bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlations between objective measurements and subjective evaluations of facial profile after orthodontic treatment
Authors: He Danqing , Gu Yan , Sun Yannan 
Published: July 2020

Objective To investigate the correlations between objective measurements and subjective evaluations of post-treatment facial attractiveness. Methods Ten orthodontists rated the subjective visual analog scale (VAS) scores of the facial profiles of 95 patients who had undergone orthodontic treatment. Post-treatment cephalograms and photographs were used. Eleven soft tissue measurements and eight maxillary incisor measurements were constructed and analyzed. Correlations between objective measurements and subjective VAS scores were evaluated using Pearson correlation and quadratic regression analysis. Results The VAS scores of different facial proportions were all correlated with the total VAS score. Among soft tissue measurements, the distances from the upper and lower lips to the E line, H angle, forehead inclination, distance from lower lip to the H line, and pogonion-menton angle were negatively correlated with the VAS scores. The Z angle, with a parabolic distribution, was also correlated with the VAS scores. Among maxillary incisor measurements, the distance from the maxillary incisors to the forehead’s anterior limit line and the angulation of the maxillary incisors to the APo line were negatively correlated with the VAS scores. Conclusions Several soft tissue and maxillary incisor position measurements were correlated with facial profile evaluation and therefore might be used to evaluate facial attractiveness.
Perspective influences eye movements during real-life conversation: Mentalising about self versus others in autism
Authors: Barzy Mahsa , Ferguson Heather J , Williams David M 
Published: July 2020

Social-communication is profoundly impaired among autistic individuals. Difficulties representing others’ mental states have been linked to modulations of gaze and speech, which have also been shown to be impaired in autism. Despite these observed impairments in ‘real-world’ communicative settings, research has mostly focused on lab-based experiments, where the language is highly structured. In a pre-registered experiment, we recorded eye movements and verbal responses while adults ( N = 50) engaged in a real-life conversation. Using a novel approach, we also manipulated the perspective that participants adopted by asking them questions that were related to the self, a familiar other, or an unfamiliar other. Results replicated previous work, showing reduced attention to socially relevant information among autistic participants (i.e. less time looking at the experimenter’s face and more time looking around the background), compared to typically developing controls. Importantly, perspective modulated social attention in both groups; talking about an unfamiliar other reduced attention to potentially distracting or resource-demanding social information and increased looks to non-social background. Social attention did not differ between self and familiar other contexts, reflecting greater shared knowledge for familiar/similar others. Autistic participants spent more time looking at the background when talking about an unfamiliar other versus themselves. Future research should investigate the developmental trajectory of this effect and the cognitive mechanisms underlying it. Lay abstract Previous lab-based studies suggest that autistic individuals are less attentive to social aspects of their environment. In our study, we recorded the eye movements of autistic and typically developing adults while they engaged in a real-life social interaction with a partner. Results showed that autistic adults were less likely than typically developing adults to look at the experimenter’s face, and instead were more likely to look at the background. Moreover, the perspective that was adopted in the conversation (talking about self versus others) modulated the patterns of eye movements in autistic and non-autistic adults. Overall, people spent less time looking at their conversation partner’s eyes and face and more time looking at the background, when talking about an unfamiliar other compared to when talking about themselves. This pattern was magnified among autistic adults. We conclude that allocating attention to social information during conversation is cognitively effortful, but this can be mitigated when talking about a topic that is familiar to them.
The role of extracellular matrix in normal and pathological pregnancy: Future applications of microphysiological systems in reproductive medicine
Authors: O’Connor Blakely B , Pope Benjamin D , Peters Michael M , Ris-Stalpers Carrie , Parker Kevin K 
Published: July 2020

