bluuebunny/crossref_metadata_2025_split huggingface dataset:
Automated total and vessel-specific coronary artery calcium (CAC) quantification on chest CT: direct comparison with CAC scoring on non-contrast cardiac CT
Authors: Yu Jie , Qian Lijuan , Sun Wengang , Nie Zhuang , Zheng DanDan , Han Ping , Shi Heshui , Zheng Chuansheng , Yang Fan 
Published: October 2022

Abstract
Background
This study aimed to evaluate the artificial intelligence (AI)-based coronary artery calcium (CAC) quantification and regional distribution of CAC on non-gated chest CT, using standard electrocardiograph (ECG)-gated CAC scoring as the reference.

Methods
In this retrospective study, a total of 405 patients underwent non-gated chest CT and standard ECG-gated cardiac CT. An AI-based algorithm was used for automated CAC scoring on chest CT, and Agatston score on cardiac CT was manually quantified. Bland-Altman plots were used to evaluate the agreement of absolute Agatston score between the two scans at the patient and vessel levels. Linearly weighted kappa (κ) was calculated to assess the reliability of AI-based CAC risk categorization and the number of involved vessels on chest CT.

Results
The AI-based algorithm showed moderate reliability for the number of involved vessels in comparison to measures on cardiac CT (κ = 0.75, 95% CI 0.70–0.79, P < 0.001) and an assignment agreement of 76%. Considerable coronary arteries with CAC were not identified with a per-vessel false-negative rate of 59.3%, 17.8%, 34.9%, and 34.7% for LM, LAD, CX, and RCA on chest CT. The leading causes for false negatives of LM were motion artifact (56.3%, 18/32) and segmentation error (43.8%, 14/32). The motion artifact was almost the only cause for false negatives of LAD (96.6%, 28/29), CX (96.7%, 29/30), and RCA (100%, 34/34). Absolute Agatston scores on chest CT were underestimated either for the patient and individual vessels except for LAD (median difference: − 12.5, − 11.3, − 5.6, − 18.6 for total, LM, CX, and RCA, all P < 0.01; − 2.5 for LAD, P = 0.18). AI-based total Agatston score yielded good reliability for risk categorization (weighted κ 0.86, P < 0.001) and an assignment agreement of 86.7% on chest CT, with a per-patient false-negative rate of 15.2% (28/184) and false-positive rate of 0.5% (1/221) respectively.

Conclusions
AI-based per-patient CAC quantification on non-gated chest CT achieved a good agreement with dedicated ECG-gated CAC scoring overall and highly reliable CVD risk categorization, despite a slight but significant underestimation. However, it is challenging to evaluate the regional distribution of CAC without ECG-synchronization.
Neck circumference cut-off points for detecting overweight and obesity among school children in Northern Cyprus
Authors: Turkay Ezgi , Kabaran Seray 
Published: October 2022

AbstractBackgroundNeck circumference is one of the anthropometric parameters that is widely used in practical applications, clinical and epidemiological studies in children. It is aimed to determine the neck circumference cut-off points and to use them in the detection of overweight and obesity in children living in Northern Cyprus.SubjectsThis cross-sectional study was conducted between October 2019 and January 2020, and covered a sample of 692 children (367 girls and 325 boys) aged 6–10 years attending primary schools in the Northern Cyprus.MethodsBody weight, height, neck circumference, waist circumference, subscapular and triceps skinfold tickness were measured. BF% was calculated with Slaughter equations. World Health Organization BMI cut-off points for age and gender percentiles were used to categorize obesity. BMI, WHtR, NC, body fat were calculated. The Pearson Correlation co-efficient between NC and the other anhtropometric measurements were calculated. Receiver operating characteristics analysis, sensitivity, specificity, PV + ve PV- was used to determine the optimal NC cut-off points for identifying children with overweight and obesity.ResultsNC was a statistically significant positive and strong relationship with body weight, BMI, waist circumference and hip circumference (p < 0,005). NC cut-off values to define overweight and obesity were calculated as 26,9 cm in girls (AUC: 0,851, 95% CI: 0,811–0,891, sensitivity 70,50%, specificity 84,65%) and 27,9 cm in boys (AUC: 0,847, 95% CI: 0,805–0,888, sensitivity 76,4%, specificity 79,3%). The ROC curves accurately define overweight and obesity of the whole cohort regardless of age for both sexes of children.ConclusionsThe cut-off points for neck circumference were found to be 27,9 cm for boys and 26,9 cm for girls in determining overweight and obesity in children aged 6–10 years. The NC cut-off points obtained in this study can be used to define overweight and obesity in children in epidemiological studies. It is considered to shed light on studies that will examine the relationship between neck circumference and diseases with more people in future studies.
Outcomes from integrating anti-cervical cancer teachings into the curriculum of high schools in a South-Eastern Nigerian State
Authors: Ifediora Christian , Veerman Lennert , Azuike Emmanuel , Ekwochi Uchenna , Obiozor Williams 
Published: October 2022

