bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-Term Follow-up of Functional and Radiographic Outcome After Revision Surgery for Fibula Malunion
Authors: Birnie Merel F. N. , Sanders Fay R. K. , Halm Jens A. , Schepers Tim 
Published: March 2020

Background. Ankle fractures are some of the most common injuries seen in the emergency department. Malunited ankle fractures are uncommon. Patients with malunion frequently present with multiple complaints. Radiographs often show abnormalities in anatomical alignment. Aim. To evaluate the anatomical alignment on radiographic imaging in patients with malunited ankle fractures. Secondary aims were to evaluate patient satisfaction after reconstruction and to investigate the relationships between radiological alignment and functional outcome. Methods. All consecutive patients (n = 25) treated for a fibula malunion between January 1, 2002, and September 1, 2017, were included. The primary outcome was anatomical alignment of the ankle mortise. The talocrural angle (TCA), talar tilt (TT), and medial clear space (MCS) were used to investigate to what extent revision surgery had improved alignment. The patient-related outcome measure consisted of the Olerud and Molander Ankle Score (OMAS). To assess quality of life (QoL) the EQ-5D-5L was used. Results. The median TCA was 78.4° before revision and 79.25° after revision; P = .297. The median TT was 2.95° before revision and 0.70° after; P < .001. The MCS before revision was 5.2 mm and 3.17 mm after; P < .000). The OMAS had a median of 67.5 points. Analysis of the QoL questionnaires yielded a score of 0.84 points. Conclusion. Anatomical alignment improves significantly after revision surgery of malunited ankles. Measurements of the TCA appeared less useful in determining the anatomical alignment. In our series, 60% of patients reported good to excellent results. The QoL scores of our patient were comparable to those in the healthy population in the Netherlands. Levels of Evidence: Level IV: Case series
Indications and Outcomes for Patients With Limited Symptoms Undergoing Endoscopic Sinus Surgery
Authors: Rahman Arifeen S. , Hwang Peter H. , Alapati Rahul , Lin Yan , Nayak Jayakar V. , Patel Zara M. , Yan Carol H. 
Published: March 2020

Background Previous research have suggested that chronic rhinosinusitis (CRS) patients with lower symptomatic scores, demonstrated by a 22-item Sinonasal Outcome Test (SNOT-22) score <20, may not achieve meaningful quality of life improvement following endoscopic sinus surgery (ESS). However, indications for ESS are continuing to be defined and many low SNOT-22 scoring patients still undergo elective surgery for CRS and other benign sinonasal pathologies. The outcomes for these patients have not been previously studied. Objectives We sought to evaluate surgical indications and outcomes for those patients with limited symptoms undergoing ESS. Methods We screened 2829 ESS procedures from 2010–2018 to identify patients with a preoperative SNOT-22 score <20. We reviewed disease characteristics, preoperative Lund–Mackay (LM) scores, and pre- and postoperative SNOT-22 scores in patients with at least 3 months’ follow-up. Results Of all surgical ESS patients screened, 114 had low preoperative SNOT-22 scores (4.0%). Indications for these surgeries included CRS (50.0%), odontogenic sinus disease (11.4%), mucocele (10.5%), recurrent acute sinusitis (7.0%), fungal ball (5.3%), and silent sinus syndrome (4.4%). Specifically, among CRS patients, 45.6% had pulmonary comorbidities and/or systemic immunodeficiencies. Moreover, 100% of CRS patients with nasal polyps and 73.1% of CRS without polyps had LM scores >5. Patients with preoperative SNOT-22 scores between 15 and 19 achieved an average 6.5 point reduction ( P < .001) postoperatively, whereas those with scores between 10 and 14 had a 5.4 point reduction ( P < .001), and preoperative scores <9 resulted in no significant decrease in postoperative symptom scores ( P = .98). Overall, there was a 3.3 point SNOT-22 reduction among all patients at 3 months postoperatively ( P < .001). Conclusion Patients with limited sinonasal symptoms may benefit from surgical treatment despite asymptomatic clinical presentations. A case-by-case analysis of comorbidities or unique clinical features should inform surgical decision-making for patients with lower SNOT-22 scores.
Endometriosis in a case with Fraser Syndrome
Authors: Ooi Rucira Xiu Xian , Griffiths Anthony 
Published: March 2020

