bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of pediatric lateral condylar humerus fractures with closed reduction and percutaneous pinning
Authors: Xie Li-wei , Wang Juan , Deng Zhi-qiang , Zhao Ren-huan , Chen Wei , Kang Chi , Ye Jia-jun , Liu Xin , Zhou Ying , Shen Hai
Published: October 2020

Background: Lateral condylar humerus fractures (LCHFs) are the second most common pediatric distal humerus fractures. Open reduction and internal fixation is recommended for fractures displaced by more than 2 mm. Few studies described using closed reduction and percutaneous pinning (CRPP) for treating fractures with greater displacements. This study aims to explore the feasibility of CRPP in treating displaced LCHFs. Methods: All patients underwent attempted CRPP first. Once a satisfying reduction was obtained, as determined using fluoroscopy based on the relative anatomical position of the fragments, an intraoperative arthrogram was performed to further confirm the congruence of the articular surface of the distal humerus. Open reduction is necessary to ensure adequate reduction if the fracture gap is more than 2.0 mm on either anteroposterior view or oblique internal rotational view by fluoroscopy after CRPP. All included fractures were treated by a single pediatric surgeon.Results: Forty-six patients were included, 29 boys and 17 girls, with an average age of 5.2 years. Of these, 22/28 (78%) Jakob type II fractures and 14/18 (78%) Jakob type III fractures were treated with CRPP. All cases in Song stages II and III, 19/25 (76%) cases in Song stage IV, and 14/18 (78%) cases of Song stage Ⅴ were treated with CRPP. The remaining converted to open reduction with internal fixation. Overall, 36 of the 46 patients (78%) were treated with CRPP. The average pre-op displacement was 7.2 mm, and the average post-op displacement was 1.1 mm on the anteroposterior or oblique internal rotational radiograph in cases treated with CRPP. CRPP was performed in an average of 37 minutes. The average casting period was 4 weeks and the average time of pin removal was 6 weeks postoperatively. The average time of follow-up was 4 months. All patients achieved union, regardless of closed or open reduction. No infection, delayed union, cubitus varus or valgus, osteonecrosis of the trochlea or capitellum, or pain were recorded during follow-up. Conclusions: Closed reduction and percutaneous pinning effectively treats LCHFs with displacement more than 4 mm. More than 3/4 of Song stage V or Jakob type III patients can avoid an incision.
Anteroposterior lumbar spine X-ray of L5 lamina for screening of possibility of lower lumbar disc herniation in young adults
Authors: Jin Lin , Zhang Li , Guo Jialiang , Zhang Ruipeng , Yin Yingchao , Hou Zhiyong , Zhang Yingze
Published: October 2020

Purpose: This study investigated the association between the height of L5 lamina under anteroposterior lumbar spine X-ray and lower LDH, to determine its significance to the onset of LDH in young adults.Methods: We conducted a retrospective study of 160 patients aged 18 to 39 years with lower LDH and 160 healthy controls. The anteroposterior lumbar spine X-ray was used to image features of the L5 lamina. The height of L5 lamina (“h”) and of the space between L4 and S1 lamina (“H”) were measured. The difference in height of L5 lamina in each study group was assessed as the ratio of “h/H”.Results: There was no significant difference in sex, age, occupation type, body mass index (BMI), family history or smoking status (p>0.05) between LDH group and the control group. The mean ratio (95% CI) of “h/H” in LDH and control group was 0.28 (0.26, 0.31) and 0.35 (0.32, 0.38) respectively, with statistical difference (p<0.05). The diagnostic accuracy of “h/H” ratio was investigated using the receiver operating characteristic (ROC) curve. The area under the curve was 0.835 (95% CI 0.789, 0.881), using a cut-off of 0.315 (sensitivity 0.806, specificity 0.794). A decrease in the “h/H” ratio, showed an increasing linear trend in the protrusion proportion of L4/5 segments (Z=5.943, p<0.05).Conclusion: Young adults with developmental defects of L5 lamina are more likely to develop lower LDH. Assessment of “h/H” ratio could be used for screening or prediction of asymptomatic or mildly symptomatic lower LDH in young adults.
Does substrate colour affect the visual appearance of gilded medieval sculptures?Part II: SEM-EDX observations on gold leaf samples taken from medieval wooden sculptures
Authors: Wu Qing , Döbeli Max , Lombardo Tiziana , Schmidt-Ott Katharina , Watts Benjamin , Nolting Frithjof , Ganz David
Published: October 2020

In the previous paper (Part I), the colorimetry and interferometric microscopy measurements on modern gold leaf models have revealed that the visual appearance of a gilded surface, both burnished and unburnished, depends strongly on the substrate type, surface roughness and texture, but not on the colour of the substrate. In this second part, we investigate the materials compositions and technical specifications of medieval gold leaf through combining literature sources and materials analysis such as scanning electron microscopy coupled with energy dispersive X-ray analysis (SEM-EDX) on samples taken from gilded wooden sculptures. Our study shows that the late medieval gold leaf has a high purity of about 23.7 carat and has an average thickness of 160 nm (with a peak value of 138 nm), purer and thicker than the modern gold leaves studies in Part I. Supportive Rutherford backscattering spectrometry (RBS) measurements on gilded models confirms the accuracy and reliability of the SEM-EDX observations on the medieval gold leaf samples. We additionally present observations of a rarely recorded special variant of medieval gold leaf – “fine reinforced gold leaf”. Combined with the findings from Part I, we conclude that light penetrating the medieval gold leaf and reflected from the gilding substrate could not be a significant, or even perceptible contribution to the visual appearance of the gilding. We argue that the misconception surrounding the correlation between the substrate colour and the gilded surface appearance can be attributed to the historical development of gilding and polychromy technologies.
Residual polymer stabiliser causes anisotropic conductivity in metal nanoparticle 2D and 3D printed electronics
Authors: Trindade Gustavo , Wang Feiran , Im Jisun , He Yinfeng , Balogh Adam , Scurr David , Gilmore Ian , Tiddia Mariavitalia , Saleh Ehab , Pervan David , Turyanska Lyudmila , Tuck Christopher , Wildman Ricky , Hague Richard , Roberts Clive
Published: October 2020

