bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimal Length of R-R Interval Segment Window for Lorenz Plot Detection of Paroxysmal Atrial Fibrillation by Machine Learning
Authors: Kisohara Masaya , Masuda Yuto , Yuda Emi , Ueda Norihiro , Hayano Junichiro 
Published: June 2020

Abstract
Background: Heartbeat interval Lorenz plot (LP) imaging is a promising method for detecting atrial fibrillation (AF) in long-term monitoring, but the optimal segment window length for the LP images is unknown. We examined the performance of AF detection by LP images with different segment window lengths by machine learning with convolutional neural network (CNN). LP images with a 32 x 32-pixel resolution of non-overlapping segments with lengths between 10 and 500 beats were created from R-R intervals of 24-h ECG in 52 patients with chronic AF and 58 non-AF controls as training data and in 53 patients with paroxysmal AF and 52 non-AF controls as test data. For each segment window length, discriminant models were made by 5-fold cross-validation subsets of the training data and its classification performance was examined with the test data.Results: In machine learning with the training data, the averages of cross-validation scores were 0.995 and 0.999 for 10 and 20-beat LP images, respectively, and >0.999 for 50 to 500-beat images. The classification of test data showed good performance for all segment window lengths with an accuracy from 0.970 to 0.988. Positive likelihood ratio for detecting AF segments, however, showed a convex parabolic curve linear relationship to log segment window length and peaked at 85 beats, while negative likelihood ratio showed monotonous increase with increasing segment window length.Conclusions: This study suggests that the optimal segment window length that maximizes the positive likelihood ratio for detecting paroxysmal AF with 32 x 32-pixel LP image is 85 beats.
Diffusion Tensor Imaging Quantifying the Severity of Chronic Hepatitis in Rats
Authors: Huang Mengping , Lu Xin , Wang Xiaofeng , Shu Jian 
Published: June 2020

Abstract
Background: Diffusion tensor imaging (DTI) is mainly used for detecting white matter fiber in the brain. DTI was applied to assess fiber in liver disorders in previous studies. However, the data obtained have been insufficient in determining if DTI can be used to exactly stage chronic hepatitis. This study assessed the value of DTI for staging of liver fibrosis (F), necroinflammatory activity (A) and steatosis (S) with chronic hepatitis in rats. Methods: Seventy male Sprague-Dawley rats were divided into a control group(n=10) and an experimental group(n=60). The rat models of chronic hepatitis were established by abdominal subcutaneous injections of 40% CCl4. All of the rats underwent 3.0T MRI. Regions of interest (ROIs) were subjected to DTI to estimate the MR parameters (rADC value and FA value). Histopathology was used as the reference standard. Multiple linear regression was used to analyze the associations between the MR parameters and pathology. The differences in the MR parameters among the pathological stages were evaluated by MANOVA or ANOVA. The LSD test was used to test for differences between each pair of groups. ROC analysis was also performed. Results: The count of each pathology was as follows: F0(n=15), F1(n=11), F2(n=6), F3(n=9), F4(n=6); A0(n=8), A1(n=16), A2(n=16), A3(n=7); S0(n=10), S1(n=7), S2(n=3), S3(n=11), S4(n=16). The rADC value had a negative correlation with liver fibrosis (r=-0.392, P=0.008) and inflammation (r=-0.359, P=0.015). The FA value had a positive correlation with fibrosis (r=0.409, P=0.005). Significant differences were found in the FA values between F4 and F0~F3 (P=0.03), while no significant differences among F0~F3 were found (P> 0.05). The AUC of the FA value differentiating F4 from F0~F3 was 0.909 (p<0.001) with an 83.3% sensitivity and an 85.4% specificity when the FA value was at the cut-off of 588.089 (×10-6mm2/s).Conclusion: The FA value for DTI can distinguish early cirrhosis from normal, mild and moderate liver fibrosis, but the rADC value lacked the ability to differentiate among the fibrotic grades. Both the FA and rADC values were unable to discriminate the stages of necroinflammatory activity and steatosis.
Knockdown of hspg2 is associated with mandibular jaw joint fusion and neural crest cell dysfunction in zebrafish
Authors: Castellanos Barbara S. , Quintana Anita 
Published: June 2020

