bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hepatic dysfunction and adverse outcomes after total arch repair of acute type a aortic dissection: application of the MELD-XI score
Authors: Lin Xinfan , Xie Linfeng , Jiang Debin , Wu Qingsong , He Jian , Chen Liangwan 
Published: November 2022

Abstract
Background
This study was aimed to investigate the incidence and outcomes of patients with postoperative hepatic dysfunction (PHD) after total arch repair of acute type A aortic dissection, and further explore the risk factors for severe adverse outcomes.

Methods
The clinical data of 227 patients with AAAD treated by modified triple-branched stent graft implantation from January 2020 to January 2021 were collected retrospectively. Including preoperative, surgical and postoperative data. Logistics regression was used to determine the independent risk factors of severe adverse outcomes in postoperative HD patients.

Results
In the early stage after operation, a total of 153 patients were complicated with PHD, accounting for 67.4%. The incidence of severe adverse outcomes in patients with PHD was 43.1%. We found that preoperative moderate/severe pericardial effusion [odds ratio (OR): 11.645, 95% confidence interval (CI): 1.144, 143.617, P = 0.045], preoperative imaging data suggest the celiac trunk involvement [OR: 6.136, 95% CI 1.019, 36.930, P = 0.048], CPB time > 180 min [OR: 4.855, 95% CI 1.218, 15.761, P = 0.034], decreased early postoperative serum albumin [OR: 0.935, 95% CI 0.856, 0.985, P = 0.026] were independent risk factors for severe adverse outcomes in patients with PHD.

Conclusions
PHD was associated with increased early mortality and morbidity. Preoperative moderate/severe pericardial effusion, preoperative celiac trunk involvement, cardiopulmonary bypass (CPB) time > 180 min and decreased early postoperative serum albumin were identified as independent risk factors for severe adverse outcomes in patients with PHD.
Overcrowding analysis in emergency department through indexes: a single center study
Authors: Colella Ylenia , Di Laura Danilo , Borrelli Anna , Triassi Maria , Amato Francesco , Improta Giovanni 
Published: November 2022

AbstractIntroductionOvercrowding in the Emergency Department (ED) is one of the major issues that must be addressed in order to improve the services provided in emergency circumstances and to optimize their quality. As a result, in order to help the patients and professionals engaged, hospital organizations must implement remedial and preventative measures. Overcrowding has a number of consequences, including inadequate treatment and longer hospital stays; as a result, mortality and the average duration of stay in critical care units both rise. In the literature, a number of indicators have been used to measure ED congestion. EDWIN, NEDOCS and READI scales are considered the most efficient ones, each of which is based on different parameters regarding the patient management in the ED.MethodsIn this work, EDWIN Index and NEDOCS Index have been calculated every hour for a month period from February 9th to March 9th, 2020 and for a month period from March 10th to April 9th, 2020. The choice of the period is related to the date of the establishment of the lockdown in Italy due to the spread of Coronavirus; in fact on 9 March 2020 the Italian government issued the first decree regarding the urgent provisions in relation to the COVID-19 emergency. Besides, the Pearson correlation coefficient has been used to evaluate how much the EDWIN and NEDOCS indexes are linearly dependent.ResultsEDWIN index follows a trend consistent with the situation of the first lockdown period in Italy, defined by extreme limitations imposed by Covid-19 pandemic. The 8:00–20:00 time frame was the most congested, with peak values between 8:00 and 12:00. on the contrary, in NEDOCS index doesn’t show a trend similar to the EDWIN one, resulting less reliable. The Pearson correlation coefficient between the two scales is 0,317.ConclusionIn this study, the EDWIN Index and the NEDOCS Index were compared and correlated in order to assess their efficacy, applying them to the case study of the Emergency Department of “San Giovanni di Dio e Ruggi d’Aragona” University Hospital during the Covid-19 pandemic. The EDWIN scale turned out to be the most realistic model in relation to the actual crowding of the ED subject of our study. Besides, the two scales didn’t show a significant correlation value.
Triclosan exposure induced disturbance of gut microbiota and exaggerated experimental colitis in mice
Authors: Liu Jing , Tao Yang , Haikun Wang , Lanfang Yang , Jingyi Lu , Ping Yao 
Published: November 2022

Abstract
Background
Triclosan, an antimicrobial agent in personal care products, could be absorbed into the human body through the digestive tract. This animal experiment aimed to clarify the effects of triclosan exposure on the microbiome and intestinal immune functions in healthy and ulcerative colitis models.

