bluuebunny/crossref_metadata_2025_split huggingface dataset:
Time-saving effects using helicopter transportation: comparison to a ground transportation time predicted using a social navigation software
Authors: Jang Ji Young , Kwon Woo-Keun , Moon Jong Ha , Hwang Jun Seong , Kim Yoon Jic , Kim Jang Hun 
Published: November 2020

Abstract
BackgroundPrevious comparison studies regarding two types of transportation, helicopter (HEMS) versus ground emergency medical services (GEMS), have shown underlying heterogeneity as these options have completely different routes and consequent times with reference to one patient. To compare the two types of transportation on a case-by-case basis, we analyzed the retrospectively reviewed HEMS and predicted GEMS data using an open-source navigation software.MethodsPatients transferred by military HEMS from 2016 to 2019 were retrospectively enrolled. The HEMS records on the time of notification, injury point and destination addresses, and time required were reviewed. The GEMS data on distance and the predicted time required were acquired using open-source social navigation systems. Comparison analyses between the two types of transportation were conducted. Further, linear logistic regression analyses were performed on the distance and time of the two options.ResultsA total of 183 patients were enrolled. There was no statistical difference (p=0.3021) in the distance between the two types of transportation, and the HEMS time was significantly shorter than that of GEMS (61.31 vs. 116.92 minutes, p<0.001). The simple linear curves for HEMS and GEMS were separately secured, and two graphs presented the statistical significance (p) as well as reasonable goodness-of-fit (R2). In general, the HEMS graph demonstrates a more gradual slope and narrow distribution compared to that of GEMS.ConclusionIdeally, HEMS is identified as a better transportation modality because it has a shorter transportation time (56 minutes saved) and a low possibility of potential time delays (larger R2). With a strict patient selection, HEMS can rescue injured or emergent patients who are “out of the golden hour.”
A Cambodian-Norwegian Competence Building Program in Child Mental Health: A Qualitative Focus-Group Study
Authors: Hafting Marit , Pat Puthy , Aadland Gunn , Fjermestad Krister , Jegannathan Bhoomikumar 
Published: November 2020

Abstract
BackgroundThe prevalence of mental health and neurodevelopmental disorders in young people is high in low- and middle-income counties, such as Cambodia, as risk factors in the perinatal period, malnutrition, infections and adverse childhood experiences can be abundant due to poverty and/or conflict. Collaboration between institutions from high-income countries and institutions in resource-poor settings for professional development can improve service providers’ knowledge and skills, which is key to bridging the gap between service needs and the ability to meet those needs. The aim of the present article is to describe some significant aspects of a transcultural capacity-building program in child mental health.MethodsA Norwegian team comprised of a pediatrician, a child and adolescent psychiatrist and a child psychologist implemented a program for competence building at Centre for Child and Adolescent Mental Health (Caritas-CCAMH) in Cambodia two weeks per year over a 14-year period. Herein, we explore some aspects of this collaboration from the perspective of the Caritas-CCAMH staff with a qualitative approach using thematic analysis of the transcripts from a focus-group interview with 11 staff members at the end of the 14-year period. Results The multidisciplinary team at Caritas-CCAMH described a learning process characterized by collaboration in planning and implementation. Mixing theory and practice in clinical case discussions with a bio-psycho-social perspective was perceived as the cornerstone of the pedagogical process. Learning by observation and supervision from the Norwegian team led to mastering skills and enhancing self-confidence and job satisfaction. A pedagogical strategy that involved constant reflection back and forth enabled the customization of the content and method of capacity building despite the differences in socio-economic conditions and learning styles that were unfamiliar to the mental health professionals from a high-income country.ConclusionsBuilding knowledge and skills within a dialogic partnership over a significant period of time contributed to learning across cultures. This model of continuity, low-investment and low-intensity capacity-building may enrich the child and adolescent mental health settings in low- and middle-income countries. Furthermore, the model appears feasible for Western professionals with an ambition to support.
CircRNA&nbsp;MFACR&nbsp;is Upregulated in Myocardial Infarction and Downregulates miR-125b&nbsp;to Promote Cardiomyocyte Apoptosis-induced by Hypoxia
Authors: Wang Shujuan , Li Long , Deng Weijie , Jiang Minhua 
Published: November 2020

