bluuebunny/crossref_metadata_2025_split huggingface dataset:
Septic arthritis of the shoulder due to Ureaplasma urealyticum after emergency caesarean section: a case report
Authors: Mahlouly Jaad , Lhopitallier Loic , Suttels Véronique , Mueller Linda , Wernly Diane , Borens Olivier , Steinmetz Sylvain 
Published: October 2020

Abstract
Background
Ureaplasma urealyticum is an intra-cellular bacterium frequently found colonizing the genital tract. Known complications include localized infections, which can result in premature deliveries. Septic arthritis due to U. urealyticum in healthy patients is exceptionally rare, although opportunistic septic arthritis in agammaglobulinemic patients have been reported. However, there are no reports of septic arthritis due to U. urealyticum following caesarean section or in the post-partum period.

Case presentation
A 38-year-old immunocompetent woman presented with severe right shoulder pain, 1 month following emergency caesarean section at 26 weeks of gestation for pre-eclampsia and spontaneous placental disruption with an uncomplicated post-operative recovery.
Our suspicion of septic arthritis was confirmed with abundant pus following arthrotomy by a delto-pectoral approach. Awaiting culture results, empirical antibiotic treatment with intravenous amoxicilline and clavulanic acid was initiated. In spite of sterile cultures, clinical evolution was unfavorable with persistent pain, inflammation and purulent drainage, requiring two additional surgical débridement and lavage procedures.
The 16S ribosomal RNA PCR of the purulent liquid was positive for U. urealyticum at 2.95 × 106 copies/ml, specific cultures inoculated a posteriori were positive for U. urealyticum. Levofloxacin and azithromycine antibiotherapy was initiated. Susceptibility testing showed an intermediate sensibility to ciprofloxacin and clarithromycin. The strain was susceptible to doxycycline. Following cessation of breastfeeding, we started antibiotic treatment with doxycycline for 4 weeks. The subsequent course was favorable with an excellent functional and biological outcome.

Conclusions
We report the first case of septic arthritis due to U. urealyticum after caesarean section. We hypothesize that the breach of the genital mucosal barrier during the caesarean section led to hematogenous spread resulting in purulent septic arthritis. The initial beta-lactam based antibiotic treatment, initiated for a purulent arthritis, did not provide coverage for cell wall deficient organisms. Detection of 16S rRNA allowed for a correct microbiological diagnosis in a patient with an unexpected clinical course.
Concurrent acute myositis and Guillain-Barre syndrome in Cytomegalovirus infection – a rare case report
Authors: Sakthivadivel Varatharajan , Naveenraj Palanisamy , Kachhwaha Arjun , Kumar Deepak , Anne Puneeth Babu , Elhence Poonam , Meena Mahadev 
Published: October 2020

AbstractBackgroundCytomegalovirus (CMV) is a double stranded DNA virus and ubiquitous in nature. Association of Guillain-Barre syndrome (GBS) and CMV is well known but CMV acute myositis is a rare condition. Restriction of movements of limbs due to severe pain in myositis may obscure the diagnosis of GBS and this may easily miss.Case presentationHere we describe a 29-year-old male presenting with pain and swelling of bilateral lower limbs which progressed rapidly with increasing serum creatine kinase levels with positive IgM CMV antibodies. In view of no improvement in clinical condition, patient was further evaluated and found to have concurrent GBS. He was treated with plasmapheresis and improved.ConclusionCytomegalovirus infection presenting as acute myositis is a uncommon and further association with GBS is a rare occurrence.
Ovarian cancer cells direct monocyte differentiation through a non-canonical pathway
Authors: Fogg Kaitlin C. , Miller Andrew E. , Li Ying , Flanigan Will , Walker Alyssa , O’Shea Andrea , Kendziorski Christina , Kreeger Pamela K. 
Published: October 2020

AbstractBackgroundAlternatively-activated macrophages (AAMs), an anti-inflammatory macrophage subpopulation, have been implicated in the progression of high grade serous ovarian carcinoma (HGSOC). Increased levels of AAMs are correlated with poor HGSOC survival rates, and AAMs increase the attachment and spread of HGSOC cells in vitro. However, the mechanism by which monocytes in the HGSOC tumor microenvironment are differentiated and polarized to AAMs remains unknown.MethodsUsing an in vitro co-culture device, we cultured naïve, primary human monocytes with a panel of five HGSOC cell lines over the course of 7 days. An empirical Bayesian statistical method, EBSeq, was used to couple RNA-seq with observed monocyte-derived cell phenotype to explore which HGSOC-derived soluble factors supported differentiation to CD68+ macrophages and subsequent polarization towards CD163+ AAMs. Pathways of interest were interrogated using small molecule inhibitors, neutralizing antibodies, and CRISPR knockout cell lines.ResultsHGSOC cell lines displayed a wide range of abilities to generate AAMs from naïve monocytes. Much of this variation appeared to result from differential ability to generate CD68+ macrophages, as most CD68+ cells were also CD163+. Differences in tumor cell potential to generate macrophages was not due to a MCSF-dependent mechanism, nor variance in established pro-AAM factors. TGFα was implicated as a potential signaling molecule produced by tumor cells that could induce macrophage differentiation, which was validated using a CRISPR knockout ofTGFAin the OVCAR5 cell line.ConclusionsHGSOC production of TGFα drives monocytes to differentiate into macrophages, representing a central arm of the mechanism by which AAMs are generated in the tumor microenvironment.
Age and gender specific association between obesity and depressive symptoms: a large-scale cross-sectional study
Authors: Liao Wei , Luo Zhicheng , Hou Yitan , Cui Ningning , Liu Xiaotian , Huo Wenqian , Wang Fang , Wang Chongjian 
Published: October 2020

Abstract
Background
This is a cross-sectional study to explore the age and gender specific association between obesity and depression in Chinese rural adults.

