bluuebunny/crossref_metadata_2025_split huggingface dataset:
A modified approach Pancreaticoduodenectomy feasible for recurrent cancer in No. 13 lymph node following gastrectomy
Authors: Feng Yechen , Zhang Hang , Qin Renyi 
Published: October 2019

Abstract
Background In a proportion of patients with recurrence of gastric cancer after surgery, that recurrence is in the No. 13 lymph node group. The treatment of these patients are still controversal and challenging. Here we used a modified ‘Artery-first’ approach technique and retrospective analysis the data to examined the efficacy and feasibility of reoperative pancreaticoduodenectomy for recurrent cancer in this lymph node group after initial subtotal gastrectomy.
Methods From January 2011 to December 2015, 24 patients underwent pancreaticoduodenectomy with a modified ‘Artery-first’ approach technique for recurrent gastric cancer in the No. 13 lymph node group at Tongji Hospital, Wuhan, China. Their medical records were retrospectively reviewed for relevant clinical characteristics, type of first and second surgical procedures, TNM stage, adjuvant treatments, complications, and survival. Kaplan–Meier curves were used to analyze survival.
Results The median interval between the first and second operations was 7.5 (range 4.5–13.5) months and the median duration of follow-up 20.1 (range 5–58) months. The median operation time was 6.5 (range 5.0–9.9) hours, and median blood loss 448 (range 110–1200) mL. The median intensive care unit stay was 1.5 (range 1–4) days and the median postoperative hospital stay 31.6 (range 15–55) days. No patient died. Two had serious complications. The median survival after pancreaticoduodenectomy was 28 (range 5–58) months. 13 patients had subsequent recurrence. T stage, N stage, and adequacy of resection influenced survival.
Conclusion s Pancreaticoduodenectomy with a modified ‘Artery-first’ approach technique is a reasonable treatment option for recurrent remnant gastric cancer following unexpanded lymphadenectomy, particularly for patients with no distant metastases. Additionally, D2+ lymphadenectomy may be more effective than D2 lymphadenectomy in patients with locally advanced gastric cancer.
Reform of health-care payments for Chinese medical insurancepractices in Luohu District, Shenzhen City, Guangdong Province
Authors: Gong Fangfang , Sun Xizhuo , Li Wenhai , Zhang Zou , Li Yanan 
Published: October 2019

Abstract
Background Following the implementation of the Healthy China 2030 strategy, China’s health-care system must shift from being disease-centered to health-centered. Medical insurance funds are the main economic resource for medical health-care service providers in China; therefore, the Chinese medical insurance system has become an important economic lever for adjusting the behavior of medical health-care providers. In the new round of medical reform, substantial progress has been made in the construction of a medical treatment insurance system. The world’s largest medical insurance network has been created in a relatively short period in China and basically achieves universal medical insurance coverage. However, this system mainly provides full coverage to the amount and has yet to fully achieve the principle of “health-care for all” proposed by the Healthy China 2020 strategy. China must promote reform in the medical insurance system and establish a medical insurance guidance mechanism to ensure that medical service providers consider and promote health care. Methods Using Luohu Hospital Group in Shenzhen City, Guangdong Province as the research object, the details of the health maintenance organization’s reform of its medical insurance payment patterns to be more health-oriented are introduced. Comparing the summarized characteristics of the health maintenance organization’s payment patterns, the relevant data for the medical insurance operation and health status of the insured before and after the reform were analyzed statistically. Results The data show that after the reform, the total hospitalization cost of the insured, number of inpatients, and hospitalization rate all decreased. The growth rate of expenditure in the medical insurance fund slowed and initial results were shown in preventive health-care work. The incidence of some infectious diseases and the hospitalization rate of patients with chronic diseases decreased. Conclusions The medical service providers form positive incentives and appropriate medical orientations, while patients demanding health care may form good habits of seeking medical treatment and healthy life, but not pursuing economic benefits through the medical insurance reform.
Time trends analysis of statin prescription prevalence, therapy initiation, dose intensity, and utilization
Authors: Liu Yujuan , Lv Xiaoqun , Xie Ning , Fang Zhonghong , Ren Weifang , Gong Yuan , Jin Yan , Zhang Jun 
Published: October 2019

