bluuebunny/crossref_metadata_2025_split huggingface dataset:
DRG grouping by machine learning: from expert-oriented to data-based method
Authors: Liu Xiaoting , Fang Chenhao , Wu Chao , Yu Jianxing , Zhao Qi 
Published: November 2021

Abstract
Background
Diagnosis-related groups (DRGs) are a payment system that could effectively solve the problem of excessive increases in healthcare costs which are applied as a principal measure in the healthcare reform in China. However, expert-oriented DRG grouping is a black box with the drawbacks of upcoding and high cost.

Methods
This study proposes a method of data-based grouping, designed and updated by machine learning algorithms, which could be trained by real cases, or even simulated cases. It inherits the decision-making rules from the expert-oriented grouping and improves performance by incorporating continuous updates at low cost. Five typical classification algorithms were assessed and some suggestions were made for algorithm choice. The kappa coefficients were reported to evaluate the performance of grouping.

Results
Based on tenfold cross-validation, experiments showed that data-based grouping had a similar classification performance to the expert-oriented grouping when choosing suitable algorithms. The groupings trained by simulated cases had less accuracy when they were tested by the real cases rather than simulated cases, but the kappa coefficients of the best model were still higher than 0.6. When the grouping was tested in a new DRGs system, the average kappa coefficients were significantly improved from 0.1534 to 0.6435 by the update; and with enough computation resources, the update process could be completed in a very short time.

Conclusions
As a new potential option, the data-based grouping meets the requirements of the DRGs system and has the advantages of high transparency and low cost in the design and update process.
Barriers and facilitators to kangaroo mother care implementation in Cote d’Ivoire: a qualitative study
Authors: Kourouma Kadidiatou Raïssa , Agbré-Yacé Marie Laurette , Doukouré Daouda , Cissé Lassina , Some-Méazieu Chantière , Ouattara Joseph , Tano-Kamelan Akoua , Konan Kouakou Virginie 
Published: November 2021

Abstract
Background
Kangaroo Mother Care (KMC) is a high impact, low technology and cost-effective intervention for the care of preterm and low birth weight newborn. Cote d’Ivoire adopted the intervention and opened the first KMC unit in 2019. This study aimed to assess barriers and facilitators of KMC implementation in Cote d’Ivoire, a year after its introduction, as well as proposed solutions for improving KMC implementation in the country.

Method
This was a qualitative study, using semi-structured interviews, carried out in September 2020 in the first KMC unit opened at the Teaching Hospital of Treichville. The study involved healthcare providers providing KMC and mothers of newborn who were receiving or received KMC at the unit. A thematic analysis was performed using both inductive and deductive (Consolidated Framework for Implementation Research-driven) approaches. NVivo 12 was used to assist with coding.

Results
A total of 44 semi-structured interviews were conducted, 12 with healthcare providers and 32 with mothers. The barriers identified were lack of supplies, insufficiency of human resources, lack of space for admission, lack of home visits, lack of food for mothers, lack of collaboration between health services involved in newborn care, increased workload, the beliefs of carrying the baby on the chest, father’s resistance, low rate of exclusive breastfeeding, lack of community awareness. Facilitators identified were training of healthcare providers, strong leadership, the low cost of KMC, healthcare providers’ perceived value of KMC, mothers−healthcare providers’ relationship, mothers’ adherence to KMC and the capacity of the KMC unit to network with external organizations. The proposed solutions for improving KMC implementation were volunteer staff motivation, intensifying education and counselling of mothers and families, the recruitment of a psychologist and the involvement of all stakeholders.

Conclusion
Our study highlighted the challenges to implement KMC in Cote d’Ivoire with unique and specific barriers to implementation. We recommend to researchers and decision makers to respectively design strategies and adopt intervention that specifically address these barriers and facilitators to a better uptake of KMC. Decision makers should also take into account the proposed solutions for a better implementation and scaling up of KMC.
Venues and methods to improve professional men’s access to HIV self-testing and linkage to HIV prevention or treatment: a qualitative study
Authors: Muwanguzi Patience A. , Nasuuna Esther M. , Namimbi Florence , Osingada Charles Peter , Ngabirano Tom Denis 
Published: November 2021