Abstract
Background
Quests for the global elimination of cervical cancer and its related SDG goals by 2030 are achievable if realistic approaches for improving outcomes in LMICs are entrenched. Targeting teenage high schoolers in these countries, which largely lack universally-affordable anti-cervical cancer measures, can be a game-changer. This paper evaluates a 2019 Harvard-endorsed measure that integrated relevant teachings into the curricula of some Nigerian high schools, in what was a global-first.

Method
A 12-month, quasi-experimental (pre-and-post-tests) research that evaluated the impact of the above initiative on three public schools randomly selected from a pool of 261 in South-east Nigeria. The intervention was “exposure” to anti-cervical teachings, which included “repetitions” and “examination/assessments” designed to enhance “engagement”. Both genders were among the 2,498 recruited participants. Data collections with questionnaires were at three different intervals over 12 months.

Results
At Phase-1 (baseline), there were 1,699 (68.0%) responses, while Phases 2 (one-month post-intervention) and 4 (12-month post-intervention) had 1,797 (71.9%) and 500 (20.0%) responses, respectively. COVID-19 lockdowns washed out Phase-3 (six-month post-intervention).
The majority in all groups were aged 15–19 years. Males dominated in phases 1 (55.9%) and 2 (67.3%), and females (65.6%) in Phase 4.
Overall, there were increased knowledge on “General Awareness”, “HPV Vaccinations”, “Risk Factors” and “Symptoms”, particularly between Phases 2 and 1. Levels at Phase-4 were higher than at Phase-2, with the exception of “Pap Smears”, as knowledge gained in half of its assessing items became negative (reversed) at Phase-4. These observed changes were non-different between gender, age groups, and classes of high schools.
Relative to Phase 2, knowledge changes at Phase-4 for questions associated with established myths (“spiritual attacks”; OR 0.39; CI 0.29–0.52 and “enemy poisons”; OR 0.49; CI 0.37–0.65) were reversed, even though they were originally increased significantly between Phases 2 and 1.

Conclusion
Anti-cervical cancer enlightenment interventions to teenage high school students were largely effective, but appears guaranteed if engagement-enhancing measures are maintained over time. Extra efforts should be put into debunking prevailing myths.
Association of metabolites of benzene and toluene with lipid profiles in Korean adults: Korean National Environmental Health Survey (2015–2017)
Authors: Shin Soon Su , Yang Eun Hye , Lee Hyo Choon , Moon Seong Ho , Ryoo Jae-Hong 
Published: October 2022

Abstract
Background
Environmental exposure to benzene and toluene is a suspected risk factor for metabolic disorders among the general adult population. However, the effects of benzene and toluene on blood lipid profiles remain unclear. In this study, we investigated the association between urinary blood lipid profiles and metabolites of benzene and toluene in Korean adults.

Methods
We analyzed the data of 3,423 adults from the Korean National Environmental Health Survey Cycle 3 (2015–2017). We used urinary trans,trans-muconic acid (ttMA) as a biomarker of benzene exposure, and urinary benzylmercapturic acid (BMA) as an indicator of toluene exposure. Multivariate logistic regression analyses were performed to explore the association between blood lipid profiles and urinary metabolites of benzene and toluene. Additionally, we examined the linear relationship and urinary metabolites of benzene and toluene between lipoprotein ratios using multivariate regression analyses.

Results
After adjusting for covariates, the fourth quartile (Q4) of ttMA [odds ratio (OR) (95% confidence interval, CI = 1.599 (1.231, 2.077)] and Q3 of BMA [OR (95% CI) = 1.579 (1.129, 2.208)] were associated with an increased risk of hypertriglyceridemia. However, the Q4 of urinary ttMA [OR (95% CI) = 0.654 (0.446, 0.961)] and Q3 of urinary BMA [OR (95% CI) = 0.619 (0.430, 0.889)] decreased the risk of a high level of low-density lipoprotein cholesterol (LDL-C). Higher urinary ttMA levels were positively associated with the ratio of triglycerides to high-density lipoproteins [Q4 compared to Q1: β = 0.11, 95% CI: (0.02, 0.20)]. Higher urinary metabolite levels were negatively associated with the ratio of low-density lipoprotein to high-density lipoprotein [Q4 of ttMA compared to reference: β = -0.06, 95% CI: (-0.11, -0.01); Q4 of BMA compared to reference: β = -0.13, 95% CI: (-0.19, -0.08)].

