bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Clinical Predictive Model for Risk Stratification of Patients with Severe Acute Lower Gastrointestinal Bleeding
Authors: Singh Manraj , Chiang Jayne , Seah Andre , Liu Nan , Mathew Ronnie , Mathur Sachin 
Published: August 2021

Abstract
Background: Lower Gastro-Intestinal Bleeding (LGIB) is a common presentation of surgical admissions, imposing a significant burden on healthcare costs and resources. There is a paucity of standardised clinical predictive tools available for the initial assessment and risk stratification of patients with LGIB. We propose a simple clinical scoring model to prognosticate patients at risk of severe LGIB and an algorithm to guide management of such patients.Methods: A retrospective cohort study was conducted, identifying consecutive patients admitted to our institution for LGIB over a 1-year period. Baseline demographics, clinical parameters at initial presentation and treatment interventions were recorded. Severe LGIB was the primary outcome measure. Multivariate logistic regression was performed to identify factors predictive of severe LGIB. A clinical management algorithm was developed to discriminate between patients requiring admission, and to guide endoscopic, angiographic and/or surgical intervention.Results: 226/649 (34.8%) patients had severe LGIB. Six variables were entered into a clinical predictive model for risk stratification of LGIB: Tachycardia (HR>100), hypotension (SBP<90mmHg), anemia (Hb<9g/dL), metabolic acidosis, use of antiplatelet/anticoagulants, and active per-rectal bleeding. The optimum cut-off score of >1 had a sensitivity of 91.9%, specificity of 39.8%, and Positive and Negative Predictive Values of 45% and 90.2% respectively for predicting severe LGIB. The Area Under Curve (AUC) was 0.77.BConclusion: Early diagnosis and management of severe LGIB remains a challenge for the acute care surgeon. The predictive model described comprises objective clinical parameters routinely obtained at initial triage to guide risk stratification, disposition and inpatient management of patients.
Characterizing the ESBL-Producing Enterobacterales Bioburden in a Neonatal Unit Using Chromogenic Culture Media: A Feasible and Efficient Environmental Sampling Method
Authors: Strysko Jonathan P , Vurayai Moses , Kgomanyane Kgomotso , Bayani One , Mokomane Margaret , Machiya Tichaona , Arscott-Mills Tonya , Goldfarb David M. , Steenhoff Andrew , McGann Carolyn , Nakstad Britt , Gezmu Alemayehu , Richards-Greenblatt Melissa , Coffin Susan 
Published: August 2021

Abstract
Introduction:

Infections due to extended spectrum beta-lactamase producing Enterobacterales (ESBL-PE) have emerged as the leading cause of sepsis among hospitalized neonates in Botswana and much of sub-Saharan Africa and south Asia. Yet, ESBL-PE reservoirs and transmission dynamics within the neonatal intensive care unit (NICU) environment are not well-understood. This study aimed to assess the efficiency and feasibility of a chromogenic-culture-media-based environmental sampling approach to characterize the ESBL-PE bioburden within a NICU.
Methods

A series of four point-prevalence surveys were conducted at a 36-bed NICU at a public tertiary referral hospital in Botswana from January-June 2021. Samples were collected on 3 occasions under semi-sterile technique using 1) flocked swabs & templates (flat surfaces); 2) sterile syringe & tubing (water aspiration); and 3) structured swabbing techniques (hands & equipment). Swabs were transported in physiological saline-containing tubes, vortexed, and 10 µL was inoculated onto chromogenic-agar that was selective and differential for ESBL-PE (CHROMagar™ ESBL, Paris, France), streaking plates to isolate individual colonies. Bacterial colonies were quantified and phenotypically characterized using biochemical identification tests.
Results

In total, 567 samples were collected, 248 (44%) of which grew ESBL-PE. Dense and consistent ESBL-PE contamination was detected in and around sinks and certain high-touch surfaces, while transient contamination was demonstrated on medical equipment, caregivers/healthcare worker hands, insects, and feeding stations (including formula powder). Results were available within 24–72 hours of collection. To collect, plate, and analyse 50 samples, we estimated a total expenditure of $269.40 USD for materials and 13.5 cumulative work hours among all personnel.
Conclusions

