bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Region- of-interest Size and Location on Quantitative Contrast-enhanced Ultrasound of Canine Splenic Perfusion
Authors: Morabito Simona , Pietro Simona Di , Cicero Luca , Falcone Annastella , Liotta Luigi , Crupi Rosalia , Cassata Giovanni , Macrì Francesco 
Published: August 2020

Abstract
BackgroundDuring the contrast enhanced ultrasound (CEUS) the features of regions of interest (ROI) can affects the value of the perfusion parameters obtained from a time intensity curves (TIC). In veterinary medicine, the influence of ROI size and location during the CEUS exam has been described using the kidney as target organ, with contrasting results. No guidelines have been reported for the ideal placement or size of the ROI during the quantitative analysis of CEUS in canine spleen.The aim of this study was to evaluate the effect of the size and location of ROIs in the spleen of conscious dogs on perfusion variables determined using contrast-enhanced ultrasonography with sulphur hexafluoride. ResultsA prospective, observational study on 15 adult client-owned mixed-breed dogs was performed using a system equipped with contrast-tuned imaging technology. Qualitative and quantitative assessment of the enhancement pattern of the spleen were performed. Three square ROIs (0.05 cm2) were manually drawn in a row and spaced 1mm apart, placing adjacent ROIs at three different depths. Three medium rectangular ROIs (0.3 cm2 ) encompass the 3 smaller ROIs of each row and a single large square ROI (1 cm2) containing all the previous ROIs were drawn. Software analysis of generated time-intensity curves within each ROI allowed to calculate the perfusion parameters: peak enhancement, time to peak, regional blood flow and volume and mean transit time. The coefficient of variation for all parameters was always lowest in the largest ROI in comparison with the other smaller ROIs. The ROI A and B, positioned in proximal and middle levels respectively, showed coefficients of variation similar to the largest ROI. The analysis of variance model showed a significant effect of location and size of ROIs in the quantitative perfusion analysis of the canine spleen, with a reduction of perfusion parameters in the distal ROI.Conclusions The analysis of splenic perfusion through quantitative evaluation of enhancement with a contrast agent into a large enough and proximal to the ultrasound beam area of ​​splenic parenchyma may be of clinical importance in the diagnosis of splenic disorders.
Assessing Neo-natal mortality trends in Pakistan: An insight using Equity Lens
Authors: Dawood Zainab , Majeed Naeem 
Published: August 2020

Abstract
BackgroundAlmost 2.5 million children died in the first year of life in the year 2017. These account for almost half of the total deaths of children under the age of five years. Overall, child mortality has declined over the past two decades. Comparatively, the pace of decline in neonatal mortality has remained much slow. Significant inequalities in health across a number of dimensions – including wealth, ethnicity, and geography – continue to exist both between and within countries, and these contribute to neonatal mortality. This study aims to quantify the magnitude of inequalities in neonatal mortality trends by wealth quintile and place of residence with province wise segregation. MethodsThe study was done using raw data from the last three Pakistan Demographic & Health Surveys (20017-18, 2012-13 and 2006-7). The concentration curves were drawn in Microsoft Excel 365 using scatter plot as graph type while the frequencies were calculated using SPSS 24. ResultsThe situation of inequity across provinces and in rural vs urban areas has slightly declined, however, gross inequities continue to exist.ConclusionsPresentation of outcomes data, such as neonatal mortality in various wealth quintiles is an effective way to highlight the inequities amongst income groups as it highlights the vulnerable and at-risk groups. In other countries, rural-urban distribution, or ethnic groups may also reflect similar differences and help in identifying high-risk groups.
Distinction Between Vaginal and Cervical Microbiota in High-risk Human Papilloma Virus Infected Women in China
Authors: Zhang Zhan , Li Ting , Zhang Dai , Zong Xiaonan , Bai Huihui , Bi Hui , Liu Zhaohui 
Published: August 2020