Remodeling of extracellular matrix in the womb facilitates the dramatic morphogenesis of maternal and placental tissues necessary to support fetal development. In addition to providing a scaffold to support tissue structure, extracellular matrix influences pregnancy outcomes by facilitating communication between cells and their microenvironment to regulate cellular adhesion, migration, and invasion. By reviewing the functions of extracellular matrix during key developmental milestones, including fertilization, embryo implantation, placental invasion, uterine growth, and labor, we illustrate the importance of extracellular matrix during healthy pregnancy and development. We also discuss how maladaptive matrix expression contributes to infertility and obstetric diseases such as implantation failure, preeclampsia, placenta accreta, and preterm birth. Recently, advances in engineering the biotic–abiotic interface have potentiated the development of microphysiological systems, known as organs-on-chips, to represent human physiological and pathophysiological conditions in vitro. These technologies may offer new opportunities to study human fertility and provide a more granular understanding of the role of adaptive and maladaptive remodeling of the extracellular matrix during pregnancy.Impact statementExtracellular matrix in the womb regulates the initiation, progression, and completion of a healthy pregnancy. The composition and physical properties of extracellular matrix in the uterus and at the maternal–fetal interface are remodeled at each gestational stage, while maladaptive matrix remodeling results in obstetric disease. As in vitro models of uterine and placental tissues, including micro-and milli-scale versions of these organs on chips, are developed to overcome the inherent limitations of studying human development in vivo, we can isolate the influence of cellular and extracellular components in healthy and pathological pregnancies. By understanding and recreating key aspects of the extracellular microenvironment at the maternal–fetal interface, we can engineer microphysiological systems to improve assisted reproduction, obstetric disease treatment, and prenatal drug safety.
Association Between Body Mass Index and Perioperative Mortality After Repair of Ruptured Abdominal Aortic Aneurysms
Authors: Liang Tiffany W. , Wang S. Keisin , Dimusto Paul D. , McAninch Christopher M. , Acher Charles W. , Timsina Lava R. , Dalsing Michael C. , Motaganahalli Raghu L. 
Published: July 2020

Objective: The attempt to repair a ruptured abdominal aortic aneurysm carries a significant risk of perioperative mortality. The relationship between body mass index (BMI) and outcomes after repair of ruptured abdominal aortic aneurysms (AAAs) has not been well defined. We report the association of BMI with outcomes after ruptured AAA repair. Methods: Patients undergoing ruptured AAA repairs between 2008 and 2017 at 2 tertiary academic centers were included in this retrospective study. Demographics (including BMI), type of repair, length of stay, and admission mortality risk scores were gathered and analyzed using bivariate and multivariate logistic regressions. Adjusted odds ratio (AOR) was reported with 95% CIs and P values from the multivariate analysis. The primary outcome was 30-day mortality. Akaike information criterion (AIC) and c-statistics were used to assess the predictive power of models including physiologic score with or without BMI. Results: A total of 202 patients underwent repair of ruptured AAA. In bivariate relationship, increased BMI was significantly associated with 30-day mortality. With multivariate analysis, adjusting for demographics, type of procedure, and physiologic score, for each kg/m2 increase in BMI, an 8% increase in the likelihood of perioperative mortality (AOR = 1.08, 95% CI: 1.01-1.17; P = .04) was observed. Conclusion: When adjusted for admission risk score, type of procedure, and demographics, obesity was associated with increased 30-day mortality. With BMI as an additional data point, the c-statistics and AIC comparisons indicated that we would have a greater ability to preoperatively estimate mortality after ruptured AAA repair. Consideration could be made to include BMI in future mortality risk scoring systems for ruptured AAA.
Physician-Modified Endovascular Gore Excluder Graft (Handmade Modified) for Complex Abdominal Aortic Aneurysm: A Step-by-Step Approach
Authors: Lopez-Pena Gabriel , Garcia-Alva Ramon , Laparra-Escareno Hugo , Anaya-Ayala Javier E. , Guerrero-Hernández Manuel , Hinojosa Carlos A. 
Published: July 2020