Abstract
Background: Heparan sulfate proteoglycan 2 (HSPG2) encodes for perlecan, a large proteoglycan that plays an important role in cartilage formation, cell adhesion, and basement membrane stability. Mutations in HSPG2 have been associated with Schwartz-Jampel syndrome and Dyssegmental Dysplasia Silverman-Handmaker Type, two disorders characterized by skeletal abnormalities. These data indicate a function for HSPG2 in cartilage development/maintenance. However, the mechanisms in which HSPG2 regulates cartilage development are not completely understood. Here, we explored the relationship between this gene and craniofacial development through morpholino-mediated knockdown of hspg2 in zebrafish. Results: Knockdown of hspg2 resulted in a fusion of the mandibular jaw joint at 5 days post fertilization (dpf). We surmised that defects in mandible development were a consequence of neural crest cell (NCC) dysfunction, as these multipotent progenitors produce the cartilage of the head. Early NCC development was normal in morphant animals as measured by distal-less homeobox 2a (dlx2a) and SRY-box transcription factor 10 (sox10) expression at 1 dpf. However, subsequent analysis at later stages of development (4 dpf) revealed a decrease in the number of Sox10 + and Collagen, type II, alpha 1a (Col2a1a)+ cells within the mandibular jaw joint region of morphants relative to random control injected embryos. Concurrently, morphants showed a decreased expression of NK3 homeobox 2 (nkx3.2), a jaw joint molecular marker at 4 dpf. Conclusions: Collectively, these data suggest a complex role for hspg2 in jaw joint formation and late stage NCC differentiation.
Experiences of oral health: before, during and after becoming a regular user of GC Tooth Mousse Plus ®
Authors: Sbaraini Alexandra , Adams Geoffrey G , Reynolds Eric C 
Published: June 2020

Abstract
Background
Clinical trials and laboratory studies from around the world have shown that GC Tooth Mousse Plus® (TMP) is effective in protecting teeth from tooth decay and erosion, buffering dental plaque pH, remineralising white spot lesions and reducing dentine hypersensitivity. However, no other study has assessed the experiences of oral health, before, during and after individuals became regular users of TMP.
Aim
To identify how participants’ oral health status changed after introducing TMP into their oral hygiene routine.
Methods
A qualitative study using Charmaz’s grounded theory methodology was conducted. Fifteen purposively sampled regular users of TMP were interviewed. Transcripts were analysed after each interview. Data analysis consisted of transcript coding, detailed memo writing, and data interpretation.
Results
Participants described their experiences of oral health and disease, before, during and after introducing TMP into their daily oral hygiene routine, together with the historical, biological, financial, psychosocial and habitual dimensions of their experiences. Before becoming a regular user of TMP, participants described themselves as having a “damaged mouth” with “vulnerable teeth, dry mouth and sensitivity”. Various aspects of participants’ histories were relevant, such as, family history and history of oral disease. Having a “damaged mouth” with “vulnerable teeth, dry mouth and sensitivity” was explained by these historical elements. Despite some initial barriers, once being prescribed TMP by a dental professional, a three-fold process of change was initiated: starting a new oral hygiene routine, persevering daily and experiencing reinforcing outcomes. This process led to a fundamental lifestyle change. Participants transitioned from having a “damaged mouth with vulnerable teeth” to having “a comfortable mouth with strong teeth”; at the same time participants felt empowered by this newly found status of being able to “keep their teeth for life”. Barriers and facilitators for incorporating TMP on daily oral hygiene routine were also identified.
Conclusions
Participants valued having “a comfortable mouth” and being able to “keep their teeth for life”. Seeing concrete results in their mouths and experiencing a more “comfortable mouth” boosted adherence to daily applications of TMP, which was maintained overtime.
A Research of self-help ventilator Sharing based on Internet of Things in Hospital
Authors: Xue-Bin Chen , An Zheng , Li Tian-Qing , Duan Jun , Song De-Jing , Lin Yang , Wu Qiao-Ling , Gao Min , Yan Dan 
Published: June 2020