Inkjet printing of metal nanoparticles (MNPs) allows for design flexibility, rapid processing and enables 3D printing of functional electronic devices through co-deposition of multiple materials. However, the performance of printed devices, especially their conductivity, is lower than those made by traditional manufacturing methods and is previously not fully understood. Here, we revealed that anisotropic electrical conductivity of printed MNPs is caused by organic residuals from MNPs inks. We employed a combination of electrical resistivity tests, morphological analysis and novel 3D nanoscale chemical analysis of printed devices using silver nanoparticles (AgNPs) to show that the polymer stabiliser polyvinylpyrrolidone (PVP) tends to concentrate between vertically stacked AgNPs layers as well as at dielectric/conductive interfaces. The understanding of organic residues behaviour in printed nanoparticles reveal potential new strategies to improve nanomaterial ink formulations for functional printed electronics.
An Indo-Pacific see-saw wobbles the Earth at intraseasonal timescales
Authors: Afroosa M , Rohith B , Paul Arya , Durand Fabien , Bourdallé-Badie Romain , Sree P.V. , de Viron Olivier , Ballu Valérie , Shenoi S.S.C.
Published: October 2020

Strong large-scale winds can relay their energy to the ocean bottom and elicit an almost immediate intraseasonal barotropic (depth independent) response in the ocean. The intense winds associated with the Madden-Julian Oscillation (MJO), over the tropical interface between the Indian Ocean and the Pacific Ocean (popularly known as Maritime Continent) generate significant basin-wide intraseasonal barotropic sea level variability in the tropical Indian Ocean. Here we show, using an ocean general circulation model and a network of in-situ bottom pressure recorders, that the concerted barotropic response of the Indian and the Pacific Ocean to these winds leads to an intraseasonal see-saw of oceanic mass in the Indo-Pacific basin. This global-scale mass shift is unexpectedly fast, as we show that the mass field of the entire Indo-Pacific basin is dynamically adjusted to MJO in a few days. We also explain how this near-global-scale MJO-induced oceanic phenomenon is the first signature from a climate mode that can be isolated into the Earth polar axis motion, in particular during the strong see-saw of early 2013.
A global assessment of drivers and risks associated with pollinator decline
Authors: Dicks Lynn , Breeze Tom , Ngo Hien , Senapathi Deepa , An Jiandong , Aizen Marcelo , Basu Parthiba , Buchori Damayanti , Galetto Leonardo , Garibaldi Lucas , Gemmill-Herren Barbara , Howlett Brad , Imperatriz-Fonseca Vera L. , Johnson Steven , Kovács-Hostyánszki Anikó , Kwon Y. , Lattorff Hans Michael , Lungharwo Thingreipi , Seymour Colleen , Vanbergen Adam , Potts Simon
Published: October 2020

Pollinator decline has attracted global attention, and substantial efforts are underway to respond, through national pollinator strategies and action plans. These policy responses require clarity on what is driving pollinator decline, and what risks it generates for society, in different parts of the world. Using a formal expert elicitation process, we evaluated relative regional and global importance of eight pressures driving pollinator decline, and ten consequent risks to human well-being. Our results indicate that global policy responses should focus on reducing pressure from changes in land cover and configuration, land management, and pesticides, as these were considered very important drivers in most regions. We quantify for the first time how the importance of drivers, and risks from pollinator decline, differ among regions. For example, losing access to managed pollinators was only considered a serious risk to people in North America, whereas yield instability in pollinator-dependent crops, classed as a serious or high risk in four regions, presented only moderate risk in Europe and North America. Overall, perceived risks were substantially higher in the Global South. Despite extensive, research on pollinator decline, our analysis reveals considerable scientific uncertainty about what this means for human society.
Early humans recipe for processing plants foods at Blombos Cave, South Africa (85-82 ka)
Authors: Larbey Cynthia , Niekerk Karen van , Henshilwood Christopher , Jones Martin
Published: October 2020

We present the results of archaeobotanical research conducted into the plant diet of early modern humans who intermittently occupied Blombos Cave on the southern Cape coast of South Africa during the Middle Stone Age (MSA). Botanical samples were taken from two combustion events in the MSA sequence dated to 85 and 82 kya (kya = thousands of years ago). Analysis of these samples shows charred starchy plants had undergone processing sequences prior to cooking. The plant cells show evidence of having been pounded whilst still fresh and some of these fragments indicate pounded starchy plant food was mixed with pounded seeds prior to cooking. We infer that these samples represent the earliest known example of food processing and mixing in a ‘recipe’ as part of early human foodways. We consider these findings and their role in human evolution in the context of human behavioural modernity.
Sustained methane emissions from China after 2012 despite declining coal production and rice-cultivated area
Authors: Sheng Jianxiong , Tunnicliffe Rachel , Ganesan Anita , Maasakkers Joannes , Shen Lu , Prinn Ronald , Song Shaojie , Zhang Yuzhong , Scarpelli Tia , Bloom Alexis , Rigby Matt , Manning Alistair , Parker Robert , Boesch Hartmut , Lan Xin , Zhang Bo , Zhuang Minghao , Lu Xi
Published: October 2020