Introduction: Fraser Syndrome is a rare genetic disorder characterized by urogenital defects, cutaneous syndactyly and cryptophthalmos commonly diagnosed during foetal autopsy. Vaginal atresia is one of the major diagnostic criteria of Fraser Syndrome and could be a contributing factor of endometriosis following the development of hematocolpos. Imperforate hymen, often misdiagnosed as vaginal atresia, is a rare diagnosis in patients with Müllerian anomalies. Here, we report a case of Fraser Syndrome with chronic pelvic pain as a result of delayed hymenotomy and the extensive management of endometriosis. Case Report: A 15-year-old girl with Fraser Syndrome presented with pelvic pain. Examination revealed a large hematocolpos caused by an imperforate hymen. Due to the lack of paediatric intensive care locally, she had a delayed hymenotomy. She continued to suffer from chronic pelvic non-cyclical pain post-hymenotomy. Preliminary laparoscopy and biopsy showed endometriosis. Despite excision and clearance of endometriosis, she experienced persistent pain while taking morphine and was trialled with several hormonal therapies such as leuprorelin acetate, progestogen and combined hormonal therapy. She received medical therapy for 10 years until she re-presented with erratic bleeding and pain. Laparoscopy again identified endometriosis. Conclusion: Early recognition and treatment minimize risk of endometriosis especially in premenarcheal adolescent girls with obstructive Müllerian anomalies presenting with pelvic pain. Adequate pain control and medical management permit a delay in surgical intervention facilitating further investigations and thorough counselling with the patient and family about the implications of endometriosis on fertility and quality of life.
Predictors of loss to follow-up of tuberculosis cases under the DOTS programme in Namibia
Authors: Kibuule Dan , Aiases Philomein , Ruswa Nunurai , Rennie Timothy William , Verbeeck Roger K. , Godman Brian , Mubita Mwangana 
Published: March 2020

BackgroundIn Namibia, one out of every 25 cases of tuberculosis (TB) is “lost to follow-up” (LTFU). This has impacted negatively on national efforts to end the disease by 2035. The aim of this study was to determine the trends and predictors of LTFU under the directly observed treatment short-course (DOTS) programme in Namibia.MethodsThe study involved a retrospective longitudinal analysis of a nationwide cohort of TB cases registered under the DOTS programme in Namibia from 2006 to 2015. The trends and predictors of LTFU among cases in the National Electronic TB Register of the National TB and Leprosy Program were respectively determined by interrupted time series and multivariate logistic regression analyses using R-Studio software.ResultsOut of 104 203 TB cases, 3775 (3.6%) were LTFU. A quarter (26%) of cases with poor outcomes were due to LTFU. The annual decline in cases of LTFU was significant between the first (2005–2010) and second (2010–2015) medium-term plan period for TB programme implementation (p=0.002). The independent predictors of LTFU were male sex (p=0.004), 15–24 years age group (p=0.03), provider of treatment (p<0.001), intensive phase (p=0.047) and living in border/transit regions (p<0.001). HIV co-infection and TB regimen were not significant predictors of LTFU.ConclusionsThere were declining trends in LTFU in Namibia. DOTS programmes should integrate socioeconomic interventions for young and middle-aged adult male TB cases to reduce LTFU.
The impact of perceived risk, screening eligibility and worry on preference for lung cancer screening: a cross-sectional survey
Authors: See Katharine , Manser Renee , Park Elyse R. , Steinfort Daniel , King Bridget , Piccolo Francesco , Manners David 
Published: March 2020

