bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between prepregnancy body mass index and risk of congenital heart defects in offspring: an ambispective observational study in China
Authors: Yuan Xuelian , Liu Zhen , Zhu Jun , Yu Ping , Deng Ying , Chen Xinlin , Li Nana , Li Shengli , Yang Shuihua , Li Jun , Liu Hanmin , Li Xiaohong 
Published: August 2020

Abstract
Background
Congenital heart defects (CHDs) are the most common birth defect around the world. Maternal prepregnancy obesity has been proposed as a risk factor of CHDs, but the relationship of CHD risk with over- and underweight is controversial, especially because body mass index (BMI) distribution differs between Asia and the West. The study aimed to examine the potential associations of maternal over- and underweight on risk of offspring CHDs.

Methods
An ambispective observational study involving 1206 fetuses with CHDs and 1112 fetuses without defects at seven hospitals in China was conducted. Standardized questionnaires were used to collect information on maternal prepregnancy weight and height, social demographic characteristics, living and occupational environments, and lifestyle behaviors. Univariate, multivariate and multilevel logistic regression as well as unrestricted cubic spline analysis were used to examine potential associations of prepregnancy BMI and offspring CHDs.

Results
Prepregnancy maternal underweight (BMI<18.5) or low average BMI (18.5 ≤ BMI<21.25) was associated with significantly higher risk of CHD in offspring than high average BMI (21.25 ≤ BMI<24.0): multilevel logistic regression indicated adjusted odds ratios of 1.53 (95%CI 1.13, 2.08) for underweight, 1.44 (95%CI 1.10, 1.89) for low average BMI and 1.29 (95%CI 0.84, 1.97) for overweight or obesity (BMI ≥ 24.0). Mothers with prepregnancy BMI < 21.25 were at greater risk of offspring with septal defects, while mothers with low average BMI were at greater risk of offspring with conotruncal defects and septal defects.

Conclusions
Our findings suggest that underweight or low average BMI may be associated with higher risk of CHDs in offspring. Health professionals may wish to advise women planning to be pregnant to maintain or even gain weight to ensure adequate, balanced nutrition and thereby reduce the risk of CHDs in their offspring.
Application of multidirectional stitching technology in a laparoscopic suturing instructional program: a randomized controlled trial
Authors: Zhao Yu , Chen Qiong , Hu Jia-Ning , Shen Qi , Xia Lu , Yan Lin-Zhi , Wang Yi , Zhu Xiu-Jie , Li Wen-Ju , Hu Yue , Zhang Qiong 
Published: August 2020

Abstract
Background
Surgeon suturing technology plays a pivotal role in patient recovery after laparoscopic surgery. Intracorporal suturing and knot tying in minimally invasive surgery are particularly challenging and represent a key skill for advanced procedures. In this study, we compared the application of multidirectional stitching technology with application of the traditional method in a laparoscopic suturing instructional program.

Methods
We selected forty residents within two years of graduation to assess the specialized teaching of laparoscopic suturing with laparoscopic simulators. The forty students were randomly divided into two groups, a control group and an experimental group, with twenty students in each group. The control group was scheduled to learn the traditional suture method, and the experimental group applied multidirectional stitching technology. The grades for suturing time, thread length, accuracy of needle entry, stability of the knot, tissue integrity, and tightness of the tissue before and after the training program were calculated.

Results
There was no significant difference between the two groups before the learning intervention. After the program, both groups significantly improved in each subject. There were significant differences between the control group and the experimental group in suture time (P = 0.001), accuracy of needle entry and exit (P = 0.035), and whether the suture tissue had cracks (P = 0.030). However, the two groups showed non-significant differences in thread length (P = 0.093), stablity of the knot (P = 0.241), or tightness of the tissue (P = 0.367).

Conclusions
Multidirectional stitching technology improves the efficiency and effectiveness of traditional laparoscopic suture instructional programs. It might be a practicable, novel training method for acquiring proficiency in manual laparoscopic skills in a training setting.
The complexity of diagnosing sarcoma in a timely manner: perspectives of health professionals, patients, and carers in Australia
Authors: Weaver Rhys , O’Connor Moira , Carey Smith Richard , Halkett Georgia KB 
Published: August 2020

Abstract
Background
Prolonged diagnosis intervals occur more often in rare cancers, such as sarcoma. Patients with a delayed diagnosis may require more radical surgery and have a reduced chance of survival. Previous research has focused on quantifying the time taken to achieve a diagnosis without exploring the reasons for potential delays. The aim of this study was to explore patients’, carers’, and health professionals’ perceived barriers to timely diagnosis and referral for treatment for sarcoma.

