility, triage of patients and rapid delivery of test results.

Methods
The UHC-Corona Web Tool (CWT) was developed as a web-based software useable on each patient’s smartphone. It provides, among others, a self-reported medical history including type and duration of symptoms and potential risk contacts and links all retrieved information to the digital patient chart via a QR code. It provides scheduling of outpatient appointments and automated transmission of SARS-CoV-2 test results.

Results
The UHC-CWT was launched on 9 April 2020. It was used by 28,652 patients until 31 August 2020. Of those, 15,245 (53,2%) consulted the CRRI, representing 43,1% of all CRRI patients during the observed period.
There were 8304 (29,0%) specifications concerning travel history and 17,145 (59,8%) indications of ≥1 symptom of SARS-CoV-2 infection. The most frequently indicated symptoms were sore throat (60,0%), headache (50,7%), common cold (45,1%) and cough (42,6%) while 11,057 (40,2%) patients did not report any symptoms. After implementation of the UHC-CWT, the amount of patient contacts per physician rose from 38 to 98,7 per day. The personnel for communication of test results were reduced from four on seven days to one on five days.

Conclusion
The UHC-CWT is an effective digital solution for management of large numbers of outpatients for SARS-CoV-2 testing.
Cardiothoracic ratio measurement using artificial intelligence: observer and method validation studies
Authors: Saiviroonporn Pairash , Rodbangyang Kanchanaporn , Tongdee Trongtum , Chaisangmongkon Warasinee , Yodprom Pakorn , Siriapisith Thanogchai , Wonglaksanapimon Suwimon , Thiravit Phakphoom 
Published: June 2021

Abstract
Background
Artificial Intelligence (AI) is a promising tool for cardiothoracic ratio (CTR) measurement that has been technically validated but not clinically evaluated on a large dataset. We observed and validated AI and manual methods for CTR measurement using a large dataset and investigated the clinical utility of the AI method.

Methods
Five thousand normal chest x-rays and 2,517 images with cardiomegaly and CTR values, were analyzed using manual, AI-assisted, and AI-only methods. AI-only methods obtained CTR values from a VGG-16 U-Net model. An in-house software was used to aid the manual and AI-assisted measurements and to record operating time. Intra and inter-observer experiments were performed on manual and AI-assisted methods and the averages were used in a method variation study. AI outcomes were graded in the AI-assisted method as excellent (accepted by both users independently), good (required adjustment), and poor (failed outcome). Bland–Altman plot with coefficient of variation (CV), and coefficient of determination (R-squared) were used to evaluate agreement and correlation between measurements. Finally, the performance of a cardiomegaly classification test was evaluated using a CTR cutoff at the standard (0.5), optimum, and maximum sensitivity.

Results
Manual CTR measurements on cardiomegaly data were comparable to previous radiologist reports (CV of 2.13% vs 2.04%). The observer and method variations from the AI-only method were about three times higher than from the manual method (CV of 5.78% vs 2.13%). AI assistance resulted in 40% excellent, 56% good, and 4% poor grading. AI assistance significantly improved agreement on inter-observer measurement compared to manual methods (CV; bias: 1.72%; − 0.61% vs 2.13%; − 1.62%) and was faster to perform (2.2 ± 2.4 secs vs 10.6 ± 1.5 secs). The R-squared and classification-test were not reliable indicators to verify that the AI-only method could replace manual operation.

Conclusions
AI alone is not yet suitable to replace manual operations due to its high variation, but it is useful to assist the radiologist because it can reduce observer variation and operation time. Agreement of measurement should be used to compare AI and manual methods, rather than R-square or classification performance tests.
SOX14 hypermethylation as a tumour biomarker in cervical cancer
Authors: Zhao Jing , Cao Huiling , Zhang Wenfan , Fan Yongjuan , Shi Shujuan , Wang Rong 
Published: June 2021