Conclusion
Benzene and toluene metabolites were significantly and positively associated with hypertriglyceridemia. However, urinary ttMA and BMA levels were negatively associated with high LDL-C levels. These findings suggest that environmental exposure to benzene and toluene disrupts lipid metabolism in humans.
Deep learning of longitudinal chest X-ray and clinical variables predicts duration on ventilator and mortality in COVID-19 patients
Authors: Duanmu Hongyi , Ren Thomas , Li Haifang , Mehta Neil , Singer Adam J. , Levsky Jeffrey M. , Lipton Michael L. , Duong Tim Q. 
Published: October 2022

Abstract
Objectives
To use deep learning of serial portable chest X-ray (pCXR) and clinical variables to predict mortality and duration on invasive mechanical ventilation (IMV) for Coronavirus disease 2019 (COVID-19) patients.

Methods
This is a retrospective study. Serial pCXR and serial clinical variables were analyzed for data from day 1, day 5, day 1–3, day 3–5, or day 1–5 on IMV (110 IMV survivors and 76 IMV non-survivors). The outcome variables were duration on IMV and mortality. With fivefold cross-validation, the performance of the proposed deep learning system was evaluated by receiver operating characteristic (ROC) analysis and correlation analysis.

Results
Predictive models using 5-consecutive-day data outperformed those using 3-consecutive-day and 1-day data. Prediction using data closer to the outcome was generally better (i.e., day 5 data performed better than day 1 data, and day 3–5 data performed better than day 1–3 data). Prediction performance was generally better for the combined pCXR and non-imaging clinical data than either alone. The combined pCXR and non-imaging data of 5 consecutive days predicted mortality with an accuracy of 85 ± 3.5% (95% confidence interval (CI)) and an area under the curve (AUC) of 0.87 ± 0.05 (95% CI) and predicted the duration needed to be on IMV to within 2.56 ± 0.21 (95% CI) days on the validation dataset.

Conclusions
Deep learning of longitudinal pCXR and clinical data have the potential to accurately predict mortality and duration on IMV in COVID-19 patients. Longitudinal pCXR could have prognostic value if these findings can be validated in a large, multi-institutional cohort.
The associations between lipid profiles and visceral obesity among gastrointestinal cancer patients: a cross-sectional study
Authors: Gao Bo , Li Xiangrui , Chen Wenqing , Wang Shu’an , He Jian , Liu Yu , Ding Chao , Chen Xiaotian 
Published: October 2022

Abstract
Background
Visceral obesity is associated with cancer incidence and prognosis. Altered lipid profiles are frequently seen in visceral obese patients. The blood test of lipid profiles is more convenient and has no radical side effects than computed tomography (CT), which is presently the most accurate way to measure visceral fat area. This article aims to investigate the associations between lipid profiles and visceral obesity in gastrointestinal cancer patients.

Methods
In total, 399 patients newly diagnosed with gastrointestinal cancer were enrolled in this observational study. Lipid profiles were obtained from blood samples, and visceral fat mass area (VFA) was measured by CT. VFA ≥ 100 cm2 was considered visceral obesity. The area under the receiver operating characteristic curve (AUROC) was utilized to evaluate the prognostic powers of lipid parameters for viscerally obese gastrointestinal cancer patients.

Results
Patients who had visceral obesity had higher triglyceride (TG) levels (1.20 ± 0.60 vs. 0.87 ± 0.57 mmo/L, P < 0.001), total cholesterol (TC) levels (3.57 ± 0.84 vs. 3.40 ± 0.82, P = 0.044), and low-density lipoprotein (LDL-C) levels (2.08 ± 0.66 vs. 1.94 ± 0.66, P = 0.047) and lower high-density lipoprotein (HDL-C) levels (0.88 ± 0.24 vs. 1.00 ± 0.26, P < 0.001) than those in the normal group. TG was positively correlated with VFA (r = 0.299, P < 0.001), while HDL-C was inversely correlated with VFA (r = -0.237, P < 0.001). TG and HDL-C had predictive capacity for visceral obesity at cutoff levels of 0.92 mmol/L (AUROC 0.700, 95% CI, 0.653–0.745, P < 0.001) and 0.98 mmol/L (AUROC 0.700, 95% CI, 0.585–0.682, P < 0.001), respectively. TG > 0.92 mmol/L with HDL-C < 0.98 mmol/L was linked with an increased risk of visceral obesity (OR = 4.068, 95% CI, 2.338—7.079, P < 0.001).

