bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiovascular disease risk prevention services by pharmacists in Saudi Arabia: what do policymakers and opinion leaders think?
Authors: Almansour Hadi A. , Aloudah Nouf M. , Alhawassi Tariq M. , Chaar Betty , Krass Ines , Saini Bandana 
Published: May 2021

Abstract
Background
Cardiovascular disease (CVD) is an emerging contributor to national morbidity and mortality in Saudi Arabia. CVD risk prevention services are limited, particularly with an over-utilised public health sector and an under-utilised and under-resourced primary care sector. Globally, there is evidence that community pharmacists can play a key role in CVD prevention within primary care. However, the perspectives of policymakers and opinion leaders are critical to successful translation of evidence into practice. Thus, the aim was to engage policymakers and professional leaders in discussions about implementing high-quality CVD risk prevention services in community pharmacy.

Methods
Qualitative semi-structured interviews were conducted, audio-recorded and transcribed verbatim. All transcripts were thematically analysed.

Results
A total of 23 participants (87% male) from government and non-government sectors were interviewed. Of these, almost 65% had pharmacy qualifications. Limited provision of CVD risks preventative services in primary care was acknowledged by most participants and building community pharmacists’ capacity to assist in preventive health services was viewed favourably as one way of improving the status quo. The data yielded four key themes: (1) future pharmacy CVD health service models; (2) demonstrable outcomes; (3) professional engagement and advocacy; and (4) implementability. CVD health services roles (health screening, primary and secondary prevention services), pragmatic factors and tiered models of care (minimal, medium, and comprehensive pharmacist involvement) were discussed. The need for humanistic, clinical, and cost effectiveness outcomes to be demonstrated and active involvement of professional bodies were deemed important for such services to be sustainable. Professional pharmacy governance to develop pharmacy careers and workforce, pharmacy curricular reform and ongoing education were posed as key success factors for novel pharmacy roles. Practice policies, standards, and guidelines were seen as required to adhere to stringent quality control for future pharmacy services provision. Participant’s implementation vision for such services included scalability, affordability, access, adoption and health system reform. Most discussions focused on the need for structural improvement with limited input regarding processes or outcomes required to establish such models.

Conclusions
Most participants favoured pharmacy-based CVD risk prevention services, despite the variability in proposed service models. However, prior to developing such services, support structures at the health system and health professional level are needed as well as building public support and acceptability for pharmacy services.
Creation of an artificial intelligence model for intubation difficulty classification by deep learning (convolutional neural network) using face images: an observational study
Authors: Hayasaka Tatsuya , Kawano Kazuharu , Kurihara Kazuki , Suzuki Hiroto , Nakane Masaki , Kawamae Kaneyuki 
Published: May 2021

Abstract
Background
Tracheal intubation is the gold standard for securing the airway, and it is not uncommon to encounter intubation difficulties in intensive care units and emergency rooms. Currently, there is a need for an objective measure to assess intubation difficulties in emergency situations by physicians, residents, and paramedics who are unfamiliar with tracheal intubation. Artificial intelligence (AI) is currently used in medical imaging owing to advanced performance. We aimed to create an AI model to classify intubation difficulties from the patient’s facial image using a convolutional neural network (CNN), which links the facial image with the actual difficulty of intubation.

Methods
Patients scheduled for surgery at Yamagata University Hospital between April and August 2020 were enrolled. Patients who underwent surgery with altered facial appearance, surgery with altered range of motion in the neck, or intubation performed by a physician with less than 3 years of anesthesia experience were excluded. Sixteen different facial images were obtained from the patients since the day after surgery. All images were judged as “Easy”/“Difficult” by an anesthesiologist, and an AI classification model was created using deep learning by linking the patient’s facial image and the intubation difficulty. Receiver operating characteristic curves of actual intubation difficulty and AI model were developed, and sensitivity, specificity, and area under the curve (AUC) were calculated; median AUC was used as the result. Class activation heat maps were used to visualize how the AI model classifies intubation difficulties.

Results
The best AI model for classifying intubation difficulties from 16 different images was generated in the supine-side-closed mouth-base position. The accuracy was 80.5%; sensitivity, 81.8%; specificity, 83.3%; AUC, 0.864; and 95% confidence interval, [0.731-0.969], indicating that the class activation heat map was concentrated around the neck regardless of the background; the AI model recognized facial contours and identified intubation difficulties.

