bluuebunny/crossref_metadata_2025_split huggingface dataset:
Technology enhanced training in family medicine during Covid-19 pandemic, trainers and trainees’ view
Authors: Ahmed Marwa Mostafa , Sayed Inas Talaat El , Fares Samar 
Published: August 2020

Abstract
Purpose of the study: how to shift from face-to-face clinical training into technology enhanced training during Covid 19 pandemic.Study design: Online trainer simulation with pre-prepared case scenarios and case discussion was our designed interventional training using Zoom application.Results: Regarding trainee’s feedback to the zoom training, 85% of them thought that it was useful. More than 75% of them recommended this online training for future trainees. More than 80% of the trainers were satisfied with the online training experience. More than 75% of them thought that this was a beneficial experience for the participating house officers. Although two-third of the trainers perceived the training to be mildly and moderately overloading, yet more than 80% of them were satisfied with this training experience and about three-fourth of them preferred it on face-to-face training. They suggested increasing the time of the session to allow for more feedback and discussion.Conclusion: Technology enhanced training is a good way of training that can improve many aspects of clinical family medicine skills as communication skills, patient-centred approach, clinical reasoning, and construction of management plan. It can be applied in other specialties especially in crisis times. In the future, it can be used as blended method of training beside face to face training in the clinics so they can complement each other.
Predicting Outcomes in Older ED Patients with Influenza in Real Time Using a Big Data-Driven and Machine Learning Approach to the Hospital Information System
Authors: Hsu Chien-Chin , Tan Tian-Hoe , Chen Chia-Jung , Hsu Shu-Lien , Liu Tzu-Lan , Lin Hung-Jung , Wang Jhi-Joung , Liu Chung-Feng , Huang Chien Cheng 
Published: August 2020

Abstract
Background: Predicting outcomes in older patients with influenza in the emergency department (ED) by machine learning (ML) has never been implemented. Therefore, we conducted this study to clarify the clinical utility of implementing ML.Methods: We recruited 5508 older ED patients (≥65 years old) in three hospitals between 2009 and 2018. Patients were randomized into a 70%/30% split for ML model training and testing. Using 10 clinical variables from their electronic health records, a random forest model using the synthetic minority oversampling technique preprocessing algorithm was constructed to predict five outcomes. Results: The areas under the curves of predicting outcomes using the random forest model were 0.807 for hospitalizations, 0.974 for pneumonia, 0.994 for sepsis or septic shock, 0.981 for intensive care unit admission, and 0.851 for death in the testing data. The predictive model was further applied in the hospital information system to assist physicians’ decisions in real time.Conclusions: ML is a promising way to assist physicians in predicting outcomes in older ED patients with influenza in real time. Evaluations of the effectiveness and impact are needed in the future.
The Impact of Patient’s Body Habitus on PET Image Quality in Digital and Analogic PET/CT
Authors: Weyts Kathleen , Quak Elske , Licaj Idlir , Lasnon Charline , Ciappuccini Renaud , Foucras Gauthier , Savigny Jean-François , Bardet Stéphane , Jaudet Cyril 
Published: August 2020

Abstract
Background: New digital versus analogic PET has higher temporal resolution and more stable count rate, potentially limiting the degradation of PET image quality in larger patients. We wanted to describe the influence of patient’s body habitus on [18F]FDG PET image quality primary in digital PET/CT and analogic PET/CT.Results:We studied retrospectively the relation between patient’s weight, BMI, fatty massand PET image quality, described by the coefficient of variance in the liver (CVliv) and visually.177 unique patient exams on digital PET/CT (weight 35-127 kg; BMI 15-44 kg/m2) were performed with 2 protocols (protocol 1: N=52: 3MBq (0,08mCi)/kg [18F]FDG; 2minutes/bed position; 2iterations10subsets; 2mm diameter voxels and protocol 2: N=125: 4MBq (0,11mCi) /kg [18F]FDG; 1min/bed position; 4iterations4subsets; 2mm voxels).74 unique patient exams were analyzed on analogic PET/CT (weight 38-130 kg; BMI 14-52 kg/m2; with one protocol: 4MBq (0,11mCi)/kg [18F]FDG; 2min40sec/bedposition for BMI<25 and 3min40sec for BMI ≥25; 3iterations21subsets; 4mm voxels).Uni-and multivariable linear regression analysis showed positive association of CVliv with weight, BMI, fatty mass (p£0.009) and male sex (p£0,03) for both camera’s, with good fit in CVliv versus weight model on digital PET/CT (R2 up to 0.62). 4MBq (0,11mCi) protocol on digital PET/CT versus analogic PET/CT obtained lower CVliv on digital PET/CT in patients <70kg, without a difference if 70-<90kg and in Pearson correlation coefficients (p=0,26) despite substantially longer acquisition time for analogic PET/CT. For digital PET/CT CVliv increased similarly with weight for both protocols, up to 26% [95% Confidence Interval 2-56%] for ³90 kg versus <70kg, but overall CVliv values were lower in 4MBq (0,11mCi) protocol 2.Also visually PET image quality decreased with habitus on each camera (p£0.001) and was lower in females on digital PET/CT only (p=0,04).Conclusions:[18F]FDG PET image quality decreases with weight and enlarging body habitus on digital and analogic PET/CT imposing further optimization and harmonization also in digital PET/CT. This is important for clinical routine, but also (multicentric) research and development of artificial intelligence software.
Fungal alpha-diversity drives the stochasticity of bacterial and fungal community assembly in soil aggregates in the apple orchard
Authors: Zheng Wei , Zhao Zhiyuan , Lv Fenglian , Yin Yanan , Wang Zhaohui , Zhao Zhengyang , Li Ziyan , Zhai Bingnian 
Published: August 2020