AbstractBackgroundHIV testing among men in sub-Saharan Africa is sub-optimal. Despite several strategies to improve access to underserved populations, evidence regarding engaging men in professional and formal occupations in HIV testing is limited. This study explored employed professional men’s preferences for uptake of HIV self-testing, and linkage to HIV care, or prevention services.MethodsThis was an explorative-descriptive qualitative study where a sample of 33 men from six Ugandan urban centres. Participants were purposively selected guided by the International Standard Classification of Occupations to participate in in-depth interviews. The data were collected using an interview guide and the sample size was determined by data saturation. Eligibility criteria included fulltime formal employment for over a year at that organization. The data were analyzed manually using thematic content analysis.ResultsThree categories emerged: uptake of HIV self-tests, process of HIV self-testing and linkage to post-test services. The different modes of distribution of HIV self-test kits included secondary distribution, self-tests at typically male dominated spaces, delivery to workplaces and technology-based delivery. The process of HIV self-testing may be optimized by providing collection bins, and mHealth or mobile phone applications. Linkage to further care or prevention services may be enhanced using medical insurance providers, giving incentives and tele counselling.ConclusionWe recommend utilization of several channels for the uptake of HIV self-tests. These include distribution of test kits both to offices and men’s leisure and recreation ‘hot spots’, Additionally, female partners, peers and established men’s group including social media groups can play a role in improving the uptake of HIV self-testing. Mobile phones and digital technology can be applied in innovative ways for the return of test results and to strengthen linkage to care or prevention services. Partnership with medical insurers may be critical in engaging men in professional employment in HIV services.
Effect of empagliflozin on ketone bodies in patients with stable chronic heart failure
Authors: Pietschner R. , Kolwelter J. , Bosch A. , Striepe K. , Jung S. , Kannenkeril D. , Ott C. , Schiffer M. , Achenbach S. , Schmieder R. E. 
Published: November 2021

Abstract
Background
Recent studies indicated that sodium glucose cotransporter (SGLT)2 inhibition increases levels of ketone bodies in the blood in patients with type 1 and 2 diabetes. Other studies suggested that in patients with chronic heart failure (CHF), increased myocardial oxygen demand can be provided by ketone bodies as a fuel substrate. Experimental studies reported that ketone bodies, specifically beta-hydroxybutyrate (β-OHB) may increase blood pressure (BP) by impairing endothelium-dependant relaxation, thereby leading to increased vascular stiffness. In our study we assessed whether the SGLT 2 inhibition with empagliflozin increases ketone bodies in patients with stable CHF and whether such an increase impairs BP and vascular function.

Methods
In a prospective, double blind, placebo controlled, parallel-group single centre study 75 patients with CHF (left ventricular ejection fraction 39.0 ± 8.2%) were randomised (2:1) to the SGLT-2 inhibitor empagliflozin 10 mg orally once daily or to placebo, 72 patients completed the study. After a run-in phase we evaluated at baseline BP by 24 h ambulatory blood pressure (ABP) monitoring, vascular stiffness parameters by the SphygmoCor system (AtCor Medical, Sydney, NSW, Australia) and fasting metabolic parameters, including β-OHB by an enzymatic assay (Beckman Coulter DxC 700 AU). The same measurements were repeated 12 weeks after treatment. In 19 of the 72 patients serum levels of β-OHB were beneath the lower border of our assay (< 0.05 mmol/l) therefore being excluded from the subsequent analysis.

Results
In patients with stable CHF, treatment with empagliflozin (n = 36) was followed by an increase of β-OHB by 33.39% (p = 0.017), reduction in 24 h systolic (p = 0.038) and diastolic (p = 0.085) ABP, weight loss (p = 0.003) and decrease of central systolic BP (p = 0.008) and central pulse pressure (p = 0.008). The increase in β-OHB was related to an attenuated decrease of empagliflozin-induced 24 h systolic (r = 0.321, p = 0.069) and diastolic (r = 0.516, p = 0.002) ABP and less reduction of central systolic BP (r = 0.470, p = 0.009) and central pulse pressure (r = 0.391, p = 0.033). No significant changes were seen in any of these parameters after 12 weeks of treatment in the placebo group (n = 17).

