bluuebunny/crossref_metadata_2025_split huggingface dataset:
Total intravenous anesthesia in combination with remimazolam and remifentanil without a neuromuscular blocking agent: a prospective observational study
Authors: Na Hyo-Seok , Park InSun , Cho Mincheul , Nam Sun Woo , Hwang Jung-Won , Do Sang-Hwan 
Published: May 2022

Abstract
Background: A novel short-acting benzodiazepine, Remimazolam, has recently been approved for general anesthesia and sedation. Hence, we investigated the feasibility and safety of remimazolam during the induction and maintenance of general anesthesia without using a neuromuscular blocking agent (NMBA) in patients undergoing hysteroscopic surgery.Methods: This prospective observational study included 38 patients undergoing hysteroscopic surgery. Remimazolam and remifentanil were the main anesthetic agents without an NMBA, and a supraglottic airway was inserted to protect the airway. The induction time, amount of each anesthetic agent used during anesthesia, intraoperative bispectral index (BIS) hemodynamic parameters, and recovery profiles were measured. Results: General anesthesia was successfully administered to 37 patients using remimazolam and remifentanil without NMBA. The induction doses of remimazolam and remifentanil were 0.4 mg/kg (interquartile range [IQR] 0.34–0.47 mg/kg) and 1.07 μg/kg (IQR, 0.90–1.29 μg/kg), respectively. Additionally, the maintenance doses of remimazolam and remifentanil were 1.14 mg/kg/h (IQR, 0.88–1.55 mg/kg/h) and 0.06 μg/kg/min (IQR, 0.04–0.08 μg/kg/min), respectively. Intraoperative BIS values had risen temporarily >60 in eight patients (21.6%) despite administration of 2 mg/kg/h of remimazolam; thus, they were treated with supplementary midazolam. The median recovery time was 7 min (IQR, 5–8 min) after approximately 40 min (IQR, 40.0–57.5 min). There was no correlation between the infusion dose of remimazolam and recovery profiles, such as recovery time, recovery BIS, modified observer assessment of alertness/sedation (OAA/S) scale in the post-anesthesia care unit (PACU), post-anesthesia recovery (PAR) score in the PACU, and length of stay in the PACU (all P>0.05).Conclusion: Remimazolam can be combined with remifentanil without an NMBA in female patients who undergo hysteroscopic surgery, during which a supraglottic airway is a feasible method to protect the airway.Trial registration: The study protocol was registered at ClinicalTrials.gov (NCT05025410) on 27/08/2021.
Development and internal validation of an improved prognostic model with limited resources (Broaln-MEWS) for predicting 28-day mortality of critical illness: a retrospective cohort study
Authors: Zhang Xianming , yang Rui , Tan Yuanfei , Zhou Yaoliang , Lu Biyun , Ji Xiaoying , chen Hongda , Cai Jinwen 
Published: May 2022

Abstract
Background
Prognostic models in intensive care unit (ICU) were extensively applied in high-income countries, but were limited in lower income countries for lack of resource. A simple prognostic model for easy use in ICU was more attractive. The modified early warning score (MEWS), age, body mass index (BMI), red cell distribution width(RDW), neutrophil to lymphocyte ratio (NLR), lactate (lac) and osmolarity were easily accessible and objective indexes in resource limited settings to predict mortality of patients in ICU. However, using these indexes alone to predict mortality has the disadvantage of insufficient diagnostic efficiency. The usefulness of a combination of these indexes to predict 28-day mortality of critical illness was unclear.
Methods
This was a retrospective cohort study of patients admitted to ICU in MIMIC-III database. A total of 44103 patients older than 14 years were randomly assigned to a development (29402 patients) or validation cohort (14701 patients). Captured variables included demographic characteristics, clinical assessments, laboratory data, acute physiology and Chronic Health Evaluation (APACHE)-II, and MEWS. After identifying independent risk factors of 28-day mortality, we developed a 28-day mortality prediction model with multivariate logistic regression in development cohort. We compared the difference among Broaln-MEWS, APACHE-II, MEWS, RDW, NLR, lac and osmolarity by using area under the receiver operating characteristic curve (AUROC) to calculate discriminative ability, Hosmer-Lemeshow C-Statistic (H/L C-statistic) to assess calibration and Brier score to evaluate accuracy. Finally, the model was validated in the validation cohort and nomogram graph was offered to fast calculate predicted mortality risk.
Results
The 28-day mortality of critical illness was 22.85% in the development cohort. Patients with increased age, MEWS, NLR, RDW, lac, osmolarity and decreased BMI at baseline exhibited higher risks of 28-day mortality. The mortality prediction model (Broaln-MEWS) that incorporated age, BMI, MEWS, RDW, NLR, lac and osmolarity had an AUROC of 0.741 for the developing data, which was higher than that of MEWS (0.669), NLR (0.634), RDW (0.591), lac (0.580), or osmolarity (0.592) alone(p < 0.000) and slightly lower than APACHE-II (0.747) (p = 0.060). The H/L C-statistic of Broaln-MEWS were equal to 9.641(p = 0.291) and Brier score was 0.103, respectively. Additionally, Broaln-MEWS model demonstrated good discriminative power in the validation group by AUROC that was 0.744 (p < 0.000)
Conclusion
The Broaln-MEWS model had higher predictive value for 28-day prognosis in critically illness, which was used easily in resource limited settings.
Women empowerment and Health insurance utilisation in Rwanda: a nationwide cross-sectional survey
Authors: Kawuki Joseph , Gatasi Ghislaine , Sserwanja Quraish 
Published: May 2022

