bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and evaluation of interprofessional patient simulation activity for physiotherapy and occupational therapy students to assess and manage patients with chronic pain
Authors: Forbes Roma , Irving Peter , Copley Jodie 
Published: April 2020

Background/aims Opportunities for interprofessional learning are a priority to prepare health professionals for the effective interprofessional assessment and management of patients with chronic pain, yet finding effective and sustainable approaches are a challenge for health professional programmes. The aim of this study was to develop and evaluate an ‘interprofessional management of pain’ learning activity using simulation for physiotherapy and occupational therapy students. Methods A total of 40 physiotherapy and 20 occupational therapy students undertook the interprofessional management of pain learning activity. Chronic pain attitudes and beliefs (HC-PAIRS) and perception of interprofessional practice (SPICE-R) were assessed before and following the intervention. A survey relating to content and format of the activity was completed following the intervention. Results There was a significant improvement in total HC-PAIRS and SPICE-R scores for both student groups. Both groups demonstrated satisfaction with the activity. Conclusions These findings support the use of an interprofessional simulated learning activity with facilitated planning and debriefing to enhance students’ attitudes to chronic pain and interprofessional practice.
Deep gluteal syndrome as a cause of posterior hip pain and sciatica-like pain
Authors: Park Jung Wee , Lee Young-Kyun , Lee Yun Jong , Shin Seunghwan , Kang Yusuhn , Koo Kyung-Hoi 
Published: April 2020

Deep gluteal syndrome is an increasingly recognized disease entity, caused by compression of the sciatic or pudendal nerve due to non-discogenic pelvic lesions. It includes the piriformis syndrome, the gemelli-obturator internus syndrome, the ischiofemoral impingement syndrome, and the proximal hamstring syndrome. The concept of the deep gluteal syndrome extends our understanding of posterior hip pain due to nerve entrapment beyond the traditional model of the piriformis syndrome. Nevertheless, there has been terminological confusion and the deep gluteal syndrome has often been undiagnosed or mistaken for other conditions. Careful history-taking, a physical examination including provocation tests, an electrodiagnostic study, and imaging are necessary for an accurate diagnosis. After excluding spinal lesions, MRI scans of the pelvis are helpful in diagnosing deep gluteal syndrome and identifying pathological conditions entrapping the nerves. It can be conservatively treated with multidisciplinary treatment including rest, the avoidance of provoking activities, medication, injections, and physiotherapy. Endoscopic or open surgical decompression is recommended in patients with persistent or recurrent symptoms after conservative treatment or in those who may have masses compressing the sciatic nerve. Many physicians remain unfamiliar with this syndrome and there is a lack of relevant literature. This comprehensive review aims to provide the latest information about the epidemiology, aetiology, pathology, clinical features, diagnosis, and treatment. Cite this article: Bone Joint J 2020;102-B(5):556–567.
When and where do patients with bone metastases actually break their femurs?
Authors: Sternheim A. , Traub F. , Trabelsi N. , Dadia S. , Gortzak Y. , Snir N. , Gorfine M. , Yosibash Z. 
Published: April 2020

AimsAccurate estimations of the risk of fracture due to metastatic bone disease in the femur is essential in order to avoid both under-treatment and over-treatment of patients with an impending pathological fracture. The purpose of the current retrospective in vivo study was to use CT-based finite element analyses (CTFEA) to identify a clear quantitative differentiating factor between patients who are at imminent risk of fracturing their femur and those who are not, and to identify the exact location of maximal weakness where the fracture is most likely to occur.MethodsData were collected on 82 patients with femoral metastatic bone disease, 41 of whom did not undergo prophylactic fixation. A total of 15 had a pathological fracture within six months following the CT scan, and 26 were fracture-free during the five months following the scan. The Mirels score and strain fold ratio (SFR) based on CTFEA was computed for all patients. A SFR value of 1.48 was used as the threshold for a pathological fracture. The sensitivity, specificity, positive, and negative predicted values for Mirels score and SFR predictions were computed for nine patients who fractured and 24 who did not, as well as a comparison of areas under the receiver operating characteristic curves (AUC of the ROC curves).ResultsThe sensitivity of SFR was 100% compared with 88% for the Mirels score, and the specificity of SFR was 67% compared with 38% for the Mirels score. The AUC was 0.905 for SFR compared with 0.578 for the Mirels score (p = 0.008).ConclusionAll the patients who sustained a pathological fracture of the femur had an SFR of > 1.48. CTFEA was far better at predicting the risk of fracture and its location accurately compared with the Mirels score. CTFEA is quick and automated and can be incorporated into the protocol of CT scanners. Cite this article: Bone Joint J 2020;102-B(5):638–645.
Is frozen tumour-bearing autograft with concurrent vascularized fibula an alternative to the Capanna technique for the intercalary reconstruction after resection of osteosarcoma in the lower limb?
Authors: Lu Yajie , Zhu Haodong , Huang Mengquan , Zhang Chunlin , Chen Guojing , Ji Chuanlei , Wang Zhen , Li Jing 
Published: April 2020

