bluuebunny/crossref_metadata_2025_split huggingface dataset:
Borderline personality disorder and depressive disorder
Authors: Rao Sathya , Broadbear Jillian 
Published: October 2019

Objective: Borderline personality disorder (BPD) is frequently accompanied by low mood, the features of which may satisfy the diagnostic criteria for major depressive disorder (MDD). Treatment of depressive symptoms in the absence of BPD-appropriate treatment is less effective and may cause iatrogenic harm. This paper briefly reviews the co-occurrence of BPD and depressive disorder and suggests ways of differentiating these disorders and optimising treatment within the Australian Mental Health context. Conclusions: Depressive symptoms are present in the majority of people with BPD. To address the difficulty differentiating clinically distinct MDD from depressive symptoms that are integral to BPD psychopathology, it is suggested that depressive symptoms arising from a primary diagnosis of BPD (i) may exhibit transience and be stress reactive, (ii) lack a robust clinical response to antidepressant medication and/or electroconvulsive treatment and (iii) are responsive to BPD-appropriate psychotherapy.
Hepatoportal Venous Trauma: Analysis of Incidence, Morbidity, and Mortality
Authors: Maithel Shelley , Grigorian Areg , Kabutey Nii-Kabu , Sheehan Brian M. , Gambhir Sahil , Wolf Ronald F. , Jutric Zeljka , Nahmias Jeffry 
Published: October 2019

Objectives: Although traumatic injuries to the superior mesenteric vein (SMV), portal vein (PV), and hepatic vein (HV) are rare, their impact is significant. Small single center reports estimate mortality rates ranging from 29% to 100%. Our aim is to elucidate the incidence and outcomes associated with each injury due to unique anatomic positioning and varied tolerance of ligation. We hypothesize that SMV injury is associated with a lower risk of mortality compared to HV and PV injury in adult trauma patients. Methods: The Trauma Quality Improvement Program database (2010-2016) was queried for patients with injury to either the SMV, PV, or HV. A multivariable logistic regression model was used for analysis. Results: From 1,403,466 patients, 966 (0.07%) had a single major hepatoportal venous injury with 460 (47.6%) involving the SMV, 281 (29.1%) involving the PV, and 225 (23.3%) involving the HV. There was no difference in the percentage of patients undergoing repair or ligation between SMV, PV, and HV injuries ( P > .05). Compared to those with PV and HV injuries, patients with SMV injury had a higher rate of concurrent bowel resection (38.5% vs 12.1% vs 7.6%, P < .001) and lower mortality (33.3% vs 45.9% vs 49.3%, P < .01). After controlling for covariates, traumatic SMV injury increased the risk of mortality (odds ratio [OR] 1.59, confidence interval [CI] = 1.00-2.54, P = .05) in adult trauma patients; however, this was less than PV injury (OR = 2.77, CI = 1.56-4.93, P = .001) and HV injury (OR = 2.70, CI = 1.46-4.99, P = .002). Conclusion: Traumatic SMV injury had a lower rate of mortality compared to injuries of the HV and PV. SMV injury increased the risk of mortality by 60% in adult trauma patients, whereas PV and HV injuries nearly tripled the risk of mortality.
A pragmatic, multi-centered, stepped wedge, cluster randomized controlled trial pilot of the clinical and cost effectiveness of a complex Stroke Oral healthCare intervention pLan Evaluation II (SOCLE II) compared with usual oral healthcare in stroke wards
Authors: Brady Marian C , Stott David J , Weir Christopher J , Chalmers Campbell , Sweeney Petrina , Barr John , Pollock Alex , Bowers Naomi , Gray Heather , Bain Brenda Jean , Collins Marissa , Keerie Catriona , Langhorne Peter 
Published: October 2019