Abstract
Background In soil ecosystems, bacteria and fungi always co-exist in the same niche and interact with each other, especially in different sized soil aggregates. The bacterial and fungal community assembly process and bacteria-fungi interactions in soil aggregates, which is important for bacterial and fungal community diversity and composition, is still unclear.Methods We examined bacterial and fungal community assembly in soil macroaggregate (> 0.25 mm), microaggregate (0.053–0.25 mm) and smaller microaggregate (silt + clay, < 0.053 mm) in an apple orchard. The microbial community assembly processes were analyzed by normalized stochasticity ratio index (NST).Results Bacterial community diversity, composition and assembly were more affected by agricultural practice and aggregate than fungal community. Bacterial community assembly was more stochastic in silt + clay than in macroaggregate, and was more stochastic (NST > 50%) than fungal community in soil aggregates. Meanwhile, bacterial NST was negatively correlated with fungal diversity, and fungal NST was positively correlated with fungal diversity. Co-occurrence network suggested that the bacteria and fungi were less strongly interacting in the network of silt + clay, compared to macroaggregate. The results indicated that fungi impact on the bacterial community assembly in soil aggregate, and the stochasticity of bacterial community assembly was increased with the decrease of interaction between bacteria and fungi in soil aggregates.Conclusions This study enhances our understanding of the mechanism of bacterial and fungal community assembly and co-exists pattern of bacteria and fungi in soil aggregates.
Exploring the Optimal Range of Central Venous Pressure in Sepsis and Septic Shock Patients: A Retrospective Study in 208 Hospitals
Authors: Song Xiaodong , Tang Zhaoxia , Li Shuhe , Xu Jinghong , Huang Fa , Hu Xiaoguang , Tong Li , Cao Lu , Zhu Yanping , Yao Jiyou , Lin Xiaobin , Guan Xiangdong , Lui Ka Yin , Cai Changjie 
Published: August 2020