Endovascular repair has become the gold standard for the treatment of infrarenal abdominal aortic aneurysmal disease. Branched and fenestrated commercially custom-made devices have been developed as a treatment option for short necks or juxtarenal aneurysms. However, the lack of availability in some countries and centers, manufacturing time (6-8 weeks requirements), urgent setting in ruptured abdominal aortic aneurysms, and elevated costs make them not a widespread option. Hereby, we expose our step-by-step technique of physician modified Gore Excluder to treat complex aneurysms. Physician-modified endovascular graft (PMEG) has emerged as an alternative to open repair for the treatment of complex aortic aneurysms. The ultimate goal of fenestrations is to increase the proximal sealing zone length. The Gore C3 delivery system allows repositioning of the graft by constraining the proximal part after a back-table physician modification; the PMEG technique with the Gore Excluder C3 delivery system can be used for complex aortic aneurysms repair as an alternative treatment option.
Atrial fibrillation trial to evaluate real-world procedures for their utility in helping to lower stroke events: A randomized clinical trial
Authors: Huang Wen-Yi , Lee Meng , Sung Sheng-Feng , Tang Sung-Chun , Chang Kuo-Hsuan , Huang Yung-Sung , Lee Jiann-Der , Lee Tsong-Hai , Jeng Jiann-Shing , Chung Chang-Min , Wu Yi-Ling , Hsieh Tsung-Ta , Ovbiagele Bruce 
Published: July 2020

Background Enhancing detection of unrecognized atrial fibrillation among acute ischemic stroke patients is crucial for secondary stroke prevention. Aim To evaluate whether the detection rate of new atrial fibrillation in acute ischemic stroke patients without known atrial fibrillation could be improved by doing serial 12-lead electrocardiograms once daily for five days, compared with conventional 24-h Holter monitoring (24-h Holter). Methods We conducted a randomized clinical trial to compare the detection rates of paroxysmal atrial fibrillation between serial electrocardiograms versus 24-h Holter from October 2015 to October 2018 at six hospitals. Eligible participants were acute ischemic stroke patients with aged ≥65 years, with neither atrial fibrillation history nor any presence of atrial fibrillation on baseline electrocardiogram at admission. The primary outcome was newly detected electrocardiogram in the serial electrocardiograms and 24-h Holter group. Results Among 826 patients, baseline characteristics were similar between both groups. In the intention-to-treat analysis, there was no statistical difference between serial electrocardiograms versus 24-Holter to detect atrial fibrillation (8.4% vs. 6.9%; adjusted odds ratio 1.17, 95% confidence interval 0.69–2.01). Stepwise multivariate logistic regression revealed age ≥80 years and history of heart failure were associated with detection of paroxysmal atrial fibrillation whereas patients with lacunar infarction had lower odds for detection of paroxysmal atrial fibrillation. Conclusions Serial electrocardiograms had comparable detection rate of paroxysmal atrial fibrillation compared with 24-h Holter and might be a viable alternative to 24-h Holter as a first-line approach to survey for potential paroxysmal atrial fibrillation among elderly patients with acute ischemic stroke. Clinical Trial Registration: URL https://clinicaltrials.gov/ct2/show/NCT02578979 Unique Identifiers: NCT02578979
A qualitative investigation into clinical documentation: why do clinicians document the way they do?
Authors: Rowlands Stella , Tariq Amina , Coverdale Steven , Walker Sue , Wood Maryann 
Published: July 2020

Background: Clinical documentation is a fundamental component of patient care. The transition from paper based to electronic medical records/electronic health records has highlighted a number of issues associated with documentation practices including duplication. Developing new ways to document the care provided to patients and in turn, persuading clinicians to accept a change, must be supported by evidence that a change is required. In Australia, there has been a limited number of studies exploring the clinical documentation practices and beliefs of clinicians. Objective: To gain an in-depth understanding of clinician documentation practices. Method: A qualitative design using semi-structured interviews with clinicians (allied health professionals, doctors (physicians) and nurses) working in a tertiary-level hospital in South-East Queensland, Australia. Results: Several themes emerged from the data: environmental factors, including departmental policy and systemic issues, and personal factors, including verification, clinical reasoning and experience influencing documentation practices. Conclusion: Our study identified that the documentation practices of clinicians are complex, being driven by both environmental and systemic factors and personal factors. This in turn leads to duplication and some redundancy. The documentation burden of duplication could be reduced by changes in policy, supported by multidisciplinary documentation procedures and electronic systems aligned with clinician workflows, while retaining some flexible documentation practices. The documentation practices of individuals, when considered from the perspective of enhancing quality care, are considered legitimate and therefore will continue to form part of the health (medical) record regardless of the format.
Cancer immunoediting and immune dysregulation in multiple myeloma
Authors: Nakamura Kyohei , Smyth Mark J. , Martinet Ludovic 
Published: July 2020