Abstract
Background Statin remains a mainstay in the prevention and treatment of cardiovascular disease. Statin utilization has evolved over time in many counties, but data on this topic from China are quite limited. This study aimed to investigate the changing trends of statins prescription, as well as detail the statin utilization through a successive longitudinal study. Methods Prescription database was established based on electronic health records retrieved from the hospital information system of Jinshan Hospital, Fudan University from January 2012 to December 2018 in Shanghai, China. The prescription rates and proportions of different statin types and doses among all patients were examined. Sub-analyses were performed by stratified by age, gender, dose intensity, and preventative intervention.Results During the study period, a total of 51,083 patients exposed to statins were included in this study (mean [SD] age, 59.78 [±13.16] years; 53.60% male, n =27, 378). The overall statins prescription rate in patients increased from 2012 (1.24%, 95% CI: 1.21%-1.27) to 2018 (3.16%, 95% CI: 3.11%-3.20%), P <0.001. Over 90% of patients were given a moderate dose of statins. Our study has witnessed a significant rise in statin therapy in primary and secondary prevention. Patients with a history of coronary or cerebrovascular events were more likely to be prescribed with statins for preventative intervention. Conclusions In conclusion, statins were frequently prescribed and steadily increased over time. However, in clinical practice, statins prescription rate in patients may be sub-optimal in local residents. A coordinated effort among the patient, clinical pharmacist, stakeholders and health system is still needed to improve statin utilization accordingly. Keywords: statins, prevalence, cardiovascular disease, initiation, preventative intervention.
Frequency of use of terminal points as an important risk factor for Legionella colonization in hospitals
Authors: Lucas Rafael Manuel Orti , Luciano Eugenio 
Published: October 2019

Abstract
Background: Hospitals have a different structure than domestic buildings. Legionella is a bacterium that can colonize the hospital water causing many outbreaks. It’s a Public Health problem and its prevention and control are essential to avoid nosocomial infections. The aims of this study are to evaluate several risk factors and parameters that can contribute to Legionella colonization in a hospital, thereby improving Legionella risk assessment process. Methods A total of 136 water samples (hot water and cold water) was investigated from different points of a hospital water network. These samples were tested for Legionella sp by three laboratories using different diagnostic tests: culture, polymerase chain reaction (PCR) and a method based on immunomagnetic separation (IMS). The results for these three techniques were combined and interpreted by three microbiologists with the aim of defining a new standard index. A multivariate analysis was performed by logistic regression to estimate the adjusted risk associated with the type of water, length of the pipe, chlorine, temperature, type of terminal point, period of the year, type of health care (ambulatory or hospital) and the frequency of use of the terminal point. Results: There was no statistically significant difference, on the basis of the new standard index, neither between laboratories nor between diagnostic tests. Positive results of this index were significantly correlated with the outpatient medical consultations, shower, frequency of use of the terminal points, and temperature. Logistic regression model revealed that outpatient medical consultations (p=0.058), shower (p=0.007) and the frequency of use of the terminal points (p=0.001) are predictors of Legionella colonization. Conclusions: The inclusion of rapid techniques (IMS, PCR) in the development of a new standard index offer increased sensitivity of Legionella detection improving classical control strategies usually based on the culture method. The proportion of hospital water-system sites testing positive, according to the defined standard index, was well correlated with the frequency of use of terminal points and the temperature, suggesting that the control of these factors may help prevent legionnaires' disease in the hospital.
The level of Bilirubin and the risk of ischemic stroke: a systematic review and dose-response meta-analysis of real-world studies
Authors: Wang Xiao , Zhou Yang , Ye Xiaofei , Liu Fangchen , Zhu Xi , Wu Danhong , Zhong Ping 
Published: October 2019