Conclusion
This is the first study to apply deep learning (CNN) to classify intubation difficulties using an AI model. We could create an AI model with an AUC of 0.864. Our AI model may be useful for tracheal intubation performed by inexperienced medical staff in emergency situations or under general anesthesia.
Clinical efficacy of amniotic membrane with biphasic calcium phosphate in guided tissue regeneration of intrabony defects- a randomized controlled clinical trial
Authors: Venkatesan Nivedha , Lavu Vamsi , Balaji S. K. 
Published: May 2021

Abstract

Background
The concept of periodontal regeneration has been revolutionised since the introduction of growth factors and bioactive bone substitutes which ensures optimal regeneration of the diseased periodontium. The aim of the present study was to evaluate the efficacy of Amniotic membrane + Biphasic Calcium phosphate as compared to Collagen membrane + Biphasic Calcium phosphate for the management of periodontal intrabony defects.

Methods
50 systemically healthy patients with localised moderate to severe periodontitis, sites which had a Probing Pocket Depth (PPD) ≥ 6 mm and an intrabony component of ≥ 3 mm as detected on Intra oral periapical radiographs (IOPAR) and bone sounding were recruited based on specific inclusion and exclusion criteria. They were randomly allocated by computer generated tables to Collagen membrane + Biphasic Calcium phosphate and Amniotic membrane + Biphasic Calcium phosphate groups. The amount of bone fill and changes in Probing Pocket Depth, Clinical Attachment Level were measured at baseline and six months.

Results
The results of the present study showed a mean reduction in the PPD of 2.89 ± 0.69 mm in the Collagen membrane + Biphasic Calcium phosphate group and 2.95 ± 0.57 mm in the Amniotic membrane + Biphasic Calcium phosphate group and CAL gain of 2.60 ± 1.43 mm in Collagen membrane + Biphasic Calcium phosphate group 3.18 ± 1.13 mm in the Amniotic membrane + Biphasic Calcium phosphate group at 6 months follow-up with no statistical significance between the groups. In terms of Defect resolution, 98.62 ± 6.51 % was achieved in Collagen membrane + Biphasic Calcium phosphate group and 98.25 ± 7.21 % in Amniotic membrane + Biphasic Calcium phosphate group.

Conclusions
Within the limitations of the present study, it can be concluded that AM can be used as a barrier membrane, in conjunction with Biphasic calcium phosphate, and provides comparable results to Collagen membrane with Biphasic calcium phosphate when used in the management of periodontal intrabony defects.
Non-invasive staging of liver fibrosis by two-dimensional shear wave elastography (2D-SWE) in patients with chronic hepatitis C and B
Authors: Alsowey Ahmed M. , Shehata Samar M. 
Published: May 2021

Abstract
Background
Non-invasive shear wave-based techniques have been developed for estimating liver fibrosis in patients with chronic liver diseases. Two-dimensional shear wave elastography provides in real-time, a tow dimensional quantitative map of tissue stiffness and enables measuring the stiffness by adjustment of a region of interest of tissue. The aim of this study was to highlight the role of tow dimensional shear wave elastography (2D-SWE) in detecting the degree of liver fibrosis in patients with chronic hepatitis C and B, in correlation with liver enzymes level and fibrotest.

Results
This study included 50 patients with chronic hepatitis C and B whose ages were (range, 30-65 years; mean, 48 years). Shear wave elastography cutoff values were 1.35 m/s, 5.48 KPa for (F>0); 1.66 m/s, 8.29 kPa for (F>1); 1.77 m/s, 9.40 kPa for (F>2); and 1.99 m/s, 11.9 kPa for (F>3). An excellent agreement was found between shear wave elastography and Fibrotest in staging of liver fibrosis in 88% of patients (κw=0.943, 95% CI, 0.88 to 1.00) achieving a highly statistical significance (P<0.001). There was a significant moderate positive concordance between US scoring and staging by 2D-SWE and staging by Fibrotest (rs, 0.49; P<0.01) and (rs, 0.48; P<0.01) respectively. However, no significant concordances were noticed between staging by AST and ALT and 2D-SWE and staging by Fibrotest (P>0.05).