Lung cancer screening is effective at reducing lung cancer deaths when individuals at greatest risk are screened. Recruitment initiatives target all current and former smokers, of whom only some are eligible for screening, potentially leading to discordance between screening preference and eligibility in ineligible individuals. The objective of the present study was to identify factors associated with preference for screening among ever-smokers.Ever-smokers aged 55–80 years attending outpatient clinics at three Australian hospitals were invited. The survey recorded: 1) demographics; 2) objective lung cancer risk and screening eligibility using the Prostate Lung Colon Ovarian 2012 risk model; and 3) perceived lung cancer risk, worry about and seriousness of lung cancer using a validated questionnaire. Multivariable ordinal logistic regression identified predictors of screening preference.The survey was completed by 283 individuals (response rate 27%). Preference for screening was high (72%) with no significant difference between low-dose computed tomography screening-eligible and -ineligible individuals (77%versus68%, p=0.11). Worry about lung cancer (adjusted-proportional odds ratio (adj-OR) 1.31, 95% CI 1.08–1.58; p=0.007) and perceived seriousness of lung cancer (adj-OR 1.31, 95% CI 1.05–1.64; p=0.02) were associated with higher preference for lung cancer screening while screening eligibility was not. The concept of “early detection” was the most important driver to have screening while practical obstacles like difficulty travelling to the scan or taking time off work were the least important barriers to screening.Most current or former smokers prefer to undergo screening. Worry about lung cancer and perceived seriousness of the diagnosis are more important drivers for screening preference than eligibility status.
Factors associated with delay in treatment initiation for pulmonary tuberculosis
Authors: Roberts David J. , Mannes Trish , Verlander Neville Q. , Anderson Charlotte 
Published: March 2020

BackgroundDelays in treatment initiation for tuberculosis (TB) may lead to worse clinical outcomes and increased transmission. We aimed to determine factors associated with treatment delays, to guide public health action.MethodsWe extracted data on clinical characteristics and documented potential barriers to treatment from all pulmonary TB cases with clinical case review data from 2011 to 2015 and linked these to TB surveillance data. We described the distribution of delays from symptom onset to first presentation (“presentation delay”) and from presentation to treatment (“healthcare delay”). We calculated time ratios (TRs) to determine the association between sociodemographic and clinical factors and delay outcomes.ResultsMedian presentation delay was 30 days (interquartile range (IQR) 11–72 days). Language barriers were associated with 40% longer presentation delay (TR 1.40, 1.01–1.94). Median healthcare delay was 40 days (IQR 13–89 days), and mostly consisted of the time taken before deciding to refer to TB specialists (median 26 days, IQR 4–73 days). Shorter healthcare delay was associated with positive sputum smear (TR 0.58, 0.47–0.70), UK residency <2 years (TR 0.47, 0.32–0.67), male sex (TR 0.74, 0.60–0.91) and secondary care referral (TR 0.63, 0.51–0.78).ConclusionsOur findings support continued initiatives to enable access to care for migrant populations to minimise presentation delay. Multifaceted approaches to increase clinician awareness of TB clinical presentations, to implement systems enabling early case recognition, to maximise the yield from sputum smear investigations and to ensure rapid diagnosis of smear negative cases are required to achieve further TB control.
Virus, allergic sensitisation and cortisol in infant bronchiolitis and risk of early asthma
Authors: Hunderi Jon Olav Gjengstø , Rolfsjord Leif Bjarte , Carlsen Karin C. Lødrup , Holst René , Bakkeheim Egil , Berents Teresa Løvold , Carlsen Kai-Håkon , Skjerven Håvard Ove 
Published: March 2020

