bluuebunny/crossref_metadata_2025_split huggingface dataset:
A tree’s quest for light—optimal height and diameter growth under a shading canopy
Authors: Fransson Peter , Brännström Åke , Franklin Oskar 
Published: September 2020

Abstract
For trees in forests, striving for light is matter of life and death, either by growing taller toward brighter conditions or by expanding the crown to capture more of the available light. Here, we present a mechanistic model for the development path of stem height and crown size, accounting for light capture and growth, as well as mortality risk. We determine the optimal growth path among all possible trajectories using dynamic programming. The optimal growth path follows a sequence of distinct phases: (i) initial crown size expansion, (ii) stem height growth toward the canopy, (iii) final expansion of the crown in the canopy and (iv) seed production without further increase in size. The transition points between these phases can be optimized by maximizing fitness, defined as expected lifetime reproductive production. The results imply that to reach the canopy in an optimal way, trees must consider the full profile of expected increasing light levels toward the canopy. A shortsighted maximization of growth based on initial light conditions can result in arrested height growth, preventing the tree from reaching the canopy. The previous result can explain canopy stratification, and why canopy species often get stuck at a certain size under a shading canopy. The model explains why trees with lower wood density have a larger diameter at a given tree height and grow taller than trees with higher wood density. The model can be used to implement plasticity in height versus diameter growth in individual-based vegetation and forestry models.
Vaginal pessary continuation in symptomatic pelvic organ prolapse patients with prior hysterectomy
Authors: Ma Congcong , Kang Jia , Xu Tao , Zhang Ye , Ma Yidi , Liang Shuo , Hui Yujie , Wang Yuhong , Zhu Lan 
Published: September 2020

Abstract

Objective:
To evaluate the success rate of pessary fitting and continuation rate for symptomatic pelvic organ prolapse (POP) patients with a hysterectomy and to explore potential predictors.

Methods:
In this prospective observational study, 119 symptomatic POP patients with a prior hysterectomy received pessary treatment between April 2015 and February 2019. A successful pessary fitting was defined as a patient who was fitted with a pessary and continued to use it 2 weeks later. Patients with successful pessary fitting were followed until February 2020. Data analysis was performed with t tests, nonparametric tests, chi-square tests, and logistic regression.

Results:
The success rate of pessary fitting was 63.2%. A history of POP reconstructive surgery (OR = 2.6, 95% CI 1.0-6.7, P = 0.043) and a short total vaginal length <7.3 cm, (OR = 0.5, 95% CI 0.3-0.9, P = 0.014) were potential risk factors for unsuccessful pessary fitting. A total of 78.1% of the patients continued pessary use for a median duration of 26 months. Among patients who discontinued, 75% ceased within 1 year. Older age (OR = 1.1, 95% CI 1.0-1.2, P = 0.038) and prolapse score improvement at 3 months less than 50% (OR = 2.8, 95% CI 1.1-7.2, P = 0.035) were potential risk factors for discontinuation.

Conclusions:
Pessaries remain a useful approach to treat prolapse in women who had a hysterectomy. Patients with POP reconstructive surgery and total vaginal length<7.3 cm should be informed that they might have lower success rate of pessary fitting. Age and prolapse score improvement at 3 months were potential predictors for continuation.
Ward nurses-focused educational intervention improves the quality of bowel preparation in inpatients undergoing colonoscopy
Authors: Liu Aihong , Yan Shuhong , Wang Huashe , Lin Yijia , Wu Junkui , Fu Liping , Wu Qining , Lu Yi , Liu Yanan , Chen Honglei 
Published: September 2020

Abstract

Background:
Adequate bowel preparation is essential for the detection of pathological lesions during colonoscopy. However, it has been found to be inadequate in approximately 20% to 30% of colonoscopy examinations. Educational interventions focused on health staff, such as physicians and nurses, may improve the patients’ understanding of the bowel preparation instructions, and consequently, increase the quality of bowel preparation.

Objectives:
To investigate whether enhanced education of ward nurses could improve the bowel preparation quality in inpatients undergoing colonoscopy.

Design:
This was a single-center randomized controlled study.

Methods:
A total of 190 consecutive inpatients scheduled to undergo colonoscopy from March 2019 to March 2020 were randomized to the educated (nurses with enhanced education) or control group (nurses without enhanced education). We assessed the bowel preparation quality using the Boston bowel preparation scale.