Abstract
Background: To solve the problem of medical equipment sharing in clinical emergency rescue between different units in hospital, especially for ventilator. Methods : In the research a self-help ventilator sharing mode based on Internet of Things is introduced, and six special programs for basic security, quality control, clinical operation, disinfection, cost estimation, and health technology assessment are formulated to support the project. Results : An Internet of Things mobile APP is developed, and the running status and real-time location of ventilators can be got and spare ventilators can be shared by Medical stuff themselves on the APP. The 6 special programs are applied to support the self-service ventilator sharing mode. For trial operations of six months, 15 spare ventilators are taken in the pool of shared equipment, which are shared for 16799 hours by 7 clinical units.Conclusions : The self-service of ventilator sharing mode meets the clinical need for equipment for emergency rescue and improves efficiency, which makes a useful exploration for the innovation management for medical equipment by Internet of Things in hospital.
Preprocedural Ultrasound Guidance for Combined Spinal-Epidural Anesthesia Results in Better Success Rates in Elderly Patients with Hip Fracture: A Randomized Controlled Trial
Authors: Qu Bo , Chen Luying , Zhang Yuling , Jiang Mengting , Wu Caineng , Ma Wuhua , Li Yuhui 
Published: June 2020

Abstract
Background: Combined spinal-epidural (CSE) anesthesia is considerably challenging for elderly patients with hip fractures. This study aimed to investigate the ability of a modified preprocedural ultrasound-guided technique to improve the success rate and efficacy of CSE anesthesia for elderly patients with hip fractures. Methods: This prospective, single-blind, parallel-group randomized controlled trial included 80 patients (aged ≥ 65 years) who were scheduled for elective hip fracture surgery with CSE anesthesia. Patients were randomly allocated into either the landmark group (n = 40) or the ultrasound group (n = 40). The primary outcome was first-pass success rate. Secondary outcomes included first-attempt success rate; number of needle insertion attempts; number of needle passes; locating, puncture, and total time; level of block; procedural adverse reactions and postoperative complications; and patient satisfaction score. Patients were blinded to group allocation.Results: All patients,40 in each group, completed the study and were included in the final analysis. The first-pass success rates for the landmark and ultrasound groups were 20% and 70%, respectively (P < 0.001). The first-attempt success rates in the landmark and ultrasound groups were 42.5% and 85%, respectively (P < 0.001). The number of needle insertion attempts and passes in the landmark group were 2 (1, 2) and 3 (2, 4), respectively; values of 1 (1, 1) and 1 (1, 2) were documented for the ultrasound group (median [interquartile range], all P < 0.001). The locating time (P < 0.001) and total time (P = 0.001) were longer in the ultrasound group, while puncture time was shorter (P = 0.003). No significant difference was found regarding the incidence of adverse reactions and complications. More patients in the ultrasound group had a satisfaction score of 4–5 (P = 0.007). Subgroup analysis demonstrated benefits for ultrasound in patients with scoliosis.Conclusions: Modified ultrasound-assisted CSE anesthesia increases first-pass and first-attempt success rates, and reduces needle insertion attempts, passes, and puncture time for elderly patients with hip fracture, especially those with scoliosis. This technique improves patient satisfaction and warrants consideration for application in clinical practice.Trial registration: Chinese Clinical Trial Register, ChiCTR1900020819. Registered January 20, 2019, http://www.chictr.org.cn/showprojen.aspx?proj=34634
Necessity of contrast agents to identify the injection site in selective nerve root block
Authors: Ko Sangbong , Song Sukkyoon , Lee Jaejun 
Published: June 2020

Abstract
Study Design:
Control arm of randomized trial
Background

While injecting contrast agents may give patients additional lower extremity radiating pain, additional radiation exposure, or delay in procedure time, care should be taken when they are used in patients with renal disease. Therefore, it is hypothesized that if it is confirmed that the pain caused by the injection needle coincides with the radiating pain that the patient mainly complains of, then the contrast agents may be used less. The purpose of this study is to understand if the identification of lancinating identical pain in the procedure could replace the use of contrast agents.
Methods

This retrospective study included 165 patients who met exclusion criteria from among patients who underwent selective nerve root block (SNRB) for the treatment of radiating lower extremity pain from January 2015 to November 2019. With the identical and lancinating pain confirmed in the same site of the patient, consistent with that of the original symptom, the subjects were divided into two groups: one without contrast injection (Non-Dye (ND) group; 57 patients) and the other with contrast injection (Dye (D) group; 108 patients). The degree of lower extremity radiating pain in the two groups was evaluated using visual analog scale (VAS) before injection, 1, 2, 6, and 12 weeks after injection. Functional outcomes were measured using Oswestry Disability Index (ODI) and Rolland Morris Disability Questionnaire (RMDQ), whereas quality of life was measured using Physical Component Score (PCS) and Mental Component Score (MCS) of Short Form – 36 (SF-36) before injection and 3 months after injection.
Results