Background Patients with stroke-associated pneumonia experience poorer outcomes (increased hospital stays, costs, discharge dependency, and risk of death). High-quality, organized oral healthcare may reduce the incidence of stroke-associated pneumonia and improve oral health and quality of life. Aims We piloted a pragmatic, stepped-wedge, cluster randomized controlled trial of clinical and cost effectiveness of enhanced versus usual oral healthcare for people in stroke rehabilitation settings. Methods Scottish stroke rehabilitation wards were randomly allocated to stepped time-points for conversion from usual to enhanced oral healthcare. All admissions and nursing staff were eligible for inclusion. We piloted the viability of randomization, intervention, data collection, record linkage procedures, our sample size, screening, and recruitment estimates. The stepped-wedge trial design prevented full blinding of outcome assessors and staff. Predetermined criteria for progression included the validity of enhanced oral healthcare intervention (training, oral healthcare protocol, assessment, equipment), data collection, and stroke-associated pneumonia event rate and relationship between stroke-associated pneumonia and plaque. Results We screened 1548/2613 (59%) admissions to four wards, recruiting n = 325 patients and n = 112 nurses. We observed marked between-site diversity in admissions, recruitment populations, stroke-associated pneumonia events (0% to 21%), training, and resource use. No adverse events were reported. Oral healthcare documentation was poor. We found no evidence of a difference in stroke-associated pneumonia between enhanced versus usual oral healthcare ( P = 0.62, odds ratio = 0.61, confidence interval: 0.08 to 4.42). Conclusions Our stepped-wedge cluster randomized control trial accommodated between-site diversity. The stroke-associated pneumonia event rate did not meet our predetermined progression criteria. We did not meet our predefined progression criteria including the SAP event rate and consequently were unable to establish whether there is a relationship between SAP and plaque. A wide confidence interval did not exclude the possibility that enhanced oral healthcare may result in a benefit or detrimental effect. Trial Registration NCT01954212.
Costs of bleeding on long-term antiplatelet treatment without routine co-prescription of proton-pump inhibitors
Authors: Luengo-Fernandez Ramon , Li Linxin , Rothwell Peter M ,   On Behalf of the Oxford Vascular Study
Published: October 2019

Background Long-term antiplatelet treatment is associated with major bleeding. Aims To determine the costs associated with major bleeding in patients treated with aspirin-based antiplatelet treatment for secondary prevention of vascular events without routine prescription of proton-pump inhibitors and to estimate the likely long-term savings from routine co-prescription. Methods In a prospective population-based cohort study of TIA, ischemic stroke, and MI treated with antiplatelet drugs, we evaluated hospital care costs associated with bleed management during 10-year follow-up. Bleeding-associated costs were averaged across all patients. For upper GI-bleeds, mean costs were compared with the cost of routine co-prescription of proton-pump inhibitor. Results Among 3166 patients on antiplatelet therapy with 405 first bleeding events, the average cost of major bleeding was $13,093 (S.D. 20,501), with similar costs for upper GI bleeds and intracranial bleeds ( p = 0.235). However, total costs among the 3166 patients were higher for upper GI bleeds ($1,158,385 vs. $740,123). Averaged across all patients, the 10-year cost of major bleeding was $838 (95%CI: 680–1007), $411 due to upper GI bleeding, the cost of which increased from $175 in those aged <75 years to $644 at age ≥75 years ( p < 0.0001). The corresponding costs of routine life-long co-prescription of proton-pump inhibitor to those patients not on prior treatment were $85 (84–88) and $39 (38–42). Conclusions In secondary prevention with aspirin-based antiplatelet treatment without routine proton-pump inhibitor use, the long-term costs of upper-GI bleeding at age ≥75 years are much higher than at younger age groups, and are at least 10-fold greater than the drug cost of routine co-prescription of proton-pump inhibitor.
How prolonged mechanical ventilation is a neglected disease in chest medicine: a study of prolonged mechanical ventilation based on 6 years of experience in Taiwan
Authors: Huang Chienhsiu 
Published: October 2019

