bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of water intake in the severity of pain and menstrual distress among females suffering from primary dysmenorrhea: a semi-experimental study
Authors: Torkan Behnaz , Mousavi Mahsasadat , Dehghani Samira , Hajipour Leila , Sadeghi Narges , Ziaei Rad Marzieh , Montazeri Ali 
Published: January 2021

Abstract
Background
Dysmenorrhea is the most common health problem among women of reproductive age. The aim of the present study was to investigate the modifying role of water intake in menstrual distress and severity of pain among young female adolescents.

Method
A semi-experimental study was conducted on a sample of undergraduate female students aged 18–30 years in Isfahan, Iran from 2016 to 2019. Volunteers who had history of suffering from primary dysmenorrhea and drank less than 1600 ml water per day were assigned into water intake (n = 70) and control (n = 70) groups. Participants could select the group in which they desired to be considered. The water intake group was asked to drink water regularly based on a protocol for two menstrual periods while the control group did not receive any form of intervention. Demographic information and menstrual characteristics and severity of menstrual pain (based on a visual analogue scale), were obtained using a short questionnaire. The data were compared between and within two groups before and after intervention using chi-square test, Mann–Whitney U test, and the Friedman’s analysis of variance.

Results
The mean age (SD) of participants was 22.0 (2.7) years and 77 students reported normal duration of menstrual bleeding. The number of students who had normal duration of menstrual bleeding (4–6 days) in water intake group increased after intervention (39 vs. 49 after first and 46 after second cycles of menstruation). However, the interval of menstrual cycle did not change significantly in either groups. Considerable decrease in using pain killer was observed in water intake group (p < 0.001). No significant differences were observed between control and water intake groups before intervention in pain intensity (pain mean score 7.64 vs. 7.06), but within group comparison showed that pain intensity was significantly decreased among water intake group (p < 0.0001) while for control group only a significant decrease was observed for the first day of menstrual bleeding.

Conclusion
The findings suggest that water intake might have modifying role in reducing menstrual bleeding duration, pain killer utilization, and pain intensity during menstrual period.

Trial registration
IRCT20180708040377N1, 16 April 2020, Retrospectively registered, at https://www.irct.ir/trial/32446
Evaluating the effect of an educational program on increasing cervical cancer screening behavior among women in Fasa, Iran
Authors: Heidari Sarvestani Maryam , Khani Jeihooni Ali , Moradi Zahra , Dehghan Azizallah 
Published: January 2021

Abstract
Background
Cervical cancer is the second most common cancer and the fifth deadliest cancer among women in Iran. Educational interventions based on the proper behavior promoting models can lead to early diagnosis of cervical cancer.This study aimed to investigate the effects of educational intervention on performing Pap smear tests based on the Theory of Planned Behavior among women living in Fasa, Iran.

Methods
A cross-sectional study was conducted on 700 participants. Thereafter, the educational intervention based on the results of cross-sectional study was conducted in a workshop form for 50 women as the intervention group and 50 women as the control group. Afterward, the data were entered into the SPSS statistical software and then analyzed via logistic regressions analysis, paired t test, independent t test, chi-square test, and McNemar test.

Result
According to the results, 45.7% of the patients had a history of performing a Pap smear test, and 20.7% of them regularly performed this test. The knowledge, attitude, subjective norms, and perceived behavioral control were the predictors of intention and behavior of Pap smear test among the women (P < 0.05). These components accounted for 57.4% and 31.6% of the intention and behavior variances, respectively. After the intervention, a significant increase was observed in the means of attitude, subjective norms, and perceived behavioral control in the intervention group compared to the control group. The results reveal no significant difference between these two groups regarding the behavioral intention (p = 0.41) and performance of the Pap smear test (p = 0.583). The number of the participants undergone the Pap smear test has increased from 10 to 26 in the intervention group by passing 3 months from the intervention. The results of McNemar test indicated that this difference was statistically significant.