AimsThe use of frozen tumour-bearing autograft combined with a vascularized fibular graft (VFG) represents a new technique for biological reconstruction of massive bone defect. We have compared the clinical outcomes between this technique and Capanna reconstruction.MethodsFrom June 2011 to January 2016 a retrospective study was carried out of patients with primary osteosarcoma of lower limbs who underwent combined biological intercalary reconstruction. Patients were categorized into two groups based on the reconstructive technique: frozen tumour-bearing autograft combined with concurrent VFG (Group 1) and the Capanna method (Group 2). Demographics, operating procedures, oncological outcomes, graft union, limb function, and postoperative complications were compared.ResultsA total of 23 patients were identified for analysis: eight in Group 1 and 15 in Group 2. There was no difference in the demographics (age, sex, and affected site) and operating procedures (resection length, duration of surgery, and blood loss) between the two groups. No significant difference was found in local recurrence in Group 1 versus Group 2 (p = 0.585). Mean union time for the frozen autograft-host junction was 8.4 months (7.0 to 11.0), significantly earlier than for the allograft-host junction in Group 2 (mean 14.1 months (10.0 to 28.0); p < 0.001). Mean Musculoskeletal Tumor Society scores in groups 1 and 2 were 90.3% (SD 7.4%) and 88.0% (SD 9.0%), respectively, with no significant statistical difference (p = 0.535). In terms of complications, infection (n = 1, 6.7%) and delayed union (n = 2, 13.3%) occurred in Group 2, but no such complications were observed in Group 1.ConclusionFrozen tumour-bearing autograft in combination with VFG can be used as an alternative to the Capanna reconstruction in properly selected patients with osteosarcoma. Cite this article: Bone Joint J 2020;102-B(5):646–652.
Modifiable risk factors for mortality in revision total hip arthroplasty for periprosthetic fracture
Authors: Gibbs Victoria N. , McCulloch Robert A. , Dhiman Paula , McGill Andrew , Taylor Adrian H. , Palmer Antony J. R. , Kendrick Ben J. L. 
Published: April 2020

Aims The aim of this study was to identify modifiable risk factors associated with mortality in patients requiring revision total hip arthroplasty (THA) for periprosthetic hip fracture. Methods The electronic records of consecutive patients undergoing revision THA for periprosthetic hip fracture between December 2011 and October 2018 were reviewed. The data which were collected included age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, the preoperative serum level of haemoglobin, time to surgery, operating time, blood transfusion, length of hospital stay, and postoperative surgical and medical complications. Univariate and multivariate logistic regression analyses were used to determine independent modifiable factors associated with mortality at 90 days and one year postoperatively. Results A total of 203 patients were identified. Their mean age was 78 years (44 to 100), and 108 (53%) were female. The median time to surgery was three days (interquartile range (IQR) 2 to 5). The mortality rate at one year was 13.8% (n = 28). The commonest surgical complication was dislocation (n = 22, 10.8%) and the commonest medical complication within 90 days of surgery was hospital-acquired pneumonia (n = 25, 12%). Multivariate analysis showed that the rate of mortality one year postoperatively was five-fold higher in patients who sustained a dislocation (odds ratio (OR) 5.03 (95% confidence interval (CI) 1.60 to 15.83); p = 0.006). The rate of mortality was also four-fold higher in patients who developed hospital-acquired pneumonia within 90 days postoperatively (OR 4.43 (95% CI 1.55 to 12.67); p = 0.005). There was no evidence that the time to surgery was a risk factor for death at one year. Conclusion Dislocation and hospital-acquired pneumonia following revision THA for a periprosthetic fracture are potentially modifiable risk factors for mortality. This study suggests that surgeons should consider increasing constraint to reduce the risk of dislocation, and the early involvement of a multidisciplinary team to reduce the risk of hospital-acquired pneumonia. We found no evidence that the time to surgery affected mortality, which may allow time for medical optimization, surgical planning, and resource allocation. Cite this article: Bone Joint J 2020;102-B(5):580–585.
Cobalt enhanced nonlinear optical properties and optical limiting of zinc oxide irradiated by femtosecond laser pulses
Authors: Shehata Abdullah , Tawfik Wael Z. , Mohamed Tarek 
Published: April 2020