Abstract
Background: Bilirubin, a marker of hepatic and hematological diseases in clinical practice, is not only a waste end-product but also an antioxidant that may protect against diseases associated with oxidative stress. Numerous epidemiological studies have shown an inverse relationship between the serum total bilirubin (TB) level and the risk of ischemic stroke (IS). However, markedly elevated TB levels may exert neurotoxic effects. Based on this, we conducted a dose-response meta-analysis to quantify the relationship between blood TB and IS as well as between TB and all types of stroke (AS) in the physiological range of bilirubin.Methods: PubMed, Embase, Web of Science, and Cochrane Central databases were searched up to March 2019. Additional studies were identified by reviewing references and contacting authors. Categorical and dose-response meta-analyses were performed to quantify the relationship between TB and IS. The primary outcome was ischemic stroke, and the secondary outcome was all types of stroke.Results: Nine observational studies (seven publications) involving 110,032 participants and 3710 stroke cases were included for analysis. The average OR of IS for every 1 µmol/L increment in TB level was 0.978 (95%CI: 0.957–0.999). The summary OR of AS for every 1 µmol/L increment in TB level was 0.974 (95%CI: 0.956–0.992). Subgroup analysis based on gender showed a negative dose-response relationship between the circulating TB level and IS or AS in males, but not in females.Conclusions: The present study indicates a negative dose-response relationship between the circulating TB level and the risk of IS or AS within physiologic range of serum TB in males. Moderately elevated blood TB levels were associated with a diminished prevalence of IS. Every 1 µmol/L increment in serum TB level was associated with a 2.2% decrease in the risk of IS and a 2.6% decrease in the risk of AS. Large-scaled prospective studies are needed to confirm the conclusion of the current analysis.Trial registration: This study was registered at PROSPERO(https://www.crd. york.ac.uk/PROSPERO/[CRD42017075988]).
Cerebrospinal fluid of chronic osteoarthritic patients induced interleukin-6 release in human glial cell-line T98G
Authors: Liu Weiling , Li Chunmei , Tan Francis Chee Kuan , Neo Hong Jye , Chan Yiong Huak , Low Chian-Ming , Lee Tat Leang 
Published: October 2019

Abstract
Background: Chronic osteoarthritic pain is not well understood in terms of its pathophysiological mechanism. Activated glial cells are thought to play a role in the maintenance of chronic pain. T98G glioblastoma cell line was previously observed to release higher amounts of interleukin-6 (IL-6) when treated with cerebrospinal fluid (CSF) from patients with another chronic pain condition, post-herpetic neuralgia. In this study, we investigated the ability of CSF from patients diagnosed with knee osteoarthritis (OA) suffering from chronic pain, to trigger the release of pro-inflammatory cytokines, IL-6, IL-1beta and tumour necrosis factor alpha (TNF-α) from T98G. Characterization of upstream signalling was also explored. Methods: 15 OA patients undergoing total knee replacement and 15 patients without pain undergoing surgery with spinal anaesthesia were prospectively recruited. CSF was collected during anaesthesia prior to surgery. CSF were added to cultured T98G cells. IL-6, IL-1β and TNF-α release from T98G cells were measured using enzyme immunoassay. Antibody array and western blotting were performed on CSF-triggered T98G cell lysates to identify possible signalling targets. Age, gender and pain scores were recorded. Mann-Whitney U test was used to compare IL-6 release and protein expression between groups. Association between IL-6 and pain score was analysed using linear regression.Results: Compared to CSF of patients without pain, significantly higher IL-6 levels were released by T98G cells when induced by CSF from OA patients. The IL-6 levels showed positive association with pain score (adjusted B estimate= 10.1 (95% Confidence Interval 4.3-15.9); p= 0.001). Array conducted with OA pain patient pooled CSF identified several proteins being upregulated greater than 2-fold including STE20-related kinase adaptor protein and spleen tyrosine kinase. Further validation in western blotting of individual samples was unable to show similar significant increase.Conclusion: IL-6 is a potential biomarker crucial in the maintenance phase of chronic pain in both OA and post-herpetic neuralgia (PHN). Identification of signalling pathways involved in pain using pooled CSF on antibody array yield several protein of interest. However, those targets are inconsistent when individually validated using western blotting. Exploring other protein targets is required to identify the signalling mechanism of chronic pain.
“Too Much to Ask, Too Much to Handle”: Women’s Coping in Times of Zika
Authors: Arias Ana Rosa Linde , Furtado Grace , Tristan-Cheever Elisa , Siqueira Eduardo 
Published: October 2019