Abstract

Background: The appropriate range of central venous pressure (CVP) in sepsis patients remains controversial. The aim of this study was to investigate the optimal CVP range in sepsis and septic shock patients admitted to intensive care unit.Methods: We performed a retrospective study with adult sepsis patients with CVP records based on the eICU Collaborative Research Database. Cases were divided into three groups according to mean CVP level during ICU stay: low (< 8 mmHg), normal (8–12 mmHg), and high (> 12 mmHg). Baseline characteristics and clinical outcomes of three groups were compared. Multivariable logistic regression was used to assess the relationship between different CVP levels (by equal interval of 4 mmHg) and in-hospital death risk. Results: 5302 sepsis patients were included in this study. Lactate level, serum creatinine, proportion of mechanical ventilation and dialysis were significantly higher in high CVP group compared to normal CVP group (2.6 [1.6,3.4] vs 2.2 [1.4,2.9] mmol/L; 1.5 [1,2.4] vs 1.2 [0.8,2] mg/dL; 52.2% vs 48.2%; 14.6% vs 9.7%; p < 0.05, respectively). In addition, high CVP group tended to have higher ICU mortality (24.8% vs 15.9%, p < 0.05) and hospital mortality (32.2% vs 22.4%, p < 0.05). The logistic regression analyses revealed that, in sepsis patients, CVP range of 12-16 mmHg, 16-20 mmHg and > 20 mmHg was related to increased in-hospital death risk compared to 8-12 mmHg level (OR: 1.349, 2.287, 3.210, respectively; 95% CI: 1.161–1.568, 1.897–2.757, 2.403–4.290, respectively); there were no significant differences between 0-4 mmHg, 4-8 mmHg and 8-12 mmHg levels regarding in-hospital death risk. Whereas in septic shock patients, CVP level of 0-4 mmHg, 12-16 mmHg, 16-20 mmHg and > 20 mmHg all contributed to increased in-hospital death risk (OR: 1.914, 1.652, 3.305, 3.554, respectively; 95% CI: 1.165–3.146, 1.299–2.101, 2.444–4.47, 2.233–5.654, respectively).Conclusions: High CVP level (> 12 mmHg) was related to worse clinical outcomes in both sepsis and septic shock patients; while very low CVP level (< 4 mmHg) in septic shock patients was also harmful. More strict fluid administration was essential in septic shock population.
The Effects of Melatonin and Propolis on Markers of Inflammation, Oxidative Stress, Clinical Outcomes, and Survival Rate in Patients with Primary Sepsis Hospitalized in Intensive Care Unit: A Randomized Clinical Trial
Authors: Pahlavani Naseh , Sedaghat Alireza , Ferns Gordon A , Mir Mahdie , Malekahmadi Mahsa , Moghaddam Ahmad Bagheri , Tabesh Hamed , Sadeghi Omid , Kiapey Seyedeh Shabnam Mazloumi , Navashenaq Jamshid Gholizadeh , Firouzi Safieh , Jarahi Lida , Najafi Mohsen Fathi , Rezvani Reza , Norouzy Abdolreza , Heshmati Maryam , Safarian Mohammad , Ghayour-Mobarhan Majid 
Published: August 2020

Abstract
Background: Systemic Inflammatory Response Syndrome (SIRS) that occurs under stressful conditions affecting all organs of the body. Previous studies have shown that propolis and melatonin have the potential to improve inflammation and oxidative stress, so the aim of this study was to investigate the effects of these supplements on SIRS treatment.Method: This was a randomized, controlled clinical trial in SIRS patients comprising 55 subjects that were randomly assigned to 3 intervention or control groups. In the 3 intervention groups, patients were treated with propolis alone (at dose of 1000 mg/day), propolis (1000 mg/day) plus melatonin (20 mg/day), and melatonin alone (20 mg/day) respectively, while there was no intervention in the control group. The inflammatory and oxidative stress markers and clinical outcomes were measured before and after of the intervention, also 28-day survival rate was assessed. Results: Propolis plus melatonin reduced serum interleukin 6 (p = 0.001) and CRP levels (p <0.001), and was associated with an increased gavage intake (p = 0.016). At the end of the study, there was no difference between the groups in the oxidative stress and hematological indices. In the propolis+melatonin group, the clinical outcomes were significantly improved (p <0.05). Also the SOFA score between the groups did not differ at any time, its changes was significant during the time (p>0.001). The average survival after 28 days of follow-up in the propolis, propolis+melatonin, melatonin and control groups were 24.08, 25.69, 22.05 and 19.42 days respectively, although this was not statistically significant (p=0.07).Conclusion and relevance: Supplementation with propolis+melatonin may help to improve clinical outcomes by reducing inflammation and was probably associated with an increase in the calorie intake, leading to an increase in the survival rate in SIRS patients, although more studies are necessary to prove these effects. Trial registration: IRCT20181025041460N1.
Relationship Between Classification of Fabellae and the Severity of Keen Osteoarthritis: A Relevant Study in Chinese Population
Authors: Zhang Lei , Wen Youliang , He Chunying , Zeng Yan , Luo Jiangqin , He Chunyan , Wang Junqiu , Feng Qi 
Published: August 2020