Conclusion
The results indicated an increase in the women’s performance of the Pap smear screening test by appropriate planning, provision of educational packages based on the women’s needs, and using effective subjective norms.
Trial Registration: Current Controlled Trials IRCT20160830029608N3:12/31/2018. “Retrospectively registered”.
Health data research on sudden cardiac arrest: perspectives of survivors and their next-of-kin
Authors: Bak Marieke A. R. , Veeken Rens , Blom Marieke T. , Tan Hanno L. , Willems Dick L. 
Published: January 2021

Abstract
Background
Consent for data research in acute and critical care is complex as patients become at least temporarily incapacitated or die. Existing guidelines and regulations in the European Union are of limited help and there is a lack of literature about the use of data from this vulnerable group. To aid the creation of a patient-centred framework for responsible data research in the acute setting, we explored views of patients and next-of-kin about the collection, storage, sharing and use of genetic and health-related data for observational research.

Methods
We conducted qualitative interviews (n = 19) with Dutch sudden cardiac arrest survivors who donated clinical and socio-economic data and genetic samples to research. We also interviewed their next-of-kin. Topics were informed by ethics literature and we used scenario-sketches to aid discussion of complex issues.

Results
Sudden cardiac arrest survivors displayed limited awareness of their involvement in health data research and of the content of their given consent. We found that preferences regarding disclosure of clinically actionable genetic findings could change over time. When data collection and use were limited to the medical realm, patients trusted researchers to handle data responsibly without concern for privacy or other risks. There was no consensus as to whether deferred consent should be explicitly asked from survivors. If consent is asked, this would ideally be done a few months after the event when cognitive capacities have been regained. Views were divided about the need to obtain proxy consent for research with deceased patients’ data. However, there was general support for the disclosure of potentially relevant post-mortem genetic findings to relatives.

Conclusions
Sudden cardiac arrest patients’ donation of data for research was grounded in trust in medicine overall, blurring the boundary between research and care. Our findings also highlight questions about the acceptability of a one-time consent and about responsibilities of patients, researchers and ethics committees. Finally, further normative investigation is needed regarding the (continued) use of participants’ data after death, which is of particular importance in this setting. Our findings are thought to be of relevance for other acute and life-threatening illnesses as well.
CardioNet: a manually curated database for artificial intelligence-based research on cardiovascular diseases
Authors: Ahn Imjin , Na Wonjun , Kwon Osung , Yang Dong Hyun , Park Gyung-Min , Gwon Hansle , Kang Hee Jun , Jeong Yeon Uk , Yoo Jungsun , Kim Yunha , Jun Tae Joon , Kim Young-Hak 
Published: January 2021

Abstract
Background
Cardiovascular diseases (CVDs) are difficult to diagnose early and have risk factors that are easy to overlook. Early prediction and personalization of treatment through the use of artificial intelligence (AI) may help clinicians and patients manage CVDs more effectively. However, to apply AI approaches to CVDs data, it is necessary to establish and curate a specialized database based on electronic health records (EHRs) and include pre-processed unstructured data.

Methods
To build a suitable database (CardioNet) for CVDs that can utilize AI technology, contributing to the overall care of patients with CVDs. First, we collected the anonymized records of 748,474 patients who had visited the Asan Medical Center (AMC) or Ulsan University Hospital (UUH) because of CVDs. Second, we set clinically plausible criteria to remove errors and duplication. Third, we integrated unstructured data such as readings of medical examinations with structured data sourced from EHRs to create the CardioNet. We subsequently performed natural language processing to structuralize the significant variables associated with CVDs because most results of the principal CVD-related medical examinations are free-text readings. Additionally, to ensure interoperability for convergent multi-center research, we standardized the data using several codes that correspond to the common data model. Finally, we created the descriptive table (i.e., dictionary of the CardioNet) to simplify access and utilization of data for clinicians and engineers and continuously validated the data to ensure reliability.

Results
CardioNet is a comprehensive database that can serve as a training set for AI models and assist in all aspects of clinical management of CVDs. It comprises information extracted from EHRs and results of readings of CVD-related digital tests. It consists of 27 tables, a code-master table, and a descriptive table.