Abstract
Background and Objectives Zika virus infection during pregnancy is a cause of congenital brain abnormalities. Its consequences to pregnancies have made governments, national and international agencies issue advice and recommendations to women. This study was designed to develop an initial understanding of the impacts of Zika on women of reproductive age who lived in areas with or without local transmission. The impacts on women who were less directly affected and less vulnerable to Zika were analyzed. The hypothesis was that all women were impacted by the epidemic. Methods A qualitative study was carried out. Women were recruited through the snowball sampling technique from various locations in Brazil, Puerto Rico, and the United States. They were of different nationalities and ethnicities. Data were collected through semi-structured interviews. The data transcripts were analyzed using thematic analysis. Results The social effects of the epidemic affect more women than had been thought before and at deeper emotional levels. Women perceived that the public health systems were placing an unfair responsibility for preventing health complications from Zika onto women who have limited ability. They also stated that the measures recommended to them were invasive, while creating the perception that women were the sole determinant of whether they contracted Zika. The results indicate that women with higher levels of education understood the limitations of the information, government actions, and medical care they received, which ended up producing higher levels of anguish and worry. Conclusions Women appeared to be disproportionately affected by the reproductive implications of the epidemic, even when they were only indirectly affected. Gender inequality and gender discrimination must be recognized and rendered visible in the public health emergency response. It is shown the importance of considering cultural aspects and behaviors when implementing health prevention or protection measures to control epidemics.
Characteristics and risk factors for extrauterine growth retardation in very-low-birth-weight infants
Authors: Zhao Xingli , Ding Li , Chen Xiaoqian , Zhu Xueping , Wang Jian , Cui Ningxun 
Published: October 2019

Abstract
This study aimed to investigate the characteristics and risk factors for extrauterine growth retardation (EUGR) in very-low-birth-weight infants (VLBWIs). The medical records of 137 VLBWIs admitted to the neonatal intensive care unit between June 2015 and December 2017 were retrospectively reviewed. The patients were divided into EUGR (n = 92) and non-EUGR (n = 45) groups. The data of demographic and clinical characteristics was collected and the risk factors for EUGR were assessed by multivariate logistic regression analysis. Gestational age (OR = 0.573, P < 0.01), SGA (OR = 3.887, P = 0.022), feeding intolerance (OR = 4.632, P = 0.002), and calories supplied by amino acids at the 7 th day (OR = 0.786, P = 0.006) were independent high-risk factors for EUGR. EUGR in VLBWIs may be prevented by strategies including early lactation, providing special formulas to reduce feeding intolerance, and sufficient calorie provision.This study aimed to investigate the characteristics and risk factors for extrauterine growth retardation (EUGR) in very-low-birth-weight infants (VLBWIs). The medical records of 137 VLBWIs admitted to the neonatal intensive care unit between June 2015 and December 2017 were retrospectively reviewed. The patients were divided into EUGR (n = 92) and non-EUGR (n = 45) groups. The data of demographic and clinical characteristics was collected and the risk factors for EUGR were assessed by multivariate logistic regression analysis. Gestational age (OR = 0.573, P < 0.01), SGA (OR = 3.887, P = 0.022), feeding intolerance (OR = 4.632, P = 0.002), and calories supplied by amino acids at the 7 th day (OR = 0.786, P = 0.006) were independent high-risk factors for EUGR. EUGR in VLBWIs may be prevented by strategies including early lactation, providing special formulas to reduce feeding intolerance, and sufficient calorie provision.
The effects of anesthesia induction and positive pressure ventilation on right-ventricular function: An echocardiography-based prospective observational study
Authors: Magunia Harry , Jordanow Anne , Keller Marius , Rosenberger Peter , Nowak-Machen Martina 
Published: October 2019