AbstractBackgroundThe association between SOX14 and cancer has been reported. The aim of this study was to identify and validate the potential value of SOX14 methylation in the early detection of cervical cancer.MethodsFirst, we extracted the data for SOX14 methylation and expression within cervical cancer from The Cancer Genome Atlas (TCGA) database and analysed them via UALCAN, Wanderer, MEXPRESS and LinkedOmics. Subsequently, according to the bioinformatics findings, primers and probes were designed for the most significantly differentiated methylation CpG site and synthesized for methylation-specific PCR (MSP) and quantitative methylation-specific PCR (QMSP) to verify SOX14 methylation in both cervical tissuses and liquid-based cell samples. Eventually, the clinical diagnostic efficacy of SOX14 methylation in the normal, cervical intraepithelial neoplasia, and cancer groups was analysed by ROCAUC.ResultsPooled analysis demonstrated that SOX14 methylation levels were significantly increased in cervical squamous cell carcinoma and endocervical adenocarcinoma (CESC) compared to normal tissues (P < 0.001). Both the verification and validation cohorts indicated that the methylation level and the positive rate of SOX14 gradually increased with increasing severity from normal to cancer samples (P < 0.01). When the cut-off value was set as 128.45, the sensitivity and specificity of SOX14 hypermethylation in the diagnosis of cervical cancer were 94.12 and 86.46%, respectively. When taken as a screening biomarker (>CINII), the sensitivity was 74.42% and the specificity was 81.48%, with a cut-off value of 10.37.ConclusionSOX14 hypermethylation is associated with cervical cancer and has the potential to be a molecular biomarker for the screening and early diagnosis of cervical cancer.
How medical students’ early workplace experience could benefit the NHS
Authors: Oyekwe George Chukwuemeka , Salam Muhammed Aizaz us , Ghani Sami Ahmad , Alriyahi Bilal Iyad Abedalaziz 
Published: June 2021

AbstractAs senior medical students who have had the privilege of undergoing early year clinical workplace experience, we believe that this opportunity medical students have through experiencing the ‘frontline’ could be utilised advantageously by the National Health Service (NHS). A system under pressure with depleting resources seemingly persists to be a constant theme that surrounds the NHS. Due to such issues, improvements in all sectors are sought, including costs, patient experience and communication between healthcare professionals. Through this article we highlight and analyse how medical students’ early workplace experience, as presented by Leedham-Green et al., could benefit the NHS through tackling some of the challenges mentioned prior.
The objective structured clinical examination as an assessment strategy for clinical competence in novice nursing practitioners in Taiwan
Authors: Chen Sue-Hsien , Chen Shu-Ching , Lai Yo-Ping , Chen Pin-Hsuan , Yeh Kun-Yun 
Published: June 2021

Abstract
Background
The conventional written tests and professional assessment have limitation in fair judgement of clinical competence. Because the examiners may not have total objectivity and may lack standardization throughout the assessment process. We sought to design a valid method of competence assessment in medical and nursing specialties. This work was aimed to develop an Objective Structured Clinical Exam (OSCE) to evaluate novice nursing practitioners’ clinical competency, work stress, professional confidence, and career satisfaction.

Methods
A Quasi-experimental study (pre-post). Fifty-five novice nursing practitioners received the OSCE three-months following their graduation, which consisted of four stations: history taking, physical examination, problem-directed management, interpersonal communication, and the required techniques of related procedures. The examiners had to complete an assessment checklist, and the participants had to complete a pre-post questionnaire (modified from a Nursing Competency Questionnaire, a Stress scale, and Satisfaction with Learning scale).

Results
Among the novice nursing practitioners, 41 of them (74.5 %) passed the exam with a mean score of 61.38 ± 8.34. There was a significantly higher passing rate among nurses who were working in medical-surgical wards (85.7 %) and the intensive care unit-emergency department (77.8 %) compared to novice nursing practitioners working in other units. All the novice nursing practitioners at Station A had poor performance in assessing patients with a fever. OSCE performance was more associated with educational attainment and work unit, rather than the gender. Finally, the participants showed statistically significant increases in their clinical competency, confidence in their professional competence, satisfaction with the clinical practice, and decreased work stress after the OSCE.

Conclusions
We found that the OSCE process had a positive educational effect, in providing a meaningful and accurate assessment of the competence of novice nursing practitioners. An appropriate OSCE program is vital for novice nursing practitioners, educators, and administrators. The effective application of OSCEs can help novice nursing practitioners gain confidence in their clinical skills.
Assessing the impact of a shadowing programme on in-hospital mortality following trainee doctors’ changeover
Authors: Violeta Balinskaite , Alex Bottle , Paul Aylin 
Published: June 2021

Abstract
Background
To assess the impact on seven-day in-hospital mortality following the introduction in 2012 of a shadowing programme for new UK medical graduates requiring them to observe the doctor they are replacing for at least 4 days before starting work.

Methods
Data on emergency admissions were derived from Hospital Episode Statistics between 2003 and 2019. A generalised estimating equation model was used to examine whether the introduction of the programme was associated with a change in mortality.

Results
There were 644,018 emergency admissions, of which 1.8% (7612) ended in death in hospital within a week following the admission. Throughout the study period, there was an annual increase in the number of emergency admissions during July and August, though in-hospital mortality rates declined. The generalised estimating equation analysis found no significant change in the odds of death within 7 days after admission for patients admitted on the first Wednesday in August compared with patients admitted on the last Wednesday in July (OR = 1.03, 95% CI 0.94–1.13, p = 0.53). Furthermore, there was no significant change observed for any clinical diagnosis category following the introduction of the shadowing programme.