Conclusions
CardioNet database specialized in CVDs was established, with continuing data collection. We are actively supporting multi-center research, which may require further data processing, depending on the subject of the study. CardioNet will serve as the fundamental database for future CVD-related research projects.
Service demand for psychological interventions among Australian adults: a population perspective
Authors: Page Imogen S. , Sparti Claudia , Santomauro Damian , Harris Meredith G. 
Published: January 2021

Abstract
Background
Psychological interventions (PIs) are good practice treatment for both subthreshold and diagnosed mental disorders. Australia has implemented major reforms to expand the provision of subsidised psychological services for individuals with a diagnosed mental disorder. But there are gaps in knowledge about demand for PIs (i.e., use of and perceived need for PIs) across the population. This study uses nationally representative survey data from the 2007 Australian National Survey of Mental Health and Wellbeing to analyse demand for PIs. It also provides a method for analysing survey data to estimate demand for PIs when new survey data becomes available, along with suggestions to inform future survey development.

Methods
Nationally representative community survey respondents (n = 8841, 16–85 years) indicated their perceived need for nine types of help for mental health problems in the past 12 months, including three PIs (cognitive behavioural therapy, psychotherapy, and counselling), and whether these needs were unmet, partially met, or fully met. Types of help were grouped as: PIs only; PIs plus other; and other only. Chi-square analyses were used to examine the association between type of intervention, sociodemographic and clinical factors, and type of professional consulted; multinomial logistic regression models were used to examine predictors of type of intervention(s) received.

Results
7.9% (95%CI: 7.2–8.6) received PIs. Receipt of PIs was positively associated with higher education and consulting a mental health specialist. Twice as many respondents received PIs plus medication as compared to PIs only (4.2% vs. 2.0%). Almost half (45.4, 95%CI 36.5–54.6) incurred out-of-pocket costs for treatment. The most common reason for partially met need for PIs was cost (24.8, 95%CI 17.2–34.3); for unmet need, it was preference for self-management (33.9, 95%CI 21.2–49.5). Perceived unmet need for PIs only (3.1, 95%CI 2.1–4.6) or PIs plus other interventions (5.2, 95%CI 3.9–6.9%) was lower than for other interventions only (22.8, 95%CI 18.7–27.6).

Conclusions
Continued reforms in Australia means that on-going monitoring of demand for PIs, using nationally representative data, is required. This study provides a baseline for comparison of the long-term effects of these reforms; this comparison may be undertaken using data from the third iteration of Australia’s NSMHWB, due for completion in 2021–22.
Metabolic profile distinguishes laminitis-susceptible and -resistant ponies before and after feeding a high sugar diet
Authors: Delarocque Julien , Reiche Dania B. , Meier Alexandra D. , Warnken Tobias , Feige Karsten , Sillence Martin N. 
Published: January 2021

Abstract
Background
Insulin dysregulation (ID) is a key risk factor for equine endocrinopathic laminitis, but in many cases ID can only be assessed accurately using dynamic tests. The identification of other biomarkers could provide an alternative or adjunct diagnostic method, to allow early intervention before laminitis develops. The present study characterised the metabolome of ponies with varying degrees of ID using basal and postprandial plasma samples obtained during a previous study, which examined the predictive power of blood insulin levels for the development of laminitis, in ponies fed a high-sugar diet. Samples from 10 pre-laminitic (PL – subsequently developed laminitis) and 10 non-laminitic (NL – did not develop laminitis) ponies were used in a targeted metabolomic assay. Differential concentration and pathway analysis were performed using linear models and global tests.

Results
Significant changes in the concentration of six glycerophospholipids (adj. P ≤ 0.024) and a global enrichment of the glucose-alanine cycle (adj. P = 0.048) were found to characterise the response of PL ponies to the high-sugar diet. In contrast, the metabolites showed no significant association with the presence or absence of pituitary pars intermedia dysfunction in all ponies.