Abstract
Background:
General anesthesia induction with the initiation of positive pressure ventilation creates a vulnerable phase for patients. The impact of positive intrathoracic pressure on cardiac performance has been studied but remains controversial. 3D echocardiography is a valid and MRI-validated bed-side tool to evaluate the right ventricle (RV). The aim of this study was to assess the impact of anesthesia induction (using midazolam, sufentanil and rocuronium, followed by sevoflurane) with positive pressure ventilation (PEEP 5, tidal volume 6 – 8 ml/kg) on 2D and 3D echocardiography derived parameters of RV function.
Methods:
A prospective observational study on fifty-three patients undergoing elective cardiac surgery in a tertiary care university hospital was designed. Transthoracic echocardiography exams were performed before and immediately after anesthesia induction and were recorded together with hemodynamic parameters and ventilator settings.
Results:
After anesthesia induction TAPSE (mean difference -1.6mm (95% CI -2.6mm to -0.7mm; p=0.0013) as well as the Tissue Doppler derived tricuspid annulus peak velocity (TDITVs’) were significantly reduced (mean difference -1.9% (95% CI: -2.6 to -1.2; p<0.0001), but global right ventricular ejection fraction (RVEF; p=0.1607) and right ventricular stroke volume (RVSV; p=0.1838) did not change.
Conclusions:
This data shows a preserved right ventricular ejection fraction and right ventricular stroke volume after anesthesia induction and initiation of positive pressure ventilation. However, the baso-apical right ventricular function is significantly reduced. Larger studies are needed in order to determine the clinical impact of these findings especially in patients presenting with impaired right ventricular function before anesthesia induction.
Trial registration:
Retrospecitvely registered, 6th June 2016, ClinicalTrials.gov Identifier NCT02820727.
Epidemiology and clinical characteristics of pathogens responsible for the hospitalization of children with segmental/lobar pattern pneumonia
Authors: Yanxia Wang , Liji Ma , Ying Li , Li Yuyun , Zheng Yanfei , Zhang Xiaoyue 
Published: October 2019

Abstract
Backgrounds: The occurrence of segmental/lobar pattern pneumonia (S/L-PP) in children has recently increased. The pathogens of the disease may change due to the misuse of antibiotics and the application of vaccines. Therefore, pathogens of S/L-PP in hospitalized children and their association with clinical characteristics may have changed. Objective: To analyze the pathogens of S/L-PP in hospitalized children and their association with clinical characteristics. Methods: The current study analyzed the epidemiological and clinical characteristics of pathogens in children with S/L-PP under 14 years old at a single hospital between 1 st Jan 2014 and 31 st Dec 2018 retrospectively. The pathogens were detected by microbial cultivation, and/or indirect immunofluorescence of the kit (PNEUMOSLIDE IgM), and/or ELISA, and/or realtime PCR in the samples of the patients. Results: A total of 593 children with S/L-PP received treatment at a single hospital during the study period by inclusion criteria. 451 (76.05%) patients were single positive for one pathogen and 83 (14.00%) patients had multiple infections. Mycoplasma pneumoniae ( M.pneumoniae ) (72.34%) was the most frequently identified pathogen, followed by Streptococcus pneumoniae ( S.pneumoniae ) (8.77%). The infection of M.pneumoniae in children with S/L-PP increased with time (p<0.05). The positive rate of M.pneumoniae increased with ages of patients (p<0.05). M.pneumoniae was statistically associated with extrapulmonary manifestations while S.pneumoniae was statistically associated with abnormal white blood cells (WBCs) and C reactive proteins (CRPs) (p<0.05). Conclusion: M.pneumoniae was the most frequently identified pathogen in children with S/L-PP. The positive rate of M.pneumoniae in children with S/L-PP increased with time and the ages of children. M.pneumoniae was associated with extrapulmonary manifestations while S.pneumoniae was associated with abnormal WBCs and CRPs.