Abstract
Background: High-risk human papilloma virus (hrHPV) is regarded as the main causal factor of cervical precancer and cancer when persistent infection is left untreated. Previous studies have declared that HPV is associated with microecological environment of lower genital tract but haven’t discriminate vaginal microbiota from that of cervix. Objective: To analyze the distinction between vaginal and cervical microbiota in high-risk HPV(+) Chinese women. Methods: One hundred participants were recruited including 20 healthy women with HPV (-), 32 with other hrHPV (+), 38 subjects with HPV16/18 (+) and 10 with cervical carcinoma, demographics of whom were collected and analyzed. Vaginal and cervical microbiota were separately tested through next-generation sequencing technology (NGS) targeting the variable region (V3-V4) of bacterial ribosome 16S rRNA gene. Results: 1. Analysis of demographics demonstrated that hrHPV infected women tend to be accustomed to vaginal douching (p =0.001), show more frequent usage of sanitary pads (p =0.007), have more sex partners (p =0.047), be more sexually active (p =0.025), have more diverse ways of contraception (p =0.001) and history of vaginitis (p =0.002). 2. NGS identified microbial diversity of cervical microbiota was much higher than that of vagina with significantly increased Proteobacteria and decreased Lactobacillus. Variation of cervical microbiota of hrHPV(+) subjects partly similar to vaginal microbiota but had its unique features. Sphingomonas of α-Proteobacteria, almost invisible in the vagina, was more frequent at normal cervix whereas decreased remarkably at hrHPV(+) cervix. Reversely, γ-Proteobacteria showed a significant positive correlation with HPV16/18 and cervical cancer. BV related anaerobes like Gardnerella, Prevotella, Atopobium and Sneathia showed similar changes in both vaginal and cervical microbiota of hrHPV(+) women and did not exhibit cervical specificity. Conclusions: Cervical microbiota has its uniqueness from that of vagina in bacterial communities presenting a higher proportion of Proteobacteria, of which Sphingomonas is potentially predictive of a health guardian of hrHPV while Pseudomonas the opposite.
Bayesian Network Models with Decision Tree Analysis for Management of Childhood Malaria in Malawi
Authors: Taneja Sanya B. , Douglas Gerald P. , Cooper Gregory F. , Michaels Marian G. , Druzdzel Marek J. , Visweswaran Shyam 
Published: August 2020

Abstract
Background: Malaria is a major cause of death in children under five years old in low- and middle-income countries such as Malawi. Accurate diagnosis and management of malaria can help reduce the global burden of childhood morbidity and mortality. Trained healthcare workers in rural health centers manage malaria with limited supplies of malarial diagnostic tests and drugs for treatment. A clinical decision support system that integrates predictive models to provide an accurate prediction of malaria based on clinical features could aid healthcare worker in judicious use of testing and treatment. We developed Bayesian network (BN) models to predict the probability of malaria from clinical features and an illustrative decision tree to model the decision to use or not use a malaria rapid diagnostic test (mRDT).Methods: We developed two BN models from data that were collected in a national survey of outpatient encounters of children in Malawi. The target diagnosis is taken as the result of mRDT. The first BN model was created manually with expert knowledge, and the second model was derived using an automated method followed by modifications guided by expert knowledge. The performance of the BN models was compared to other statistical models on a range of performance metrics. We developed a decision tree that integrates predictions from these predictive models with the costs of mRDT and a course of recommended treatment. Results: Compared to the logistic regression and random forest models, the BN models had similar accuracy of 64% but had higher sensitivity at the cost of lower specificity at the default threshold. Sensitivity analysis of the decision tree showed that at low (below 0.04) and high (above 0.4) probabilities of malaria in a child, the preferred decision that minimizes expected costs is not to perform mRDT.Conclusion: In resource-constrained settings, judicious use of mRDT is important. Predictive models in combination with decision analysis can provide personalized guidance on when to use mRDT in the management of childhood malaria. BN models can be efficiently derived from data to support such clinical decision making.
Associations of poor oral health with frailty and physical functioning in the oldest old: results from two studies in England and Japan
Authors: Albani Viviana , Nishio Kennsuke , Ito Tomoka , Kotronia Eftychia , Moynihan Paula , Robinson Louise , Hanratty Barbara , Kingston Andrew , Abe Yukiko , Takayama Michiyo , Iinuma Toshimitsu , Arai Yasumichi , Ramsay Sheena E 
Published: August 2020

