bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient-Specific Risk Adjustment Improves Comparison of Infection Rates Following Posterior Fusion for Adolescent Idiopathic Scoliosis
Authors: Newton Peter O. , Bastrom Tracey P. , Yaszay Burt 
Published: November 2019

Background:
There is increasing interest in surgeon “performance measures.” Understanding patient factors that increase the risk of adverse events is important for the comparison of such metrics among surgeons and centers. The purpose of this study was to ascertain whether patient characteristics, beyond the control of the surgeon, were associated with increased risk of postoperative infection following posterior spinal fusion for the correction of adolescent idiopathic scoliosis (AIS) and to establish a “risk-adjusted” method of reporting postoperative infection rates.

Methods:
We reviewed the data of patients from 14 participating scoliosis treatment centers who experienced an infection within 90 days following posterior spinal fusion for the treatment of AIS. Patients with a deep infection (irrigation and debridement performed) were compared with those without an infection with regard to age, sex, body mass index (BMI) percentile for age, Lenke classification of curve type, primary curve magnitude, and estimated 3-dimensional sagittal kyphosis (T5-T12). A regression model was created to identify variables that were associated with infection, and the performance of the risk model was evaluated. The actual infection rate by site was divided by the predicted infection rate for that site and multiplied by the overall rate to create a risk-adjusted rate.

Results:
Of 2,122 patients analyzed, 21 (1.0%) had an infection within 90 days following surgery. Obesity was the only significant risk factor (odds ratio [OR], 7.6; p ≤ 0.001), with the resultant model demonstrating good discrimination and calibration. For the 8 sites that enrolled ≥100 patients, the predicted infection rates based on the proportion of obese patients ranged from 0.8% to 1.2%. The range of the risk-adjusted infection rates varied more substantially, from 0.2% to 2.0%.

Conclusions:
For the posterior approach to surgical correction of AIS, the only identified patient risk factor for postoperative infection was a BMI percentile for age of ≥95%. To assess infection rates, we suggest adjusting for the proportion of obese patients in the cohort. A risk-adjusted infection rate for posterior spinal fusion with instrumentation for AIS allows for more accurate assessment of performance and comparison among centers.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Vigorous cool room treadmill training to improve walking ability in people with Multiple Sclerosis using ambulatory assistive devices: A feasibility study.
Authors: Devasahayam Augustine J , Chaves Arthur R , Lasisi Wendy O , Curtis Marie E , Wadden Katie P , Kelly Liam P , Pretty Ryan , Chen Alice , Wallack Elizabeth M , Newell Caitlin J , Williams John B , Kenny Hannah , Downer Matthew B , McCarthy Jason , Moore Craig S , Ploughman Michelle 
Published: November 2019