Conclusion
There was a rising trend in the number of emergency admissions over the study period, though mortality was decreasing. We found no significant association between the introduction of shadowing programme and in-hospital mortality; however, lack of power means that we cannot rule out a small effect on mortality. There are other outcomes that might have changed but were not examined in this study.
Lung macrophages drive mucus production and steroid-resistant inflammation in chronic bronchitis
Authors: Andelid Kristina , Öst Karolina , Andersson Anders , Mohamed Esha , Jevnikar Zala , Vanfleteren Lowie E. G. W. , Göransson Melker 
Published: June 2021

Abstract
Background
Patients with chronic obstructive pulmonary disease (COPD) frequently suffer from chronic bronchitis (CB) and display steroid-resistant inflammation with increased sputum neutrophils and macrophages. Recently, a causal link between mucus hyper-concentration and disease progression of CB has been suggested.

Methods
In this study, we have evaluated the steroid sensitivity of purified, patient-derived sputum and alveolar macrophages and used a novel mechanistic cross-talk assay to examine how macrophages and bronchial epithelial cells cross-talk to regulate MUC5B production.

Results
We demonstrate that sputum plug macrophages isolated from COPD patients with chronic bronchitis (COPD/CB) are chronically activated and only partially respond to ex vivo corticosteroid treatment compared to alveolar macrophages isolated from lung resections. Further, we show that pseudo-stratified bronchial epithelial cells grown in air–liquid-interface are inert to direct bacterial lipopolysaccharide stimulation and that macrophages are able to relay this signal and activate the CREB/AP-1 transcription factor complex and subsequent MUC5B expression in epithelial cells through a soluble mediator. Using recombinant protein and neutralizing antibodies, we identified a key role for TNFα in this cross-talk.

Conclusions
For the first time, we describe ex vivo pharmacology in purified human sputum macrophages isolated from chronic bronchitis COPD patients and identify a possible basis for the steroid resistance frequently seen in this population. Our data pinpoint a critical role for chronically activated sputum macrophages in perpetuating TNFα-dependent signals driving mucus hyper-production. Targeting the chronically activated mucus plug macrophage phenotype and interfering with aberrant macrophage-epithelial cross-talk may provide a novel strategy to resolve chronic inflammatory lung disease.
Overcoming the UCB HSCs –Derived NK cells Dysfunction through Harnessing RAS/MAPK, IGF-1R and TGF-β Signaling Pathways
Authors: Shokouhifar Alireza , Anani Sarab Gholamreza , Yazdanifar Mahboubeh , Fereidouni Mohammad , Nouri Masoumeh , Ebrahimi Marzieh 
Published: June 2021

AbstractBackgroundThe natural killer (NK) cells differentiated from umbilical cord blood (UCB) hematopoietic stem cells (HSCs) may be more suitable for cell-based immunotherapy compared to the NK cells from adult donors. This is due to the possibility to choose alloreactive donors and potentially more robust in vivo expansion. However, the cytotoxicity of UCB-HSC-derived NK cells against cancer cells might be suboptimal. To overcome this obstacle, we attempted to generate NK cells with potent antitumor activity by targeting RAS/MAPK, IGF-1R and TGF-β signaling pathways using IL-15, IGF-1 and SIS3 respectively.MethodsThe CD34 + cells were isolated from human UCB mononuclear cells through magnetic activation cell sorting (MACS) with purity of (≥ 90%) and were subjected to differentiate into NK cells. After 21 days of induction with SFTG36 (SCF, FLt-3L, TPO, GM-CSF, IL-3 and IL-6), IS721 (IGF-1, SIS3, IL-7 and IL-21) and IL-15/Hsp70 media, NK cells phenotypes were studied and their cytotoxicity against K562 human erythroleukemia cells and SKOV3 ovarian carcinoma cells was analyzed.ResultsThe NK cells induced in SFTG36/IS721 medium were selected for activation due to their higher expression of CD56 + 16 + CD3 −  (93.23% ± 0.75) and mean fluorescence intensity (MFI) of NKG2D + (168.66 ± 20.00) and also a higher fold expansion potential (11.893 ± 1.712) compared to the other groups. These cells once activated with IL-15, demonstrated a higher cytotoxicity against K562 (≥ 90%; P ≤ 0.001) and SKOV3 tumor cells (≥ 65%; P ≤ 0.001) compared to IL-15/Hsp70-activated NK cells.ConclusionsThe differentiation of ex vivo expanded CD34 + cells through manipulation of RAS/MAPK, IGF-1R and TGF-β signaling pathways is an efficient approach for generating functional NK cells that can be used for cancer immunotherapy.