BackgroundAcute bronchiolitis during infancy and human rhinovirus (HRV) lower respiratory tract infections increases the risk of asthma in atopic children. We aimed to explore whether specific viruses, allergic sensitisation or cortisol levels during acute bronchiolitis in infancy increase the risk of early asthma, using recurrent wheeze as a proxy.MethodsIn 294 children with a mean (range) age of 4.2 (0–12) months enrolled during hospitalisation for acute infant bronchiolitis, we analysed virus in nasopharyngeal aspirates, serum specific immunoglobulin E against food and inhalant allergens, and salivary morning cortisol. These factors were assessed by regression analyses, adjusted for age, sex and parental atopy, for risk of recurrent wheeze, defined as a minimum of three parentally reported episodes of wheeze at the 2-year follow-up investigation.ResultsAt 2 years, children with, compared to without, recurrent wheeze had similar rates of respiratory syncytial virus (RSV) (82.9%versus81.8%) and HRV (34.9%versus35.0%) at the acute bronchiolitis, respectively. During infancy, 6.9% of children with and 9.2% of children without recurrent wheeze at 2 years were sensitised to at least one allergen (p=0.5). Neither recurrent wheeze nor incidence rate ratios for the number of wheeze episodes at 2 years were significantly associated with specific viruses, high viral load of RSV or HRV, allergic sensitisation, or morning salivary cortisol level during acute bronchiolitis in infancy.ConclusionIn children hospitalised with acute infant bronchiolitis, specific viruses, viral load, allergic sensitisation and salivary morning cortisol did not increase the risk of early asthma by 2 years of age.
Strategies adopted by Aphanizomenon flos-aquae in response to phosphorus deficiency and their role on growth
Authors: Chen Xiaoyan , Dolinova Iva , Sevcu Alena , Jurczak Tomasz , Frankiewicz Piotr , Wojtal-Frankiewicz Adrianna , Wan Lingling , Deng Qinghui , Song Chunlei , Zhou Yiyong , Cao Xiuyun 
Published: March 2020

Abstract
Background
The N2-fixing cyanobacterium, Aphanizomenon flos-aquae is a globally distributed bloom causing species that degrades water quality of fresh and marine water bodies. Overcoming phosphorus (P) deficiency is one of the ecological advantages for bloom-forming cyanobacteria. It remains unclear to what extent can A. flos-aquae alleviate P deficiency by regulating P using strategies.

Results
Based on in situ observations of extracellular alkaline phosphatase (APase) in A. flos-aquae via enzyme-labeled fluorescence in freshwater bodies in China, Poland and Czechia, we further investigated responses of isolated A. flos-aquae to different P supplies (dissolved inorganic P (Pi) as +DIP, dissolved organic α-glycerophosphate and β-glycerophosphate as +DOPα and +DOPβ, P-free condition as P-depleted). The significantly negative relationships between percentage of APase producing cells and soluble reactive P concentration in both fields and cultures suggested that the excretion of APase in cyanobacterium was regulated by ambient Pi supply. Suffering from P deficiency in the P-depleted treatments, A. flos-aquae showed the highest APase activity but a vigorous growth at the early culture stage, which might also benefit from the formation of polyphosphate body (PPB) and the decrease of cell P quota. In the +DOP treatments, the coordination of dissolved DOP mineralization and continuous prompt utilization of PPB might contribute to a maintenance but not reproduction of A. flos-aquae when relying on DOP, since the specific growth rate kept around 0 cells L−1 day−1 at the second half culture period and the highest cell density reached only 13.38% of that in +DIP treatments while photochemical efficiency was comparable during the whole experiment. Luxury uptake of phosphate as PPB in the +DIP treatments was consistent to the canonical view of polyphosphate as P storage.

Conclusion
Aphanizomenon flos-aquae could achieve an instantaneous growth in response to P deficiency with the coordination of P utilization strategies, while it maintained a long-term sustainable growth but not reproduction under sole DOP supply. Persistent and active reproduction could only be achieved in high Pi supply, which implying that an effective consequence can be expected for combating the bloom of A. flos-aquae when controlling P supply.
First line in psychiatric emergency: pre-hospital emergency protocol for mental disorders in Iran
Authors: Shirzad Fatemeh , Hadi Fatemeh , Mortazavi Seyede Salehe , Biglari Maryam , Sari Hassan Noori , Mohammadi Zeinab , Atoofi Mehrdad Kazemzade , Shariat Seyed Vahid 
Published: March 2020

Abstract
Introduction
This article is a report of designing a rapid and effective guide for paramedics who take care of patients in a pre-hospital setting to answer developing demands.

Methods
The relevant literature was reviewed, and the topics were extracted. Then, the extracted items were discussed in an expert panel. Finally, items were discussed in a meeting including emergency technicians and emergency technical assistants to identify implementation problems.