Methods
Balb/c mice were maintained on an AIN-93G diet containing 80ppm triclosan dissolved in polyethylene as vehicle or vehicle alone for 1 week or 4 weeks. In the end, the mice were sacrificed, blood samples and colon tissues were collected for analysis of inflammation, and fecal samples were collected for 16 S rRNA sequencing of gut microbiota. To establish ulcerative colitis mice model, at the beginning of the 4th week, mice maintained on the diet with or without triclosan were treated with 2% Dextran sulfate sodium(DSS) in drinking water for 1 week. Then mice were sacrificed for analysis of colitis and gut microbiota.

Results
Triclosan exposure to common mice enhanced the levels of p-NF-κb and Toll-like receptor 4 (TLR4), and decreased the Occludin in the colon. Triclosan exposure to DSS-induced mice increased the level of inflammatory cytokines, reduced the levels of Occludin, and exacerbated the degree of damage to intestinal mucosa and crypt, infiltration of inflammatory cells and atypia of glandular cells. Low-grade intraepithelial neoplasia appeared. Both in common and DSS-induced mice, triclosan exposure changed the diversity and composition of gut microbiota. Fecal samples showed higher enrichment of sulfate-reducing bacteria and Bacteroides, and less butyrate-producing bacteria.

Conclusion
Triclosan exposure induced disturbance of gut microbiota and exaggerated experimental colitis in mice. And changes in the composition of gut microbiota were characterized by the increase of harmful bacteria, including sulfate-reducing bacteria and Bacteroides, and the reduction of protective probiotics, butyrate-producing bacteria.
Brain tumour segmentation based on an improved U-Net
Authors: Zheng Ping , Zhu Xunfei , Guo Wenbo 
Published: November 2022

Abstract
Background
Automatic segmentation of brain tumours using deep learning algorithms is currently one of the research hotspots in the medical image segmentation field. An improved U-Net network is proposed to segment brain tumours to improve the segmentation effect of brain tumours.

Methods
To solve the problems of other brain tumour segmentation models such as U-Net, including insufficient ability to segment edge details and reuse feature information, poor extraction of location information and the commonly used binary cross-entropy and Dice loss are often ineffective when used as loss functions for brain tumour segmentation models, we propose a serial encoding–decoding structure, which achieves improved segmentation performance by adding hybrid dilated convolution (HDC) modules and concatenation between each module of two serial networks. In addition, we propose a new loss function to focus the model more on samples that are difficult to segment and classify. We compared the results of our proposed model and the commonly used segmentation models under the IOU, PA, Dice, precision, Hausdorf95, and ASD metrics.

Results
The performance of the proposed method outperforms other segmentation models in each metric. In addition, the schematic diagram of the segmentation results shows that the segmentation results of our algorithm are closer to the ground truth, showing more brain tumour details, while the segmentation results of other algorithms are smoother.

Conclusions
Our algorithm has better semantic segmentation performance than other commonly used segmentation algorithms. The technology we propose can be used in the brain tumour diagnosis to provide better protection for patients' later treatments.
Whole-genome analysis of monozygotic Brazilian twins discordant for type 1 narcolepsy: a case report
Authors: Campos João H. C. , Aguilar Ana C. R. , Antoneli Fernando , Truzzi Giselle , Briones Marcelo R. S. , Ferreira Renata C. , Coelho Fernando M. S. 
Published: November 2022