Abstract
Background: Aerobic training has the potential to restore function, stimulate brain repair, and reduce inflammation in people with Multiple Sclerosis (MS). However, disability, fatigue, and heat sensitivity are major barriers to exercise for people with MS. We aimed to determine the feasibility of conducting vigorous harness-supported treadmill training in a room cooled to 16°C (10 weeks; 3times/week) and examine the longer-term effects on markers of function, brain repair, and inflammation among those using ambulatory aids. Methods: Ten participants (9 females) aged 29 to 74 years with an Expanded Disability Status Scale ranging from 6 to 7 underwent training (40 to 65% heart rate reserve) starting at 80% self-selected walking speed. Feasibility of conducting vigorous training was assessed using a checklist, which included attendance rates, number of missed appointments, reasons for not attending, adverse events, safety hazards during training, reasons for dropout, tolerance to training load, subjective reporting of symptom worsening during and after exercise, and physiological responses to exercise. Functional outcomes were assessed before, after, and 3 months after the completion of training. Walking ability was measured using Timed 25 Foot Walk test and on an instrumented walkway at both fast and self-selected speeds (stance (%), swing (%), double support (%)). Fatigue was measured using standardized questionnaires (fatigue/energy/vitality sub-scale of 36-Item Short-Form (SF-36) Health Survey, Fatigue Severity Scale, modified Fatigue Impact Scale). Aerobic fitness (maximal oxygen consumption) was measured using maximal graded exercise test (GXT). Quality-of-life was measured using SF-36 Health Survey. Serum levels of neurotrophin (brain-derived neurotrophic factor) and cytokine (interleukin-6) were assessed before and after GXT. Results: Fast walking speed (cm/s), gait quality (double-support (%)) while walking at self-selected speed, fatigue (modified Fatigue Impact Scale), fitness (maximal workload achieved during GXT), and quality-of-life (physical functioning sub-scale of SF-36 Health Survey) improved significantly after training, and improvements were sustained after 3-months. Improvements in fitness (maximal respiratory exchange ratio and maximal oxygen consumption during GXT) were associated with increased brain-derived neurotrophic factor and decreased interleukin-6. Conclusion: Vigorous cool room training is feasible and can potentially improve walking, fatigue, fitness, and quality-of-life among people with moderate to severe MS-related disability.
Metagenomics Reveals Impact of Urbanisation in Central India on the Human Gut Microbiome and its Antimicrobial Resistance Profiles
Authors: Monaghan Tanya , Sloan Tim J. , Stockdale Stephen R. , Blanchard Adam M. , Emes Richard D. , Wilcox Mark , Biswas Rima , Nashine Rupam , Manke Sonali , Gandhi Jinal , Jain Pratishtha , Bhotmange Shrejal , Ambalkar Shrikant , Satav Ashish , Draper Lorraine A. , Hill Colin , Kashyap Rajpal Singh 
Published: November 2019

Abstract
Background The impact of the rapid urbanisation of low- and middle-income countries on the human gut microbiome remains grossly understudied. Whilst the effect of urbanisation on the bacterial populations of the human gut microbiome have been documented, little is known about the influence of diet and antibiotics on the bacteriome, its virome, and antibiotic resistome. Here, we use shotgun metagenomics to comprehensively characterise the bacterial and viral fractions of the human gut microbiome, and their encoded functions, from two divergent Central Indian populations (rural agriculturalists from Melghat and an urban population in Nagpur). Additionally, we investigate cohorts with and without diarrhoea, and the potential burden of Clostridioides difficile, associated with widespread unregulated use of antibiotics in India. Results We observed distinct rural-urban differences in the gut microbiome, including viral diversity and composition, with geography exhibiting a greater influence than diarrhoeal status. Urban microbiomes were enriched in metabolic pathways responsible for degradation of drugs and organic compounds, which were predicted to relate to replacement of rural-enriched Prevotella spp. and fermentative Clostridiales with Enterobacteriaceae and Bacteroides spp. By linking phages present in the microbiome to their bacterial hosts through CRISPR spacers, a shift from Prevotella- and Eubacterium-infecting phages to Bacteroides- and Parabacteroides-infecting phages was observed in rural and urban populations, respectively. Additionally, the auxiliary metabolic potential of rural-associated phage populations was enriched for carbon and amino acid energy harvesting potential, compared to urban-associated phages. A core set of antimicrobial resistance genes was identified in both populations, particularly those conferring resistance to macrolides, tetracyclines and 1stgeneration cephalosporins, with the majority also showing evidence of resistance to fluoroquinolones, aminoglycosides and sulphonamides. In a subgroup of urban subjects with diarrhoea and high antibiotic exposure, most of whom tested positive for C. difficile toxin, evidence of resistance to fosfomycin, glycopeptides, daptomycin, 3rd generation cephalosporins and carbapenems was widespread. Conclusions We report distinct differences in antimicrobial resistance gene profiles as well as a marked variation in the burden of C. difficile disease between rural and urban populations. The key drivers of variation in urban and rural Indian microbiomes are geography, diet, industrial and healthcare exposures.
Tongue coating microbiome characterization of Chinese preschool children with halitosis
Authors: Zhang Yu , Zhu Ce , Feng XiPing , Chen Xi 
Published: November 2019