Conclusions
The present results suggest that ID and laminitis risk are associated with alterations in the glycerophospholipid and glucose metabolism, which may help understand and explain some molecular processes causing or resulting from these conditions. The prognostic value of the identified biomarkers for laminitis remains to be investigated in further metabolomic trials in horses and ponies.
Novel PRKAG2 variant presenting as liver cirrhosis: report of a family with 2 cases and review of literature
Authors: Beyzaei Zahra , Ezgu Fatih , Geramizadeh Bita , Alborzi Alireza , Shojazadeh Alireza 
Published: January 2021

Abstract
Background
Mutations in the PRKAG2 gene encoding the 5′ Adenosine Monophosphate-Activated Protein Kinase (AMPK), specifically in its γ2 regulatory subunit, lead to Glycogen storage disease of heart, fetal congenital disorder (PRKAG2 syndrome). These mutations are rare, and their functional roles have not been fully elucidated. PRKAG2 syndrome is autosomal dominant disorder inherited with full penetrance. It is characterized by the accumulation of glycogen in the heart tissue, which is clinically manifested as hypertrophic cardiomyopathy. There is little knowledge about the characteristics of this disease. This study reports a genetic defect in an Iranian family with liver problems using targeted-gene sequencing.

Case presentation
A 4-year-old girl presented with short stature, hepatomegaly, and liver cirrhosis. As there was no specific diagnosis made based on the laboratory data and liver biopsy results, targeted-gene sequencing (TGS) was performed to detect the molecular basis of the disease. It was confirmed that this patient carried a novel heterozygous variant in the PRKAG2 gene. The echocardiography was a normal.

Conclusion
A novel heterozygous variant c.592A > T (p.Met198Leu) expands the mutational spectrum of the PRKAG2 gene in this family. Also, liver damage in patients with PRKAG2 syndrome has never been reported, which deserves further discussion.
Co-expression of CMTM6 and PD-L1: a novel prognostic indicator of gastric cancer
Authors: Zhang Chao , Zhao Shutao , Wang Xudong 
Published: January 2021

Abstract
Background
CKLF Like MARVEL Transmembrane Domain Containing 6 (CMTM6) is involved in the epigenetic regulation of genes and tumorigenesis. Programmed cell death ligand 1 (PD-L1) is closely related to the prognosis of some human cancers. CMTM6 is a key regulator of PD-L1 in many cancers. The purpose of this study was to investigate the expressions of these proteins in gastric cancer and the correlations with clinicopathological features and survival.

Methods
The expression levels of CMTM6 and PD-L1 were examined in 185 gastric cancer specimens using immunohistochemistry, quantitative real-time PCR and Western blot. Immunofluorescence was used to examine the localizations of CMTM6 and PD-L1. Chi-square test was used to analyze the relationship between CMTM6 and PD-L1 expressions and clinicopathological characteristics. Kaplan–Meier method and log-rank test were used to analyze the survival data of patients.

Results
The positive expression rates of CMTM6 and PD-L1 in gastric cancers were 78.38% (145/185) and 75.68% (140/185), respectively. CMTM6 and PD-L1 were both mainly expressed in the cell membrane and nucleus of gastric cancer tumor cells. High expression of CMTM6 and PD-L1 was correlated with Borrmann type (P < 0.001), N stage (P = 0.002), peritoneal metastasis (P = 0.007) and TNM stage (P = 0.038). CMTM6 and PD-L1 expression in gastric cancer tissues showed a positive correlation (Pearson’s coefficient test, r = 0.260; P < 0.001). CMTM6 may positively regulate PD-L1 expression. High expression of CMTM6 was correlated with poor prognosis of gastric cancer patients (HR = 1.668; 95% CI = 1.032–2.695; P = 0.037). High expression of both CMTM6 and PD-L1 may be an independent factor for overall survival (HR = 1.554; 95% CI = 1.011–2.389; P = 0.044).