Abstract
Background: The fabella is a sesamoid bone having anatomical variations and it is more common in patients with primary keen osteoarthritis (KOA). The purpose of this study was to classify the fabellae and discuss the relationship between the classification of fabellae and the severity of KOA in Chinese. Material and methods: 136 patients were measured and classified using CT three-dimensional reconstruction. According to the CT imaging characteristics, the fabellae were divided into 5 types: type Ⅰ, a fabella on the lateral femoral condyle; type Ⅱ, a fabella on the medial femoral condyle; type Ⅲ, a fabella on the lateral femoral condyle and a fabella on the medial femoral condyle; type Ⅳ, two fabellae on the medial femoral condyle and type Ⅴ, two fabellae on the lateral femoral condyle. The severity of KOA was assessed on the Recht grade by MRI. The data were analyzed with SPSS 24.0. Results: The classification of fabellae were correlated with KOA grades (c 2 =35.026, P<0.05). In terms of KOA grades, grade Ⅰ and grade Ⅱ were occupied most of fabellar type Ⅱ (32, 72.8%); type Ⅱ and other types were significant statistical difference (P<0.05). Grade Ⅰ and grade Ⅱ were also the most of fabellar type Ⅳ (4, 100%). Fabellar type Ⅴ’s biggest component were grade Ⅲ and grade Ⅳ (6, 75%). Type Ⅳ and type Ⅴ were significant statistical difference (P<0.05). Conclusion: The classification of fabellae were correlated with KOA grades. The type Ⅱ may mean the lower KOA grades while type Ⅴ may mean the higher KOA grades. Trial registration: the Ethics Inspection Committee at Southwest Medical University, V1.0/20180801. Registered 20 August 2018.
WITHDRAWN: A Universal Approach to Target Various HBB Gene Mutations in Hematopoietic Stem/Progenitor Cells for Beta-Thalassemia Gene Therapy by CRISPR/Cas9 and the rAAV6 Vector
Authors: He Li-Na , Yang Yi , Cheng Yi , Wu Han , Lin Shou-Heng , Song Bing , Liu Neng-Qing , Chen Di-Yu , Lu Dian , Yang Ying-Hong , Zeng Juan , Fan Yong , Sun Xiaofang 
Published: August 2020

Abstract
Background: Engineered nuclease-mediated gene targeting through homology-directed repair (HDR) in autologous hematopoietic stem and progenitor cells (HSPCs) has the potential to cure β-thalassemia (β-thal). Although previous studies have precisely corrected site-specific HBB mutations by HDR in vitro and in vivo, targeting the various HBB mutations in β-thal is still challenging. Here, we devised a universal strategy to achieve repaired most types of HBB mutations through the CRISPR/Cas9 and the rAAV6 donor.Methods: Using cord blood-derived HSPCs from health donors, we tested the strategy to achieved highly efficient targeted integration by optimizing design and delivery parameters of a ribonucleoprotein (RNP) complex comprising Cas9 protein and modified single guide RNA, together with a rAAV6 donor. We assessed the edited HSPCs function in vitro by methylcellulose colonies assay, CFU assay, differentiation experiment and Wright-Giemsa staining. Edited HSPCs transplanted into NSI mice to assess the long-term reconstitution in vivo. Whole-genome sequencing was used to analysis the off-target mutagenesis of edited HSPCs.Results: Edited HSPCs exhibited normal multilineage formation and erythroid differentiation abilities without off-target mutagenesis and retained the ability to engraft. Moreover, we used the strategy to efficiently correct the β-CD41/42 mutation of patient-derived HSPCs, erythrocytes differentiation from which expressed more HBB mRNA than uncorrected cells.Conclusion: This strategy demonstrated a universal approach to correct most types of HBB gene mutations in β-thal.
Spatial Transmission Network Construction of Influenza-Like Illness Using Dynamic Bayesian Network and Vector-Autoregressive Moving Average Model
Authors: Qiu Jianqing , Wang Huimin , Zhang Tao , Yang Changhong 
Published: August 2020

Abstract
Background: Influenza is an acute respiratory infection caused by an influenza virus, and the primary intervention strategy is seasonal vaccine. Due to various influenza strains and their rapid mutation each year, how to recognize the key population and timing of the vaccination becomes essential. Considering the importance of finding possible spreading directions and effects of influenza between cities for department of influenza prevention, the construction of influenza transmission network becomes meaningful.Methods: 21 cities in Sichuan province were divided into different learning communities according to whether they were adjacent to each other or not. In each community, the first-order conditional dependencies approximation algorithm was performed to learn the possible structure of the time-lagged correlations between different time series vectors of the ILI estimated weekly number, and the vector autoregressive moving average models were performed for learning the lag orders and parameters of the time-lagged correlations between different time series vectors in each community.Results: It detected a number of significant time-lagged correlations between cities in Sichuan province using two models, and the lag was from 1 week to 3 weeks. The parameters indicating the suspected propagation relationship were between -0.90 and 0.75, and the proportion of the negative values in parameters increased with time. Furthermore, the spreading routes learning from two models were almost in accordance with the traffic network of Sichuan province.Conclusions: This study proposed an innovative framework for exploring the potentially stable transmission routes between different regions and measuring specific size of the transmission effect. It could be used for the infectious disease key area confirmation by considering their adjacent areas’ incidence and the transmission relationship.
FLT-PET for the Assessment of Systemic Sarcoidosis Including Cardiac and Cns Involvement: a Prospective Study With Comparison to FDG-PET
Authors: Martineau Patrick , Pelletier-Galarneau Matthieu , Juneau Daniel , Leung Eugene , Nery Pablo , deKemp Rob , Beanlands Rob , Birnie David 
Published: August 2020