Abstract
Background: Halitosis may affect individuals of any age. However, epidemiological surveys and etiological research into halitosis among children are limited. To assess the bacterial characteristics and environmental factors associated with intra-oral halitosisamong Chinese preschool children. Methods: An epidemiological study was conducted among 273 preschool children (aged 3 to 4 years) in Shanghai, China,followed by collection of 16 samples from the tongue coating of caries-free healthy and halitosis participants according to their organoleptic score.The characterization of associated microbial communities was performed using 16S rRNA genesequencingon the MiSeq. Results:Halitosis was observed in 13.1% of the preschool children.Logistic regression analysis showed that less frequent intake of sweet snacks and mothers’ poor oral condition were associated with children’s halitosis positively. Further analysis detected the presence of 15 phyla, 24 classes, 35 orders, 53 families, 93 genera, and 226 operational taxonomic units (OTUs) in the microbial communities. In terms of microbial diversity, the tongue coating of control and halitosis groups showed no significant difference (P>0.05). Both groups shared a mass of common OTUs. The dominant bacterial genera observed in both groups included Prevotella_7(15.17% vs. 10.72%), Veillonella (13.52% vs. 10.86%), Streptococcus (13.95% vs. 18.68%),Neisseria (9.44% vs. 21.14%), Actinomyces(7.37% vs. 5.88%), Haemophilus (6.69% vs. 5.69%), andLeptotrichia (5.05% vs. 1.95%). At the genus level, the proportion of Gemellawas statistically larger in the control group (P=0.018). Conclusions: Overall, halitosis is associated with multi-microbial mutual interactions. The oral flora microorganisms may exert potentiating or inhibiting effects on each other.
The true panel of Cystic Fibrosis mutations in the Sicilian population
Authors: chamayou sandrine , SICALI Maria , LOMBARDO Debora , MAGLIA Elena , LIPRINO Annalisa , CARDEA Clementina , FICHERA Michele , VENTI Ermanno , GUGLIELMINO Antonino 
Published: November 2019

Abstract
Background: the aim was to establish the true risk of having an affected child with Cystic Fibrosis (CF) in the Sicilian infertile population.
Methods: a longitudinal CFTR screening of 1,279 Sicilian infertile patients for all CFTR mutations sequencing the entire gene by Next Generation Sequencing (NGS) was performed from patient ‘blood.
Results: one patient out of 16 was a carrier of a CFTR mutation. Twenty-four mutations were found. Theoretically one couple out of 256 was at risk of CF transmission.
Conclusions: the risk of CF transmission is unexpectedly high in Sicily and with a high heterogeneity. Sequencing an entire and long gene such as CFTR makes accessible the real panel of mutations in a specific population and helps better to understand the true risk of having an affected child.
Clinical outcomes of prophylactic compression sutures for treatment of uterine atony during the cesarean delivery of twins
Authors: Kim Mi-La , Hur Yoon-Mi , Ryu Hye Jin , Lee Min Jin , Seong Seok Ju , Shin Joong Sik 
Published: November 2019

Abstract
Introduction : Twin pregnancy has a high risk for developing uterine atony (UA). This study aimed to evaluate efficacy and clinical outcomes of prophylactic compression sutures to treat UA during the twin cesarean section (CS). Materials and Methods : All patient records of twin pregnancies in a large maternity hospital in South Korea between January 2013 and June 2018 were reviewed. Patients with monochorionic monoamniotic twins, fetal loss of one or both fetus before 20 gestational weeks, twins delivered prior to 24 gestational weeks, and patients who were delivered twins vaginally were excluded from data analysis. In total, 953 women were eligible for data analysis. Results : Of the 953 patients, compression sutures were applied to 147 cases refractory to uterine massage and uterotonics. Of 147, two patients (1.4%) proceeded to additional uterine artery ligation to achieve hemostasis, yielding a success rate of 98.6%. The rate of transfusion after the first 24 hours of delivery in the suture group was not significantly different from that in the non-suture group, suggesting that both groups achieved hemostasis at an equal rate after the first 24 hours of delivery. The difference in the operation time between the two groups was only 8.5 minutes. The rate of subsequent pregnancy among the patients who received compression sutures was 44.4%. Conclusions : Overall, our findings suggest that with early and fast implementation of compression sutures, UA can be treated in the setting of twin cesarean delivery without significantly increasing maternal morbidity.
Determinants of early postnatal care attendance: analysis of the 2016 Uganda Demographic and Health Survey
Authors: Ndugga Patricia , Namiyonga Noor Kassim , Sebuwufu Deogratious 
Published: November 2019