Methods
Semi-structured interviews were conducted with: health professionals working with sarcoma (n = 21); patients who have been diagnosed with sarcoma (n = 22); and carers of patients diagnosed with sarcoma (n = 17). Interview transcripts were analysed using thematic analysis.

Results
Four overarching themes were identified: patient perception of symptoms, difficulties of diagnosis, lack of experience, and availability of health services. Diagnosis was prolonged by the limited availability of health services, lack of prompt referrals to a sarcoma specialist centre, and diagnostic challenges. Intervals also occurred when patients underestimated the severity of their symptoms and did not seek prompt medical consultation.

Conclusions
Patients with a potential sarcoma need to be promptly referred to a sarcoma specialist centre and additional diagnosis pathways need to be developed to reduce the rate of patients being referred to wrong specialists. Sarcoma education must be embedded in medical courses and professional development curricula. A public health approach should be taken to improve sarcoma knowledge and health seeking behaviours in the community.
The role of overweight and obesity in adverse cardiovascular disease mortality trends: an analysis of multiple cause of death data from Australia and the USA
Authors: Adair Tim , Lopez Alan D. 
Published: August 2020

Abstract
Background
In recent years, there have been adverse trends in premature cardiovascular disease (CVD) mortality rates (35–74 years) in the USA and Australia. Following long-term declines, rates in the USA are now increasing while falls in Australia have slowed rapidly. These two countries also have the highest adult obesity prevalence of high-income countries. This study investigates the role of overweight and obesity in their recent CVD mortality trends by using multiple cause of death (MCOD) data—direct individual-level evidence from death certificates—and linking the findings to cohort lifetime obesity prevalence.

Methods
We identified overweight- and obesity-related mortality as any CVD reported on the death certificate (CVD MCOD) with one or more of diabetes, chronic kidney disease, obesity, lipidemias or hypertensive heart disease (DKOLH-CVD), causes strongly associated with overweight and obesity. DKOLH-CVD comprises 50% of US and 40% of Australian CVD MCOD mortality. Trends in premature age-standardized death rates were compared between DKOLH-CVD and other CVD MCOD deaths (non-DKOLH-CVD). Deaths from 2000 to 2017 in the USA and 2006–2016 in Australia were analyzed. Trends in in age-specific DKOLH-CVD death rates were related to cohort relative lifetime obesity prevalence.

Results
Each country’s DKOLH-CVD mortality rate rose by 3% per annum in the most recent year, but previous declines had reversed more rapidly in Australia. Non-DKOLH-CVD mortality in the USA increased in 2017 after declining strongly in the early 2000s, but in Australia it has continued declining in stark contrast to DKOLH-CVD. There were larger increases in DKOLH-CVD mortality rates at successively younger ages, strongly related with higher relative lifetime obesity prevalence in younger cohorts.

Conclusions
The increase in DKOLH-CVD mortality in each country suggests that overweight and obesity has likely been a key driver of the recent slowdown or reversal of CVD mortality decline in both countries. The larger recent increases in DKOLH-CVD mortality and higher lifetime obesity prevalence in younger age groups are very concerning and are likely to adversely impact CVD mortality trends and hence life expectancy in future. MCOD data is a valuable but underutilized source of data to track important mortality trends.
LINC00441 promotes cervical cancer progression by modulating miR-450b-5p/RAB10 axis
Authors: Han Haiyan , Shao Qingchun , Liu Xuejie 
Published: August 2020

Abstract
Background
As one of the most common gynaecological malignant tumors, cervical cancer (CC) has become an important public health issue. Emerging evidence has revealed long non-coding RNAs (lncRNAs) are crucial regulators of biological functions in cancers, including CC. And the oncogenic role of LINC00441 has been verified in hepatocellular carcinoma (HCC). But the molecular mechanism and biological functions of LINC00441 in CC remain unknown.