Results:
There were 89 patients in the educated group and 101 patients in the control group. The proportion of colonoscopies with adequate bowel preparation was 83.1% in the educated group and 69.3% in the control group. Patients’ compliance with bowel preparation in the educated group was superior to that in the control group. Furthermore, significantly better sleep quality was found in the educated group. The multivariate logistic regression analysis identified the ward nurses-focused enhanced educational intervention as a risk factor for bowel preparation quality.

Conclusions:
The ward nurses-focused educational intervention improved the bowel preparation quality and reduced the adverse event rates in inpatients undergoing colonoscopy.

Trial registration:
This study was registered in the Chinese Clinical Trial Registry under number ChiCTR2000030366.
Experimental study of expression profile and specific role of human microRNAs in regulating atrophic bone nonunion
Authors: Wei Junqiang , Chen Hua , Fu Yangmu , Zhang Boxun , Zhang Lihai , Tao Sheng , Lin Feng 
Published: September 2020

Abstract
The expression profile and specific roles of microRNAs (miRNAs) in regulation of atrophic bone nonunion are not fully understood. Here, we present evidence that miRNAs are involved in regulation of several osteogenic genes and may contribute to the development of atrophic bone nonunion.
The miRNA expression profile of repairing tissues in atrophic bone nonunion patients (group A) and in callus tissues from patients with healed fractures (group B) were quantitatively measured. microRNA microarrays were used to identify differentially expressed miRNAs, and the bioinformatics methods were used to predict the potential target genes. Quantitative real-time polymerase chain reaction (qRT-PCR), western blot, and dual-luciferase reporter assay were performed in human bone marrow stromal cells (hBMSCs) to validate the microarray results.
Nine miRNAs in group A were up-regulated 1.5 times compared to group B, while the other 9 miRNAs in group A were down-regulated 1.5 times. Several target regions of these miRNAs were identified in the osteogenic genes, as well as in the other genes in their families or related regulatory factors. Four miRNAs (hsa-miR-149∗, hsa-miR-221, hsa-miR-628-3p, and hsa-miR-654-5p) could play important roles in regulating bone nonunion development. hBMSCs transfected with these miRNAs significantly decreased mRNA levels of alkaline phosphatase, liver/bone/kidney (ALPL), platelet derived growth factor subunit A (PDGFA), and bone morphogenetic protein 2 (BMP2). Lower protein expression levels were observed using western blotting, confirming that ALPL, PDGFA, and BMP2 were directly targeted by hsa-miR-149∗, hsa-miR-221, and hsa-miR-654-5p, respectively.
In summary, hsa-miR-149∗, hsa-miR-221, and hsa-miR-654-5p may play important biological roles by repressing osteogenic target genes ALPL, PDGFA, and BMP2, and, therefore, contributing to progression of atrophic bone nonunion.
5-HT3 blockade does not attenuate postspinal blood pressure change in cesarean section
Authors: Neumann Claudia , Velten Markus , Heik-Guth Cornelia , Strizek Brigitte , Wittmann Maria , Hilbert Tobias , Klaschik Sven 
Published: September 2020

Abstract
Spinal anesthesia (SpA) for elective caesarean section (CS) is often accompanied by clinically relevant arterial hypotension. The Bezold-Jarisch reflex, causing postspinal hypotension, has been shown to be antagonized by serotonin type 3 (5-HT3) blockade. Our aim was to assess if routine prophylactic administration of the 5-HT3 antagonist ondansetron (ODS) attenuates postspinal change in maternal blood pressure.
Elective CS under SpA were retrospectively analyzed. Eighty parturients having routinely received 8 mg ODS prior to SpA were compared with 80 patients having not (control group).
Mean arterial blood pressure significantly decreased from baseline to the postspinal period (P < .0001) without differences in blood pressure decreases between the 2 groups. This also applied to the heart rate. Overall use of cafedrine/theodrenaline was higher in the ODS group (0.8 (0.4–1.6) mL vs 0.8 (0–1.0) mL in the control group, P = .01). APGAR values showed a presumably clinically irrelevant decrease in control group compared with the ODS group.
Our results suggest that routine administration of ODS in a dosage of 8 mg does not effectively attenuate postspinal change in maternal blood pressure during CS in our setting. Given the wide variability of anesthetic techniques, only large prospective and randomized multicenter trials will ultimately serve to elucidate this issue.
The outcomes of carbon dioxide digital subtraction angiography for percutaneous transluminal balloon angioplasty of access circuits and venous routes in hemodialysis patients
Authors: Tasaki Yutaro , Sueyoshi Eijun , Takamatsu Hiroko , Matsushima Yoshifumi , Miyamura Shuto , Sakamoto Ichiro , Mochizuki Yasushi , Uetani Masataka 
Published: September 2020