Conclusions
2D shear wave elastography showed better diagnostic performance than visual assessment by conventional US for detection of chronic liver diseases, as well as for evaluation of their severity and prognosis. Elastograhy—Fibrotest combination gives best diagnostic performance in detecting the degree of fibrosis non-invasively and can be used reliably as a first-line pre-therapeutic evaluation of fibrosis in HCV and HBV-infected patients.
Elevation of Fasting GLP-1 Levels in Child and Adolescent Obesity: Friend or Foe?
Authors: Kubota Sodai , Yabe Daisuke 
Published: May 2021

Abstract
Glucagon-like peptide-1 (GLP-1) receptor agonists have been gaining much attention as a therapeutic approach to type 2 diabetes and obesity. Stinson et al recently reported that fasting GLP-1 is higher in children and adolescents with overweight/obesity and that it associates with cardiometabolic risk factors in a cross-sectional study comprising more than 4000 subjects. Obvious questions include why fasting GLP-1 is significantly increased in children and adolescents with overweight/obesity and why this is correlated with cardiometabolic risks. It has been shown that the inflammatory cytokine interleukin-6 (IL-6) stimulates GLP-1 secretion from pancreatic α-cells. IL-6-induced GLP-1 secretion could therefore play a role in expanding the β-cell reservoir in compensation for increased insulin needs due to exacerbation of insulin resistance. On the other hand, augmented GLP-1 secretion leads to increased insulin secretion, thereby enhancing hepatic lipogenesis and stimulating adipogenesis, which might underlie the associations of fasting GLP-1 with % body fat, triglycerides, and alanine aminotransferase. It is also possible that GLP-1 levels are naturally increased to oppose body weight gain to maintain body weight. However, it is important to note the differing biological effects of GLP-1 at physiological and pharmacological levels, which are evident in body weight reduction by GLP-1 receptor agonists and DPP-4 inhibitors. The Stinson study clearly demonstrated that fasting GLP-1 associates with overweight/obesity and cardiometabolic risk factors in children and adolescents. However, additional experiments need to be carried out to fully understand the relevance of these observations to human disease and health.
Randomized Controlled Trial Evaluating the Use of Zoledronic Acid in Duchenne Muscular Dystrophy
Authors: Zacharin Margaret , Lim Angelina , Gryllakis James , Siafarikas Aris , Jefferies Craig , Briody Julie , Heather Natasha , Pitkin Janne , Emmanuel Jaiman , Lee Katherine J , Wang Xiaofang , Simm Peter J , Munns Craig F 
Published: May 2021

AbstractContextPatients with glucocorticoid-dependent Duchenne muscular dystrophy (DMD) have increased fracture risk and reduced bone mineral density (BMD), often precipitating mobility loss.ObjectiveTo investigate use of zoledronic acid (ZA) in DMD in improving BMD.MethodsTwo arm, parallel, randomized controlled trial, set in pediatric hospitals across Australia and New Zealand. Sixty-two (31 per arm) boys with glucocorticoid-dependent DMD between 6 and 16 years were included. Five ZA infusions (0.025 mg/kg at months 0, and 3, and 0.05 mg/kg at months 6, 12, and 18), plus calcium and vitamin D, were compared with calcium and vitamin D alone. The main outcome measures were change in lumbar spine (LS) BMD raw and Z-score by dual energy absorptiometry x-ray (DXA) at 12 and 24 months, secondary outcomes assessing mobility, fracture incidence, bone turnover, peripheral quantitative computerized (pQCT) and pain scores.ResultsAt 12 and 24 months, mean difference in changes of LS BMD Z-score from baseline was 1.2 SD (95% CI 0.9-1.5), higher by 19.3% (14.6-24.0) and 1.4 SD (0.9-1.9), higher by 26.0% (17.4-34.5) in ZA than control arms respectively (both P &lt; .001). Five controls developed Genant 3 vertebral fractures, 0 in the ZA arm. Mobility, pain, and bone turnover markers were similar between arms at 12 and 24 months. Trabecular BMC and vBMD pQCT at radius and tibia were greater at 12 months in the ZA cohort than control; the evidence for this difference remained at 24 months for radius but not tibia.ConclusionZA improved BMD in glucocorticoid-dependent DMD boys. Although the small cohort precluded demonstrable fracture benefit, improved BMD might reduce incident vertebral fracture.
Development of a physiologically relevant and easily scalable LUHMES cell-based model of G2019S LRRK2-driven Parkinson's disease
Authors: Calamini Barbara , Geyer Nathalie , Huss-Braun Nathalie , Bernhardt Annie , Harsany Véronique , Rival Pierrick , Cindhuchao May , Hoffmann Dietmar , Gratzer Sabine 
Published: May 2021