Abstract
Background: Health insurance coverage is one of the several measures being implemented to reduce the inequity in access to quality health services among the vulnerable groups. Moreover, women empowerment has been viewed as a cost-effective strategy for the reduction of maternal and child morbidity and mortality, as it enables women tackle the barriers to accessing healthcare. Our study aims at examining the prevalence of health insurance utilisation and its association with women empowerment among Rwandan women. Methods: We used Rwanda Demographic and Health Survey (RDHS) 2020 data of 14,634 women aged 15 to 49 years. Multistage stratified sampling was used to select study participants and we conducted multivariable logistic regression to establish the association between women empowerment and health insurance utilisation using SPSS version 25. Results: Out of the 14,634 women, 12095 (82.6%) (95% CI: 82.0-83.2) were using or had subscribed to health insurance, and the majority (77.2%) were covered by mutual/community organization insurance. Women empowerment indicators significantly associated with health insurance utilisation were; exposure to mass media, decision making and economic empowerment. Low decision making (AOR=1.195, 95% CI: 0.897-1.592), and low economic empowerment (AOR=1.128, 95% CI: 0.986-1.290) had a positive association with health insurance coverage, while high exposure to media had a negative association (AOR=0.664, 95% CI: 0.522-0.845). Other factors that were significant include; educational level, wealth index, residence, region, household size, and household head.Conclusions: Improving women's access to health facilities as well as media material tailored to the specific knowledge gaps could significantly increase enrolment rates of Rwandan women to health insurance.
Restriction policies and effects of COVID-19 pandemic in environment: analysis and role of sustainable technology to cope with future pandemics
Authors: Coccia Mario 
Published: May 2022

Abstract
Restriction or containment policies (e.g., business and workplace closures, travel bans and restrictions, compulsory facemask coverings, mandatory vaccinations, etc.) can prevent high numbers of Coronavirus Disease 2019 (COVID-19) related infected individuals and deaths. However, one of the critical questions is varying degrees of strictness in containment policies to cope with negative effects of COVID-19 pandemic crisis in environment and society. This study confronts the question here by developing a comparative analysis between countries with high and low levels of strictness in containment measures to assess the effectiveness of their policy responses to cope with high numbers of infections and deaths of COVID-19 in society. A homogenous sample of 31 countries having a level of Gross Domestic Product (GDP) per capita higher than U$16,000 are categorized in two sets: countries with high or low containment index (100 = highest restrictions and strictness). The findings here seem to be that countries with a containment index lower than 50 (i.e., lower degree of strictness) have average COVID-19 confirmed cases on population (24.69% vs. 26.06%) and fatality rates (74.33% vs = 76.38%) lower than countries with high level of containment index (about 60). This empirical evidence reveals that government responses based on high degrees of strictness seem to be ineffective to cope with COVID-19 pandemic crisis because can create socioeconomic issues. This study suggests that one of the best strategy of prevention of high numbers of deaths of new airborne diseases generating respiratory disorders is based on high levels of investment in health sector and in particular, high investments in new sustainable technology of medical ventilators that can reduce negative effects of emerging infectious diseases similar to COVID-19, when specific drugs lack and/or need months or years for process of drug discovery.
Biomedical Named Entity Recognition with the Combined Feature Attention and Fully-Shared Multi-Task Learning
Authors: Zhang Zhiyu , Chen Arbee L.P. 
Published: May 2022