Using basic environmental sampling and laboratory techniques aided by chromogenic culture media, we identified ESBL-PE reservoirs (sinks) and plausible transmission vehicles (medical equipment, infant formula, hands of caregivers/healthcare workers, & insects) in this NICU environment. This strategy was a simple and cost-efficient method to assess ESBL-PE bioburden and may be feasible for use in other settings to support ongoing infection control assessments and outbreak investigations.
Study of Thirteen Causal Genes in Turkish Patients with Clinically Suspected Maturity-Onset Diabetes of the Young (MODY) using a Targeted Next-Generation Sequencing Panel
Authors: Dogan Mustafa , Eroz Recep , Bolu Semih , Yüce Hüseyin , Gezdirici Alper , Arslanoğlu İlknur , Teralı Kerem 
Published: August 2021

Abstract
Background: Maturity-onset diabetes of the young (MODY), which is the most common cause of monogenic diabetes, has an autosomal dominant pattern of inheritance and exhibits marked clinical and genetic heterogeneity. The aim of the current study was to investigate molecular defects in patients with clinically suspected MODY using a next-generation sequencing (NGS)-based targeted gene panel. Candidate patients with clinical suspicion of MODY and their parents were included in the study. Molecular genetic analyses were performed on genomic DNA by using NGS. A panel of thirteen MODY-related genes involving ABCC8, BLK, CEL, GCK, HNF1A, HNF1B, HNF4A, INS, KCNJ11, KLF11, NEUROD1, PAX4, PDX1 was designed and subsequently implemented to screen 44 patients for genetic variants. Ten different pathogenic or likely pathogenic variants were identified in MODY-suspected patients, with a diagnostic rate of 22.7%. Eight variants of uncertain significance were also detected. Four novel pathogenic or likely pathogenic variants were detected in the genes GCK (c.1301G>T [p.Cys434Phe]), HNF1A (c.505_506delAA [p.Lys169AlafsTer18]), ABCC8 (c.3584C>T [p.Thr1195Ile]), and CEL (c.679-1G>A). Intriguingly, we were able to detect variants associated with rare forms of MODY in our study population. Our results suggest that in heterogenous diseases such as MODY, NGS analysis enables accurate identification of underlying molecular defects in a timely and cost-effective manner. Although MODY accounts for 1–2% of all diabetic cases, molecular genetic diagnosis of MODY is necessary for optimal long-term treatment and prognosis as well as for effective genetic counseling.
Quercetin and Vitamin E ameliorate cardio-apoptotic risks in diabetic rats
Authors: Ojo Oluwatoyin , Obaidu Ifedayo M. , Obigade Oluwatosin C. , Olorunsogo Olufunso O. 
Published: August 2021

Abstract
Background: Apoptosis is upregulated in all forms of diabetes, with the mitochondria acting as a target in diabetes pathophysiology. Quercetin and vitamin E have shown usefulness in the delay of progression of diabetes-induced complications. However, their effect on the apoptotic process in diabetes mellitus is unknown. We hypothesize that quercetin treatment in diabetes may decrease the propensity for cardio-myocytic death via regulation of the mitochondria permeability transition (mPT) pore opening. Methods: Hearts from normal and streptozotocin-induced diabetic rats were used for the study. Low-ionic strength heart mitochondria were used for swelling assay, and mitochondrial lipid peroxidation (mLPO) activity was spectrophotometrically assessed. Levels of cytochrome c, caspase 3 and 9 were determined by immunohistochemistry, while lesions assessed by histology.Discussion: Diabetic heart mPT pore showed larger amplitude swelling than control, while mLPO levels was increased in diabetic rats relative to control, this resulted in cytochrome c release. This initiated increased caspase 3 and 9 activity in diabetic rats (p<0.05). Histology showed haemorrphagic lesions in diabetic rat hearts. Quercetin and vitamin E treatment reversed these effects, suggestive of their anti-apoptotic effect. Conclusions: Quercetin and vitamin E protection in diabetes is mediated by mPT pore inhibition and modulation of mitochondrial-mediated apoptosis.
Difference Between Delayed Anastomosis and Early Anastomosis in Damage Control Laparotomy Affecting the Infusion Volume and NPWT Output volume: Is Infusion Restriction Necessary in Delayed Anastomosis? A Single-Center Retrospective Analysis
Authors: Tanahashi Yohta , Sato Hisaho , Kawakami Akiko , Sasaki Shusaku , nishinari Yu , Ishida Kaoru , Kojika Masahiro , Endo Shigeatsu , Inoue Yoshihiro , Sasaki Akira 
Published: August 2021