Abstract
Background: Very few studies have examined the relationship of oral health with physical functioning and frailty in the oldest old (>85 years). We examined the association of poor oral health with markers of disability, physical function and frailty in studies of oldest old in England and Japan.Methods: The Newcastle 85+ Study in England (n=853) and the Tokyo Oldest Old Survey on Total Health (TOOTH; n=542) comprise random samples of people aged >85 years. Oral health markers included tooth loss, dryness of mouth, and self-reported difficulty eating due to dental problems. Physical functioning was based on grip strength and gait speed; disability was assessed as mobility limitations. Frailty was ascertained using the Fried frailty phenotype. Cross-sectional analyses were undertaken using logistic regression.Results: In the Newcastle 85+ Study, dry mouth symptoms, difficulty swallowing, difficulty eating, and tooth loss were associated with increased risks of mobility limitations after adjustment for gender, socioeconomic position, behavioural factors and co-morbidities [odds ratios (95%CIs) were 1.76 (1.26-2.46); 2.52 (1.56-4.08); 2.89 (1.52-5.50); 2.59 (1.44-4.65) respectively]. Similar results were observed for slow gait speed. Difficulty eating was associated with weak grip strength and frailty on full adjustment. In the TOOTH Study, difficulty eating was associated with increased risks of frailty, mobility limitations and slow gait speed; and complete tooth loss was associated with increased risk of frailty.Conclusion: Different markers of poor oral health are independently associated with worse physical functioning and frailty in the oldest old age groups. Research to understand the underlying pathways is needed.
PSMA PET Before and After Initial Long Term Androgen Deprivation in Patients With Newly Diagnosed Prostate Cancer
Authors: Hoberück Sebastian , Löck Steffen , Winzer Robert , Zöphel Klaus , Froehner Michael , Fedders Dieter , Kotzerke Jörg , Hölscher Tobias 
Published: August 2020

Abstract
Purpose: The study aimed to evaluate the effect of androgen deprivation therapy (ADT) on PSMA imaging and its correlation to the PSA concentration comparing qualitative and quantitative parameters: SUVmax, SUVmean, PSMA-derived tumor volume (PSMA-TV), total lesion PSMA (TL-PSMA) and metabolic imaging (mi)PSMA score. Methods: Retrospective analysis of 19 therapy-naïve and oligometastatic prostate cancer patients (median age 73 years) who underwent either 68Ga-PSMA-11-PET/CT or -PET/MRI before initiation (T1) of as well as during ADT (T2). The median duration of ADT was 156 days (range: 61-289 days). All lesions were analyzed using several qualitative and quantitative PET parameters.Results: During long term ADT occurred a relevant decrease of lesion count and PSMA expression. A total of 104 PSMA-positive lesions (21 intraprostatic, 54 lymphonodal, 29 osseous) were visually detected at each of the two points, while at T2 two new bone lesions were detected in one patient. All analyzed PET parameters, which correlated strongly with each other. During ADT, all patients experienced a decrease of their PSA level (median: 29.1 before vs. 0.69 after; p<0.001). The PSA level at T2 correlates modestly with the decrease of PSMA expression and its derived volumes.Conclusion: Post ADT scans detected less PSMA-positive lesions with overall lower PSMA expression, regardless of primary tumor site or metastatic sites. None of the PET parameters has proven to be superior, as they all correlated modestly with the PSA value at T2. Thus, the simply acquirable miPSMA score seems to be the most suitable for evaluating the effect of ADT on PSMA expression.
The Transverse Diameter of Right Common Femoral Vein by Ultrasound in the Supine Position for Predicting Post-spinal Hypotension During Cesarean Delivery
Authors: Yao Shi-Fa , Zhao Yan-Hong , Zheng Jing , Qian Jie-Yan , Zhang Chen , Xu Zifeng , Xu Tao 
Published: August 2020