Abstract
The outcomes of carbon dioxide digital subtraction angiography (CO2-DSA) for performing percutaneous transluminal balloon angioplasty (balloon PTA) in hemodialysis patients has not been fully clarified. The purpose was to compare the outcomes of balloon PTA of hemodialysis shunts in terms of vessel patency between patients treated using CO2-DSA and conventional digital subtraction angiography using iodine contrast medium (C-DSA).
We retrospectively evaluated 76 patients (38 males and 38 females, mean age: 65.0 ± 14.0 years). They were under hemodialysis and treated with balloon PTA using CO2-DSA or C-DSA at our institution between 2009 and 2016. Mean duration of the follow-up period was 25.59 ± 21.45 months. We compared the patency rates obtained after CO2-DSA-based balloon PTA with those after C-DSA-based balloon PTA. Secondary patency, which was defined as the duration of patency after all further endovascular interventions until surgical repair, was considered as the endpoint in this study.
Overall, 19 and 57 patients underwent CO2-DSA- and C-DSA-based balloon PTA, respectively. CO2-DSA- and C-DSA-based balloon PTA produced clinical success rates of 100% and 96.5%, respectively. Blood vessel injury occurred in one patient who underwent C-DSA-based balloon PTA. No major complications occurred in CO2 group. At 24 months, the post-PTA secondary patency rates of CO2-DSA- and C-DSA-based balloon PTA were 94.1% and 93.9%, respectively (P = .9594).
CO2-DSA is safe for hemodialysis patients. Compared with C-DSA, CO2-DSA-based balloon PTA produces have a similar secondary patency rate.
Is bodyweight affecting plantar pressure distribution in children?
Authors: Feka Kaltrina , Brusa Jessica , Cannata Rosanna , Giustino Valerio , Bianco Antonino , Gjaka Masar , Iovane Angelo , Palma Antonio , Messina Giuseppe 
Published: September 2020

Abstract
The aim of this study is twofold: firstly, to investigate the plantar pressure distribution differences in children coming from 4 different weight categories and secondly to analyze the presence of sex-related plantar pressure distribution differences.
Overall, 416 children, aged 7 to 12 years old were randomly selected from 6 different local schools, and voluntarily participated in the study. Two hundred twenty six of them were men, while 190 were women (mean age: 9.93 ± 1.02 years; height: 1.39 ± 0.8 m; body mass: 37.76 ± 10.34 kg; BMI: 19.24 ± 4.02 kg/m2). Based on the body mass index (BMI) the sample was grouped in the following categories: underweight (UW); normal weight (NW); overweight (OW), and obese (OB). Besides, the plantar load distribution parameters (total plantar load distribution and load distribution in forefoot and rearfoot) were assessed employing freeMed Maxi; Sensor Medica device. Shapiro-Wilk test was used to test the data distribution. Between-groups comparisons were conducted using Mann–Whitney U test, or using Kruskal-Wallis test associated with pairwise comparisons.
There were significant differences in load distribution between weight categories, with (OW) and (NW) being significantly different with (O), P = .03 and P = .04, respectively. No significant differences were found on load distribution on the rearfoot and forefoot between categories. The sex effect, particularly among boys, revealed a different pattern of load distribution among (O) compared with other categories. This effect was not detected among women. Different profile of load distribution on the rearfoot and forefoot between boys and girls was found, with girls bearing significantly more weight in the right rearfoot compared with boys (P = .001).
It can be concluded that the weight status of the children can affect the plantar load distribution, with obese category being different from (NW) and (OW). Additionally, the sex plays a role when it comes to the load distribution in different regions of the foot. Moreover, since the young age, due to growth and development process, is accompanied with anatomical foot changes which might be affected from numerous factors, assessing plantar pressure distribution in young children results to be a quite complicated matter.
Comparison of intrathecal morphine versus local infiltration analgesia for pain control in total knee and hip arthroplasty
Authors: Qi Bao-chang , Yu Jing , Qiao Wei-song 
Published: September 2020

Abstract

Background:
The purpose of this meta-analysis was to comprehensively collect randomized controlled trials (RCTs) to assess the clinical efficacy of intrathecal morphine (ITM) versus local infiltration analgesia (LIA) in the treatment of total knee and hip arthroplasty patients.