There was no statistically significant difference in the lower extremity radiating pain severity in both groups at all times and no statistical difference in the degree of VAS improvement relative to the before-injection VAS value between the two groups at 2 and 6 weeks after injection. At 12 weeks after injection, there was a statistically significant difference, with group ND 4.37 ± 2.81 and group D 3.48 ± 2.43 (p = 0.037), but they were below Minimal Clinically Important Difference (MCID), bearing little clinical implications.
Conclusions

Instead of contrast agent injections that have been used for accurate nerve root identification during SNRB, the method of merely checking if the needle-induced pain under fluoroscopic imaging is consistent with the lower extremity radiating pain that the patient predominantly experiences shows the same effect in the patient’s pain control and functional outcome.
Medial Abrasion Syndrome: A Neglected Cause of Persistent Pain After Knee Arthroplasty
Authors: Lyu Shaw-Ruey , Hsu Chia-Chen , Hung Jung-Pin 
Published: June 2020

Abstract
Background: Persistent postoperative pain (PPOP) has detracted from some otherwise successful knee arthroplasties. This study investigated medial abrasion syndrome (MAS) as a cause of PPOP after knee arthroplasty and presented the technique and outcome of arthroscopic medial release (AMR) procedure to treat such patients. Methods: In a one-year period, the author performed unicompartmental or total knee arthroplasty (the UKA or TKA group) that also eliminated MAS on 196 knees of 150 patients at advanced stages of knee osteoarthritis (OA). During the same year, 16 knees of 16 patients with unknown causes of PPOP after knee arthroplasty were referred to the author for the AMR procedure (the AMR group). Subjective satisfaction, Knee Society Score (KSS), and Knee injury and Osteoarthritis Outcome Score (KOOS) evaluations were used for outcome study.Results: All 166 patients were followed up for more than 3 years (mean: 3.7 years, 3.1-4.2) for outcome study. All knees receiving arthroplasty showed pathologic medial plicae of various severities at the time of arthroplasty. Only 2 patients suffered PPOP: one was a neglected tibial plateau fracture with residual varus deformity after UKA and the other was a late infection after TKA and received revision. The satisfactory rate was 98.8% in the UKA group, 99.1% in the TKA group, and 100% in the AMR group. The Knee Society scores and all subscales of KOOS were statistically improved in all groups.Conclusion: MAS is a cause of pain in patients who have received knee arthroplasty, and MAS should be managed before wound closure to ensure a successful knee arthroplasty. PPOP after knee arthroplasty can be caused by MAS, which can be managed by AMR.
Relative Hyperlactatemia in the Emergency Department: A Retrospective Cohort Study
Authors: Chebl Ralphe Bou , Jamali Sarah , Mikati Nancy , Assaad Reem Al , Daem Karim Abdel , Kattouf Nadim , Safa Rawan , Makki Maha , Tamim Hani , Dagher Gilbert Abou 
Published: June 2020

Abstract
Objective

The clinical interpretation of lactate ≤ 2.00 mmol/L in emergency department (ED) patients is not well characterized. This study aims to determine the optimal cutoff value for lactate within the reference range that predicts in-hospital mortality among ED patients with initial serum lactate levels within the reference range.
Methods

This was a retrospective study of adult patients presenting to a tertiary ED between the dates of January 1, 2014 and June 30, 2019 with an initial serum lactate level less than 2.00 mmol/L. The primary outcome was in-hospital mortality. Youden’s index was utilized to determine the optimal threshold that predicts mortality. Patients above the threshold were labeled as having relative hyperlactatemia. A multivariate logistic regression was performed to determine the association between relative hyperlactatemia and in-hospital mortality. Subgroup analyses were done to further examine the interaction between relative hyperlactatemia and hospital mortality.
Results