Conclusion
In patients with stable CHF ketone bodies as assessed by β-OHB increased after treatment with empagliflozin. This increase led to an attenuation of the beneficial effects of empagliflozin on BP and vascular parameters.
Trial registration The study was registered at http://www.clinicaltrials.gov (NCT03128528).
Narciclasine induces autophagy-mediated apoptosis in gastric cancer cells through the Akt/mTOR signaling pathway
Authors: Yuan Yunfeng , He Xue , Li Xiang , Liu Yan , Tang Yueliang , Deng Huiming , Shi Xinyuan 
Published: November 2021

Abstract
Background
Gastric cancer is a common gastrointestinal cancer and currently has the third-highest mortality rate. Research shows that the natural compound narciclasine has a variety of biological activities. The present study aimed to investigate the effect of narciclasine on gastric cancer cells and its molecular mechanisms and determine whether this compound could be a novel therapy for gastric cancer.

Methods
MTT and clone assays were employed to detect the proliferation of gastric cancer cells. The cell apoptosis was detected by flow cytometry. The formation of autophagosomes and autophagosomal lysosomes was observed by transmission electron microscopy and laser confocal scanning microscopy. Western blotting was used to detect the expression of apoptosis, autophagy and Akt/mTOR pathway-related proteins.

Results
In this study, we found that narciclasine could inhibit the proliferation of gastric cancer cells and promote apoptosis in gastric cancer cells. Further experiments showed that narciclasine promoted the levels of autophagy proteins LC3-II, Atg-5 and Beclin-1, reduced the expression of the autophagy transporter p62, and increased autophagic flux. By using the autophagy inhibitors 3-MA and CQ, it was shown that narciclasine could induce autophagy-mediated apoptosis in gastric cancer cells. Finally, we found that narciclasine had no significant effects on the total content of Akt and mTOR in gastric cancer cells, and it involved autophagy in gastric cancer cells by reducing the phosphorylation level of p-Akt and p-mTOR.

Conclusions
Narciclasine can induce autophagy-dependent apoptosis in gastric cancer cells by inhibiting the phosphorylation level of Akt/mTOR and thus reduce the proliferation of gastric cancer cells.
Efficacy of preoperative testosterone therapy in hypospadias: a systematic review and meta-analysis
Authors: Sembiring Gozali , Sigumonrong Yacobda 
Published: November 2021

Abstract
Background
Bleeding, hematoma, edema, wound infection, and scar formation are the common problems linked with hypospadias reconstruction. Hormone treatment is recommended before surgical treatment to improve intraoperative circumstances. However, no meta-analysis has explored the effectiveness and side effects of testosterone treatment before surgery in hypospadias.

Main body of the abstract
The purpose of this paperwork is to evaluate the impact of preoperative testosterone treatment in hypospadias based on clinical data from published trials. This study searched MEDLINE, Science Direct, and the Cochrane Library without regard to year. However, only English journals were included, with a manual search using the Preferred Reporting Items for Systematic Reviews and Meta-analysis of Observational Studies in Epidemiology Guidelines supplementing the search. In this meta-analysis, five papers were considered. Two of these investigations were multicenter randomized clinical trials. Two of the studies were prospective, with a median follow-up of varying lengths. A retrospective investigation was conducted. There were 585 patients in all that took part in this trial. After surgery, the complication rate was measured in both the intervention and control groups, including meatal stenosis, fistula, glans dehiscence, scarring, reoperation rate, urethral diverticulum, fine pubic hair, and sexual precocity. The only significant difference between the intervention and control groups was that the intervention group had a decreased frequency of glans dehiscence following surgery (OR 0.40 with the 95% CI of 0.17 until 0.97).

Conclusions
This study discovered that a patient who got testosterone before surgery had a considerably decreased complication risk for glandular dehiscence. Reoperation rate, urethral-cutaneous fistula, meatal stenosis, and penile scarring in children with hypospadias, on the other hand, revealed no significant difference in the testosterone-treated group against the control group.
Hypocalcemia as the Initial Presentation of Type 2 Bartter Syndrome: A Family Report
Authors: London Shira , Levine Michael A , Li Dong , Spiegel Ronen , Lebel Asaf , Halevy Rephael , Tenenbaum-Rakover Yardena 
Published: November 2021