China's anthropogenic methane emissions are the largest of any country in the world. A recent study using atmospheric observations suggested that recent policies aimed at reducing emissions of methane due to coal production in China after 2010 had been largely ineffective. Here, based on a longer observational record and an updated modelling approach, we find that China's growth in methane emissions did decline (0.3±0.1 (±1σ) Tg CH4 yr-2 for 2012-2017, as compared to 0.77±0.2 Tg CH4 yr-2 for 2010-2012). We find that the decrease in growth rate after 2012 can in part be attributed to a decline in China's coal production. However, coal mine methane emissions have not declined as rapidly as production, implying that there may be substantial fugitive emissions from abandoned coal mines that have previously been overlooked. We also find that emissions over rice-growing regions do not show a negative trend (0.13±0.05 Tg CH4 yr-2 for 2010-2017) despite reports of shrinking rice paddy areas, implying potentially significant emissions from new aquaculture activities, which are thought to be primarily located on converted rice paddies.
Assessing information-sharing networks within small-scale fisheries and the implications for conservation interventions
Authors: Arlidge William , Firth Josh , Alfaro-Shigueto Joanna , Ibanez-Erquiaga Bruno , Mangel Jeffrey , Squires Dale , Milner-Gulland EJ
Published: October 2020

The effectiveness of biodiversity conservation interventions is often dependent on local resource users' underlying social interactions. However, it remains unclear how fine-scale differences in information shared between resource users can influence network structure and the success of behavior-change interventions. Using network null models that incorporate a pre-network data permutation procedure, we compare information-sharing networks in a Peruvian fishing community where a trial conservation intervention is underway to reduce the incidental capture of sea turtles (bycatch). We show that the general network structure detailing information sharing about sea turtle bycatch differs from other fishing-related information sharing, specifically in degree assortativity and eccentricity. This finding highlights the importance of assessing social networks in contexts directly relevant to the desired intervention and that fine-scale differences in the information shared between resource users may influence network structure. Our findings also demonstrate how null model approaches developed in the ecological sciences can elucidate important differences between human networks and identify the social contexts which might be more or less appropriate for information-sharing related to conservation interventions.
Fluid Proteomics of CSF and Serum Reveal Important Neuroinflammatory Proteins in Blood-Brain Barrier Disruption and Outcome Prediction Following Severe Traumatic Brain Injury: A Prospective, Observational Study
Authors: Lindblad Caroline , Pin Elisa , Just David , Nimer Faiez Al , Nilsson Peter , Bellander Bo-Michael , Svensson Mikael , Piehl Fredrik , Thelin Eric Peter
Published: October 2020

Background: Severe traumatic brain injury (TBI) is associated with blood-brain barrier (BBB) disruption and a subsequent neuroinflammatory process. We aimed to perform a multiplex screening of brain enriched and inflammatory proteins in blood and cerebrospinal fluid (CSF) in order to study their role in BBB disruption, neuroinflammation and long-term functional outcome in TBI patients and healthy controls. Methods: We conducted a prospective, observational study on 90 severe TBI patients and 15 control subjects. Clinical outcome data, Glasgow Outcome Scale, was collected after 6-12 months. We utilized a suspension bead antibody array analyzed on a FlexMap 3D Luminex platform to characterize 177 unique proteins in matched CSF and serum samples. In addition, we assessed BBB disruption using the CSF-serum albumin quotient (QA), and performed Apolipoprotein E-genotyping as the latter has been linked to BBB function in the absence of trauma. We employed pathway-, cluster-, and proportional odds regression analyses.Results: TBI patients had an upregulation of structural and neuroinflammatory pathways in both CSF and serum. In total, 114 proteins correlated with QA, among which the top-correlated proteins were complement proteins. A cluster analysis revealed protein levels to be strongly associated with BBB integrity, but not carriage of the Apolipoprotein E4-variant. Among cluster-derived proteins, innate immune pathways were upregulated. Forty unique proteins emanated as novel independent predictors of clinical outcome, that individually explained ~10% additional model variance. Among proteins significantly different between TBI patients with intact or disrupted BBB, complement C9 in CSF (p = 0.014, ΔR2 = 7.4%) and complement factor B in serum (p = 0.003, ΔR2 = 9.2%) were independent outcome predictors also following step-down modelling. Conclusions: This represents the largest concomitant CSF and serum proteomic profiling study so far reported in TBI, providing substantial support to the notion that neuroinflammatory markers, including complement activation, predicts BBB disruption and long-term outcome. Individual proteins identified here could potentially serve to refine current biomarker modelling or represent novel treatment targets in severe TBI.
Prevalence of Abnormal Umbilical Arterial Flow on Doppler Ultrasound in Low-risk and Unselected Pregnant Women: A Systematic Review
Authors: Vogel Joshua Peter , Vannevel Valerie , Robbers Gianna , Gwako George , Lavin Tina , Adanikin Abiodun , Hlongwane Tsakane , Pattinson Robert C , Qureshi Zahida P. , Oladapo Olufemi T.
Published: October 2020