AbstractBackgroundNarcolepsy type 1 (NT1) is a rare and chronic neurological disease characterized by sudden sleep attacks, overwhelming daytime drowsiness, and cataplexy. When associated with a sudden loss of muscle tone (cataplexy) narcolepsy is classified as type 1, while the absence of cataplexy indicates type 2. Genetic, degenerative, and immunological hypotheses to explain the pathophysiology of NT1 are still a matter of debate. To contribute to the understanding of NT1 genetic basis, here we describe, for the first time, a whole genome analysis of a monozygotic twin pair discordant for NT1.Case presentationWe present the case of a pair of 17-year-old male, monozygotic twins discordant for NT1. The affected twin had Epworth Sleepiness Scale (ESS) of 20 (can range from 0 to 24), cataplexy, hypnagogic hallucinations, polysomnography without abnormalities, multiple sleep latency tests (MSLT) positive for narcolepsy, a mean sleep latency of 3 min, sleep-onset REM periods SOREMPs of 5, presence of alleleHLA-DQB1*06:02, and Hypocretin-1 level of zero pg/mL (normal values are > 200 pg/mL). The other twin had no narcolepsy symptoms (ESS of 4), normal polysomnography, MSLT without abnormalities, presence of alleleHLA-DQB1*06:02, and Hypocretin-1 level of 396,74 pg/mL. To describe the genetic background for the NT1 discordant manifestations in this case, we present the whole-genome analysis of this monozygotic twin pair. The whole-genome comparison revealed that both twins have identical NT1 pathogenic mutations in known genes, such asHLA-DQB1*06:02:01,HLA-DRB1*11:01:02/*15:03:01. The affected twin has the expected clinical manifestation while the unaffected twin has an unexpected phenotype. The unaffected twin has significantly more frameshift mutations as compared to the affected twin (108 versus 75) and mutations that affect stop codons (61 versus 5 in stop gain, 26 versus 2 in start lost).ConclusionsThe differences observed in frameshift and stop codon mutations in the unaffected twin are consistent with loss-of-function effects and protective alleles, that are almost always associated with loss-of-function rare alleles. Also, overrepresentation analysis of genes containing variants with potential clinical relevance in the unaffected twin shows that most mutations are in genes related to immune regulation function, Golgi apparatus, MHC, and olfactory receptor. These observations support the hypothesis that NT1 has an immunological basis although protective mutations in non-HLA alleles might interfere with the expression of the NT1 phenotype and consequently, with the clinical manifestation of the disease.
What influences the implementation of kangaroo mother care? An umbrella review
Authors: Cai Qian , Chen Dan-Qi , Wang Hua , Zhang Yue , Yang Rui , Xu Wen-Li , Xu Xin-Fen 
Published: November 2022

Abstract
Background
Kangaroo mother care (KMC) is an evidence-based intervention that reduces morbidity and mortality in preterm infants. However, it has not yet been fully integrated into health systems around the world. The aim of this study is to provide a cogent summary of the evidence base of the key barriers and facilitators to implementing KMC.

Methods
An umbrella review of existing reviews on KMC was adopted to identify systematic and scoping reviews that analysed data from primary studies. Electronic English databases, including PubMed, Embase, CINAHL and Cochrane Library, and three Chinese databases were searched from inception to 1 July 2022. Studies were included if they performed a review of barriers and facilitators to KMC. Quality assessment of the retrieved reviews was performed by at least two reviewers independently using the Joanna Briggs Institute (JBI) critical appraisal checklist and risk of bias was assessed with the Risk of Bias Assessment Tool for Systematic Reviews (ROBIS) tool. This umbrella review protocol was documented in the PROSPERO registry (CRD42022327994).

Results
We generated 531 studies, and after the removal of duplicates and ineligible studies, six eligible reviews were included in the analysis. The five themes identified were environmental factors, professional factors, parent/family factors, access factors, and cultural factors, and the factors under each theme were divided into barriers or facilitators depending on the specific features of a given scenario.

Conclusions
Support from facility management and leadership and well-trained medical staff are of great significance to the successful integration of KMC into daily medical practice, while the parents of preterm infants and other family members should be educated and encouraged in KMC practice. Further research is needed to propose strategies and develop models for implementing KMC.
Anatomical and visual outcomes of fovea-sparing internal limiting membrane peeling with or without inverted flap technique for myopic foveoschisis
Authors: Zheng Dezhi , Huang Zijing , Zeng Qin , Wang Yifan , Chen Shirong , Yi Jingsheng , Fang Danqi , Huang Dingguo , Chen Weiqi 
Published: November 2022