Abstract
Background: Post-spinal anesthesia hypotension during cesarean delivery is caused by decreased systemic vascular resistance due to the blockage of autonomic nerves, which is further worsened by aortocaval compression by the gravid uterus. The aim of this study was to assess whether peak velocities and diameters of the abdominal aorta (AA) and inferior vena cava (IVC) below the xiphoid or the right common femoral artery (RCFA) and right common femoral vein (RCFV) in the inguinal region, as measured on ultrasound, could reflect the degree of aortocaval compression and further identify parturients at risk of post-spinal hypotension.Methods: After ultrasound measurement of peak velocities and anteroposterior diameters of the AA, and IVC and peak velocities and transverse diameters of the RCFA and RCFV before anesthesia, 56 parturients undergoing elective cesarean section with spinal anesthesia were enrolled in this study. Multinomial logistic regression analysis was used to identify the risk factors for post-spinal hypotension during cesarean delivery. Receiver operating characteristic curves were used to test the abilities of the identified parameters to predict post-spinal hypotension, and the areas under the curve and the optimum cut-off values for the predictive parameters were calculated. Results: The transverse diameter of the RCFV was a risk factor for post-spinal hypotension (odds ratio = 2.022, 95% confidence interval [CI] 1.261–3.243). The area under the receiver operating characteristics curve for the prediction of post-spinal hypotension was 0.759 (0.628–0.890; P = 0.001). A transverse diameter of the RCFV longer than 12.2 mm could predict post-spinal hypotension during cesarean delivery. Conclusions: We demonstrated a higher transverse RCFV diameter was associated with hypotension and it could effectively predict parturients at risk of hypotension before anesthesia. Trial Registration: This study was registered at http://www.chictr.org.cn on 16, May, 2018. No. ChiCTR1800016163
Bathing and Toileting Difficulty of Chinese Older Adults: The Role of Environment
Authors: Liu Changxi , Fong Joelle H. , Hoh Jasmon W. T. , Wu Hailin , Dong Yunsheng , Gu Danan , Qiushi Feng 
Published: August 2020

Abstract
Background: For older adults, difficulties in bathing and toileting are often the most prevalent in the index of Activities of daily living (ADL). Few studies, however, have investigated how the built environment and other environmental factors affect bathing and toileting in later life. This study aims to fill this gap. Method: The data are from the 2014 Thousand-Village Survey (TVS), a national survey of Chinese rural residents of old age. The sample consists of 10,689 subjects, 55 years or older, from 536 villages across all provinces of China. The multinomial logistic regressions were applied to examine how difficulty in bathing and toileting was related to environmental factors such as geographic location, community amenity, and built environment of bathing and toileting. Results: Older adults living in the southern regions of China had lesser difficulty in bathing and toileting than those living in Northern China, controlling on other confounders. Better community conditions also reduced the likelihood of having such disabilities. Persons who bathed indoors without shower facilities, in public facility, and outdoors were significantly more likely to have bathing disability than those who showered indoors. Rural older adults who used pedestal pan and indoor bucket for toileting were more likely to have toileting disability than those who used indoor squatting facilities. Conclusion: Environmental factors are strongly associated with functional disability among older adults, but the relationship is not unidirectional. Having a showering facility could reduce difficulties of bathing for rural Chinese. Very frail older persons may actively choose to change their environmental settings to suit their needs, for instance, by using a pedestal pan or bucket for toileting as an alternative to squatting. There is an urgent need to promote the use of showering facilities and pedestal pans for toileting in rural China.
An assessment of the potential miscalibration of cardiovascular disease risk predictions caused by a secular trend in cardiovascular disease in England
Authors: Pate Alexander , Staa Tjeerd van , Emsley Richard 
Published: August 2020