Abstract
Background: CircRNA MFACR promotes cardiomyocyte death, which contributes to myocardial infarction (MI). We analyzed the role of MFACR in MI.Methods: RT-qPCR was applied to determine MFACR and miR-125b expression in plasma samples from both MI patients (n=61) and healthy controls (n=61). MFACR and miR-125b were overexpressed in AC16 cells (cardiomyocytes) to study the interactions between them. Methylation of miR-125b gene in cells with MFACR overexpression was analyzed by methylation-specific PCR. Cell apoptosis after transfections was analyzed by cell apoptosis assay.Results: MFACR was overexpressed in MI and inversely correlated with miR-125b. In AC16 cells, hypoxia treatment increased MFACR expression and decreased miR-125b expression. In AC16 cells, MFACR overexpression decreased miR-125b expression and increased the methylation of miR-125b gene. Under hypoxia, MFACR overexpression increased AC16 cell apoptosis, and miR-125b overexpression decreased cell apoptosis. In addition, miR-125b overexpression reversed the effects of MFACR overexpression on cell apoptosis. Conclusion: MFACR may increase the methylation of miR-125b gene to downregulate its expression, thereby promoting the apoptosis of cardiomyocytes in MI.
Impact of Overt Hypothyroidism on Early Outcomes of Coronary Artery Surgery
Authors: Zhao Dong , Zhao Wei , Yuan Xin , Wang Chuangshi , Feng Wei 
Published: November 2020

Abstract
Background: The association between preoperative overt hypothyroidism and early outcomes after coronary artery bypass grafting (CABG) is unclear. This study aimed to evaluate the influence of overt hypothyroidism on the outcomes of CABG. Methods: The series included 189 overt hypothyroid patients who underwent CABG at Fuwai Hospital. These patients were 1:4 matched with 737 euthyroid patients using propensity score matching. The early postoperative outcomes were compared. Results: After propensity score matching, the incidences of impaired wound healing, reintubation, and the total complications were higher in hypothyroid patients than euthyroid patients (11.8% vs. 0.9%, p<0.001; 2.1% vs. 0.4%, p=0.03; 39.6% vs. 30.3%, p=0.015, respectively). Multivariate analysis showed overt hypothyroidism was significantly associated with the occurrence of impaired wound healing (odds ratio [OR]=12.29, p<0.001), reintubation (OR=5.71, p=0.047), and the total complications (OR=1.31, p=0.049). The OR of the total complications was 1.43 (p=0.03) in hypothyroid patients with abnormal thyroid-stimulating hormone compared with euthyroid patients. The proportions of the use of dopamine, adrenaline, milrinone, and dobutamine in hypothyroid patients were higher than euthyroid patients (75.4% vs. 67.6%, p=0.038; 10.7% vs. 6.1%, p=0.028; 3.2% vs. 0.3%, p=0.001; 4.8% vs. 1.2%, p=0.004, respectively). The total duration of inotropic support and mechanical ventilation time in hypothyroid patients were longer than euthyroid patients (median duration: 4 days vs. 3 days, p=0.003; 17 hours vs. 15 hours, p<0.001, respectively). Conclusions: CABG in overt hypothyroid patients is associated with a higher incidence of postoperative complications, stronger postoperative inotropic support, and longer mechanical ventilation time.
An Adult With Episodic Retrosternal Chest Pain: An Unusual Presentation of Congenital Pulmonary Airway Malformation
Authors: Goldsmith Ira , George Joseph , Aslam Umair , Sharma Sobaran 
Published: November 2020

Abstract
Background: Congenital pulmonary airway malformation (CPAM) with partial anomalous pulmonary venous connection presenting as episodic retrosternal chest pain on exertion in an adult has not been described. Case presentation: A 21-year-old female, non-smoker, presented with a 4-year history of sharp, episodic, retrosternal chest pains brought on with exercise. A contrast-enhanced computed tomography (CT) scan showed a grossly overinflated left lower lobe with partial anomalous pulmonary venous drainage into the left hemi-azygos vein. Lobectomy, the recommended treatment of choice, carried out thoracoscopically, was curative with satisfactory mid-term results. Histology confirmed type-II congenital pulmonary airway malformation.Conclusions: CPAM can present in young adults with unusual symptoms of chest pain on exertion. When suspected a contrast-enhanced CT scan is the gold standard for establishing the diagnosis. An anatomical lung resection is curative with satisfactory medium term results.
Application of Right Bronchial Occlusion Under Artificial Pneumothorax in the Thoracic Phase of Minimally Invasive Mckeown Oesophagectomy
Authors: Li Li , Zhao Luo , He Jia , Han Zhijun 
Published: November 2020