Results
Important topics for managing psychiatric patients were categorized at three levels: 1) Patient safety and security issues, 2) Patient status assessment and diagnosis, and 3) Patient management (medical, behavioral management, and referral to a treatment center).

Discussion
This protocol can be a solution to improve emergency technician training. Such summarized protocols can be used for rapid review immediately before exposing a patient with an acute psychiatric condition. Due to specific cultural and different access to medicines in Iran, some issues are different.
A rare cause of dysphagia due to esophageal intramural pseudodiverticulosis: a case report and review of literature
Authors: Ali Osman , Asumu Hazel , Kaur Tanisha , Mathew Angelina , Kim Raymond 
Published: March 2020

Abstract
Background
Esophageal intramural pseudodiverticulosis is an uncommon, idiopathic disorder characterized by multiple small outpouchings protruding from the esophageal lumen. Esophageal intramural pseudodiverticulosis is associated with conditions such as gastroesophageal reflux disease and diabetes mellitus, as well as emergent complications including pneumomediastinum. The most common presenting symptom is dysphagia with associated esophageal stricture formation. While the pathogenesis of EIP has yet to be determined, it is important to bring awareness to this unique disease with distinctive diagnostic findings and treatment options.

Case presentation
In this case, we present a 62-year-old woman who suffered from dysphagia, an inability to tolerate a regular diet, and unintentional weight loss for several years prior to her diagnoses. She was diagnosed by esophagram and esophagogastroduodenoscopy to have esophageal intramural pseudodiverticulosis, complicated by severe stricture formation. Following treatment with sequential dilatation and maintenance H2-blocker therapy, she achieved significant symptomatic improvement.

Conclusions
This case highlights the importance of accurate identification and treatment of an uncommon cause of dysphagia, esophageal intramural pseudodiverticulosis. Treatment includes dilatational therapy, as successfully demonstrated in our patient. Furthermore, treatment is focused on optimizing medical management, as demonstrated in our patient with the addition of an H2-blocker for GERD, or addressing potentially serious underlying causes, such as carcinoma, with surgery.
Impact of preoperative fecal short chain fatty acids on postoperative infectious complications in esophageal cancer patients
Authors: Motoori Masaaki , Tanaka Koji , Sugimura Keijiro , Miyata Hiroshi , Saito Takuro , Miyazaki Yasuhiro , Fujitani Kazumasa , Kado Yukiko , Asahara Takashi , Yano Masahiko 
Published: March 2020

Abstract
Background
The intestinal epithelial barrier allows absorption of dietary nutrients and prevents passage of pathogens and toxins into the body. Severe insults have a negative impact on the intestinal environment, which may decrease intestinal barrier function and cause bacterial translocation. Bacterial translocation, which can cause infectious complications, is defined as the passage of microbes from the gastrointestinal tract across the mucosal barrier to extraintestinal sites. The aim of this study was to investigate the correlation between concentrations of preoperative fecal organic acids and the occurrence of postoperative infectious complications in patients with esophageal cancer.

Methods
Fifty-five patients with esophageal cancer who underwent esophagectomy were enrolled in this study. Perioperative synbiotics were administered to all patients. Perioperative clinical characteristics and concentrations of preoperative fecal organic acids were compared between patients with and without postoperative infectious complications.

Results
Postoperative infectious complications occurred in 10 patients. In patients with complications, the concentrations of acetic acid and propionic acid were significantly lower than in patients without complications (p = 0.044 and 0.032, respectively). The concentration of butyric acid was nonsignificantly lower in patients with complications, while the concentration of lactic acid was nonsignificantly higher. The calculated gap between the concentrations of fecal acetic acid plus propionic acid plus butyric acid minus lactic acid was significantly lower in patients with complications. Multivariate analysis revealed that a low gap between acetic acid plus propionic acid plus butyric acid minus lactic acid was an independent risk factor for postoperative infectious complications (p = 0.027).

Conclusions
Preoperative fecal concentrations of organic acids had a clinically important impact on the occurrence of postoperative infectious complications in patients with esophageal cancer. To reduce postoperative infectious complications, it may be useful to modulate the intestinal environment and maintain concentrations of fecal organic acids before surgery.