Conclusions
Lipid profiles were significantly correlated with VFA. Gastrointestinal cancer patients with TG > 0.92 mmol/L and HDL-C < 0.98 mmol/L were at elevated risk of visceral obesity in the Chinese population. Identifying visceral obesity and taking proper actions in gastrointestinal cancers are helpful for overall tumor prognosis.
Opening up the black box of recovery processes in persons with complex mental health needs: a qualitative study of place-making dynamics in a low-threshold meeting place
Authors: De Ruysscher Clara , Vandevelde Stijn , Vanheule Stijn , Bryssinck Dirk , Haeck Wim , Vanderplasschen Wouter 
Published: October 2022

Abstract
Background
The recovery processes of persons with complex mental health needs take a slow and unpredictable course. Despite the fact that a number of essential building blocks of recovery in this population have been identified (e.g. social relationships, treatment, personal beliefs), the actual process of recovery in persons with complex mental health needs largely remains a black box. The aim of this study was to gain insight into how the recovery processes of persons with complex mental health needs take place, by applying a relational geographical approach and scrutinizing the place-making dynamics of one low-threshold meeting place in Belgium engaging with this group.

Methods
Data collection took place during the height of the COVID-19 pandemic by means of 11 in-depth interviews with different involved actors (service users, staff members, volunteers) and analyzed thematically.

Results
Results showed how the daily practice of the meeting place is continuously reproduced through place-making rituals that create an inclusive space of hospitality, are fueled by creative processes and form an indispensable counterweight for service users’ mental health needs.

Conclusions
To further open up the ‘black box’ of recovery in persons with complex mental health needs, it is vital to focus our analytic gaze onto recovery as a dynamic and relational practice.
Reading activities compensate for low education-related cognitive deficits
Authors: Wang Yue , Wang Shinan , Zhu Wanlin , Liang Na , Zhang Chen , Pei Yuankun , Wang Qing , Li Shiping , Shi Jiong 
Published: October 2022

Abstract
Background
The incidence of cognitive impairment is increasing with an aging population. Developing effective strategies is essential to prevent dementia. Higher education level is associated with better baseline cognitive performance, and reading activities can slow down cognitive decline. However, it is unclear whether education and reading activities are synergistic or independent contributors to cognitive performance.

Methods
This was a sub-study of an ongoing prospective community cohort of China National Clinical Research Center Alzheimer’s Disease and Neurodegenerative Disorder Research (CANDOR). Demographic and clinical information, educational levels, and reading activities were collected. All participants finished neuropsychological testing batteries and brain MRIs. We analyzed cognitive performance and brain structures with education and reading activities.

Results
Four hundred fifty-nine subjectively cognitively normal participants were enrolled in the study. One hundred sixty-nine (36.82%) of them had regular reading activities. Participants in the reading group had better performance in all cognitive tests compared with those in the non-reading group, but no difference in brain MRI variables. Participants with higher education levels (more than 13 years) had better cognitive performance and higher hippocampal volumes. In low education groups (less than 12 years), more reading activities were associated with better cognitive test scores.

Conclusions
Both education and reading activities are important and synergistic for baseline cognitive function. Higher education level is associated with larger hippocampal volumes. Education may stimulate the growth and development of the hippocampus. Reading activities help to maintain and improve cognitive function in people with low levels of education.

Trial registration
NCT04320368.
Plasma metabolomics provides new insights into the relationship between metabolites and outcomes and left ventricular remodeling of coronary artery disease
Authors: Zhu Qian , Qin Min , Wang Zixian , Wu Yonglin , Chen Xiaoping , Liu Chen , Ma Qilin , Liu Yibin , Lai Weihua , Chen Hui , Cai Jingjing , Liu Yemao , Lei Fang , Zhang Bin , Zhang Shuyao , He Guodong , Li Hanping , Zhang Mingliang , Zheng Hui , Chen Jiyan , Huang Min , Zhong Shilong 
Published: October 2022