Abstract
Background: To evaluate the feasibility and safety of single-lumen endotracheal intubation combined with right bronchial occlusion under artificial pneumothorax in minimally invasive McKeown oesophagectomy.Methods: A total of 165 patients who underwent minimally invasive McKeown oesophagectomy at Peking Union Medical College Hospital from 2014 to 2019 were retrospectively analysed. A total of 117 patients received single-lumen endotracheal intubation combined with right bronchial occlusion (SLET-B group), and 48 patients received double-lumen endotracheal intubation (DLET group). Clinical data, intraoperative haemodynamics, surgical variables, and postoperative complications were analysed and compared.Results: The clinical characteristics of the two groups were similar. Compared with the DLET group, a shorter intubation time and lower tube dislocation rate were found in the SLET-B group (P <0.05). In the thoracic phase, with the application of artificial pneumothorax, patients in the SLET-B group had lower PaCO2 and PetCO2 values and higher pH (P <0.05) than those in the DLET group. These parameters gradually returned to normal half an hour after the thoracic phase. Patients in the SLET-B group had shorter thoracic phase times and hospital stays and less intraoperative haemorrhage than those in the DLET group. The numbers of thoracic and bilateral recurrent laryngeal lymph nodes harvested were significantly higher in the SLET-B group.Conclusions: Compared with double-lumen endotracheal intubation anaesthesia, single-lumen endotracheal intubation combined with right bronchial occlusion under artificial pneumothorax is feasible and safe in minimally invasive McKeown oesophagectomy. It has great advantages in surgical safety and the number of thoracic lymph nodes harvested.
Effect of COVID-19 on the Treatment of Acute Appendicitis
Authors: Lee Kil-yong , Lee Jaeim , Park Youn Young , Oh Seong Taek 
Published: November 2020

Abstract
Background: There has been debate on delaying an appendectomy for acute appendicitis because of the possibility of a severe acute respiratory syndrome coronavirus 2 infection being present and operating immediately due to the high possibility of complications from delaying the surgery. This study aimed to investigate the safety of delaying surgery for acute appendicitis in patients with a confirmed coronavirus disease (COVID-19) status.Methods: Patients admitted for acute appendicitis during the same period in 2019 and 2020 were enrolled in the study. We categorized them into 2 groups: those admitted before the outbreak of the COVID-19 pandemic in 2019 and those admitted after the outbreak in 2020. Clinical variables including demographics, operative and postoperative factors were analyzed. Statistical analyses was performed for the two groups. The primary end point was postoperative complication. Results: A total of 200 consecutive patients (127 from 2019 and 73 from 2020) were included in the study. There was no statistically significant difference in demographics and laboratory findings between the groups. In 2020, it took a longer time between a visit and surgery (6.3 vs 14.4 hours, p < 0.001); there was no difference in the type of surgery, appendix pathology, and postoperative complications.Conclusion: Our results demonstrated that, during the COVID-19 pandemic, it is safe to delay a surgery for acute appendicitis until after determining a patient’s COVID-19 status with the possibility of COVID-19 transmission.
Validation of the Chinese Version of the Care Evaluation Scale for Measuring the Quality of Structure and Process of End-Of-Life Care From the Perspective of Bereaved Family
Authors: Zhao Juanjuan , You Liming , Tao Hongmei , Wong Frances Kam Yuet 
Published: November 2020