Abstract
Background The first two days after childbirth present the highest risk of dying for a mother. Providing postnatal care within the first two days after childbirth can help avert maternal mortality because it allows early detection of problems that could result in adverse maternal health outcomes. Unfortunately, knowledge of the uptake of early postnatal care (EPNC), which is imperative for informing policies aimed at reducing maternal mortality, remains low in Uganda. Therefore, the purpose of this study is to investigate the determinants of early postnatal care attendance among Ugandan women. Methods This study was based on nationally representative data from the 2016 Uganda Demographic and Health Survey. The study sample comprised 5,471 women (age 15–49) who delivered a child in the 2 years preceding the survey. We used logistic regression to identify factors associated with the use of early postnatal care. Results Our findings showed that 50% of mothers used EPNC services for their most recent delivery in the 2 years preceding the survey. Women’s residence, education level, religion, wealth status, marital status, occupation, antenatal care attendance, place of delivery, birth order, perceived accessibility of health facilities, and access to mass media messages were associated with greater use of EPNC. The percentage of women receiving EPNC was much higher among women who delivered at a health facility, either a public facility (63%) or private facility (65%), versus only 9% among women who delivered at home. Multivariate analysis showed that delivery at a health facility was the most important determinant of early postnatal care attendance. Conclusions To increase mothers’ use of EPNC services and improve maternal survival in Uganda, programs could promote and strengthen health facility delivery and ensure that EPNC services are provided to all women before discharge. Even so, the fact that only about two-thirds of women who delivered at a health facility received early postpartum care shows substantial room for improvement.
How can gastro-intestinal tuberculosis diagnosis be improved? A prospective cohort study
Authors: Lowbridge Christopher , Fadhil Soraya A. M. , Krishnan Gayathri D. , Schimann Emma , Karuppan Raman Muthu , Sri Nagaraj , Rajahram Giri Shan , Menon Jayaram , Patel Aatish , William Timothy , Paul Dawn Carmel , Ralph Anna P. 
Published: November 2019

Abstract
Gastrointestinal tuberculosis (TB) is diagnostically challenging; therefore, many cases are treated presumptively. We aimed to describe features and outcomes of gastrointestinal TB, determine whether a clinical algorithm could distinguish TB from non-TB diagnoses, and calculate accuracy of diagnostic tests. Methods We conducted a prospective cohort study of hospitalized patients in Kota Kinabalu, Sabah, Malaysia, with suspected gastrointestinal TB. We recorded clinical and laboratory characteristics and outcomes. Tissue samples were submitted for histology, microscopy, culture and GeneXpert MTB/RIF®. Patients were followed for up to two years. Results Among 88 patients with suspected gastrointestinal TB, 69 were included in analyses; 52 (75%) had a final diagnosis of gastrointestinal TB; 17 had a non-TB diagnosis. People with TB were younger (42.7 versus 61.5 years, p=0.01) and more likely to have weight loss (91% versus 64%, p=0.03). An algorithm using age <44, weight loss, cough, fever, no vomiting, albumin >26 g/L, platelets >340 x109/L and immunocompromise had good specificity (96.2%) in predicting TB, but very poor sensitivity (16.0%). GeneXpert® performed very well on gastrointestinal biopsies (sensitivity 95.7% versus culture 35.0% against a gold standard case definition of confirmed TB). Most patients (79%) successfully completed treatment and no treatment failure occurred, however adverse events (21%) and mortality (13%) among TB cases were high. We found no evidence that six months of treatment was inferior to longer courses. Conclusions The prospective design provides important insights for clinicians managing gastrointestinal TB. We recommend wider implementation of high-performing diagnostic tests such as GeneXpert® on extra-pulmonary samples.
What determines the operational sustainability of rural drinking water points in Ethiopia? The case of Woliso woreda
Authors: Gurmessa Birki , Mekuriaw Abate 
Published: November 2019