Abstract
Background: Delayed anastomosis is a treatment strategy used in damage control laparotomy (DCL). During temporary abdominal closure (TAC) with DCL, infusion volume, and negative-pressure wound therapy (NPWT) output volume are associated with the success and prognosis of primary fascial closure (PFC). The same may also hold true for anastomosis. The aim of this research is to evaluate whether the difference between early anastomosis and delayed anastomosis in DCL is related to infusion volume and NPWT output volume.Methods: This single-center retrospective analysis targeted patients managed with TAC during emergency surgery for trauma or intra-abdominal sepsis between January 2011 and December 2019. It included patients who underwent repair/anastomosis/artificial anus construction in the first surgery and patients who underwent intestinal resection in the first surgery followed by delayed anastomosis with no intestinal continuity. The main outcomes were infusion volume, NPWT output volume and complications.Results: One hundred nine patients who underwent emergency surgery were evaluated. Seventy-three patients were managed with TAC using NPWT. In 16 patients with early anastomosis and 21 patients with delayed anastomosis, there was no difference in the infusion volume (p=0.2318) or NPWT output volume (p=0.7128) 48 hours after surgery. Additionally, there was no difference in the occurrence of surgical site infection (p=0.315) and suture failure (p=0.8428). During the second-look surgery after 48 hours, the anastomosis was further postponed for 48% of the patients who underwent delayed anastomosis. There was no difference in the infusion volume (p=0.0783) up to the second-look surgery between the patients whose delayed anastomosis was postponed and those who underwent delayed anastomosis, but there was a tendency toward a large NPWT output volume (p=0.024) in the postponed delayed anastomosis group. Anastomosis and PFC were achieved for all patients whose delayed anastomosis was postponed.Conclusions: The presence or absence of anastomosis during TAC management does not affect NPWT output volume. Delayed anastomosis may be managed with the same infusion volume as that used for early anastomosis. There is also the option of postponing anastomosis if the planned delayed anastomosis is complicated.Trial RegistrationThe retrospective protocol of this study was approved by our institutional review board (MH2018-611).
Low dose niacin versus placebo in the treatment of Parkinson’s Disease: A Randomized Controlled Trial
Authors: Wakade Chandramohan , Chong Raymond , Seamon Marissa , Purohit Sharad , Giri Banabihari , Morgan John C. 
Published: August 2021

Abstract
BackgroundParkinson’s Disease (PD) patients have lower niacin levels compared to their spouses. The main objective was to study low-dose daily niacin supplementation versus placebo on motor symptoms in Parkinson’s disease subjects.MethodsA randomized, placebo-controlled, double-blind, single-center clinical trial in Parkinson’s disease patients was performed in Augusta, GA, between September 2016 to September 2019. Randomized participants were 47 PD patients who received either low-dose niacin (N = 21 ) or placebo (N = 26) for the first six months (mean age 68.4 SD, 8.7; mean duration of disease 5.8 SD 4.9; H&Y scores between 0.5 to 4; 64% subjects were Veterans). The Veterans Affairs Pharmacy generated the randomized sequence. After the double-blind phase, all participants received open-label niacin for the next six months. All patients were evaluated at baseline, six months, and one year of treatment. The main outcome measure was the Unified Parkinson’s Disease Rating Scale III (UPDRS III) scores. Secondary outcome measures were depression, sleep quality, mental flexibility and cognition, and physical fatigue.Results39 subjects were analyzed with low-dose niacin (N = 18) and placebo (N = 21) for the completion of the first six months (randomized, double-blind), and 31 subjects were analyzed for the completion of the next six months (open-label) with low-dose niacin (N = 14) and placebo (N = 17). Niacin treatment was not tolerated by two subjects. The baseline mean UPDRS III score was 21.3 ± 15.8 for the niacin group and 22.4 ± 11.8 for placebo. The change with six months of placebo was 0.05 [95% CI, -2.4 to 2.32], and niacin was 1.06 [95% CI, -3.68 to 1.57]. From six to twelve months, the average UPDRS III score decreased for the placebo group by 4.58 [95% CI, -0.85 to 8.30] and the niacin group by 4.63 [95% CI, 1.42 to 7.83]. Eight subjects withdrew from the study before the 6-month time point and eight more before the one-year time point due to voluntary discontinuation, flushing, or inability to continue (SARS-CoV-2 shut-down).ConclusionLow-dose niacin supplementation may be helpful as an adjunct therapy in improving motor function in PD.Trial registrationClinicaltrials.gov, NCT03462680. Registered 12 March 2018- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03462680?term=gpr109A&draw=2&rank=1
Nutritional Status and Associated Factors Among Children With Congenital Heart Disease in Selected Governmental Hospitals and Cardiac Center, Addis Ababa Ethiopia.
Authors: Woldesenbet Rediet , Murugan Rajalakshmi , Moges Tamirat , Mulugeta Feven 
Published: August 2021