AbstractBackgroundVitrectomy and peeling of the internal limiting membrane (ILM) was an effective therapeutic approach for myopic foveoschisis with progressive visual loss. This study investigated the anatomical and visual outcomes of fovea-sparing ILM peeling with or without the inverted flap technique for patients with symptomatic myopic foveoschisis (MF).MethodsWe retrospectively reviewed the clinical data of patients with MF. Vitrectomy with fovea-sparing ILM peeling and air tamponade was performed in all patients. The primary outcome measures included best-corrected visual acuity (BCVA), mean macular thickness (MMT), and central foveal thickness (CFT). Depending on whether an inverted ILM flap technique was utilized, further subgroup comparisons between the inverted flap group and the non-inverted flap group were conducted.ResultsTwenty-six eyes of 22 patients were included. Fifteen eyes were underwent fovea-sparing ILM peeling without inverted ILM flap and 11 of the 26 eyes were treated with fovea-sparing ILM peeling and an inverted ILM flap technique. In the mean follow-up period of 10.74 ± 4.58 months, a significant improvement in BCVA was observed from 0.97 ± 0.45 logMAR to 0.58 ± 0.51 logMAR (P < 0.01), during which the BCVA of 20 eyes (76.92%) improved and remained stable in 5 eyes (19.23%). Moreover, a positive correlation was also found between the preoperative BCVA and the postoperative BCVA (r = 0.50,P = 0.01). At the last visit, the final MMT decreased from 492.69 ± 209.62 μm to 234.73 ± 86.09 μm, and the CFT reduced from 296.08 ± 209.22 μm to 138.31 ± 73.92 μm (allP < 0.01). A subgroup analysis found no significant differences in BCVA, MMT, or CFT between the inverted and non-inverted flap groups (allP > 0.05).ConclusionFovea-sparing ILM peeling with or without inverted flap technique resulted in favorable visual and anatomical outcomes for the treatment of MF. An important factor affecting the postoperative visual outcome was the preoperative visual acuity. Our study found no significant difference between the presence and absence of the inverted ILM flap.
Patient characteristics associated with retrospectively self-reported treatment outcomes following psychological therapy for anxiety or depressive disorders - a cohort of GLAD study participants
Authors: Rayner Christopher , Coleman Jonathan R.I. , Skelton Megan , Armour Cherie , Bradley John , Buckman Joshua E.J. , Davies Molly R. , Hirsch Colette R. , Hotopf Matthew , Hübel Christopher , Jones Ian R. , Kalsi Gursharan , Kingston Nathalie , Krebs Georgina , Lin Yuhao , Monssen Dina , McIntosh Andrew M. , Mundy Jessica R. , Peel Alicia J. , Rimes Katharine A. , Rogers Henry C. , Smith Daniel J. , ter Kuile Abigail R. , Thompson Katherine N. , Veale David , Wingrove Janet , Walters James T.R. , Breen Gerome , Eley Thalia C. 
Published: November 2022

AbstractBackgroundProgress towards stratified care for anxiety and depression will require the identification of new predictors. We collected data on retrospectively self-reported therapeutic outcomes in adults who received psychological therapy in the UK in the past ten years. We aimed to replicate factors associated with traditional treatment outcome measures from the literature.MethodsParticipants were from the Genetic Links to Anxiety and Depression (GLAD) Study, a UK-based volunteer cohort study. We investigated associations between retrospectively self-reported outcomes following therapy, on a five-point scale (global rating of change; GRC) and a range of sociodemographic, clinical and therapy-related factors, using ordinal logistic regression models (n = 2890).ResultsFour factors were associated with therapy outcomes (adjusted odds ratios, OR). One sociodemographic factor, having university-level education, was associated with favourable outcomes (OR = 1.37, 95%CI: 1.18, 1.59). Two clinical factors, greater number of reported episodes of illness (OR = 0.95, 95%CI: 0.92, 0.97) and higher levels of personality disorder symptoms (OR = 0.89, 95%CI: 0.87, 0.91), were associated with less favourable outcomes. Finally, reported regular use of additional therapeutic activities was associated with favourable outcomes (OR = 1.39, 95%CI: 1.19, 1.63). There were no statistically significant differences between fully adjusted multivariable and unadjusted univariable odds ratios.ConclusionTherapy outcome data can be collected quickly and inexpensively using retrospectively self-reported measures in large observational cohorts. Retrospectively self-reported therapy outcomes were associated with four factors previously reported in the literature. Similar data collected in larger observational cohorts may enable detection of novel associations with therapy outcomes, to generate new hypotheses, which can be followed up in prospective studies.
Eight-year experience of maternal death surveillance in Morocco: qualitative study of stakeholders’ views at a subnational level
Authors: Abouchadi Saloua , Godin Isabelle , Zhang Wei-Hong , De Brouwere Vincent 
Published: November 2022

Abstract
Background
Since 2009, Morocco has been implementing the Maternal Death Surveillance System (MDSS). The results obtained indicate significant regional variations in terms of implementation stage, completeness of maternal death reporting, and information use for action. The objective of this research is to better understand the contextual factors involved in the implementation process and use of MDSS, with a focus on the facilitators and barriers, as experienced by stakeholders in health regions.