Abstract
Water is a fundamental element essential for life and health. However, more than 33.3% of rural water services in Ethiopia are not functioning and hence sustainability of rural drinking water points in the country is under question. With this in mind, this study was undertaken to investigate the factors that affect the operational sustainability of rural drinking water points in Woliso woreda, Ethiopia. A semi-structured questionnaire was administered to a randomly selected 211 households from six rural Kebeles, which were selected using stratified sampling technique. Focus group discussions and key interviews were also held along with observation. The quantitative data were analysed through descriptive statistics and binary logistic regression. The qualitative data were used to augment the results from the regression analysis. The results revealed that water service fee, willingness to pay, occurrence of conflict in the water points, monitoring by water user committees, willingness to sustain service, users' participation in the water point construction, satisfaction with the water point service, perception on the possibility of contamination, and training on maintenance are found to be significant factors that affect the operational sustainability of rural drinking water points. Therefore, these significant factors should be sufficiently addressed when planning water supply projects.
Analysis of the characteristics of poultry slaughterhouse wastewater (PSW) and its treatability
Authors: Njoya M. , Basitere M. , Ntwampe S. K. O. 
Published: November 2019

Abstract
The first step towards selecting a suitable treatment option for poultry slaughterhouse wastewater (PSW) treatment is to characterize it. Various parameters such as the pH, tCOD, BOD5, TSS, FOG, turbidity, salinity or conductivity were analyzed in this study and provided values significantly higher than discharge limits imposed by various countries. Furthermore, the biodegradability index (BOD5/COD) of PSW was determined and averaged a value of 0.61 for the samples collected during normal processing operations in the slaughterhouse and 0.72 for samples collected during the cleaning of equipment after broiler processing operations. This good biodegradability translated to a good biological decomposition potential, which can be a risk for the environment as a result of untreated effluent, and also highlights the suitability of biological treatment processes for the treatment of such wastewater. Moreover, to reduce the production of chemical waste from the toxic reagents used for some analyses, and to alleviate the cost and the time required for these analyses, linear regressions were used to correlate three water quality parameters (tCOD, BOD5, and FOG), interchangeably. These linear regressions provided a good relationship between these parameters, with R2 &gt; 0.9 for the samples collected during normal operation periods; and weaker correlation for the FOG/BOD5 and FOG/tCOD of samples collected during the cleaning of processing equipment. This was attributed to the high concentration of FOG (5,216 ± 2,534) in the samples collected during this period, from the collection of carcass debris and fats left on the equipment during the slaughtering.
The Emerging Role of Exosomal Non-coding RNAs in Musculoskeletal Diseases
Authors: Tu Chao , He Jieyu , Chen Ruiqi , Li Zhihong 
Published: November 2019

:Exosomes are phospholipid bilayer-enclosed membrane vesicles derived and constitutively secreted by various metabolically active cells. They are capable of mediating hetero- and homotypic intercellular communication by transferring multiple cargos from donor cells to recipient cells. Nowadays, non-coding RNAs (ncRNAs) have emerged as novel potential biomarkers or disease-targeting agents in a variety of diseases. However, the lack of effective delivery systems may impair their clinical application. Recently, accumulating evidence demonstrated that ncRNAs could be efficiently delivered to recipient cells using exosomes as a carrier, and therefore can exert a critical role in musculoskeletal diseases including osteoarthritis, rheumatoid arthritis, osteoporosis, muscular dystrophies, osteosarcoma and other diseases. Herein, we present an extensive review of biogenesis, physiological relevance and clinical implication of exosome-derived ncRNAs in musculoskeletal diseases.
Marine Actinomycetes-derived Natural Products
Authors: Yang Chengfang , Qian Rui , Xu Yao , Yi Junxi , Gu Yiwen , Liu Xiaoyu , Yu Haobing , Jiao Binghua , Lu Xiaoling , Zhang Wei 
Published: November 2019

:
Actinomycetes is an abundant resource for discovering a large number of lead compounds,
which play an important role in microbial drug discovery. Compared to terrestrial microorganisms, marine
actinomycetes have unique metabolic pathways because of their special living environment, which
has the potential to produce a variety of bioactive substances. In this paper, secondary metabolites isolated
from marine actinomycetes are reviewed (2013-2018), most of which exhibited cytotoxic, antibacterial,
and antiviral biological activities.