Methods:
Relevant studies were identified from the Embase, PubMed, Cochrane Library, Web of Science, Wanfang, and Chinese National Knowledge Infrastructure (CNKI) databases. We also reviewed the references of all identified articles to identify additional studies. For each study, we assessed the risk ratio (RR), weighted mean difference (WMD), and corresponding 95% confidence interval (95% CI) to synthesize outcomes. Meta-analysis was performed with Stata 12.0 software.

Results:
We included 13 studies with 942 patients for meta-analysis. LIA significantly decreased the pain value with rest or mobilization until 72 hours (P < .05). LIA significantly decreased cumulative morphine consumption by 13.52 mg. Moreover, the length of hospital stay was lower in the LIA group than in the ITM analgesia group. Finally, LIA significantly reduced morphine-related complications (nausea and vomiting, pruritus, and respiration depression).

Conclusions:
LIA was an effective approach for relieving postoperative pain and reducing postoperative consumption of morphine compared with ITM in total knee and hip arthroplasty patients.
The comparison of evaluative effectiveness between antral follicle count/age ratio and ovarian response prediction index for the ovarian reserve and response functions in infertile women
Authors: Zhou Shan-Jie , Zhao Ming-Jia , Li Cui , Su Xing 
Published: September 2020

Abstract
Aim of the present study was to explore the evaluative effectiveness of age, ovarian volume (OV), antral follicle count (AFC), serum follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), AFC/Age ratio, AMH/Age ratio, FSH/luteinizing hormone (LH) ratio, and ovarian response prediction index (ORPI) to determine which could more advantageously assess ovarian reserve and response.
This research enrolled 319 consecutive infertile women who had undergone in vitro fertilization-ET/intracytoplasmic sperm injection (IVF-ET/ICSI) treatments. Abovementioned variables were measured and calculated. Receiver operating characteristic (ROC) curve analysis was used to analyze the predictive accuracy of variables and to calculate cut-off values and corresponding sensitivity and specificity.
Our study revealed that the significant variables for evaluating a decline in ovarian reserve include age, OV, FSH, AFC/Age ratio, AMH/Age ratio, and ORPI. Moreover, the area under the curve (AUC) of AFC/Age ratio was higher than other 5 variables (AUC = 1.000), and the cut-off value of AFC/Age ratio was 0.111 (sensitivity 100.00%, specificity 100.00%). The significant variables forecasting excessive ovarian response were age, AFC, AMH, FSH, AFC/Age ratio, AMH/Age ratio, FSH/LH ratio, and ORPI, and the significant variables forecasting poor ovarian response were AMH, LH, OV, AFC/Age ratio, AMH/Age ratio, and FSH/LH ratio. When ORPI was used to predict excessive response, the cut-off value of ORPI was 0.880 (sensitivity 84.72%, specificity 67.32%) and ORPI presented better effectiveness. When used to predict poor response, the evaluative effectiveness of 6 variables was almost similar, although the AUC of AFC/Age ratio presented the largest value.
Regarding the infertile women, AFC/Age ratio performed better than did the other variables in evaluating ovarian reserve, and it offered excellent effectiveness in predicting poor ovarian response, however, ORPI presented better effectiveness in predicting excessive ovarian response.
Epidemiological characteristics of dengue in mainland China from 1990 to 2019
Authors: Lin Haixiong , Wang Xiaotong , Li Zige , Li Kangju , Lin Chunni , Yang Huijun , Yang Weiqin , Ye Xiaopeng 
Published: September 2020