Methods
qRT-PCR analysis detected the expression of genes in CC tissues or cells. CCK-8, colony formation, flow cytometry, transwell, western blot assays as well as animal studies were conducted to analyze the function of LINC00441 in CC. Luciferase reporter, RIP and RNA pull down assays were applied to verify the binding relations among the indicated genes.

Results
LINC00441 was upregulated in CC tissues and cells. Further, LINC00441 depletion repressed cell proliferation and motility in vitro as well as tumor growth in vivo. LINC00441 could sponge miR-450b-5p to upregulate RAB10 expression. Finally, miR-450b-5p inhibitor or RAB10 upregulation counteracted LINC00441 knockdown-mediated function on the development of CC.

Conclusions
LINC00441 drives CC progression by targeting miR-450b-5p/RAB10 axis, which might provide new idea for researching CC-related molecular mechanism.
Effects of particulate matter on atherosclerosis: a link via high-density lipoprotein (HDL) functionality?
Authors: Holme Siri A. N. , Sigsgaard Torben , Holme Jørn A. , Holst Gitte Juel 
Published: August 2020

AbstractBackgroundExposure to air pollution has been associated with adverse effects on human health, and ultimately increased morbidity and mortality. This is predominantly due to hazardous effects on the cardiovascular system. Exposure to particulate matter (PM) is considered to be responsible for the most severe effects.Main bodyHere we summarize current knowledge from existing epidemiological, clinical and animal studies on the influence of PM exposure on high-density lipoprotein (HDL) functionality and the potential initiation and progression of atherosclerosis. We highlight experimental studies that bring support to the causality and point to possible mechanistic links. Recent studies indicate that the functional properties of HDL are more important than the levels per se. Fine (PM2.5–0.1) and ultrafine (UFP) PM are composed of chemicals as well as biological elements that are redox-active and may trigger pro-inflammatory responses. Experimental studies indicate that these properties and responses may promote HDL dysfunction via oxidative pathways. By affecting protein and lipid components of the HDL particle, its anti-atherosclerotic characteristics including cholesterol efflux capacity, as well as other anti-oxidative and anti-inflammatory features might be impaired.ConclusionCurrent literature suggests that PM promotes HDL dysfunction via oxidative pathways. However, as relatively few studies so far have evaluated the impact of particulate air pollution on HDL functionality, more human epidemiological as well as experimental studies are needed to strengthen any possible causal relationship and determine any relevance to atherosclerosis.Graphical abstract
A knowledge-based intensity-modulated radiation therapy treatment planning technique for locally advanced nasopharyngeal carcinoma radiotherapy
Authors: Bai Penggang , Weng Xing , Quan Kerun , Chen Jihong , Dai Yitao , Xu Yuanji , Lin Fasheng , Zhong Jing , Wu Tianming , Chen Chuanben 
Published: August 2020

Abstract
Background
To investigate the feasibility of a knowledge-based automated intensity-modulated radiation therapy (IMRT) planning technique for locally advanced nasopharyngeal carcinoma (NPC) radiotherapy.

Methods
One hundred forty NPC patients treated with definitive radiation therapy with the step-and-shoot IMRT techniques were retrospectively selected and separated into a knowledge library (n = 115) and a test library (n = 25). For each patient in the knowledge library, the overlap volume histogram (OVH), target volume histogram (TVH) and dose objectives were extracted from the manually generated plan. 5-fold cross validation was performed to divide the patients in the knowledge library into 5 groups before validating one group by using the other 4 groups to train each neural network (NN) machine learning models. For patients in the test library, their OVH and TVH were then used by the trained models to predict a corresponding set of mean dose objectives, which were subsequently used to generate automated plans (APs) in Pinnacle planning system via an in-house developed automated scripting system. All APs were obtained after a single step of optimization. Manual plans (MPs) for the test patients were generated by an experienced medical physicist strictly following the established clinical protocols. The qualities of the APs and MPs were evaluated by an attending radiation oncologist. The dosimetric parameters for planning target volume (PTV) coverage and the organs-at-risk (OAR) sparing were also quantitatively measured and compared using Mann-Whitney U test and Bonferroni correction.