AbstractContextBartter syndrome (BS) is a group of rare autosomal-recessive tubulopathies characterized by hypokalemic, hypochloremic metabolic alkalosis in which the primary defect is a deficiency of transporters involved in sodium chloride reabsorption. Type 2 BS results from a defect in the renal outer medullary potassium channel encoded by the KCNJ1 gene. Type 2 BS presents with polyhydramnios, intrauterine growth retardation, prematurity, failure to thrive, polyuria, hypercalciuria, and life-threatening episodes of dehydration. Hypocalcemia is a very rare presenting symptom of BS, with only a few published cases reporting it as the initial manifestation of type 2 BS.ObjectiveTo describe a child who presented with hypocalcemic seizure at the age of 2.3 years that was first related to vitamin D deficiency and high-phosphate soft drink consumption.MethodsWhole exome sequencing (WES) was used to evaluate the biochemical abnormalities of the proband.ResultsWe identified a previously described homozygous missense mutation c.212C&gt;T, p.T71M in the KCNJ1 gene associated with type 2 BS. Six additional family members with the same mutation and diagnosed clinically with BS are also reported, 2 presenting with hypocalcemia associated with vitamin D deficiency.ConclusionThis report expands the clinical spectrum associated with KCNJ1 mutations and emphasizes the role of WES in unsolved cases of hypocalcemia when genetic disease is suspected. It also highlights the hazardous effects of phosphate-containing soft drinks on calcium metabolism.
Integrated molecular analysis identifies a conserved pericyte gene signature in zebrafish
Authors: Shih Yu-Huan , Portman Daneal , Idrizi Feston , Grosse Ann , Lawson Nathan D. 
Published: November 2021

ABSTRACT
Pericytes reside in capillary beds where they share a basement membrane with endothelial cells and regulate their function. However, little is known about embryonic pericyte development, in part, due to lack of specific molecular markers and genetic tools. Here, we applied single cell RNA-sequencing (scRNA-seq) of platelet derived growth factor beta (pdgfrb)-positive cells to molecularly characterize pericytes in zebrafish larvae. scRNA-seq revealed zebrafish cells expressing mouse pericyte gene orthologs, and comparison with bulk RNA-seq from wild-type and pdgfrb mutant larvae further refined a pericyte gene set. Subsequent integration with mouse pericyte scRNA-seq profiles revealed a core set of conserved pericyte genes. Using transgenic reporter lines, we validated pericyte expression of two genes identified in our analysis: NDUFA4 mitochondrial complex associated like 2a (ndufa4l2a), and potassium voltage-gated channel, Isk-related family, member 4 (kcne4). Both reporter lines exhibited pericyte expression in multiple anatomical locations, and kcne4 was also detected in a subset of vascular smooth muscle cells. Thus, our integrated molecular analysis revealed a molecular profile for zebrafish pericytes and allowed us to develop new tools to observe these cells in vivo.
Bilateral Post Traumatic Myositis Ossificans of Adductor Longus in a Young Soccer Player: A Case Report and Literature Review
Authors: Iorio Raffaele , Massafra Carlo , Viglietta Edoardo , Mazza Daniele , Ferretti Andrea 
Published: November 2021

Abstract
Myositis ossificans traumatica (MOT) is a self-limiting and self-resolving pathology. In most cases, conservative treatment is chosen as the first step. Surgical treatment is reserved for cases of failure of conservative treatment with persistence of pain and mass. The case presented concerns an 18-year-old soccer player suffering from bilateral adductor longus (AL) MOT results following two different sports injuries. The patient reports the appearance of swelling and palpable mass at the proximal and medial region of the thigh, about 2 cm from the pubic symphysis, along the course of the adductor magnus. The radiological investigation showed the presence of a calcification along the course of the right and left AL muscles. Surgical treatment was considered for the right thigh injury, being symptomatic 1 year after the onset and refractory to other treatments. At 3 months of follow-up, the patient was asymptomatic and completed the rehabilitation program for the recovery of muscle strength and range of motion (ROM). In cases where MOT manifests with resistant pain, ROM restriction and daily activity reduction, surgical excision is the preferred option.
Interobserver reproducibility of contrast-enhanced ultrasound in diabetic nephropathy
Authors: Lin Lin , Wang Yiru , Yan Lin , Li Nan , Tian Xiaoqi , Li Qiuyang , Tang Jie , Luo Yukun 
Published: November 2021

Objective:
To investigate the interobserver reproducibility of contrast-enhanced ultrasound (CEUS) in patients with diabetic nephropathy.