Abstract
Background: Assessing the quality of structure and process of end-of-life care can help improve outcomes. There was currently no valid tool for this purpose in mainland China. The aim of this study is to validate the Chinese version of the Care Evaluation Scale (CES).Methods: From January to December 2017, a cross-sectional online survey was conducted among bereaved family members of cancer patients from 10 medical institutes. The reliability of the CES was assessed with Cronbach’s α, and structural validity was evaluated by confirmatory factor analysis. Concurrent validity was tested by examining the correlation between the CES total score and overall satisfaction with end-of-life care, quality of dying and death, and quality of life.Results: A total of 305 valid responses were analyzed. The average CES score was 70.67±16.42, and the Cronbach’s α of the CES was 0.967 (range: 0.802–0.927 for the 10 domains). The fit indices for the 10-factor model of CES were good (root-mean-square error of approximation, 0.047; comparative fit index, 0.952; Tucker–Lewis index, 0.946; standardized root mean square residual, 0.053). The CES total score was highly correlated with overall satisfaction with medical care (r=0.775, P<0.01), and moderately correlated with patients’ quality of life (r=0.579, P<0.01) and quality of dying and death (r=0.570, P<0.01). In addition, few associations between CES total score and demographic characteristics, except for the family members’ age.Conclusions: The Chinese version of the CES is a reliable and valid tool to evaluate the quality of structure and process of end-of-life care for patients with cancer from the perspective of bereaved family in mainland China.
Automatic Intrahepatic Biliary Segmentation Based Image Processing Techniques using Magnetic Resonance Images
Authors: AL-Oudat Mohammad Atallah , Oudat Mohammad AL , Migdady Hazem , Munaizel Tariq AL , Mahmoud Mohammad Awni , Jaafreh Somayya 
Published: November 2020

Abstract
A set of tubes known as bile ducts connects the liver to an organ below it directly that is called Gallbladder. The dilation of a bile duct is an important indicator regarding any serious issue in the human body. Number of reasons may cause bile duct dilation, such as: stones, tumors which commonly occur due to pancreas or papilla of vater. In this paper, the main contributions are: 1) a novel framework that consists of three phases to be applied on a set of Magnetic Resonance Imaging (MRI) images 2) an extracted set of features with their accurate values that express the condition of the biliary trees from the MRI images. Such dataset can be used in several applications to determine whether a bile duct is dilated or not. The dataset is organized as the following: half of the MRI images are for normal bile ducts, while the other half is for dilated bile ducts. To extract the useful features to diagnose the medical condition of the bile ducts from the MRI images, we implemented and applied the proposed framework that is started by using the enhanced active contour technique without edges in combination with Denoising Convolutional Neural Networks (DnCNN) to perform the segmentation and features extraction process. After that, the output of the segmentation process is the segmented biliary tree that will be used later to extract the needful features to make a diagnostic decision whether there is a dilation or not by comparing the features values of the normal versus the dilated bile ducts. We applied the feed forward neural network with backpropagation training algorithm for classification purposes. According to the experiments, the overall accuracy of the proposed framework was 90.00%. Such approach improves and increases the accuracy of the physicians’ diagnostic decisions which is considered as of significant importance for treatment and cure.
Clinical Outcomes in type 2 Diabetes with in-stent Restenosis and Late/very Late Stent Thrombosis Undergoing Primary Percutaneous Coronary Intervention: A Single-center Observational Cohort Study
Authors: Zhao Xiaoxiao , Zhou Jinying , Tan Yu , Sheng Zhaoxue , Li Jiannan , Wang Ying , Chen Runzhen , Liu Chen , Zhou Peng , chen Yi , Song Li , Zhao Hanjun , Yan Hongbing 
Published: November 2020