ABSTRACT
Parkinson's disease (PD) is a fatal neurodegenerative disorder that is primarily caused by the degeneration and loss of dopaminergic neurons of the substantia nigra in the ventral midbrain. Mutations in leucine-rich repeat kinase 2 (LRRK2) are the most common genetic cause of late-onset PD identified to date, with G2019S being the most frequent LRRK2 mutation, which is responsible for up to 1-2% of sporadic PD and up to 6% of familial PD cases. As no treatment is available for this devastating disease, developing new therapeutic strategies is of foremost importance. Cellular models are commonly used for testing novel potential neuroprotective compounds. However, current cellular PD models either lack physiological relevance to dopaminergic neurons or are too complex and costly for scaling up the production process and for screening purposes. In order to combine biological relevance and throughput, we have developed a PD model in Lund human mesencephalic (LUHMES) cell-derived dopaminergic neurons by overexpressing wild-type (WT) and G2019S LRRK2 proteins. We show that these cells can differentiate into dopaminergic-like neurons and that expression of mutant LRRK2 causes a range of different phenotypes, including reduced nuclear eccentricity, altered mitochondrial and lysosomal morphologies, and increased dopaminergic cell death. This model could be used to elucidate G2019S LRRK2-mediated dopaminergic neural dysfunction and to identify novel molecular targets for disease intervention. In addition, our model could be applied to high-throughput and phenotypic screenings for the identification of novel PD therapeutics.
The temperature sensitivity of memory formation and persistence is altered by cold acclimation in a pond snail
Authors: Fernell Maria , Rivi Veronica , Batabyal Anuradha , Lukowiak Ken 
Published: May 2021

ABSTRACT
There are reports on the inability of inbred, laboratory-reared Lymnaea stagnalis to perform feeding and aerial respiration in the cold. It has also been suggested that laboratory-bred snails have an inability to perform aerial respiration in winter months in the laboratory. Here, we used an inbred, laboratory-reared strain of Lymnaea (the S-strain) to demonstrate that the snails are capable of performing those behaviours in a cold (4°C) environment after a 2 day acclimation period. In addition, the inbred snails were able to perform aerial respiration during winter months at room temperature (20°C) in the laboratory. The persistence of long-term memory (LTM) was extended for at least 4 weeks by placing S-strain snails into a 4°C environment following training. Typically, the cold block (CB) procedure (1 h at 4°C) immediately after a training session blocks LTM formation in the S-strain but not in a freshly collected strain. Four weeks at 4°C transformed the S-strain phenotype into one resisting the CB procedure. Thus, with a 4 week cold spell snails gain a resistance to the CB procedure, and that would explain why freshly collected snails are resistant to the procedure. However, we found that F1 progeny of a freshly collected strain reared in the laboratory were resistant to the CB procedure. This suggests that an unknown selection resulted in the S-strain being susceptible to the CB procedure.
Hot days are associated with short-term adrenocortical responses in a southern African arid-zone passerine bird
Authors: Moagi Lesedi L. , Bourne Amanda R. , Cunningham Susan J. , Jansen Raymond , Ngcamphalala Celiwe A. , Ganswindt André , Ridley Amanda R. , McKechnie Andrew E. 
Published: May 2021

ABSTRACT
Relatively little effort has been directed towards elucidating the role of physiological stress pathways in mediating avian responses to global heating. For free-ranging southern pied babblers, Turdoides bicolor, daily maximum air temperatures (Tmax) between ∼35 and ∼40°C result in reduced foraging efficiency, loss of body mass and compromised breeding success. We tested the hypothesis that very hot days are experienced as stressors by quantifying relationships between Tmax and faecal glucocorticoid metabolite (fGCM) levels in naturally excreted droppings. On days when Tmax&lt;38°C, fGCM levels were independent of Tmax (mean±s.d. 140.25±56.92 ng g−1 dry mass). At Tmax&gt;38°C, however, fGCM levels increased linearly with Tmax and averaged 190.79±70.13 ng g−1 dry mass. The effects of Tmax on fGCM levels did not carry over to the following morning, suggesting that very hot days are experienced as acute stressors.
Surgery for Bismuth-Corlette Type 4 Perihilar Cholangiocarcinoma: Results from a Western Multicenter Collaborative Group
Authors: Ruzzenente Andrea , Bagante Fabio , Olthof Pim B. , Aldrighetti Luca , Alikhanov Ruslan , Cescon Matteo , Koerkamp Bas Groot , Jarnagin William R. , Nadalin Silvio , Pratschke Johann , Schmelzle Moritz , Sparrelid Ernesto , Lang Hauke , Iacono Calogero , van Gulik Thomas M. , Guglielmi Alfredo ,   Perihilar Cholangiocarcinoma Collaboration Group, Andreou A. , Bartsch F. , Benzing C. , Buettner S. , Campagnaro T. , Capobianco I. , Charco R. , de Reuver P. , de Savornin Lohman E. , Dejong C. H. C. , Efanov M. , Erdmann J. I. , Franken L. C. , Giovinazzo G. , Giglio M. C. , Gomez-Gavara C. , Heid F. , IJzermans J. N. M. , Isaac J. , Jansson H. , Ligthart M. A. P. , Maithel S. K. , Malagò M. , Malik H. Z. , Muiesan P. , Damink S. W. M. Olde , Quinn L. M. , Ratti F. , Ravaioli M. , Rolinger J. , Schadde E. , Serenari M. , Troisi R. , van Laarhoven S. , van Vugt J. L. A. 
Published: May 2021