AbstractBackgroundCoronary artery disease (CAD) is a metabolically perturbed pathological condition. However, the knowledge of metabolic signatures on outcomes of CAD and their potential causal effects and impacts on left ventricular remodeling remains limited. We aim to assess the contribution of plasma metabolites to the risk of death and major adverse cardiovascular events (MACE) as well as left ventricular remodeling.ResultsIn a prospective study with 1606 Chinese patients with CAD, we have identified and validated several independent metabolic signatures through widely-targeted metabolomics. The predictive model respectively integrating four metabolic signatures (dulcitol, β-pseudouridine, 3,3ʹ,5-Triiodo-l-thyronine, and kynurenine) for death (AUC of 83.7% vs. 76.6%, positive IDI of 0.096) and metabolic signatures (kynurenine, lysoPC 20:2, 5-methyluridine, andl-tryptophan) for MACE (AUC of 67.4% vs. 59.8%, IDI of 0.068) yielded better predictive value than trimethylamine N-oxide plus clinical model, which were successfully applied to predict patients with high risks of death (P = 0.0014) and MACE (P = 0.0008) in the multicenter validation cohort. Mendelian randomisation analysis showed that 11 genetically inferred metabolic signatures were significantly associated with risks of death or MACE, such as 4-acetamidobutyric acid, phenylacetyl-l-glutamine, tryptophan metabolites (kynurenine, kynurenic acid), and modified nucleosides (β-pseudouridine, 2-(dimethylamino) guanosine). Mediation analyses show that the association of these metabolites with the outcomes could be partly explained by their roles in promoting left ventricular dysfunction.ConclusionsThis study provided new insights into the relationship between plasma metabolites and clinical outcomes and its intermediate pathological process left ventricular dysfunction in CAD. The predictive model integrating metabolites can help to improve the risk stratification for death and MACE in CAD. The metabolic signatures appear to increase death or MACE risks partly by promoting adverse left ventricular dysfunction, supporting potential therapeutic targets of CAD for further investigation.Graphical Abstract
Helmet noninvasive support for acute hypoxemic respiratory failure: rationale, mechanism of action and bedside application
Authors: Cesarano Melania , Grieco Domenico Luca , Michi Teresa , Munshi Laveena , Menga Luca S. , Delle Cese Luca , Ruggiero Ersilia , Rosà Tommaso , Natalini Daniele , Sklar Michael C. , Cutuli Salvatore L. , Bongiovanni Filippo , De Pascale Gennaro , Ferreyro Bruno L. , Goligher Ewan C. , Antonelli Massimo 
Published: October 2022

AbstractIntroductionHelmet noninvasive support may provide advantages over other noninvasive oxygenation strategies in the management of acute hypoxemic respiratory failure. In this narrative review based on a systematic search of the literature, we summarize the rationale, mechanism of action and technicalities for helmet support in hypoxemic patients.Main resultsIn hypoxemic patients, helmet can facilitate noninvasive application of continuous positive-airway pressure or pressure-support ventilation via a hood interface that seals at the neck and is secured by straps under the arms. Helmet use requires specific settings. Continuous positive-airway pressure is delivered through a high-flow generator or a Venturi system connected to the inspiratory port of the interface, and a positive end-expiratory pressure valve place at the expiratory port of the helmet; alternatively, pressure-support ventilation is delivered by connecting the helmet to a mechanical ventilator through a bi-tube circuit. The helmet interface allows continuous treatments with high positive end-expiratory pressure with good patient comfort. Preliminary data suggest that helmet noninvasive ventilation (NIV) may provide physiological benefits compared to other noninvasive oxygenation strategies (conventional oxygen, facemask NIV, high-flow nasal oxygen) in non-hypercapnic patients with moderate-to-severe hypoxemia (PaO2/FiO2 ≤ 200 mmHg), possibly because higher positive end-expiratory pressure (10–15 cmH2O) can be applied for prolonged periods with good tolerability. This improves oxygenation, limits ventilator inhomogeneities, and may attenuate the potential harm of lung and diaphragm injury caused by vigorous inspiratory effort. The potential superiority of helmet support for reducing the risk of intubation has been hypothesized in small, pilot randomized trials and in a network metanalysis.ConclusionsHelmet noninvasive support represents a promising tool for the initial management of patients with severe hypoxemic respiratory failure. Currently, the lack of confidence with this and technique and the absence of conclusive data regarding its efficacy render helmet use limited to specific settings, with expert and trained personnel. As per other noninvasive oxygenation strategies, careful clinical and physiological monitoring during the treatment is essential to early identify treatment failure and avoid delays in intubation.