Methods
Evaluation research was conducted in 2017 based on a descriptive qualitative study using semi-structured in-depth interviews, in four out of the twelve health regions of Morocco. A total of thirty-one in-depth interviews were held with members of regional committees of maternal death reviews (RC-MDR) and other key informant staff. Interviews focused on participants’ views and their experiences with the MDSS since the introduction in 2009. We conducted thematic analysis relied on inductive and deductive approaches. Applying the Consolidated Framework for Implementation Research guided data analysis and reporting findings.

Findings
Engaging leadership at all health system levels, regular training of district and regional MDSS coordinators and supportive supervision at a national level were the most important MDSS implementation facilitators. Reported barriers were essentially related to the review system: Irregular review meetings, blame culture, high turn-over of RC-MDR members, lack of analytical capacity to inform the review process and formulate recommendations, finally limited accountability for recommendation follow-up. While financial incentives boosted MDSS adoption, they were nonetheless a substantial barrier to its sustainability.

Conclusions
The MDSS is a complex process that requires taking numerous steps, including the commitment of multiple stakeholders with varying roles as well as information sharing across health system levels. Contextual factors that influence MDSS implementation at the sub-national level are to be considered. Horizontal and vertical communication about MDSS goals and feedback is crucial to strengthen stakeholders’ commitment, hence improving quality and use of MDSS. Furthermore, health regions should place emphasis on making high-quality recommendations in partnerships between the regional management teams, RC-MDR members and external stakeholders.
A cross-sectional survey on the lung ultrasound training and practice of respiratory therapists in mainland China
Authors: Liu Kai , Yao Yu-long , Wang Yu-xian , Wei Bi-lin , Li Liu-cun , Wang Qi-xing , Ge Hui-qing , Wang Er-shan , Yang Li-min , Chen Huan , Yang Yun-qing , Qin Hao , Zhai Wen-jun , Yu Shen-ji , Wang Xiao-ting , Luo Zhe , Tu Guo-wei 
Published: November 2022

Abstract
Purpose
This national study aimed to investigate the lung ultrasound (LUS) training and practice of respiratory therapists (RTs) in mainland China.

Methods
A cross-sectional multicenter survey was conducted from May 22, 2021 to August 12, 2021, through online platforms. This survey included RTs in mainland China. The survey was divided into four sections: (1) demographic characteristics and basic information; (2) basic information about LUS training and practice; (3) LUS practice details; and (4) Other ultrasound training and practice.

Results
A total of 514 responses were received, and 494 valid responses were included in the analysis. 81.2% (401/494) participants’ highest degree of education was a bachelor’s degree, and 43.1% (213/494) participants were at level II in terms of job ranking. 99.2%(490/494) participants agreed that the RTs needed to learn lung ultrasound, but only 12.3% (61/494) participants had received a LUS training course. Further, 66.2% (327/494) experienced participants responded to Sect. 3. Most of RTs used LUS when the patient had hypoxia (265/327, 81%) or dyspnea (260/317, 79.5%); they also used it during spontaneous breathing trial(SBT) (191/327, 58.4%) or in prone position (177/327, 54.1%). The A-line (302/327, 92.4%), B-line (299/327, 91.4%), lung slide (263/327, 80.4%), and bat sign (259/327, 79.2%) were well known as LUS signs. Also, 30.6% (100/327) participants did not use the LUS protocol in their clinical practice, and only 25.4%(83/327) participants said they had used LUS scores. Moreover, 55.7% (182/327) participants frequently changed the respiratory therapy strategy according to LUS results.

Conclusions
We should improve the number and workplace of RTs in mainland China in the future. We should also standardize the application of LUS practice and training for RTs in mainland China and establish corresponding certification pathways.