Background: An increasing number of patients require prolonged mechanical ventilation (PMV) to survive recovery from critical care. It should be emphasized that PMV is a neglected disease in chest medicine. We investigated 6 years of clinical outcomes and long-term survival rates of patients who required PMV. Methods: We analyzed retrospectively data from patients in respiratory care center (RCC) to investigate the main causes of respiratory failure leading patients to require PMV. We also studied the factors that influence the ventilator weaned rate, factors that influence the long-term ventilator dependence of patients who require PMV, as well as patients’ hospital mortality and long-term survival rates. Results: A total of 574 patients were admitted to RCC during the 6 years. Of these, 428 patients (74.6%) were older than 65 years. A total of 391 patients (68.1%) were successfully weaned from the ventilator while 83 patients (14.4%) were unsuccessfully weaned. A total of 95 patients (16.6%) died during RCC hospitalization. The most common cause of acute respiratory failure leading to patients requiring PMV was pneumonia. The factor that affected whether patients were successfully weaned from the ventilator was the cause of the respiratory failure that lead patients to require PMV. Our hospital mortality rate was 32.4%; the 1-year survival rate was 24.3%. There was a strong correlation between higher patient age and higher hospital mortality rate and poor 1-year survival rate. Patients with no comorbidity demonstrated good 1-year survival rates. Patients with four comorbidities and patients with end-stage renal disease requiring hemodialysis comorbidity showed poor 1-year survival rates. Conclusions: The factor that affected whether patients were successfully weaned from the ventilator was the cause of the respiratory failure that lead patients to require PMV. Older patients, patients with renal failure requiring hemodialysis, and those with numerous comorbidities demonstrated poor long-term survival. The reviews of this paper are available via the supplemental material section.
Global transcriptional regulation of STAT3- and MYC-mediated sepsis-induced ARDS
Authors: Zhang Jianfeng , Luo Yifeng , Wang Xiaoling , Zhu Jieyun , Li Qian , Feng Jihua , He Dan , Zhong Zhimei , Zheng Xiaowen , Lu Junyu , Zou Donghua , Luo Jiefeng 
Published: October 2019

Background: In recent years, sepsis-induced acute respiratory distress syndrome (ARDS) has remained a major clinical challenge for patients in intensive care units. While some progress has been reported over the years, the pathogenesis of ARDS still needs to be further expounded. Methods: In the present study, gene set enrichment analysis, differentially expressed genes analysis, short time-series expression miner, protein–protein interaction (PPI) networks, module analysis, hypergeometric test, and functional enrichment analysis were performed in whole blood gene expression profiles of sepsis and induced-sepsis ARDS to explore the molecular mechanism of sepsis-induced ARDS. Results: Further dysregulated genes in the process evolving from healthy control through sepsis to sepsis-induced ARDS were identified and organized into 10 functional modules based on their PPI networks. These functional modules were significantly involved in cell cycle, ubiquitin mediated proteolysis, spliceosome, and other pathways. MYC, STAT3, LEF1, and BRCA1 were potential transcription factors (TFs) regulating these modules. A TF-module-pathway global regulation network was constructed. In particular, our findings suggest that MYC and STAT3 may be the key regulatory genes in the underlying dysfunction of sepsis-induced ARDS. Receiver operating characteristic curve analysis showed the core genes in the global regulation network may be biomarkers for sepsis or sepsis-induced ARDS. Conclusions: We found that MYC and STAT3 may be the key regulatory genes in the underlying dysfunction of sepsis-induced ARDS. The reviews of this paper are available via the supplementary material section.
Oct-4: a prognostic biomarker of urinary bladder cancer in North India
Authors: Siddiqui Zainab , Srivastava Anand N. , Sankhwar Satya N. , Zaidi Noorin , Fatima Naseem , Singh Shivangi , Yusuf Mohd. 
Published: October 2019