Abstract
In the past 30 years, dengue has undergone dramatic changes in China every year. This study explores the epidemiological trend of dengue in China during this period to identify high-risk seasons, regions, ages, susceptible populations, and provide information for dengue prevention and control activities.
Dengue data from 1990 to 2019 were derived from the Public Health Science Data Center, Web of Science, China National Knowledge Infrastructure, PubMed, and Centers for Disease Control and Prevention of the corresponding province. GraphPad Prism 7 was conducted to generate disease evolution maps, occupational heat maps, and monthly heat maps of dengue cases and deaths in mainland China and Guangdong Province. Excel 2016 was used to create a cyclone map of age and gender distribution. Powerpoint 2016 was performed to create geographic maps.
From 1990 to 2019, the annual number of dengue cases showed an increasing trend and reaching a peak in 2014, with 46,864 dengue cases (incidence rate: 3.4582/100,000), mainly contributed by Guangdong Province (45,189 cases, accounting for 96.43%). Dengue pandemics occurred every 4 to 6 years. The prevalence of dengue fever was Autumn, which was generally prevalent from June to December and reached its peak from September to November. The provinces reporting dengue cases each year have expanded from the southeastern coastal region to the southwest, central, northeast, and northwest regions, and the provinces with a high incidence were Guangdong, Guangxi, Yunnan, Fujian, and Zhejiang. People aged 25 to 44 years were more susceptible to dengue virus infection. And most of them were male patients. Dengue mainly occurs in the following groups: students, business service staffs, workers, farmers, retired staffs, housewives, and the unemployed. Four provinces reported deaths from dengue, namely Guangdong Province, Zhejiang Province, Henan Province, and Hunan Province.
The dengue fever epidemic occurred every 4 to 6 years, mostly in autumn. The endemic areas were Guangdong, Guangxi, Yunnan, Fujian, and Zhejiang provinces. People aged 25 to 44 years, men, students, business service staffs, workers, farmers, retired staffs, housewives, and the unemployed were more susceptible to dengue fever. These findings help to develop targeted public health prevention and control measures.
Clinical study on improving postoperative symptoms of cervical spondylotic myelopathy by Qishe pill
Authors: Xu Jinhai , Zhou Xiaoning , Xu Chen , Xu Chongqing , Ding Xing , Jin Kun , Yan Ming , Ma Junming , Wu Xuequn , Ye Jie , Mo Wen , Yuan Wen 
Published: September 2020

Abstract

Background:
Cervical spondylotic myelopathy (CSM) is the most serious type of cervical spondylosis, which is often treated surgically in patients with progressive neurological symptoms following ineffective conservative treatment. However, some patients have residual symptoms such as neck pain, stiffness, and C5 nerve palsy after surgery. The Qishe pill can effectively relieve the symptoms of neck pain and numbness, but there is no evidence showing the efficacy and safety of the Qishe pill in treating symptoms after spinal cord surgery.

Methods/design:
A multicenter, randomized controlled clinical trial will be conducted to evaluate the efficacy and safety of the Qishe Pill. A total of 330 patients with CSM who receive surgical treatment will be randomly divided into 2 groups, treated for 12 weeks and with a 1-year follow-up. The primary outcome will be Japanese Orthopaedic Association score from the baseline to 4 weeks, 12 weeks, 24 weeks, and 48 weeks after surgery. Secondary outcomes will include Visual Analogue Scale score, Neck Disability Index, and imaging indicators (including magnetic resonance imaging and X-ray). Additionally, adverse reactions will be observed and recorded as safety indicators.

Discussion:
Although the Qishe pill can effectively improve the discomfort of the neck and upper limbs in clinical applications, there is a lack of clinical research on postoperative patients. This study will investigate the efficacy and safety of the Qishe pill in treating postoperative symptoms of CSM.

Trial registration:
Clinical Trials.gov ID: ChiCTR1900028173. Registered on 17 December 2019.
Prevalence and risk factors for intensive care unit acquired weakness
Authors: Li Zheng , Zhang Qian , Zhang Peng , Sun Ruixiang , Jiang Haijiao , Wan JingJing , Wu Fang , Wang Xiaoye , Tao Xiubin 
Published: September 2020

AbstractBackground:Intensive care unit-acquired weakness (ICU-AW) is an acquired neuromuscular lesion and a common occurrence in patients who are critically ill. We will systematically summarize and incorporate the important risk factors and prevalence from previously published multivariate analyses for ICU-AW.Methods:We will search the PubMed, Embase, Web of Science, and the Cochrane library to identify the relevant studies about the prevalence and risk factors for ICU-AW. Two reviewers will independently review the studies for eligibility according to the inclusion criteria. Two reviewers will independently assess the quality of studies by using the Newcastle–Ottawa scale for nonrandomized studies. Heterogeneity among studies will be estimated by theI2statistic.Results:This systematic review and meta-analysis will provide an evidence of prevalence and risk factors for the ICU-AW.Conclusion:We hope that our research will contribute to clinicians and public decision making about the ICU-AW.