Abstract
Background
Although Bismuth-Corlette (BC) type 4 perihilar cholangiocarcinoma (pCCA) is no longer considered a contraindication for curative surgery, few data are available from Western series to indicate the outcomes for these patients. This study aimed to compare the short- and long-term outcomes for patients with BC type 4 versus BC types 2 and 3 pCCA undergoing surgical resection using a multi-institutional international database.

Methods
Uni- and multivariable analyses of patients undergoing surgery at 20 Western centers for BC types 2 and 3 pCCA and BC type 4 pCCA.

Results
Among 1138 pCCA patients included in the study, 826 (73%) had BC type 2 or 3 disease and 312 (27%) had type 4 disease. The two groups demonstrated significant differences in terms of clinicopathologic characteristics (i.e., portal vein embolization, extended hepatectomy, and positive margin). The incidence of severe complications was 46% for the BC types 2 and 3 patients and 51% for the BC type 4 patients (p = 0.1). Moreover, the 90-day mortality was 13% for the BC types 2 and 3 patients and 12% for the BC type 4 patients (p = 0.57). Lymph-node metastasis (N1; hazard-ratio [HR], 1.62), positive margins (R1; HR, 1.36), perineural invasion (HR, 1.53), and poor grade of differentiation (HR, 1.25) were predictors of survival (all p ≤0.004), but BC type was not associated with prognosis. Among the N0 and R0 patients, the 5-year overall survival was 43% for the patients with BC types 2 and 3 pCCA and 41% for those with BC type 4 pCCA (p = 0.60).

Conclusions
In this analysis of a large Western multi-institutional cohort, resection was shown to be an acceptable curative treatment option for selected patients with BC type 4 pCCA although a more technically challenging surgical approach was required.
Optimized scan delay for late hepatic arterial or pancreatic parenchymal phase in dynamic contrast-enhanced computed tomography with bolus-tracking method
Authors: Noda Yoshifumi , Kawai Nobuyuki , Ishihara Takuma , Tsuboi Yoshiki , Kaga Tetsuro , Miyoshi Toshiharu , Hyodo Fuminori , Matsuo Masayuki 
Published: May 2021

Objectives:
To determine the optimal scan delay corresponding to individual hemodynamic status for pancreatic parenchymal phase in dynamic contrast-enhanced CT of the abdomen.

Methods:
One hundred and fourteen patients were included in this retrospective study (69 males and 45 females; mean age, 67.9 ± 12.1 years; range, 39–87 years). These patients underwent abdominal dynamic contrast-enhanced CT between November 2019 and May 2020. We calculated and recorded the time from contrast material injection to the bolus-tracking trigger of 100 Hounsfield unit (HU) at the abdominal aorta (s) (TimeTRIG) and scan delay from the bolus-tracking trigger to the initiation of pancreatic parenchymal phase scanning (s) (TimeSD). The scan delay ratio (SDR) was defined by dividing the TimeSD by TimeTRIG. Non-linear regression analysis was conducted to assess the association between CT number of the pancreas and SDR and to reveal the optimal SDR, which was ≥120 HU in pancreatic parenchyma.

Results:
The non-linear regression analysis showed a significant association between CT number of the pancreas and the SDR (p &lt; 0.001). The mean TimeTRIG and TimeSD were 16.1 s and 16.8 s, respectively. The SDR to peak enhancement of the pancreas (123.5 HU) was 1.00. An SDR between 0.89 and 1.18 shows an appropriate enhancement of the pancreas (≥120 HU).

Conclusion:
The CT number of the pancreas peaked at an SDR of 1.00, which means TimeSD should be approximately the same as TimeTRIG to obtain appropriate pancreatic parenchymal phase images in dynamic contrast-enhanced CT with bolus-tracking method.

Advances in knowledge:
The hemodynamic state is different in each patient; therefore, scan delay from the bolus-tracking trigger should also vary based on the time from contrast material injection to the bolus-tracking trigger. This is necessary to obtain appropriate late hepatic arterial or pancreatic parenchymal phase images in dynamic contrast-enhanced CT of the abdomen.