Abstract
Background: Biomedical named entity recognition (BioNER) is a basic and important task for biomedical text mining with the purpose of automatically recognizing and classifying biomedical entities. The performance of BioNER systems directly impact on downstream applications. Recently, deep neural networks, especially pre-trained language models, have made great progress for BioNER. However, because of the lack of high-quality and large-scale annotated data and relevant external knowledge, the capability of the BioNER system remains limited.Results: In this paper, we propose a novel fully-shared multi-task learning model based on the pre-trained language model in biomedical domain, namely BioBERT, with a new attention module to integrate the auto-processed syntactic information for the BioNER task. We have conducted numerous experiments on seven benchmark BioNER datasets. The proposed best multi-task model obtains F1 score improvements of 1.03% on BC2GM, 0.91% on NCBI-disease, 0.81% on Linnaeus, 1.26% on JNLPBA, 0.82% on BC5CDR-Chemical, 0.87% on BC5CDR-Disease, and 1.10% on Species-800 compared to the single-task BioBERT model. Conclusion: The results demonstrate our model outperforms previous studies on all datasets. Further analysis and case studies are also provided to prove the importance of the proposed attention module and fully-shared multi-task learning method used in our model.
Risk factors of postoperative hypoxemia after shoulder arthroscopic surgery: a single-center retrospective study
Authors: Chen Wenchao , Yu Guojun , Ning Fanyou , Yuan Zhe 
Published: May 2022

Abstract
Background
Shoulder arthroscopic surgery has become the first choice for the surgical treatment of a variety of shoulder diseases. In previous studies, the incidence of hypoxemia after shoulder arthroscopic surgery was 12.6% and 16%, which is usually accompanied by several unfavourable consequences, including prolonged ventilator support, increased hospital length of stay, increased intensive care unit length of stay, and higher perioperative mortality. The Purpose of this study is to identify independent risk factors of postoperative hypoxemia in the post anesthesia care unit(PACU)after shoulder arthroscopic surgery.
Methods
This was a single-center retrospective study including 358 patients undergoing shoulder arthroscopic surgery between January 2020 and January 2021 at LuoYang Orthopedic Hospital of Henan Province Orthopedic Hospital of Henan Province. The relative factors of postoperative hypoxemia were tested through descriptive analysis and logistic regression, and the independent risk factors were obtained.
Results
The incidence of postoperative hypoxemia was 14.0% in our study. Through descriptive analysis and logistic regression, the independent risk factors of postoperative hypoxemia were as follows: age[odd ratio(OR)=1.069, 95% confidence interval (CI) = 1.012–1.129,P = 0.018]、body mass index (BMI) (OR = 1.425,95% CI = 1.250–1.626,P = 0.000、operating time (OR = 1.011,95%CI = 1.000-1.021,P = 0.041) irrigation fluid volume (OR = 1.093,95%CI 1.033–1.156,P = 0.002) .
Conclusion
Age, BMI, operating time, irrigation fluid volume were 4 independent risk factors for postoperative hypoxemia in the PACU after shoulder arthroscopic surgery.
Evaluation and countermeasures of the contracted services of Chinese family doctors from the perspective of demanders -- a case study of a city
Authors: Liu Songyi , Meng Wenqi , Yu Qianqian , Peng Haibo , Jiang Xiaoli , Li Zixin , Yin Wenqiang , Chen Zhongming , Ma Dongping , Sun Kui 
Published: May 2022