Abstract
Background
A downwards secular trend in the incidence of cardiovascular disease (CVD) in England was identified through previous work and the literature. Risk prediction models for primary prevention of CVD do not model this secular trend, this could result in over prediction of risk for individuals in the present day. We evaluate the effects of modelling this secular trend, and also assess whether it is driven by an increase in statin use during follow up.
Methods
We derived a cohort of patients (1998–2015) eligible for cardiovascular risk prediction from the Clinical Practice Research Datalink with linked hospitalisation and mortality records (N = 3,855,660). Patients were split into development and validation cohort based on their cohort entry date (before/after 2010). The calibration of a CVD risk prediction model developed in the development cohort was tested in the validation cohort. The calibration was also assessed after modelling the secular trend. Finally, the presence of the secular trend was evaluated under a marginal structural model framework, where the effect of statin treatment during follow up is adjusted for.
Results
Substantial over prediction of risks in the validation cohort was found when not modelling the secular trend. This miscalibration could be minimised if one was to explicitly model the secular trend. The secular trend was still present under the marginal structural model framework, indicating increasing statin use during follow up is not the cause.
Conclusions
Inclusion of the secular trend into the model substantially changed the CVD risk predictions. Models that are being used in clinical practice in the UK do not model secular trend and may thus overestimate the risks, possibly leading to patients being treated unnecessarily.
Squamanitaceae and Three New Species of Squamanita Parasitic on Amanita Basidiomes
Authors: Liu Jian-Wei , Ge Zai-Wei , Horak Egon , Vizzini Alfredo , Halling Roy. E. , Pan Chunlei , Yang Zhu L. 
Published: August 2020

Abstract
The systematic position of the enigmatic genus Squamanita (Agaricales, Basidiomycota) is largely unknown. Together with Cystoderma and Phaeolepiota, they were categorized as belonging in the tribe Cystodermateae. In this study, with newly generated sequences of the type species of the genus Squamanita, namely S. schreieri, and sequences of a few species of Cystodermateae, the phylogeny of this “tribe” is reinvestigated with a concatenated (28S-5.8S-18S) dataset. Our study reveals that Squamanita and Phaeolepiota-Cystoderma are indeed sister groups with moderate statistic support (MLBS/PP = 80/1), and Squamanita is a monophyletic clade with highly statistic support (MLBS/PP = 92/1). The family name Squamanitaceae is resurrected and emended to accommodate the three genera. Meanwhile, another concatenated (ITS-28S-18S) dataset is used to investigate the phylogenetic relationship and species delimitation in Squamanita. Our data indicated that “S. umbonata” from North America, Europe, East Asia, and Central America harbors a complex of species, and species of Squamanita can parasitize species of Amanita, besides other fungal species. Squamanita mira parasitizes A. kitamagotake (A. sect. Caesareae), while S. orientalis and S. sororcula are parasites of species belonging to the A. sepiacea complex (A. sect. Validae). “Squamanita umbonata” from Italy occurs on A. excelsa (A. sect. Validae). Three new species of Squamanita from East Asia, viz. S. mira, S. orientalis and S. sororcula are documented with morphological, multi-genes phylogenetic, ecological data, line drawings, and photographs and compared with similar species.
Metabolic syndrome and 5-year incident hyperuricemia among older Chinese adults: a community-based cohort study
Authors: Liu Jing-Hong , Ma Qing-Hua , Xu Yong , Chen Xing , Pan Chen-Wei 
Published: August 2020

Abstract
Background
There was a lack of studies focusing on older adults about the longitudinal association between metabolic syndrome (MetS) and hyperuricemia (HUA). We aimed to assess the association of baseline MetS and incident HUA among older Chinese adults, with a special focus on the associations between different combinations of MetS components and HUA.
Methods
Data of 3,247 Chinese adults aged 60 years or older included in a community-based longitudinal cohort study were analyzed. Anthropometric examinations and collection of blood sample were conducted both at baseline and follow-up. HUA was defined as 7 mg/dl or above for men and 6 mg/dl or greater for women. MetS was assessed based on the National Cholesterol Education Program-Adult Treatment Panel Ⅲ, and older adults with presence of at least three of MetS components were considered as having MetS.
Results
MetS and its components including high blood pressure (BP), high body mass index, diabetes mellitus and high triglycerides were significantly related to incident HUA. The association between high BP and incident HUA is strongest among the five MetS components. Among all combinations of MetS components, the group consisting of diabetes mellitus, high BP and high triglycerides had the highest odds for incident HUA (OR = 13.07, 95%CI = 4.95–34.54).
Conclusions
MetS and its components except for low high-density lipoprotein cholesterol could increase the risk of HUA among community-dwelling older adults and high BP may be the most important determinant.