In this paper the nonlinear optical properties of Co-doped ZnO and pure ZnO thin films were measured. The films were irradiated with 100 femtosecond laser pulses at 950 nm and at different input intensities ranging from 9 to

14

G
W

/

c
m

2

. We observed that two-photon absorption induced a reverse saturable absorption and saturable absorption in Co-doped ZnO, while the three-photon absorption was observed to induce saturable absorption in pure ZnO. The nonlinear absorption coefficient

β

and nonlinear refractive index

n

2

of Co-doped ZnO were found to be intensity dependent. An enhancement of 100 times in the nonlinear refractive index was observed for the Co-doped ZnO thin films compared to pure ZnO thin films. This reveal a strong optical limiting behavior for the Co-doped ZnO in comparison to pure ZnO thin films.
Antxoaren maneiu eta kontserbazioa: biomasan eragiten duten faktoreen azterketa
Authors: Txurruka Alberdi Estibalitz , Barroeta Legarreta Ziortza , Fanjul Miranda Alvaro 
Published: April 2020

Antxoa arrantza-munduko genero pelagiko garrantzitsuenetariko bat da. Bizkaiko Golkoan, 2005 eta 2010 bitartean antxoaren arrantza debekatu egin zen aurreko urteetan izandako errekrutamendu baxuak zirela eta. Halakorik errepikatu ez dadin populazioaren egoera eta honi eragiten dioten faktoreak zeintzuk diren jakitea garrantzitsua da; hala nola tamaina handiko indibiduoen kopurua zein den, harrapariak, korronteak, parasitoak, birusak eta bakterioak, ibaien lumak, zooplanktonaren (beraren elikagaia) ugaritasuna eta komunitatearen estruktura/dibertsitatea etab. Antxoaren biomasan (eta errekrutamenduan) zuzenean eragiten duten faktore horietaz gainera, badira zeharkako eragile batzuk ere, antxoaren elikagai nagusia den zooplanktonean eragiten dutenak hain zuzen ere. Adibidez, uraren tenperatura, fitoplanktona, gazitasuna, upwellinga, etab. Eragile horiek kontuan ez hartzeak ondorioak ekarri ditzake etorkizuneko antxoaren biomasan eta, beraz, horiek aztertzea ezinbestekoa da.
The Compulsion to Create: Definition and Genesis of the Phenomenon
Authors: Janiszewska-Szczepanik Agnieszka 
Published: April 2020

Abstract
Is it possible to speak of the compulsion to create? And if so, what underlies it? In this article, I set out to offer a comprehensive explanation of what may cause the strong desire for creative activity observable in many artistically-inclined individuals. To describe this desire, I use the term compulsion to create, and drawing upon examples from both pop-culture and the lives of famous artists on the one hand, and philosophical and scholarly writings on the other, I seek its sources in the individual’s psyche. I discuss how the compulsion to create depends, among other factors, on an individual’s personality and mental state (in the sense of Sigmund Freud’s and Elaine N. Aron’s theories), transcendental circumstances (in the sense of Carl Jung’s theory) and character traits (as defined by Jordan Peterson). Then, I frame the phenomenon studied within the 4Ps Model of Creativity. I point to a significant correlation between the compulsion to create and high levels of an individual’s creativity. Additionally, I discriminate between the notions of the drive to create and the compulsion to create. The article proposes a definition of the compulsion to create which allows for a clear understanding of this notion and its popular application in the field of creatology.
Loneliness in Artistic Expression
Authors: Morozewicz Marzanna 
Published: April 2020