Abstract
Background: Children with congenital heart disease are at risk for poor growth and under-nutrition compared with healthy children. Inadequate energy intake, high energy requirement or both of these reasons are thought to be the reason for malnourishment of children with congenital heart disease. Therefore aim of this study to assess the nutritional status of children with congenital heart disease and associated factors in selected governmental hospitals and cardiac center Addis Ababa, Ethiopia.Method: Institutional based cross sectional study was include 395 samples among children age under15years old diagnosed with CHD. Data was collected with structured questionnaire and chart review. Samples were selected by consecutive sampling method and data was collected by face to face interview. Multivariable regression model was developed after p value <0.25 in the binary logistic analysis then after p value< 0.05 was taken as significant. Result: A total of 373 children were participated in this study. The prevalence of wasting and stunting was 144(38.6%) and 134(35.9%) respectively. The prevalence of underweight and malnutrition in children under 10years was 143(43.1%). Most of the children were diagnosed with VSD (36.7%). Children age group of 13months-5years were associated with wasting and underweight [AOR=0.434, 95%CI :( 0.231, 0.816)] and [AOR=0.360, 95%CI :( 0.183, 0.711)] respectively. Children diagnosed with PAH were 1.885 times more likely to be underweight [AOR=1.885, 95%CI :( 1.094, 3.246)]. When the hemoglobin level increases by every unit per g/dl the chance to be wasting and underweight decreases by 13.1% and 18.6%[AOR=0.869, 95%CI :( 0.792, 0.955)] and [AOR=0.869, 95%CI :( 0.792, 0.955)] respectively. The level of SPO2 is associated with stunting and underweight [AOR=0.970, 95%CI :( 0.943, 0.998)] and [AOR=0.970, 95%CI :( 0.943, 0.998)] respectively. Conclusion: The prevalence of malnutrition in children with CHD is pretty high. The responsible bodies should act on the accessibility of early treatment; focus on working in multidisciplinary way to prevent malnutrition and its consequences.
Propagation Network of Tailings Dam Failure Risk: An Empirical Research and The Identification of Key Hazard Node
Authors: Zhen Zhixin , Ma Bo , Zhao Huijie 
Published: August 2021

Abstract
The tailings dam system is complex, and the dam structure changes continuously over time, which makes it difficult to identify hazards and analyze the causes of failure accidents. This paper uses hazards to represent the nodes, and the relationship between hazards to represent the edges. Based on the complex network theory, the propagation network of tailings dam failure risk is constructed. The traditional identification methods usually focus on one aspect of the information of the network, while it cannot take into account to absorb the advantages of different methods, resulting in the lack of information, which will lead to a certain difference between identified key hazards and real key hazards. In order to solve this problem, by absorbing the advantages of different methods under different hazard remediation (deleted) ratios, combined with the characteristics of multi-stage propagation of tailings dam failure risk, this paper proposes a multi-stage collaborative hazard remediation method (MCHRM) to determine the importance of hazard nodes. When the important nodes of this network that affect the network efficiency are found, by consulting the monitoring data, daily inspection results and safety evaluation information of each hazard before the dam failure, we can determine the real cause of the accident from the above important nodes according to the grading standards of hazard indicators. In the application example of Feijão Dam I, this article compares the key hazards obtained by the above methods with the conclusions of the accident investigation team. It can be found that the above method has a very good effect on finding the key causes of tailings dam failure.
Barriers to meeting the Global Nutrition Target 2025 for Exclusive Breastfeeding: an analysis of three decades (1990, 2000, 2010) in six Latin American and Caribbean countries
Authors: Meira Camila Abadia Rodrigues , Buccini Gabriela dos Santos , Azeredo Catarina Machado , Conde Wolney Lisboa , Rinaldi Ana Elisa Madalena 
Published: August 2021