Background: While Doppler ultrasound screening is beneficial for women with high-risk pregnancies, there is insufficient evidence on its benefits and harms in low- and unselected-risk pregnancies. This may be related to fewer events of abnormal Doppler flow, however the prevalence of absent or reversed end diastolic flow (AEDF or REDF) in such women is unknown. In this systematic review, we aimed to synthesise available data on the prevalence of AEDF or REDF.Methods: We searched PubMed, Embase, CINAHL, CENTRAL and Global Index Medicus with no date, setting or language restrictions. All randomized or non-randomized studies reporting AEDF or REDF prevalence based on Doppler assessment of umbilical arterial flow >20 weeks’ gestation were eligible. Two authors assessed eligibility and extracted data on primary (AEDF and REDF) and secondary (fetal, perinatal, and neonatal mortality, caesarean section) outcomes, with results presented descriptively. Results: A total of 42 studies (18,282 women) were included. Thirty-six studies reported zero AEDF or REDF cases. However, 55 AEDF or REDF cases were identified from just six studies (prevalence 0.08% to 2.13%). Four of these studies were in unselected-risk women and five were conducted in high-income countries. There was limited evidence from low- and middle-income countries.Conclusions: Evidence from largely observational studies in higher-income countries suggests that AEDF and REDF are rare among low- and unselected-risk pregnant women. There are insufficient data from lower-income countries and further research is required.
Analysis on Bouguer Gravity Anomaly Characteristics and Boundary Identification in China and Surrounding Regions
Authors: Xue Zhixin , Guo Dongmei , Zhang Panpan
Published: October 2020

China is located in the southeast of the Eurasian Plate and is subject to the effects of subducting, squeezing and collision by the Pacific Plate to the east, Philippine Plate to the southeast and Indian Ocean Plate to the southwest. It has exceptional geotectonic structure. Based on the satellite gravity data with high precision, high resolution and ample geophysical information, combined with geological data, by using satellite gravity potential field and its full tensor gradient, this paper studies the distribution characteristics of gravity anomalies and the identification of tectonic boundaries in China and surrounding regions. Results suggest that the Bouguer gravity anomaly in eastern China reduces gradually from east to west, mostly in the direction of NNE; in the western, it reduces gradually in a wave mode from north to south, mainly in the directions of NW and NWW. In general, the stress field reduces gradually from west to east, and the tectonic of stress field in western China is complex. The maximum principal compressive stress in Xinjiang exists in SN direction and that in Qinghai-Tibet Plateau mostly changes gradually from NNE to SSE; the change in eastern China is relatively simple, and the maximum principal compressive stress direction gradually changes from NE to WE and then to SE. In addition to the above study results, by comprehensively referencing the previous studies by other people and by using the boundary identification methods based on the satellite gravity full-tensor gradient data and its combinations, we update the extension route of Red River fault zone and deduce the tectonic unit boundary between the North China and South China active tectonic block regions. This paper identifies in China and surrounding regions 6 primary active tectonic blocks, 22 secondary active tectonic blocks, 3 tertiary active tectonic blocks and the 20 active tectonic block boundary zones constituted of deformation belts and active tectonic belts with various geometric structures and width variations. The results of this study can improve the understanding of gravity anomalies and boundary structures in China and surrounding regions, and provide certain geophysical supports for geological structure analysis and crustal dynamic process.
Diabetes Distress, Depressive Symptoms and Type 2 Diabetes Management and Glycemic Control: The Mediating Role of Self-Efficacy
Authors: Gao Yuexia , Han Yarong , Zou Xin , Xu Judy , Mawen Dean Getrude , Zhong Yaqing , Lun qingyun , Chu Minjie , Ma Qiang , Zhuang Xun , Xiao Jing
Published: October 2020

BackgroundDiabetes distress has been distinguished from depressive symptoms in the linkages to type 2 diabetes management and glycemic control. There are few evidences in rural China untangled the underlying pathways among them. The aim of our study was to examine whether self-efficacy reduced the detrimental effects of psychological variables on diabetes outcomes such as self-care behaviors, glycemic control and health-related quality of life (HRQoL).Methods1574 adults diagnosed with type 2 diabetes from 31 rural clinics in China were assessed for psychological variables, self-management and HRQoL. Hemoglobin A1c (HbA1c) data at 6 months after the survey were extracted from electronic medical records. Hierarchical regression model examined independent effects of psychological variables, self-efficacy on diabetes outcomes. KHB method and bootstrapping confidence intervals were employed to test the mediating effect of self-efficacy.ResultsHierarchical regression analysis showed both diabetes distress and depressive symptoms were significantly related to diet and HRQoL, but not related to glycemic control and medication adherence. Depressive symptoms, but not diabetes distress, was directly associated with physical activity. Mediation analysis demonstrated self-efficacy mediated the relationships of both diabetes distress and depressive symptoms on self-care behaviors, glycemic control and HRQoL.ConclusionsSelf-efficacy may contribute to better diabetes outcome by ameliorating the effects of diabetes distress and depressive symptoms. Patients with psychological conditions may need tailored intervention that enhance self-efficacy to improve diabetes management.
A Transparent Dialogue Between Iconography and Chemical Characterisation: A Set of Foreign Stained Glasses in Portugal
Authors: Rodrigues Alexandra J. , Coutinho Mathilda Larsson , Machado Andreia , Martinho Bruno A. , Alves Luís Cerqueira , Macedo Maria Filomena , Vilarigues Márcia
Published: October 2020