Abstract
Delving into the nature of the creative process, attention is given in the article to particular kinds of emotions appearing in the course of the work of a creative person. Particular emphasis is given to the emotions the artist is guided by during the act of creation. The reflections presented in the text result not only from theoretical analysis, but also from the author’s experience in the process of creation. In this context they refer closely to the personal emotional sensations accompanying the author when painting pictures.
The article distinguishes and analizes the concept of loneliness in artistic creation. Selected visual artists are recalled, who deliberately refer in their work to the experience of loneliness in the process of creation. The significance of artists belonging to creative community groups is also pointed out. Positive and negative aspects of experiencing loneliness by the creator in the act of artistic creation are also stressed.
Hippocampal Synaptic Dysfunction in a Mouse Model of Huntington Disease Is Not Alleviated by Ceftriaxone Treatment
Authors: Wilkie Crystal M. , Barnes Jocelyn R. , Benson Cherry-Lynn M. , Brymer Kyle J. , Nafar Firoozeh , Parsons Matthew P. 
Published: April 2020

AbstractGlutamate transporters, particularly glutamate transporter 1 (GLT-1), help to prevent the adverse effects associated with glutamate toxicity by rapidly clearing glutamate from the extracellular space. Since GLT-1 expression and/or function are reduced in many neurodegenerative diseases, upregulation of GLT-1 is a favorable approach to treat the symptoms of these diseases. Ceftriaxone, a β-lactam antibiotic reported to increase GLT-1 expression, can exert neuroprotective effects in a variety of neurodegenerative diseases; however, many of these diseases do not exhibit uniform brain pathology. In contrast, as a drug that readily crosses the blood–brain barrier, ceftriaxone administration is likely to increase GLT-1 levels globally throughout the neuroaxis. In Huntington disease (HD), low GLT-1 expression is observed in the striatum in postmortem tissue and animal models. While ceftriaxone was reported to increase striatal GLT-1 and ameliorate the motor symptoms in a mouse model of HD, the extrastriatal effects of ceftriaxone in HD are unknown. Using electrophysiology and high-speed imaging of the glutamate biosensor iGluSnFR, we quantified real-time glutamate dynamics and synaptic plasticity in the hippocampus of the Q175FDN mouse model of HD, following intraperitoneal injections of either saline or ceftriaxone. We observed an activity-dependent increase in extracellular glutamate accumulation within the HD hippocampus, which was not the result of reduced GLT-1 expression. Surprisingly, ceftriaxone had little effect on glutamate clearance rates and negatively impacted synaptic plasticity. These data provide evidence for glutamate dysregulation in the HD hippocampus but also caution the use of ceftriaxone as a treatment for HD.
Pembrolizumab-induced fulminant type 1 diabetes with C-peptide persistence at first referral
Authors: Kusuki Kazuhisa , Suzuki Saya , Mizuno Yuzo 
Published: April 2020

Summary
A 72-year-old man with no history of diabetes was referred to our department due to hyperglycemia during pembrolizumab treatment for non-small-cell lung carcinoma. His blood glucose level was 209 mg/dL, but he was not in a state of ketosis or ketoacidosis. Serum C-peptide levels persisted at first, but gradually decreased, and 18 days later, he was admitted to our hospital with diabetic ketoacidosis (DKA). The patient was diagnosed with fulminant type 1 diabetes (FT1D) induced by pembrolizumab. According to the literature, the insulin secretion capacity of a patient with type 1 diabetes (T1D) induced by anti-programmed cell death-1 (anti-PD-1) antibody is depleted in approximately 2 to 3 weeks, which is longer than that of typical FT1D. Patients with hyperglycemia and C-peptide persistence should be considered for hospitalization or frequent outpatient visits with insulin treatment because these could indicate the onset of life-threatening FT1D induced by anti-PD-1 antibodies. Based on the clinical course of this patient and the literature, we suggest monitoring anti-PD-1 antibody-related T1D.

Learning points:

Immune checkpoint inhibitors, such as anti-PD-1 antibodies, are increasingly used as anticancer drugs. Anti-PD-1 antibodies can cause immune-related adverse events, including T1D.

FT1D, a novel subtype of T1D, is characterized by the abrupt onset of hyperglycemia with ketoacidosis, a relatively low glycated hemoglobin level and depletion of C-peptide level at onset.

In patients being treated with anti-PD-1 antibody, hyperglycemia with C-peptide level persistence should be monitored through regular blood tests. Because of C-peptide persistence and mild hyperglycemia, it is possible to miss a diagnosis of life-threatening FT1D induced by anti-PD-1 antibody.