Abstract
Avoiding immune destruction is a hallmark of cancer. Over the past few years, significant advances have been made in understanding immune dysfunction and immunosuppression in multiple myeloma (MM), and various immunotherapeutic approaches have delivered improved clinical responses. However, it is still challenging to completely eliminate malignant plasma cells (PCs) and achieve complete cure. The interplay between the immune system and malignant PCs is implicated throughout all stages of PC dyscrasias, including asymptomatic states called monoclonal gammopathy of undetermined significance and smoldering myeloma. Although the immune system effectively eliminates malignant PCs, or at least induces functional dormancy at early stages, malignant PCs eventually evade immune elimination, leading to progression to active MM, in which dysfunctional effector lymphocytes, tumor-educated immunosuppressive cells, and soluble mediators coordinately act as a barrier for antimyeloma immunity. An in-depth understanding of this dynamic process, called cancer immunoediting, will provide important insights into the immunopathology of PC dyscrasias and MM immunotherapy. Moreover, a growing body of evidence suggests that, together with nonhematopoietic stromal cells, bone marrow (BM) immune cells with unique functions support the survival of normal and malignant PCs in the BM niche, highlighting the diverse roles of immune cells beyond antimyeloma immunity. Together, the immune system critically acts as a rheostat that fine-tunes the balance between dormancy and disease progression in PC dyscrasias.
What makes a fang? Phylogenetic and ecological controls on tooth evolution in rear-fanged snakes
Authors: Westeen Erin P. , Durso Andrew M. , Grundler Michael C. , Rabosky Daniel L. , Davis Rabosky Alison R. 
Published: July 2020

Abstract
Background
Fangs are a putative key innovation that revolutionized prey capture and feeding in snakes, and – along with their associated venom phenotypes – have made snakes perhaps the most medically-significant vertebrate animals. Three snake clades are known for their forward-positioned fangs, and these clades (Elapidae, Viperidae, and Atractaspidinae) contain the majority of snakes that are traditionally considered venomous. However, many other snakes are “rear-fanged”: they possess potentially venom-delivering teeth situated at the rear end of the upper jaw. Quantification of fang phenotypes – and especially those of rear-fanged species – has proved challenging or impossible owing to the small size and relative rarity of many such snakes. Consequently, it has been difficult to understand the evolutionary history of both venom and prey-capture strategies across extant snakes. We quantified variation in the dentition of 145 colubriform (“advanced”) snake species using microCT scanning and compared dental characters with ecological data on species’ diet and prey capture method(s) to understand broader patterns in snake fang evolution.

Results
Dental traits such as maxilla length, tooth number, and fang size show strong phylogenetic signal across Colubriformes. We find extreme heterogeneity and evolutionary lability in the rear-fanged phenotype in colubrid (colubrine, dipsadine, and natricine lineages) and lamprophiid snakes, in contrast to relative uniformity in the front fanged phenotypes of other groups (vipers and, to a lesser extent, elapids). Fang size and position are correlated with venom-use in vipers, elapids, and colubrid snakes, with the latter group shifting fangs anteriorly by shortening the entire maxillary bone. We find that maxilla length and tooth number may also be correlated with the evolution of dietary specialization. Finally, an ancestral state reconstruction suggests that fang loss is a recurring phenomenon in colubrid snakes, likely accompanied by shifts in diet and prey capture mode.