This work presents the first results of the iconographic study and analytical characterisation of a set of four stained-glass panels that are part of the collection of National Palace of Pena (Sintra, Portugal). These panels were collected by the King Ferdinand II in the mid-19th century, for his main residence the Palace of Necessidades (Lisbon, Portugal), and only first presented to the general public in 2011. This study contributes with the knowledge of Technichal Art History and Heritage Science to a better and deeper understanding of their history, materials and techniques used in the production, where an art-historical and a scientific approach are applied to attribute their origins. Based on the analysis of the formal and stylistic characteristic of the panels, it is proposed that the drawings used for the production of three of these panels may be based on the design and painting being carried out in the same workshop, and that the four panels have the same provenance (Germany). The composition of the glass and grisaille was determined and colourising elements were identified. Through this approach, conclusive correlation among the analysed glasses was possible: all are calcium rich or calcium-potassium rich types, and the results also suggest that the same source of silica was used for their production. A typical mixture of glass and lead oxide was found on the grisaille applied on the painted panels. However, less usual was the use of a copper oxide pigment for the black grisaille. All these findings support the proposals made regarding provenance and production period (15th century).
How is Organisational Fit Addressed in Australian Entry Level Midwifery Job Advertisements
Authors: Bloxsome Dianne , Glass Courtney , Bayes Sara
Published: October 2020

Background Midwifery job retention is an ongoing global issue. Prior research has recognised that considering an individual’s attributes in relation to their work environment may assist in improving job satisfaction among midwives, leading to improved long-term job retention in the midwifery profession. The aim of this study was to evaluate whether, and how organisational fit is addressed in current entry level midwifery job advertisements within Australia. Methods Midwifery jobs were searched for within 12 search engines, using the search term ‘midwife’, including Seek.com, Indeed.com, government employment websites for all Australian states and territories, and private health organisation websites. Data were extracted from eligible job advertisements by three independent researchers. Extracted data encompassed elements addressing person-job fit and person-organisation fit. Content analysis involving chi-square and Fischer exact tests were completed on extracted data. Results Key findings demonstrate private health care organisations (29.2%) are more likely than public health care organisations (8.8%) to ask potential candidates to have additional qualifications, however, public health care organisations (34.1% vs. 16.7%) are more likely to ask for dual registration as a midwife and nurse. This is further supported by private health care organisations being more likely to refer to the candidate as a midwife (72.9% vs. 48.4%) than as a nurse. Private health care organisations more often noted access to support for employees and were more likely to mention access to employee assistance programs (41.7% vs. 13.2%), orientations (16.7% vs. 0%) and included benefits (72.9% vs. 42.9%). Clinical skills and personality traits were more frequently addressed in public health organisation advertisements; these included a requirement of employees to be accountable (49.5% vs. 6.3%), innovative (28.6% vs. 0%), have teamwork (69.2% vs. 52.1%) and conflict resolution skills (36.3% vs. 8.3%), and have knowledge of legislation (44.0% vs. 25.0%) and contemporary midwifery issues (28.6% vs. 4.2%). Conclusion This study highlights that organisations employing midwives may be unwittingly contributing to the problem of midwife attrition through inattention to factors that endear midwives to workplaces in job advertisements. Further work developing employee selection and recruitment processes that are informed by the concept of person-job-organisation fit, is necessary.
Co-location of Out of Hours Primary Care and Emergency Department in Belgium: Patients’ and Physicians’ View
Authors: Schoenmakers Birgitte , Criekinge Jasper Van , Boeve Timon , Wilms Jonas , Mullen Chris Van Der , Sabbe Marc
Published: October 2020

Background In Belgium, General Practitioner Cooperatives (GPC) aim to improve working conditions for unplanned care and to reduce the number of inappropriate emergency visits. Although this system is well organised, the number of inappropriate visits does not decrease. Methods We explored the position of patients and physicians on the co-location of a GPC and an emergency service for unplanned care. The study was carried out in a cross section design in primary and emergency care services, including patients and physicians. Main outcome measures were the position of patients and physician on co-location a GPC and an emergency service. Results 404 patients and 488 physicians participated. 334 (82.7%) of all patients favored a co-location. The most important advantages were fast service (104, 25.7) and adequate referral (54, 13.4%). 237 (74%) of the GP’s and 38 (95%) of the emergency physicians were in favor of a co-location. The major advantage of this system was a more adequate referral of patients. 254 (79%) of the GP’s and 23 (83%) of the emergency physicians believed that a co-location would lower the workload, decrease waiting time and increase care quality (resp. 251 (78%), 224 (70%) and 37 (93%), 34 (85%). Conclusions To meet all concerns and to reach for high care quality information campaigns and development of workflows are necessary for a successful implementation of a co-location of primary and emergency care.
A Meta-Analysis of HDL Cholesterol Efflux Capacity and Concentration in Patients With Rheumatoid Arthritis
Authors: Xie Binbin , He Jiang , Liu Yong , Liu Ting , Liu Chaoqun
Published: October 2020