Abstract
BACKGROUND: This study aimed to compare differences in the risk factors and clinical outcomes of type 2 diabetes mellitus (DM) and non-DM patients with de novo lesions (DNL), definite in-stent restenosis (ISR), and late or very late stent thrombosis (LST/VLST). METHODS: A total of 4151 patients with acute coronary syndrome were screened angiographically to determine DNL, ISR, and LST/VLST. A total of 3976 patients were included in the analysis and divided into DM (n=1302) or non-DM (n=2674) group at admission. The primary endpoint was a composite of major adverse cardiovascular events (MACEs), defined as death, myocardial infarction, revascularization, and ischemic stroke within a 1-year follow-up period. RESULTS: In the group with total white blood cell count >10 10^9/L (p=0.004), neutral granular cell count >7 10^9/L (p=0.030), neutrophil-lymphocyte ratio >1.5 (p=0.041), DNL outperformed LST/VLST lesions in terms of revascularization at a median follow-up of 698 days. Among patients with DNL, the incidences of MACEs (log-rank p=0.0002), all-cause death (log-rank p=0.00032), cardiac-related death (log-rank p=0.021), and revascularization (log-rank p=0.029) were significantly lower in the non-DM group than in the DM group. However, no difference was observed in the event rates of endpoints among patients with ISR and LST/VLST between the non-DM and DM groups. Furthermore, among DM patients, there was a critically higher cumulative incidence of revascularization (log-rank p=0.0002) in the subgroup with ISR lesions and higher rate of ischemic stroke (log-rank p=0.033) in the subgroup with LST/VLST lesions. CONCLUSION: This study found that DM patients have a higher incidence of composite clinical outcomes than non-DM patients among patients with DNL. Compared with patients with DNL, patients with ISR lesions and LST/VLST lesions had more incidence of revascularization by long-term follow up. Thus, ISR and LST/VLST lesions are critical problems after coronary stenting, especially among DM patients.
Bidirectional Temporal Relationship Between Obesity and Hyperinsulinemia: Longitudinal Observation From a Chinese Cohort
Authors: Xu Chao , Zhou Guangshuai , Zhao Meng , Zhang Xu , Fang Li , Guan Qingbo , Zhang Haiqing , Gao Ling , Zhang Tao , Zhao Jiajun 
Published: November 2020

Abstract
Background: This study aims to investigate the temporal sequences between obesity and hyperinsulinemia (insulin, HOMA-IR, or HOMA-%β) and examine the impacts of different obesity measures (body mass index, BMI; waist circumference, WC; hip waist circumference, HC; waist-to-hip ratio, WHR) on the temporal patterns between obesity and hyperinsulinemia in Chinese adults. Methods: The longitudinal cohort consisted of 2493 participants (860 males and 1633 female, mean age 56.71 years at follow-up) for whom measurements of obesity and hyperinsulinemia measures were collected twice between 2010 and 2014, with an average follow-up time of 3 years. Cross-lagged panel analysis was used to examine the temporal relationship between obesity and hyperinsulinemia. Results: After the adjustment of age, sex, smoking, drinking and follow-up years, in the BMI-insulin model, the path coefficient (β2=0.229; P<0.001) of baseline BMI to follow-up insulin was significantly greater than the path coefficient (β1=0.073; P<0.001) of baseline insulin to follow-up BMI (P<0.001 for β2>β1). In the WHR-insulin model, the path coefficient (β1=0.152; P<0.001) of baseline insulin to follow-up WHR was significantly greater than the path coefficient (β2=0.077; P<0.001) of baseline WHR to follow-up insulin (P=0.007 for β1>β2). In the WC/HC-insulin model the path coefficients of baseline insulin to follow-up WC or HC (β1s) were also greater than the path coefficients of baseline WC or HC to follow-up insulin (β2s), but the difference between β1s and β2s were not significant. The similar temporal patterns were founded between obesity measures with HOMA-IR or HOMA-%β. Conclusions: These findings indicate that there is a bidirectional relationship between obesity and hyperinsulinemia, and abdominal obesity measures are more sensitive to hyperinsulinemia measures than BMI.
Evaluation of Organic Loading Rate and Chemical Oxygen Demand Removal: A Coupled Anaerobic-aerobic Treatment Approach for Molasses Distillery Stillage Treatment
Authors: Gebreeyessus Getachew D. , Mekonnen Andualem , Chebude Yonas , Perumal Asaithambi , Alemayehu Esayas 
Published: November 2020

Abstract
The objective of the current study is to determine the optimum organic loading rate for a continuous anaerobic digestion (AD) of an ethanol distillery stillage with and without of feed pretreatment. The AD has been performed in scoria packed continuous reactors. The pretreatment of the molasses ethanol distillery stillage brought a significantly better chemical oxygen demand (COD) removal with an increased loading rate to 2000 mg/L-d, when compared with the raw. The results obtained also showed a complete removal of the BOD, which was realized after applying the coupling of AD and aerobic treatments. During aerobic treatment, 68% of the organics were removed within eight hours of retention time. Despite the persistence of color, the removal of organics from integrating the wet air pretreatment, continuous AD and aerobic remediations appear to be promising technique towards the sustainable management of stillage thereby meeting discharge limits.