In particular, in patients who have no history of diabetes, hyperglycemia without DKA is likely to be the very beginning of anti-PD-1 antibody-induced T1D. Therefore, such patients must be considered for either hospitalization or frequent outpatient visits with insulin injections and self-monitoring of blood glucose.
Type B insulin resistance syndrome in a patient with type 1 diabetes
Authors: Sjöholm Åke , Pereira Maria João , Nilsson Thomas , Linde Torbjörn , Katsogiannos Petros , Saaf Jan , Eriksson Jan W 
Published: April 2020

Summary
Type B insulin resistance syndrome (TBIRS) is a very rare autoimmune disorder with polyclonal autoantibodies against the insulin receptor, resulting in severe and refractory hyperglycemia. Described here is a patient who within a few months after the onset of autoimmune type 1 diabetes increased her insulin requirements more than 20-fold; despite this she had considerable difficulty maintaining a plasma glucose value of <40–60 mmol/L (720–1100 mg/dL). On suspicion of TBIRS, the patient was started on tapering dose of glucocorticoids to overcome the autoimmune insulin receptor blockade, resulting in an immediate and pronounced effect. Within days, insulin requirements decreased by 80–90% and plasma glucose stabilized around 7–8 mmol/L (126–144 mg/dL). The presence of antibodies to the insulin receptor was detected by immunoprecipitation and binding assays. After a 4-month remission on low maintenance dose prednisolone, the patient relapsed, which required repeated plasmaphereses and immune column treatments with temporarily remarkable effect. Mixed and transient results were seen with rituximab, mycophenolic acid and bortezomib, but the glycemic status remained suboptimal. Lack of compliance and recurrent infections may have contributed to this.

Learning points:

Type B insulin resistance syndrome (TBIRS) is a very rare autoimmune disorder with acquired polyclonal autoantibodies against the insulin receptor, resulting in severe and refractory hyperglycemia.

We describe here a young patient in whom, a few months after the onset of a regular autoimmune diabetes, insulin requirements in a short time increased more than 20-fold, but despite this, the plasma glucose level could be kept at <40–60 mmol/L only with considerable difficulty. Did this patient have TBIRS?

On suspicion of TBIRS, the patient was started on tapering glucocorticoids to overcome the autoimmune insulin receptor blockade, resulting in an immediate and pronounced effect; within days insulin requirements decreased by 80–90% and plasma glucose stabilized around 7–8 mmol/L.

The presence of antibodies to the insulin receptor was detected by immunoprecipitation and binding assays.
After a 4-month remission on low maintenance dose prednisolone, the patient relapsed, which required repeated plasmaphereses with temporarily remarkable effect.

TBIRS should be considered in diabetic patients whose glycemia and/or insulin requirements are inexplicably and dramatically increased.
Performance of deep neural network-based artificial intelligence method in diabetic retinopathy screening: a systematic review and meta-analysis of diagnostic test accuracy
Authors: Wang Shirui , Zhang Yuelun , Lei Shubin , Zhu Huijuan , Li Jianqiang , Wang Qing , Yang Jijiang , Chen Shi , Pan Hui 
Published: April 2020

Objective
Automatic diabetic retinopathy screening system based on neural networks has been used to detect diabetic retinopathy (DR). However, there is no quantitative synthesis of performance of these methods. We aimed to estimate the sensitivity and specificity of neural networks in DR grading.

Methods
Medline, Embase, IEEE Xplore, and Cochrane Library were searched up to 23 July 2019. Studies that evaluated performance of neural networks in detection of moderate or worse DR or diabetic macular edema using retinal fundus images with ophthalmologists’ judgment as reference standard were included. Two reviewers extracted data independently. Risk of bias of eligible studies was assessed using QUDAS-2 tool.

Results
Twenty-four studies involving 235 235 subjects were included. Quantitative random-effects meta-analysis using the Rutter and Gatsonis hierarchical summary receiver operating characteristics (HSROC) model revealed a pooled sensitivity of 91.9% (95% CI: 89.6% to 94.3%) and specificity of 91.3% (95% CI: 89.0% to 93.5%). Subgroup analyses and meta-regression did not provide any statistically significant findings for the heterogeneous diagnostic accuracy in studies with different image resolutions, sample sizes of training sets, architecture of convolutional neural networks, or diagnostic criteria.

Conclusions
State-of-the-art neural networks could effectively detect clinical significant DR. To further improve diagnostic accuracy of neural networks, researchers might need to develop new algorithms rather than simply enlarge sample sizes of training sets or optimize image quality.