Background: Poor cholesterol efflux capacity (CEC) has been proposed to be an independent risk factor for cardiovascular diseases. However, the current evidences in the literature are inconsistent. This meta-analysis aimed to identify whether CEC is impaired or altered by drug therapy in individuals with rheumatoid arthritis (RA).Methods: The PubMed, Embase, and Cochrane library databases were searched to identify studies on CEC in RA patients. The searches were focused on studies in human subjects that were published before 10 Sep 2020, without language restrictions. The primary outcomes were CEC and the high-density lipoprotein cholesterol (HDL-C) and C-reactive protein levels (CRP).Results: A total of 11 eligible articles, including 6 observational and 5 intervention studies, were retrieved. The pooled results showed that CEC is not significantly lower in RA patients than in healthy controls (SMD: -0.34, 95% CI: -0.83 to 0.14), whereas the plasma HDL-C level is not significantly lower HDL-C levels (WMD: -3.91, 95% CI: -7.15 to -0.68). Furthermore, in the before-after studies, the CEC of RA patients (SMD: 0.20, 95% CI: 0.02 to 0.37) increased, but the plasma HDL-C level (WMD: 3.63, 95% CI: -0.13 to 7.39) remained at a similar level after anti-rheumatic treatment compared to the baseline. In addition, the funnel plot was relatively symmetric and did not suggest the presence of publication bias.Conclusion: The current meta-analysis demonstrated that HDL-mediated CEC can be improved by the early control of inflammation and anti-rheumatic treatment in RA patients, which is independent of HDL-C levels. Future research is needed to determine whether therapeutic strategies to enhance CEC in RA patients have beneficial effects for preventing CVD.
Cumulative Risk Exposure and Emotional Symptoms among Early Adolescent Girls
Authors: Demkowicz Ola , Panayiotou Margarita , Humphrey Neil
Published: October 2020

BackgroundFrom early adolescence, girls and women report the highest rates of emotional symptoms, and there is evidence of increased prevalence in recent years. We investigate risk factors and cumulative risk exposure (CRE) in relation to emotional symptoms among early adolescent girls.MethodsUsing structural equation modelling, risk factors were identified in relation to symptoms and collated into a CRE index to investigate associations among 8,327 girls aged 11–12 years.ResultsFour risk factors were identified: Low academic attainment, special educational needs, low family income, and caregiving responsibilities. CRE was positively associated with symptoms.ConclusionsFindings offer insight into the epidemiology of emotional symptoms among adolescent girls during a vulnerable period, offering a timely contribution given current evidence of increased prevalence. Results suggest that several factors in day-to-day life are associated with emotional symptoms among early adolescent girls. Furthermore, early adolescent girls experiencing higher CRE are likely to experience greater emotional distress, highlighting the need for identification and intervention for of those facing greater adversity in daily life.
The Time-varying Networks of the Wrist Extension in Post-stroke Hemiplegic Patients
Authors: Li Fali , Jiang Lin , Li Yuqin , Huang Dongfeng , Jiang Yuanling , Peng Yueheng , Zhang Xiabing , Yao Dezhong , Xu Peng , Li Hai
Published: October 2020

Background: Hemiplegia is a common dysfunction caused by a stroke and leads to movement disability. Although the movement-related oscillation, the lateralization of the movement-related potential, and the event-related desynchronization have been investigated, the dynamic network modalities related to the movements in post-stroke hemiplegic patients are still left unveiled. Methods: In our present study, we designed the motor execution task of the wrist extension, collected the movement-related electroencephalograms, and adopted the adaptive directed transfer function to investigate the dynamic motor networks in post-stroke hemiplegic patients. The corresponding time-varying networks of the wrist extension in post-stroke hemiplegic patients were constructed and then statistically explored. Results: The results demonstrated that the effective connectivity between the stroked motor area and other areas decreased. In contrast, connectivity between non-stroked motor area and other areas was enhanced, especially the frontal and parietal-occipital lobes, to compensate for the dysfunction of the motor behaviors of the stroked patients.Conclusions: These findings help us better understand the time-varying networks underlying the implementation of the motor behaviors of the patients with post-stroke hemiplegia and might provide a reliable biomarker to predict their future rehabilitation.
A Structured Program for Teaching Pancreatojejunostomy Outside the Operating Room
Authors: Oshiro Kenichi , Endo Kazuhiro , Morishima Kazue , Kaneda Yuji , Koizumi Masaru , Sasanuma Hideki , Sakuma Yasunari , Lefor Alan Kawarai , Sata Naohiro
Published: October 2020

Background: Pancreatojejunostomy (PJ) is one of the most difficult and challenging abdominal surgical procedures. Most trainees learn this procedure in the operating room (OR) because there are no appropriate training systems available outside the OR. This extends the learning curve and may affect patient safety. We developed a structured program for teaching PJ to increase training opportunities outside the OR. Methods: We have created this structured program to help trainees acquire both didactic knowledge and technical skills to perform PJ. A manual was created to provide general knowledge about PJ and the specific PJ procedure used in our institution. Based on questionnaires completed by trainers and trainees, the procedure for PJ was divided into twelve steps and described in detail. After creating the manual, we developed organ models, needles and a frame box for simulation training.Results: Trainees learn about PJ by reading the procedure manual, acquiring both general and specific knowledge. We conducted simulation training outside the OR using the training materials created for this system. Training was performed with participants referring to the procedure manual while performing the simulation training. They simulate the procedure with surgical instruments as both primary and assistant surgeon. After finishing the anastomosis, trainees inspect the resulting structures from all angles including the posterior side and intraluminally, which cannot be observed during the actual operation. Conclusion: We developed a structured program for teaching PJ. By implementing this program, it is expected that a trainee’s learning curve will be shortened while ensuring patient safety.
Three-dimensional Camera Systems Assistant the Sheath of Prostate Preservation Laparoscopic Radical Prostatectomy: Technique and Initial Experience
Authors: Song Lingmin , Wang Gang , Gao Wenbo , Yang Yusheng , Weng Guobin
Published: October 2020