Conclusions
Our study provides a framework for quantifying the complex morphologies associated with venom use in snakes. Our results suggest that fang phenotypes, and particularly the rear-fanged phenotype, in snakes are both diverse and labile, facilitating a wide range of ecological strategies and contributing to spectacular radiations of these organisms in tropical and subtropical biomes worldwide.
VviERF6Ls: an expanded clade in Vitis responds transcriptionally to abiotic and biotic stresses and berry development
Authors: Toups Haley S. , Cochetel Noé , Gray Dennis , Cramer Grant R. 
Published: July 2020

Abstract
Background
VviERF6Ls are an uncharacterized gene clade in Vitis with only distant Arabidopsis orthologs. Preliminary data indicated these transcription factors may play a role in berry development and extreme abiotic stress responses. To better understand this highly duplicated, conserved clade, additional members of the clade were identified in four Vitis genotypes. A meta-data analysis was performed on publicly available microarray and RNA-Seq data (confirmed and expanded with RT-qPCR), and Vitis VviERF6L1 overexpression lines were established and characterized with phenotyping and RNA-Seq.

Results
A total of 18 PN40024 VviERF6Ls were identified; additional VviERF6Ls were identified in Cabernet Sauvignon, Chardonnay, and Carménère. The amino acid sequences of VviERF6Ls were found to be highly conserved. VviERF6L transcripts were detected in numerous plant organs and were differentially expressed in response to numerous abiotic stresses including water deficit, salinity, and cold as well as biotic stresses such as red blotch virus, N. parvum, and E. necator. VviERF6Ls were differentially expressed across stages of berry development, peaking in the pre-veraison/veraison stage and retaining conserved expression patterns across different vineyards, years, and Vitis cultivars. Co-expression network analysis identified a scarecrow-like transcription factor and a calmodulin-like gene with highly similar expression profiles to the VviERF6L clade. Overexpression of VviERF6L1 in a Seyval Blanc background did not result in detectable morphological phenotypes. Genes differentially expressed in response to VviERF6L1 overexpression were associated with abiotic and biotic stress responses.

Conclusions
VviERF6Ls represent a large and distinct clade of ERF transcription factors in grapevine. The high conservation of protein sequence between these 18 transcription factors may indicate these genes originate from a duplication event in Vitis. Despite high sequence similarity and similar expression patterns, VviERF6Ls demonstrate unique levels of expression supported by similar but heterogeneous promoter sequences. VviERF6L gene expression differed between Vitis species, cultivars and organs including roots, leaves and berries. These genes respond to berry development and abiotic and biotic stresses. VviERF6L1 overexpression in Vitis vinifera results in differential expression of genes related to phytohormone and immune system signaling. Further investigation of this interesting gene family is warranted.
Osteoporotic fracture rates in chronic hemodialysis and effect of heparin exposure: a retrospective cohort study
Authors: Harrak Hind , René Emilie , Alsalemi Noor , Elftouh Naoual , Lafrance Jean-Philippe 
Published: July 2020

Abstract
Background
Patients receiving chronic hemodialysis treatments are at a higher risk of fracture compared to the general population. While the use of heparin during dialysis is crucial to avoid thrombosis of the extracorporeal circuit, the association of unfractionated heparin (UFH) and the risk of osteoporotic fracture has been shown for many years. However, this association was not as clear for low-molecular-weight heparin (LMWH) and the few collected data originated from studies among pregnant women. Our aim was to measure osteoporotic fracture rate among hemodialysis patients and to evaluate the association of LMWH compared to UFH in hemodialysis.

Methods
A retrospective cohort study was conducted on data extracted from the RAMQ and Med-Echo databases from January 2007 to March 2013 with patients chronically hemodialyzed in 21 participating centers. Incidence rates for each fracture sites were measured per 1000 patient-year (p-y) and their 95% confidence intervals (CI). Osteoporotic fracture risk for a first event with LMWH compared to UFH was estimated using a cox proportional hazard model using demographics, comorbidities and drug use as covariates.

Results
4796 patients undergoing chronic hemodialysis were identified. The incidence rate for all fracture sites was 22.7 /1000 p-y (95% CI: 19.6–26.1) and 12.8 /1000 p-y (95% CI: 10.5–15.4) for hip and femur fractures. We found a similar risk of osteoporotic fracture for LMWH compared to UFH (adjusted HR = 1.01; 95%CI: 0.72–1.42). Age and malignancy increased the risk of fracture while cerebrovascular disease decreased the risk of fracture.

Conclusions
Compared to UFH, LMWH did not change the risk of osteoporotic fracture when used for the extracorporeal circuit anticoagulation in chronic hemodialysis.