Abstract
Background: From the perspective of the demander, the purpose of the study is to find out the weak link of the family doctor contracted service in a city, that is, to optimize the effect of the family doctor contracted service in China.Methods: In this study, a city in Shandong Province, China was selected as the sample city. In January 2020, 1098 contracted residents (including 40.5% men and 59.5% women) from 18 primary medical institutions (including township health centers and community health centers) were selected for on-site investigation. The PCAT-AS scale revised in Chinese was used as the research tool to understand the treatment experience of contracted residents in primary medical institutions.Results: Among the four core dimensions of PCAT-AS, the score of Continuous was the highest (3.44 ± 0.58); The score of Coordinated was the lowest (3.08 ± 0.66); Among the three derived dimensions, the score of Family-centeredness was the highest (3.33 ± 0.65); The score of Culturally-competent was the lowest (2.93 ± 0.77). The PCAT scores of contracted residents with different demographic characteristics such as contracted institution, age, education level, marital status and occupation were statistically significant (P < 0.05).Conclusions: The family doctor contracted service in the city has achieved certain results. At the same time, there are still some problems, such as difficult access to outpatient services during nonworking hours and incomplete service items. It is suggested that primary medical institutions further improve their service capacity in the dimensions of Coordinated and Comprehensiveness, in order to provide better services for contracted residents.
Prevalence and management of dysphagia in Nursing Home Residents in Europe and Israel: the SHELTER Project
Authors: Dell’Aquila Giuseppina , Peladic Nikolina Jukic , Nunziata Vanessa , Fedecostante Massimiliano , Salvi Fabio , Carrieri Barbara , Liperoti Rosa , Carfì Angelo , Eusebi Paolo , Onder Graziano , Orlandoni Paolo , Cherubini Antonio 
Published: May 2022

Abstract
Background
Dysphagia is a frequent condition in older nursing home residents (NHRs) which may cause malnutrition and death. Nevertheless, its prevalence is still underestimated and there is still debate about the appropriateness and efficacy of artificial nutrition in subjects with severe dysphagia. The objective assesses the prevalence of dysphagia in European and Israeli NHRs, its association with mortality, and the relationship of different nutritional interventions, i.e. texture modified diets and artificial nutrition (AN) - with weight loss and mortality.
Methods
A prospective observational study three thousand fifty one European and Israeli NHRs older than 65 years, participating in the SHELTER study from 2009 to 2011, at baseline and after 12 months. All residents underwent a standardized comprehensive evaluation using the interRAI Long Term Care Facility (LTCF). Cognitive status was assessed using the Cognitive Performance Scale (CPS), functional status using Activities of Daily Living (ADL) Hierarchy scale. Trained staff assessed dysphagia at baseline by clinical observation. Data on weight loss were collected for all participants at baseline and after 12 months. Deaths were registered by nursing home staff.
Results
The prevalence of dysphagia was 30,3%. During the one-year follow-up, the mortality rate in subjects with dysphagia was significantly higher compared with that of non-dysphagic subjects (31.3% vs 17.0% (p = 0,001). The multivariate analysis showed that NHRs with dysphagia had 58% higher risk of death within 1 year compared with non-dysphagic subjects (OR 1.58, 95% CI, 1.31–1.91). The majority of NHRs with dysphagia were prescribed texture modified diets (90,6%), while AN was used in less than 10% of subjects. No statistically significant difference was found concerning weight loss and mortality after 12 months following the two different nutritional treatments.
Conclusions
Dysphagia is prevalent among NHRs and it is associated with increased mortality, independent of the nutritional intervention used. Noticeably, after 12 months of nutritional intervention, NHRs treated with artificial nutrition had similar mortality and weight loss compared to those who were treated with texture modified diets, despite the clinical conditions of patients on artificial nutrition were more compromised.
Study on the treatment of hepatocellular carcinoma with Lenvatinib and bevacizumab after hepatic arterial chemoembolization
Authors: Liu Feng-hao , Ma Zhong-guang , Zhou Zhen-zhen , Li Xue-feng 
Published: May 2022