Methods:
A total of 40 patients with diabetic nephropathy were enrolled in this retrospective study. We measured peak intensity (PEAK), time-to-peak (TP), area under the curve (AUC) and mean transit time (MTT) of renal CEUS in each patient. Each parameter was performed by two independent observers. The interobserver reproducibility was assessed using intraclass correlation coefficients (ICCs) with 95% confidence intervals (CIs) and Bland–Altman plots by mean difference with 95% limits of agreement (LOAs).

Results:
The parameters of the left and right kidneys showed moderate or good reliability. The best was the left kidney AUC parameters (ICC,0.945),with a 95% CI of 0.896–0.971.The Bland–Altman plots showed that the mean differences between the right renal parameters (PEAK, TP, AUC and MTT) obtained between the observers 1 and 2 were −6.63%,2.54%,−11.30%,−2.22%, and the 95% LOAs are −30.78 to 17.52%, −30.15 to 35.23%, −43.95 to 21.35%, −44.50 to 40.06%. While the left ones were −2.89%, 0.32%, −8.26%, 1.25% , and the 95% LOAs were −38.50 to 32.72%, −31.98 to 32.62%, −57.89 to 41.37%, −37.21 to 39.71%, respectively.

Conclusion:
Quantitative CEUS can show good interobserver reproducibility, which is better for the right kidney. It seems necessary to establish standardized techniques for obtaining contrast-enhanced quantitative analysis of renal blood perfusion.

Advances in knowledge:
Quantitative assessment of renal perfusion by CEUS in patients with diabetic nephropathy provides diagnostic information. Furthermore, renal perfusion assessment in patients with diabetic nephropathy using CEUS has good reproducibility.
The changing face of MedEdPublish
Authors: Hays Richard , Gibbs Trevor , Hunt Julie , Jennings Barbara , Masters Ken 
Published: November 2021

MedEdPublish has come a long way since it was launched in 2016 by AMEE as an independent academic e-journal that supports scholarship in health professions education. Beginning as a relatively small, in-house publication on a web platform adapted for the purpose, we invited members of our community of practice to submit articles on any topic in health professions education, and encouraged a wide range of article types. All articles were published so long as they met editing criteria and where within scope. Reviews were welcomed from both members of our Review panel and the general readership, all published openly with contributors identified. Many articles attracted several reviews, responses and comments, creating interactive discussion threads that provided learning opportunities for all. The outcome surpassed our expectations, with over 500 articles submitted during 2020, beyond the capacity of our editing team and platform to achieve our promise of rapid publishing. We have now moved to a much larger and powerful web platform, developed by F1000 Research and within the Taylor and Francis stable, the home of AMEE’s other journal, Medical Teacher. Most of our innovations are supported by the new platform and there is scope for further developments. We look forward to an exciting new phase of innovation, powered by the F1000 platform.
DETERMINATION OF THE NUMBER OF NURSES FOR HOSPITAL AID IN THE REPUBLIC OF BULGARIA
Authors: Koleva Greta , Georgieva Despina , Hristova Irinka 
Published: November 2021

The nurses in the Republic of Bulgaria addressed a number of official demands to the Ministry of Health, one of them was to work out a long-term strategy for the development of standards, including detailed minimal requirements for the number of staff for both hospital, and outpatient care.
Objectives: The goal of the current report is a summary of the regulatory documents, concerning the number of nurses in the Republic of Bulgaria, in context of the global practices.
Methods: Current medical standards in the Republic of Bulgaria are being taken into account, and methods for determining the number of nurses in other countries.
Results: In the period between November and December 2020, within the public consultations for projects of different Regulations for approval of medical standards, the proposed and developed methods by the Bulgarian association of health professionals in nursing to be included in the standards, which concern calculating the necessary staff of nurses, was not admitted for inclusion in any of those standards.
Conclusions: Until now, the number of active nurses in the Republic of Bulgaria in all active medical standards is calculated either on the basis of doctors (not patients), or it’s pointed out that the methods of calculating the sufficient number of nurses may be applied. It should be noted that the International Council of Nurses, actually does not recommend universal methods for all countries worldwide.