Conclusion
The combined detection of CMTM6 and PD-L1 may be used as an indicator for judging the prognosis of gastric cancer patients.
Tumor mutation burden in connection with immune-related survival in uterine corpus endometrial carcinoma
Authors: Zhao Ling , Fu Xueshu , Han Xiling , Yu Yanjun , Ye Yaping , Gao Jun 
Published: January 2021

Abstract
Background
UCEC is the most common gynecological malignancy in many countries, and its mechanism of occurrence and development is related to tumor mutation burden (TMB) and immune cell infiltration. Therefore, it is necessary to systematically explore the TMB-related gene profile in immune cells to improve the prognosis of UCEC.

Methods
We integrated TMB-related genes with basic clinical information of UCEC patients based on TCGA dataset. Differentially expressed genes (DEGs) were selected through differential expression screening, PPI, and enrichment analysis. Additionally, we analyzed the components of immune cell infiltration of the DEGs to obtain the differential immunity-related genes. A single factor and multifactor Cox regression analyses were conducted to establish new prognostic indicators of OS and DFS based on TMB-related immune genes. To further study the correlation between survival and immune cell infiltration, a Cox model based on these immune infiltration compositions was built. Using the clinical variables, we established nomograms for OS and DFS.

Results
393 DEGs were significantly associated with clinical outcomes and the immune component in patients with UCEC. Gene Ontology (GO) and Kyoto Encyclopedia of Genes, Genomes (KEGG) pathway and protein-protein interaction network (PPI) analyses revealed the role of these genes and information on related pathways. Then, two prognostic models were established based on the differential immune genes for OS (GFAP and MX2) and DFS (MX2, GFAP, IGHM, FGF20, and TRAV21). In DFS, the differential immune genes were related to CD4+ T cell, CD8+ T cell, macrophage, and neutrophil (all P < 0.05). B cell and CD8+ T cell were independent prognostic factors from among the immune cell elements in UCEC. Finally, the risk scores of these models were combined with the clinical elements-based nomogram models, and the AUC values were all over 0.7.

Conclusions
Our results identified several clinically significant differential immune genes and established relevant prognostic models, providing a basis for the molecular analysis of TMB and immune cells in UCEC, and identified potential prognostic and immune-related genes for UCEC. We added clinical related conditions for further analysis to confirm the identity of the genes and clinical elements-based models.
Attention-based multi-scale features fusion for unobtrusive atrial fibrillation detection using ballistocardiogram signal
Authors: Jiang Fangfang , Hong Chuhang , Cheng Tianqing , Wang Haoqian , Xu Bowen , Zhang Biyong 
Published: January 2021

Abstract
Background
Atrial fibrillation (AF) represents the most common arrhythmia worldwide, related to increased risk of ischemic stroke or systemic embolism. It is critical to screen and diagnose AF for the benefits of better cardiovascular health in lifetime. The ECG-based AF detection, the gold standard in clinical care, has been restricted by the need to attach electrodes on the body surface. Recently, ballistocardiogram (BCG) has been investigated for AF diagnosis, which is an unobstructive and convenient technique to monitor heart activity in daily life. However, here is a lack of high-dimension representation and deep learning analysis of BCG.

Method
Therefore, this paper proposes an attention-based multi-scale features fusion method by using BCG signal. The 1-D morphology feature extracted from Bi-LSTM network and 2-D rhythm feature extracted from reconstructed phase space are integrated by means of CNN network to improve the robustness of AF detection. To the best of our knowledge, this is the first study where the phase space trajectory of BCG is conducted.

Results
2000 segments (AF and NAF) of BCG signals were collected from 59 volunteers suffering from paroxysmal AF in this survey. Compared to the classical time and frequency features and the state-of-the-art energy features with the popular machine learning classifiers, AF detection performance of the proposed method is superior, which has 0.947 accuracy, 0.935 specificity, 0.959 sensitivity, and 0.937 precision, for the same BCG dataset. The experimental results show that combined feature could excavate more potential characteristics, and the attention mechanism could enhance the pertinence for AF recognition.

Conclusions
The proposed method can provide an innovative solution to capture the diverse scale descriptions of BCG and explore ways to involve the deep learning method to accurately screen AF in routine life.