Abstract
Background
Hepatocellular carcinoma is characterized by high morbidity and mortality, poor prognosis and many complications. Hepatic arterial chemoembolization (TACE) is the main treatment for patients with advanced hepatocellular carcinoma. To investigate the effect of Lenvatinib and bevacizumab on hepatocellular carcinoma after hepatic arterial chemoembolization.
Method
30 patients with primary hepatocellular carcinoma treated by hepatic artery chemoembolization were selected. The observation group was injected with bevacizumab (5 mg/ kg) into the blood vessels supplying tumor, Lenvatinib mesylate capsules were given orally. SPSS 25.0 was used for statistical analysis. χ2 test ,analysis of variance and T test were used.
Results
The levels of AFP, Angiotension Converting Enzyme (ACE), AST and albumin in the observation group was significantly lower than in the control group. In the observation group, the number of cases with decreased platelet after treatment was 11, which was significantly higher than that in the control group. The pain relief and clinical efficacy of the observation group after treatment were better than the control group.
Conclusions
After hepatic arterial chemoembolization, Lenvatinib and bevacizumab can effectively improve the serum AFP, ACE, AST, albumin and platelet levels, improve liver pain.
Valvular heart complications in children with osteogenesis imperfecta
Authors: Izui Masafumi , Harada Daisuke , Ueyama Kaoru , Oriyama Kyoko , Ishiura Yoshihito , Kashiwagi Hiroko , Yamada Hiroyuki , Seino Yoshiki 
Published: May 2022

Abstract
Purpose: The aim of this study was to determine the cardiovascular function and prevalence of valvular diseases in children with osteogenesis imperfecta (OI). Methods: Twenty-eight OI children (mean age: 9.9±6.0 years) underwent echocardiography. Heart function, heart dimensions, and valvular complications were assessed calculating standard deviation (SD) scores referring to body surface area, and compared retrospectively in clinical types according to Sillence’s classification and with height SD scores. Results: Of the 28 OI children, 17 (61%) were complicated with valvular diseases. The mean height SD scores was lower in more severe clinical types (p<0.01). Tricuspid regurgitation was detected in 54%, mitral regurgitation occurred in 21%, and aortic regurgitation was observed in 4% of the patients. Any valvular disease was detected in 86% (6/7), 46% (5/11), and 60% (6/10) of the patients with OI type 1, 4, and 3, respectively. A negative correlation was detected between aortic root diameters and height SD scores (r=-0.55). Interventricular septum (IVS) thicknesses were within ±2 SD in all cases, but those in 79% of the patients were indicated above the mean value of normal population. The mean IVS SD scores was +0.62±0.72. All measured values, including ventricular diastolic dimensions and ejection fraction, were within normal range and not different between the clinical types. Conclusions: Valvular dysfunction is a frequent complication of OI patients, even in childhood. Aortic root enlargement and hypertrophic IVS appeared to be negatively impacted by the disease. Thus, careful echocardiographic follow-up during childhood, especially for patients with severe short stature, should be performed.
The incidence and risk factors of chronic kidney disease after radical nephrectomy in patients with renal cell carcinoma
Authors: Wang Shuai , Liu Zhenghong , Zhang Dahong , Xiang Fei , Zheng Wei 
Published: May 2022

Abstract
Background: Radical nephrectomy (RN) is the standard treatment for localized renal cell carcinoma. The decrease of nephrons by the RN could lead to postoperative chronic kidney disease(CKD). The study aims to investigate the incidence and risk factors of CKD in patients who had received RN.Methods: A Total of 1233 patients were diagnosed with renal cell carcinoma and underwent radical nephrectomy in Zhejiang Provincial People’s Hospital from January 2010 to December 2018. Those who had abnormal renal function before surgery or lost to follow-up were excluded. 500 patients were enrolled in the end. eGFR was calculated using the abbreviated MDRD equation. CKD was defined as eGFR less than 60 ml/min/1.73m2. Incidence of postoperative CKD was estimated using the Kaplan-Meier method. The independent risk factors of the occurrence of CKD was determined through logistic multivariate regression analysis.Results: Patients were followed up for a median of 40 month (3-96 months), with CKD occurred in 189 cases. 5-year cumulative incidence of CKD was 43.4%. There was a significant difference between these 189 patients and the rest patients without post nephrectomy CKD in terms of age, sex, weight, preoperative eGFR(P＜0.05). Multivariate regression analysis shows that age (OR=1.038, 95%CI=1.002-1.076), preoperative eGFR of the contralateral kidney (OR=0.934, 95%CI=0.884-0.988) and postoperative eGFR (OR=0.892, 95%CI=0.854-0.931) were independent risk factors for postoperative CKD.Conclusions: The incidence of CKD after radical nephrectomy was not uncommon. Age, preoperative eGFR of the contralateral kidney and postoperative eGFR are independent risk factors for postoperative CKD.