Abstract
Background: The World Health Organization set a global nutrition target to increase the rate of exclusive breastfeeding (EBF) among infants younger than 6 months to at least 50% by the year 2025. Yet, the early introduction of solid food (before 6 months of age) occurs in approximately one in three infants, making it a major barrier to EBF. The aim of this study was to analyze the evolution of the early introduction of foods offered to infant under the age of six months in Latin American and Caribbean countries in the last three decades (1990, 2000,2010).Method: This is a time series study with data from Demographic and Health Surveys carried out between 1990 and 2017 in six countries in Latin America and the Caribbean: Bolivia (1994 to 2008); Colombia (1995 to 2010), Guatemala (1995 to 2015), Haiti (1994/1995 to 2016/2017), Peru (1996 to 2012) and the Dominican Republic (1996 to 2013). The total sample consisted of 20,633 infants under the age of six months. Surveys were grouped in three decades as following: 1990s for surveys from 1990 to 1999; 2000s for surveys from 2000 to 2009; and 2010s for surveys from 2010 to 2017. EBF, predominant breastfeeding (PBF), mixed breastfeeding (mixed BF), supplemented breastfeeding (supplemented BF) and non-breastfeeding (non-BF), and individual foods (water, liquids, milk, formula and semi-solid/solid) were analyzed. Mean prevalence rates of breastfeeding and food indicators were calculated for all countries, according to monthly age groups and decade of survey.Results: Between 1990s and 2010s, there was an increase in the mean prevalence of EBF (38.6% and 46.2%, respectively) and a reduction in the mean prevalence of PBF (50.8% and 43.0%, respectively). There was a reduction in the means of liquids (1990s=40.4%,2010s=15.9%) and milk (1990s=20.3%,2010s=8.4%) and an increase in water (1990s=31.7%,2010s=37.5%), and formula (1990s=16.4%, 2010s=25.8%).Conclusions: In the last three decades, n all age groups, there was an increase in the prevalence of EBF, as well as a significant reduction in fluids and milk. The increased supply of water and infant formula are the main barriers to achieving the Global Nutrition Target 2025 for EBF.
Brain CT Registration Using Hybrid Supervised Convolutional Neural Network
Authors: Yuan Hongmei , Yang MingLei , Qian Shan , Wang WenXin , Jia XiaoTian , Huang Feng 
Published: August 2021

Abstract
Background: Brain computed tomography (CT) image registration is an essential step in the image evaluation of acute cerebrovascular disease (ACVD). Due to the complexity of human brain morphology, low brain CT soft-tissue resolution, low gray/white matter contrast, and the large anatomy variation across individuals, it is still a great challenge to perform brain CT registration accurately and rapidly. This study developed a hybrid supervised convolutional neural network (HSCN-Net) which may be used for assessment of ACVD in brain CT.Method: HSCN-Net generates synthetic deformation fields by a simulator to solve the lack of registration gold standard. The simulator are used to generate multi-scale deformation fields to overcome the registration challenge of large deformation. HSCN-Net adopts a hybrid loss function constituted by deformation field and image similarity to improve registration accuracy and generalization ability. In this work, one hundred and one brain CT images were included for HSCN-Net training and evaluation, and the results were compared with Demons and VoxelMorph. Qualitative analysis by visual evaluation, as well as quantitative analysis by Endpoint Error (EPE) between deformation fields, image Normalized Mutual Information (NMI), and Dice coefficient were carried out to access the model performance.Results: Qualitative analysis of HSCN-Net was similar to that of Demons, and both were superior to that of VoxelMorph. Moreover, HSCN-Net was more competent for large and smooth deformations. For quantitative evaluation, the EPE mean of HSCN-Net (3.29 mm) was lower than that of Demons (3.47 mm) and VoxelMorph (5.12 mm); the Dice mean of HSCN-Net was 0.96, which was better than that of Demons (0.90) and VoxelMorph (0.87); and the NMI mean of HSCN-Net (0.83) was slightly lower than that of Demons(0.84) but higher than that of VoxelMorph (0.81). In addition, the mean registration time of HSCN-Net (17.86 s) was lower than that of VoxelMorph (18.53 s) and Demons (147.21 s).Conclusion: The proposed hybrid supervised convolution registration network can achieve accurate and rapid brain CT registration. It is helpful for improving image evaluation of ACVD, thereby assisting clinicians in diagnosis and treatment decision-making.