During the study period, 1638 patients were included. The mean age was 66.9 ± 18.6 years, 47.1% of the population were female, and the most prevalent comorbidity was hypertension (56.7%). The mean lactate level at presentation was 1.5 ± 0.3 mmol/L. In-hospital mortality was 3.8% in the overall population and 16.2% were admitted to the ICU. A lactate of 1.33 mmol/L was found to be the optimal cutoff that best discriminates between survivors and non-survivors. Relative hyperlactatemia was an independent predictor of in-hospital mortality (OR 1.78 CI1.18-4.03; p 0.02). Finally, Relative hyperlactatemia was associated with increased mortality in patients without hypertension (4.7% versus 1.1%; p 0.008), as well as patients without diabetes or COPD.
Conclusion

The optimal cutoff of initial serum lactate that discriminates between survivors and non-survivors is in the ED 1.33 mmol/L. Relative hyperlactatemia is associated with increased mortality in emergency department patients, and this interaction seems to be more important in healthy patients.
EphA4 regulates Aβ production via BACE1 expression in neurons
Authors: Tamura Kensuke , Chiu Yung-Wen , Shiohara Azusa , Hori Yukiko , Tomita Taisuke 
Published: June 2020

Abstract
BackgroundSeveral lines of evidence suggest that the aggregation and deposition of amyloid-β peptide (Aβ) initiate the pathology of Alzheimer disease (AD). Recently, a genome- wide association study demonstrated that a single-nucleotide polymorphism proximal to the EPHA4 gene, which encodes a receptor tyrosine kinase, is associated with AD risk. However, the molecular mechanism of EphA4 in the pathogenesis of AD, particularly in Aβ production, remains unknown.MethodsTo clarify the molecular regulatory mechanism of EphA4 in detail, we performed several pharmacological and biological experiments both in vitro and in vivo. In addition, we referred to two public RNAseq datasets to confirm the changes in EPHA4 mRNA expression levels in the brains of AD patients.ResultsWe demonstrated that EphA4 is responsible for the regulation of Aβ production. Pharmacological inhibition of EphA4 signaling and knockdown of Epha4 led to increased Aβ levels accompanied by increased expression of β-site APP cleaving enzyme 1 (BACE1), which is an enzyme responsible for Aβ production. On the other hand, EPHA4 overexpression and activation of EphA4 signaling via ephrin ligands decreased Aβ levels. In particular, the sterile-alpha motif domain of EphA4 was necessary for the regulation of Aβ production. Finally, EPHA4 mRNA levels were significantly reduced in the brains of AD patients, and negatively correlated with BACE1 mRNA levels.ConclusionsOur results indicate a novel mechanism of Aβ regulation by EphA4, which is involved in AD pathogenesis.
ATF4 promotes renal tubulointerstitial fibrosis by suppressing autophagy in diabetic nephropathy
Authors: Liang Qiuer , Liu Tianhao , Guo Tingting , Tao Wencong , Chen Xudong , Chen Weihao , Chen Liguo , Xiao Ya 
Published: June 2020

Abstract
Background
Diabetic nephropathy (DN) is the dominant cause of end-stage renal disease which is characterized by extracellular matrix accumulation. The purpose of this study was to investigate the role of activating transcription factor 4 (ATF4) in regulating renal fibrosis and autophagy in DN.
Methods
Streptozotocin (STZ) was administered to heterozygous ATF4 knockout (KO) and wild-type (WT) mice via an intraperitoneal injection to induce DN. NRK-52E cells were cultured in high glucose to mimic diabetic pathological. qRT-PCR, western blot, immunofluorescence, histology and electron microscopic analysis were performed. The autophagy flow was observed by tandem mRFP-GFP-LC3 fluorescence microscopy.
Results
DN mice experienced severe renal injury and fibrosis and showed increased expression of ATF4 and inhibition of autophagy in kidney tissues. STZ-induced ATF4 KO mice showed significant improvement in urinary albumin, serum creatinine and blood urea nitrogen and the pathological changes of renal tubulointerstitial fibrosis compared with STZ-induced WT mice. Furthermore, western blot assays and immunofluorescence staining revealed that inhibition of ATF4 could restore autophagy in DN mice. Overexpression of ATF4 in NRK-52E cells cultured in high glucose condition suppressed autophagy and upregulated Col-IV expression, while inhibition of ATF4 could increase the number of the autophagosomes, improve autophagic flux and decrease Col-IV level.
Conclusion
Our study provided the first evidence of a crucial role for ATF4 in inhibiting autophagy against diabetic kidney damage. Suppression of ATF4 may be an effective therapy in restraining renal tubulointerstitial fibrosis in DN.