Results
APs and MPs had the same rating for more than 80% of the patients (19 out of 25) in the test group. Both AP and MP achieved PTV coverage criteria for no less than 80% of the patients. For each OAR, the number of APs achieving its criterion was similar to that in the MPs. The AP approach improved planning efficiency by greatly reducing the planning duration to about 17% of the MP (9.85 ± 1.13 min vs. 57.10 ± 6.35 min).

Conclusion
A robust and effective knowledge-based IMRT treatment planning technique for locally advanced NPC is developed. Patient specific dose objectives can be predicted by trained NN models based on the individual’s OVH and clinical TVH goals. The automated planning scripts can use these dose objectives to efficiently generate APs with largely shortened planning time. These APs had comparable dosimetric qualities when compared to our clinic’s manual plans.
Long-term outcomes of concomitant tricuspid valve repair in patients undergoing mitral valve surgery
Authors: Cetinkaya Ayse , Ganchewa Natalia , Hein Stefan , Bramlage Karin , Bramlage Peter , Schönburg Markus , Richter Manfred 
Published: August 2020

Abstract
Background
We aimed to find out how the concomitant performance of tricuspid valve repair (TVR) affects outcomes of patients undergoing mitral valve surgery (MVS).

Methods
Single-centre, retrospective analysis of 1357 patients who underwent MVS between January 2005 and December 2015, including 1165 patients with isolated MVS and 192 patients with MVS plus TVR. We used propensity scores to match patients for baseline characteristics other than valve related parameters and arrived at a matched sample of 182 patients per group.

Results
The overall procedure duration was longer in the MVS + TVR (224 min) versus the MVS group (176 min; p < 0.001), as were the duration of mechanical ventilation (13 vs. 11 h; p < 0.001), X-clamp (90.5 vs. 66 min; p < 0.001) and cardiopulmonary bypass time (136 vs. 95.5 min; p < 0.001). Rates of procedural complications were not different between groups with the exception of pacemaker rates which were 16.0% in the MVS + TVR group and 8.8% in the isolated MVS group (p = 0.037).
There was no difference in death rates within 30 days, stroke, myocardial infarction or repeat MVS. The long-term survival rate was 60.8% in the MVS + TVR vs. 57.5% in the isolated MVS group (HR 1.048; 95%CI 0.737–1.492; p = 0.794). The rate of grade III/IV tricuspid regurgitation (TR) remained low after MVS + TVR during long-term follow-up while the rate of grade ≥ II TR increased slightly in the isolated MVS group.

Conclusion
The data show that the concomitant performance of TVR in patients undergoing MVS is a safe and effective procedure with good long-term outcomes. Patients can undergo MVS + TVR with confidence as it improves their prognosis up to the level of patients undergoing isolated MVS.
A GPIU method for fractional diffusion equations
Authors: Shen Hai-Long , Li Yu-Han , Shao Xin-Hui 
Published: August 2020

AbstractThe fractional diffusion equations can be discretized by applying the implicit finite difference scheme and the unconditionally stable shifted Grünwald formula. Hence, the generating linear system has a real Toeplitz structure when the two diffusion coefficients are non-negative constants. Through a similarity transformation, the Toeplitz linear system can be converted to a generalized saddle point problem. We use the generalization of a parameterized inexact Uzawa (GPIU) method to solve such a kind of saddle point problem and give a new algorithm based on the GPIU method. Numerical results show the effectiveness and accuracy for the new algorithm.
Stability and bifurcation analysis of two-species competitive model with Michaelis–Menten type harvesting in the first species
Authors: Yu Xiangqin , Zhu Zhenliang , Li Zhong 
Published: August 2020

AbstractIn this paper, a two-species competitive model with Michaelis–Menten type harvesting in the first species is studied. We have made a detailed mathematical analysis of the model to describe some important results that may be produced by the interaction of biological resources. The permanence, stability, and bifurcation (saddle-node bifurcation and transcritical bifurcation) of the model are investigated. The results show that with the change of parameters, two species could eventually coexist, become extinct or one species will be driven to extinction and the other species will coexist. Moreover, by constructing the Lyapunov function, sufficient conditions to ensure the global asymptotic stability of the positive equilibrium are given. Our study shows that compared with linear harvesting, nonlinear harvesting can exhibit more complex dynamic behavior. Numerical simulations are presented to illustrate the theoretical results.
Person-centered analysis of factors related to STEM students’ global awareness
Authors: Kulturel-Konak Sadan 
Published: August 2020