Abstract
BACKGROUND:FDG’s biodistribution limits the evaluation of cardiac sarcoidosis (CS) and neurosarcoidosis (NS). While protocols for cardiac suppression exist, they can be inconvenient for patients and lead to incomplete cardiac suppression in many cases. Furthermore, FDG PET is limited in the detection of neurosarcoidosis due to an inability to suppress high level of physiological uptake within the brain. FLT has been shown to accumulate in sarcoidosis lesions and this tracer lacks significant physiological myocardial and brain uptake, suggesting that this tracer may be useful for the assessment of sarcoidosis, including CS and NS, without the need for patient preparation. This prospective pilot study examined the performance of FLT vs FDG PET for systemic sarcoidosis, including cardiac and neural involvement.MATERIALS AND METHODS:14 subjects with sarcoidosis were prospectively recruited and imaged with FDG- and FLT-PET. Two blinded, experienced readers independently reviewed the FLT-PET and FDG-PET images. Lesion distribution was compared between FLT and FDG. Agreement between FLT- and FDG-PET was determined using Cohen’s kappa and the intra-class correlation coefficient. Inter-observer variability of FLT and FDG-PET was assessed. RESULTS:12 subjects had CS as per Heart Rhythm Society criteria and 1 had NS. FLT-PET was positive in 12 (86%), and FDG-PET in 11 (79%), with cardiac uptake present in 6 (50%) and 7 (58%) of subjects with CS, respectively. The subject with NS demonstrated uptake on both FLT and FDG-PET, with more lesions on FLT. There were no significant differences in the anatomical distribution of lesions between FLT and FDG. SUVs were significantly (p<0.001) higher for FDG than FLT (5.8 (3.0) vs 2.3 (1.1), respectively), but not (p=0.90) after adjusting for blood pool activity (2.8 (1.4) vs 2.8 (1.1), respectively). Agreement between FLT- and FDG-PET was good to excellent for the diagnosis of sarcoidosis, lung involvement, CS, and NS (κ = 0.76, 0.69, 0.86, and 1.0, respectively). Inter-observer agreement for FLT was excellent for diagnosing sarcoidosis, CS and NS (κ = 0.81, 0.85, and 1.0, respectively) and comparable to that of FDG.CONCLUSIONS:FLT-PET may be useful for the assessment of systemic sarcoidosis, as well as cardiac and neural involvement.
Joint Optic Disc and Dup Segmentation Based on Densely Connected Depthwise Separable Convolution Deep Network
Authors: Liu Bingyan , Pan Daru , Song Hui 
Published: August 2020

Abstract
Background: Glaucoma is an eye disease that causes vision loss and even blindness. The cup to disc ratio is the main indicator used to screen and diagnose glaucoma, optic disc and optic cup segmentation can assist computer in diagnosing glaucoma.Therefore, accurate segmentation of optic disc and optic cup is beneficial to the screening and diagnosis of glaucoma and helps patients diagnose and treat early. Method: In this paper, we consider the segmentation of the optic disc and the optic cup as a multi-category semantic segmentation task, and proposed a deep learning-based model model named DDSC-Net(densely connected depthwise separable convolution network) to extract the optic disc and the optic cup. The backbone network is composed of densely connected deep separable convolution blocks to form a deeper network and the image pyramid input is introduce into the input layer to widen the network. In the post-process, we apply the morphological method to refine the output segmentation results. Result: The proposed method is evaluated on two publicly available datasets, DRISHTI-GS dataset and REFUGE dataset. And the experiment results show that our DDSC-Net outperforms state-of-the-art optic disc and cup segmentation methods in terms of disc coefficients and Jaccard score. Furthermore,our method achieves the best result on the more challenging optic cup segmentation task. Conclusion: The promising segmention performances reveal that our method has potential in assisting the screening and diagnosis of the glaucoma.