Background: To report our refinement of laparoscopic radical prostatectomy by preservation of the sheath of prostate (SPP-LRP) and 1-year follow-up results.Methods: SPP-LRP was performed in 39 consecutive patients diagnosed as clinically localized prostate cancer from January 2016 to December 2018. The inclusion criteria consisted of Gleason score ≤7, tPSA＜10 ng/ml, positive in no more than 3 in 12 needles by systematical puncture biopsy, less than 50% tumor core involvement, clinical stage T1-2, good potency. The oncological results were identified by postoperative pathology test. Functional outcomes, including continence and potency, were followed postoperatively.Results: The mean operation time was 108.3±35.2 min and the mean estimated blood loss was 129.3±46.4 ml with no transfusion. The catheter was removed 7 days after the surgery. There were no relevant postoperative complications requiring intervention. The histopathological results showed 2 cases (6.1%) in pT2 and 1 case (16.7%) in pT3 presented positive resection margins for tumor (R1). Only 1 case (pT3a,Gleason score 8) suffered pelvic lymph node metastasis. No biochemical relapse was observed after 1-year follow-up. The continence rates were 71.8% and 87.2% after 1 and 3 months, and no patients suffered G2 incontinence after 6 months , and 97.4% recovered continence after 12 months. The potency rates were 61.5% and 82.1% after 1 and 3 months, and that was 92.3% after 12 months. Conclusion:SPP-LRP is a practical and worth-promoting technique for RP. The initial results are preferable and promising in technical, oncological and functional aspects.
Validation of a newly developed competency assessment tool for the Posterior Sagittal Anorectoplasty
Authors: Joosten Maja , Bökkerink Guus MJ , Sutcliffe Jonathan , Levitt Marc A , Diefenbach Karen A , Reck Carlos A , Krois Wilfried , Blaauw Ivo de , Botden Sanne MBI
Published: October 2020

Background: The correction of an anorectal malformation (ARM) is highly complex and relatively infrequent. Simulation training and subsequent assessment of its effectiveness may result in better clinical outcomes. Assessment can be done using a CAT to assess surgical skills of a specific procedure. This study aims to develop and validate a competency assessment tool (CAT) for the posterior sagittal anorectoplasty (PSARP) for the repair of anorectal malformation. Methods: The CAT-PSARP was developed after consultation with experts in the field. The PSARP was divided into five steps, while general skills (tissue and instrument handling) were scored separately. During several pediatric colorectal hands-on courses in 2019 and 2020 participants were asked to voluntarily participate. They performed one PSARP procedure on an ARM simulation model, while being assessed by two objective observers using the CAT-PSARP.Results: A total of 82 participants were enrolled. Intra-class correlation coefficient analysis demonstrated a fair inter-observer agreement for ‘total score of general skills’ (ICC =0.524, p<0.001), a good agreement for ‘total score of specific skills’ (ICC=0.646 , p<0.001) and ‘total score overall’ (ICC=0.669, p<0.001). When comparing the experienced with the inexperienced group a significantly higher score for the experienced group was found for all steps (p=0.013 to p<0.001), except for step 5 ‘anoplasty’ (p=0.440). Conclusion: Good inter-observer agreement was found for the total scores of the CAT-PSARP. It is a suitable objective assessment tool for the overall performance of the included steps of the PSARP for repair of an ARM.
Pathologic Response Rates for Breast Cancer Stages as a Predictor of Outcomes in Patients Receiving Neoadjuvant Chemotherapy Followed by Breast-Conserving Surgery
Authors: Zhang jiaqiang , Lu Chang-Yun , Chen Ho-Min , Wu Szu-Yuan
Published: October 2020

PURPOSE: To determine easy-to-use predictors of overall survival (OS), locoregional recurrence (LRR), and distant metastasis (DM) in patients with breast invasive ductal carcinoma (IDC) receiving neoadjuvant chemotherapy (NACT) followed by breast-conserving surgery (BCS), we obtained pathologic response rates (PRRs) for combined primary and nodal diseases (American Joint Committee on Cancer [AJCC] stages) from clinical and pathologic reports, and we used these as predictors.PATIENTS AND METHODS: We enrolled patients with IDC who had received NACT followed by BCS. Cox regression analysis was used to calculate hazard ratios (HRs) and confidence intervals (CIs) for the patients’ PRRs; other independent predictors were controlled for or stratified in the analysis.RESULTS: We analyzed 1047 patients with IDC (611, 260, and 176 patients in clinical stages IIB, IIIA, and IIIB-C, respectively) receiving NACT and BCS. After multivariate Cox regression analyses, the adjusted HRs (aHRs; 95% CI) in patients with pathologic complete response (ypT0N0) were 0.26 (0.13–0.56), 0.36 (0.15–0.85), and 0.15 (0.08–0.31) for all-cause mortality, LRR, and DM, respectively. The aHRs (95% CI) in patients with downstaging of AJCC stages were 0.55 (0.35–0.89), 0.91 (0.62–0.96), and 0.63 (0.43–0.91) for all-cause mortality, LRR, and DM, respectively. The aHRs (95% CI) in patients with upstaging of AJCC stages were 1.77 (1.06–2.24), 1.08 (1.03–1.82), and 1.19 (1.07–2.01) for all-cause mortality, LRR, and DM, respectively.CONCLUSION: The impacts of AJCC-stage PRRs are useful predictive tools and strong predictors for OS, LRR, and DM in patients with breast IDC receiving NACT followed by BCS.
Comparison the Efficacy of Intranasal Ketamine Versus Intravenous Ketorolac on Acute Non-traumatic Headaches: A Randomized Double-Blind Clinical Trial
Authors: Sarvari Houman Rafiee , Baigrezaii Hamidreza , Nazarianpirdosti Mohammad , Meysami Amirhossein , Safari-Faramani Roya
Published: October 2020