AbstractBackgroundTwenty-first century communication has changed how we connect to the rest of the world. Therefore, it requires the preparation of undergraduate science, technology, engineering, and mathematics (STEM) students who are capable of coping with problems on a global scale and who can participate effectively in a global economic and civic environment. Breathtaking ability to send vast amounts of data instantly and at times globally often translates to graduates entering the workforce needing to be aware of the global community. Hence, in this study, factors related to engineering students’ global awareness have been explored so that higher education institutions may consider those factors when designing programs meant to influence this competence. The current study used a validated new instrument, based on a developmental model—the Model of Domain Learning (MDL)—to gauge engineering students’ growth in global awareness. The presented research is studying the following research question:What is the relation between students’ curricular and co-curricular experiences and levels of global awareness classified using MDL?ResultsPerson-centered analyses were used to answer the research question. Four hundred twenty-five engineering students, who enrolled in 18 different engineering programs in a US land-grant university, participated in this study. The study found that engineering students’ engagement in extra-curricular activities was correlated with an increase of their knowledge, strategic processing, and interest in the domain of global awareness.ConclusionsBased on the data analysis, students’ international experiences were positively related to not only their interest and knowledge but also their strategic processing predicted by the MDL. Moreover, engineering students’ international experience and high academic engagement are important variables related to their perception of increased global awareness and improved skills for international careers. Hence, higher education institutions should consider making pedagogical interventions in their programs to effectively embed international experience into students’ curriculum.
Effect of using different approximation models to the exact Mohr–Coulomb material model in the FE simulation of Anchor Foundations in sand
Authors: Riyad A. S. M. , Rokonuzzaman Md. , Sakai Toshinori 
Published: August 2020

AbstractSingularities in the Mohr–Coulomb (MC) yield criterion create numerical difficulties when implemented in the finite element model (FEM). In this research, a two-dimensional (2D) and a three-dimensional (3D) elasto-plastic FEM coupled with isotropic strain hardening–softening or simple strain-softening law incorporating non-associated flow rule including shear band, is used to investigate the effect of singularities, embedment, shape, soil frictional as well as dilation angle on vertically uploaded shallow anchor foundations buried in Toyoura sand. Mohr–Coulomb–Drucker Prager (MC–DP) model provides a more appropriate solution than Drucker Prager–Drucker Prager (DP–DP) model. Besides, the peak resistance factor and the settlement at the ultimate capacity have been found as the functions of embedment, shape, and sand density. Also, the numerical model gives satisfactory agreement with the previous studies. In particular, a simple strain-softening model cannot capture the settlement behavior of anchor foundations in sand efficiently.
OCT changes of idiopathic epiretinal membrane after cataract surgery
Authors: Vallejo-Garcia Jose Luis , Romano Mary , Pagano Luca , Montericcio Alessio , Borgia Alfredo , Morenghi Emanuela , Vinciguerra Paolo 
Published: August 2020

Abstract
Background
We reviewed our experience in the management of cataract and idiopatic epiretinal membrane surgeries at the Humanitas Research Institute–Milan, Italy- over the past 3 years.

Methods
We conducted a single center retrospective observational case series of patients that underwent sequential cataract and idiopatic epiretinal membrane (ERM) surgeries from 2012–2015 in Humanitas Research Institute. Full data was obtained for 53 eyes of 57 patients. Patients with ERM secondary to uveitis or trauma or associated with simultaneous retinal detachment were excluded. Diabetic retinopathy, glaucoma, age-related macular degeneration, and myopia of more than 6 diopters were exclusion criteria as well.

Results
Cataract surgery was not associated with an ERM stage progression at one month follow up, but caused retinal inflammation that resulted in a significant increase in central macular thickness (CMT), macular volume (MV), central macular edema (CME), IS/OS disruption (IS/OS) and neurosensory detachment (NSD). However, there was no significant change in Best corrected visual acuity (BCVA).

Conclusion
We suggest that patients undergoing cataract surgery in the presence of epiretinal membranes need tight follow up to treat and control eventual macular inflammatory changes and eventual prompt vitrectomy if BCVA is threatened.