Background: The objective of this study was to evaluate Octamer-binding transcription factor 4 (Oct-4), neutrophil to lymphocyte ratio (NLR) and body mass index (BMI) as independent prognostic biomarkers for prediction of urinary bladder cancer (UBC) outcomes. With the advancement in prognostic biomarker discovery, tumor recurrence is difficult to accurately predict in UBC. UBC is costly to treat due to the requirement of frequent invasive follow-up sessions. Therefore, it is of utmost importance to evaluate good prognostic biomarkers for UBC surveillance. Methods: We studied 39 UBC tissue samples. Oct-4 protein expression was evaluated semiquantitatively by immunohistochemistry (IHC). Complete blood count data and body weight as well as the height of the patients were retrieved and recorded before the date of the first transurethral resection of bladder tumor (TURBT). The follow-up period was 48 months for recurrence-free survival (RFS), progression-free survival (PFS), and overall survival (OS). Results: Oct-4 expression profile was found to be significantly associated with gender ( p = 0.028), tumor grade ( p = 0.038), tumor stage ( p = 0.003), lymph node status ( p = 0.029), recurrence ( p = 0.004), progression ( p = 0.011), and treatment modality ( p = 0.016). Tumor grade and progression were found significant with NLR values (tumor grade, p = 0.006; progression, p = 0.038) and BMI (tumor grade, p = 0.036; progression, p = 0.014). Moreover, BMI was also significantly associated with UBC recurrence ( p = 0.014). Kaplan–Meier survival analysis showed poor prognosis with both high Oct-4 expression (RFS, p = 0.001; PFS, p = 0.004; OS, p = 0.014) and high NLR values (RFS, p = 0.049; PFS, p = 0.004; OS, p = 0.005). Patients with high BMI too had poor RFS ( p = 0.025) and poor PFS ( p = 0.032). Furthermore, multivariate Cox regression analysis, indicated Oct-4 as an independent prognostic biomarker for RFS (HR = 0.240, 95% CI, 0.072–0.804, p = 0.021). Conclusions: We conclude that the expression profile of Oct-4 will be beneficial in prediction of UBC recurrence, and could have profound implications on the development of new therapeutic targets for UBC treatment.
Effectiveness of surgical management with an adjustable sling versus an artificial urinary sphincter in patients with severe urinary postprostatectomy incontinence: a systematic review and network meta-analysis
Authors: Guachetá Bomba Pedro Luis , Ocampo Flórez Ginna Marcela , Echeverría García Fernando , García-Perdomo Herney Andrés 
Published: October 2019

Background: The purpose of this study was to determine the effectiveness of an adjustable sling compared with an artificial urinary sphincter (AUS) in patients with severe urinary incontinence (SUI) postprostatectomy (PP). Methods: This review was carried out following the Cochrane Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration. We searched Medline, Embase, LILACS, and CENTRAL databases. Studies with patients older than 18 years of age with SUI PP who underwent sling or AUS intervention and had been monitored for longer than 12 months were included. Results: Seven studies were included, yielding a sample size of 420. Pads were reportedly dry or improved in 70% of the sling group compared with 74% in the AUS group. The Incontinence Impact Questionnaire, Short Form (IIQ-7) was the most frequently used scale and showed improvement, with a score of 82.8% in the AUS group compared with 86.1% in the sling group. When comparing interventions with nonintervention, relative risks (RRs) of 35.37 (95% confidence interval [CI]: 7.17–174.35) and 45.14 (95% CI: 11.09–183.70) were found for the adjustable sling and AUS, respectively, which were statistically significant. No significant differences were found when AUS versus adjustable sling were compared, with an RR of 0.78 (95% CI: 0.09–6.56). We found a low risk of bias in most studies. Conclusions: Both interventions can reduce incontinence and improve the quality of life of patients with SUI PP. The published literature is substantially limited as no randomized clinical trials are available, no consensus has been reached regarding the definition of severity of incontinence, and considerable heterogeneity exists across the outcome variables measured.
Effects of preoperative anti‐tumour necrosis factor alpha infusion timing on postoperative surgical site infection in inflammatory bowel disease: A systematic review and meta‐analysis
Authors: Qiu YuJie , Zheng ZiCheng , Liu Gang , Zhao XinYu , He AnQi 
Published: October 2019

BackgroundAnti‐tumour necrosis factor alpha agents (anti‐TNF‐α) have been widely used in patients with inflammatory bowel disease (IBD). However, few published meta‐analyses have focused on timing of the last infusion before surgery. We evaluated the relationship between preoperative anti‐TNF‐α timing and postoperative surgical site infection to provide additional evidence for surgeons to choose appropriate dates for surgery.MethodsWe searched from inception until January 2019 for studies that documented postoperative complications of adults with IBD who underwent preoperative anti‐TNF‐α treatment. Primary outcomes of included studies were the odds ratios of preoperative anti‐TNF‐α time frames (4, 8 and 12 weeks). In addition, surgical site infection and its subtypes (anastomotic leakage, abscesses and wound infection) were analysed.ResultsTwenty‐seven publications were included. No significant difference between anti‐TNF‐α and control cohorts was observed for most postoperative surgical site infections (or its subtypes) when the preoperative anti‐TNF‐α infusion time window was within 4, 8 or 12 weeks. Additionally, no significant difference in postoperative complications was observed between preoperative anti‐TNF‐α windows of within four weeks and more than four weeks.ConclusionsIn terms of surgical site infection and its subtypes, anti‐TNF‐α may be safe for ulcerative colitis and Crohn's disease patients who receive their last infusion of anti‐TNF‐α more than four weeks before surgery. We also found no evidence that anti‐TNF‐α was a risk factor when administered within four weeks, with the exception of subgroup results from a single study. Stratified by time window, use of anti‐TNF‐α until surgery has the potential to become a more considered strategy in clinical practice.
New National Initiatives of Modernizing Education in China
Authors: Zhu Yiming 
Published: October 2019