Introduction: Non - traumatic headaches are one of the most common causes of referral to hospital emergency. This study aimed to compare the efficacy of intranasal ketamine and intravenous ketorolac on acute non-traumatic headaches.Methods: This randomized and double-blind clinical trial in 2019 years. 140 people were randomly divided into intranasal ketamine (A) and intravenous ketorolac (B). Group (A) received ketamine intranasal (0.75 mg/kg, max 75mg), and group B received intravenous ketorolac (30 mg). Headache severity was measured on arrival, 30, 60, and 120 minutes after intervention with Visual Analogue Scale (VAS). The side effects were recorded an hour after the intervention.Result: The mean difference of pain intensity 30, 60, and 120 minutes after the intervention between the two groups were statistically significant (p<0.001). In the first 30 minutes, significant changes were observed in the VAS levels of the two groups. These changes were more and significant in the intranasal ketamine group (p <0.001). Side effects such as fatigue, dizziness, public discomfort, nausea, increased heart rate, and hypertension were significantly higher in the ketamine group (p <0.05).Conclusion: Intranasal ketamine and intravenous ketorolac both effectively reduced headaches. However, more analgesic effects of intranasal ketamine in a short time can be considered as a selective approach to reducing headaches.Trial registration: IRCT20180108038276N3, Registered 29 September 2019.
Homelessness and Health: A Retrospective Analysis of Medical Records From 2006 - 2020 to Explore the Health and Social Situation of Homeless People in Berlin. A Study Protocol
Authors: Lech Sonia , Schenk Liane , Castro Jenny De la Torre , Schindel Daniel
Published: October 2020

Background: Homelessness is often described as both a driver and a consequence of poor health, social exclusion and economic marginalisation. The present protocol provides a detailed description of the study Examining the health situation of homeless people in Berlin: a retrospective analysis of data from the health centre for the homeless of the Jenny De la Torre Foundation from 2006 to 2020 (GIG study). The primary objective of the GIG study is to describe and analyse the social and health situation of homeless people in Berlin. Methods: A retrospective secondary data analysis of an anonymous full census of medical records for the years 2006 until 2020 from a health centre for homeless people will be carried out. The main outcome is the description and analysis of the social and health situation of homeless people in Berlin. Total and cross-sectional sample characteristics will be presented in a descriptive analysis using Chi-Square Test, Mann-Whitney-U-Test or independent t-Test as appropriate to test (sub)group differences. Further, outcomes will be analysed using finite mixture modelling in order to distinguish different types of social and health conditions. Latent variable regressions will be applied in order to identify sociodemographic and disease-related factors associated with decreasing health conditions.Discussion: Given the high number of homeless individuals in Germany, it is of great importance to examine their social and health situation in order to gain a better understanding of challenges and needs of homeless people and work on new approaches and solutions to effectively address these.Trail Registration: The study was prospectively registered with the German Clinical Trials Register (trial registration number: DRKS00021172). Registered 26 June 2020, https://www.drks.de/DRKS00021172
The Correlation Between Endotoxin, D-Lactate and Diamine Oxidase With Endoscopic Activity in Inflammatory Bowel Disease
Authors: Zhang Qi , Chen Xi , Chen Min
Published: October 2020

Background & Objective: The disease activity monitoring of inflammatory bowel disease (IBD) plays a crucial role for making therapeutic strategies. Endoscopy has been recognized as a gold standard for evaluating disease activity of IBD. However, this method is invasive. Currently, a noninvasive biomarker that could replace endoscope is needed in clinical practice. In this study, we examined whether the diamine oxidase (DAO), D-lactate and endotoxin (ETX) could monitor the disease activity and predict endoscopic remission in patient with IBD. Methods: A total of 149 eligible IBD patients (82CD and67UC) who had received both endoscopic examination and intestinal barrier function detection in our hospital were enrolled in this study. Endoscopic activity was estimated by the Simple Endoscopic Score (SES-CD) for Crohn’s disease, and the ulcerative colitis endoscopic index of severity (UCEIS) for ulcerative colitis. The predictive value and optimal predictive thresholds for those biomarkers were determined by Receiver operating characteristic analysis.Results: For UC patients, DAO, D-lactate and ETX showed better correlation with UCEIS than ESR and CRP, and exhibited satisfactory predictive value in predicting remission. Among patients with CD, DAO and ETX not only showed a better correlation than ESR and CRP with SES-CD, but also capacity to identify more severe patients.Conclusion: DAO and ETX could be used to distinguish different endoscopic activity of CD. DAO, D-lactate and ETX could predict UC endoscopic remission.