Purpose: This article aims to shed light on a latest education policy blueprint in China, titled China’s education modernization 2035, which was issued by the Central Government of China in February of 2019. Design/Approach/Methods: This is an analytical policy review. Findings: The author argues that this new Chinese educational policy was driven by three factors: UN 2030 Agenda, China’s national strategy, and Chinese educational reform and improvement. In China’s education modernization 2035, eight key principles were rooted in the Chinese context and also recognized by international society. According to this policy initiative, 10 specific strategical tasks are outlined to reform Chinese education toward 2035. Originality/Value: The article will be useful to learn and understand the new directions and the future approaches of Chinese education development and reform toward 2035.
Failure Pressures of Dural Repairs in a Porcine Ex Vivo Model: Novel Use of Titanium Clips Versus Tissue Glue
Authors: Chorath Kevin , Krysinski Mason , Bunegin Leonid , Majors Jacob , Weitzel Erik Kent , McMains Kevin Christopher , Chen Philip G. 
Published: October 2019

Objective Endoscopic skull base surgery is advancing, and it is important to have reliable methods to repair the resulting defect. The objective of this study was to determine the failure pressures of 2 commonly used methods to repair large dural defects: collagen matrix underlay with fibrin glue and collagen matrix underlay with polyethylene glue, as well as a novel repair method: fascia lata with nonpenetrating titanium vascular clips. Methods The failure pressure of the 3 dural repairs was determined in a closed testing apparatus. Defects in porcine dura were created and collagen matrix grafts were used as an underlay followed by either fibrin glue (FG/CMG) or polyethylene glycol glue (PEG/CMG). A third condition using a segment of fascia lata was positioned flush with the edges of the dural defect and secured with titanium clips (TC/FL). Saline was infused to simulate increasing intracranial pressure (ICP) applied to the undersurface of the grafts until the repairs failed. Results The mean failure pressure of the PEG/CMG repair was 34.506 ± 14.822 cm H2O, FG/CMG was 12.413 ± 5.114 cm H2O, and TC/FL was 8.330 ± 3.483 cm H2O. There were statistically significant differences in mean failure pressures among the 3 repair methods. Conclusion In this ex vivo model comparing skull base repairs’ ability to withstand cerebrospinal fluid leak, the repairs that utilized PEG/CMG tolerated the greatest amount of pressure and was the only repair that exceeded normal physiologic ICP’s. Repair methods utilizing glues generally tolerated higher pressures compared to the novel repair using clips alone.
Fuzzy Torque Control of the Bionic Flexible Manipulator Actuated by Pneumatic Muscle Actuators
Authors: Liu Kai , Chen Yining , Xu Jiaqi , Wu Yang , Lu Yonghua , Zhao Dongbiao 
Published: October 2019

Abstract
A bionic flexible manipulator driven by pneumatic muscle actuator (PMA) can better reflect the flexibility of the mechanism. Current research on PMA mainly focuses on the modeling and control strategy of the pneumatic manipulator system. Compared with traditional electro-hydraulic actuators, the structure of PMA is simple but possesses strong nonlinearity and flexibility, which leads to the difficulty in improving the control accuracy. In this paper, the configuration design of a bionic flexible manipulator is performed by human physiological map, the kinematic model of the mechanism is established, and the dynamics is analyzed by Lagrange method. A fuzzy torque control algorithm is designed based on the computed torque method, where the fuzzy control theory is applied. The hardware experimental system is established. Through the co-simulation contrast test on MATLAB and ADAMS, it is found that the fuzzy torque control algorithm has better tracking performance and higher tracking accuracy than the computed torque method, and is applied to the entity control test. The experimental results show that the fuzzy torque algorithm can better control the trajectory tracking movement of the bionic flexible manipulator. This research proposes a fuzzy torque control algorithm which can compensate the error more effectively, and possesses the preferred trajectory tracking performance.