Methods
A total of 29,900 eligible participants from the Henan Rural Cohort Study were included. Standard anthropometric measurements were undertaken to obtain data on body mass index (BMI) and waist circumference (WC). The Patient Health Questionnaire-2 (PHQ-2) was utilized to discover depressive symptoms. Logistic regression was performed to explore the association between obesity (independent variable) and depressive symptoms (dependent variable).

Results
There were 1777 subjects with depressive symptoms, accounting for 5.94%. After multivariable adjustment, compared with normal weight group, the odds ratios (ORs) [95% confidence interval (CI)] for depressive symptoms in underweight, overweight and general obese groups were 1.41 (1.08–1.84), 0.87 (0.78–0.97) and 0.86 (0.74–0.99), respectively. Similarly, the OR (95% CI) of abdominal obesity group was 0.84 (0.76–0.93). Besides, there was linear decreasing trend of WC with depressive symptoms, but not BMI. Moreover, the inverse association between obesity and depressive symptoms was stronger in men and the elderly than that in women and the young.

Conclusion
Underweight was associated with a higher prevalence of depressive symptoms, which indicated that health care should pay attention to underweight as well as obesity, especially for women and the young.

Clinical trial registration
The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 2015-07-06.
Public awareness and knowledge of factors associated with dementia in China
Authors: Zheng Yong-Bo , Shi Le , Gong Yi-Miao , Wang Xiao-Xiao , Lu Qing-Dong , Que Jian-Yu , Khan Muhammad Zahid , Bao Yan-Ping , Lu Lin 
Published: October 2020

Abstract
Background
Dementia is a global public health priority. Many modifiable factors have been shown to influence the development of dementia, but these factors are not adequately known by the general public. This study aimed to assess public awareness of the factors that are associated with dementia in China.

Methods
A cross-sectional study was conducted from May to October 2019 using an Internet-based questionnaire. Data on basic sociodemographic characteristics were collected, and the knowledge of risk and protective factors for dementia was investigated. Logistic regression analysis was performed to compare levels of the knowledge of factors associated with dementia across populations with different demographic characteristics.

Results
Data from 3338 respondents were analyzed. The percentages of participants who accurately identified the risk factors of dementia were follows: 84.24% for negative affect, 65.07% for alcohol use, 56.68% for smoking, 48.74% for hypertension, and 42.66% for diabetes. The percentages of participants who accurately identified the protective factors for dementia were follows: 90.00% for exercise, 84.69% for social activity, 80.92% for intelligence games, 74.45% for reading, and 6.14% for antihypertensive or hypolipidemic drugs. The majority of Chinese people correctly recognized the role of lifestyle factors in the development of dementia but not medical factors. The levels of knowledge of the factors associated with dementia were significantly distinct across populations with different characteristics. The following sociodemographic characteristics were associated with more comprehensive knowledge of dementia risk and protective factors: women, young age, high education levels, nonmanual jobs, and contact with patients with dementia.

Conclusions
Public awareness and knowledge of risk and protective factors for dementia in China are still insufficient. More efforts are needed to publicize information to reduce the risk of dementia.
A new decellularized tendon scaffold for rotator cuff tears – evaluation in rabbits
Authors: de Lima Santos Alex , da Silva Camila Gonzaga , de Sá Barreto Leticia Siqueira , Leite Katia Ramos Moreira , Tamaoki Marcel Jun Sugawara , Ferreira Lydia Massako , de Almeida Fernando Gonçalves , Faloppa Flavio 
Published: October 2020

Abstract
Background
Scaffolds have considerably advanced in recent years. In orthopaedic surgery, scaffolds have been used as grafts in procedures involving tendon and ligament reconstruction. This paper aimed to produce and evaluate decellularized tendon scaffolds (DTSs) from biomechanical, microscopic, macroscopic and in vivo perspectives.

Methods
Bilateral gastrocnemius muscle tendons from 18 adult New Zealand rabbits were collected. Of these 36 tendons, 11 were used as controls (Group A - control), and 25 were used in the decellularization protocol (Group B - DTS). The groups were subjected to histological, biomechanical and macroscopic analyses, and Group B - DTS was subjected to an additional in vivo evaluation. In the decellularization protocol, we used a combination of aprotinin, ethylenediamine tetraacetic acid (EDTA), sodium dodecyl sulfate (SDS) and t-octyl-phenoxypolyethoxyethanol (Triton X-100) for six days. During this period, the scaffolds were kept at room temperature on an orbital shaker with constant motion.

Results
The DTSs showed an increased cross-sectional area and inter-fascicular distance and no change in parallelism or matrix organization. The nuclear material was not organized in the DTSs as it was in the control. In the biomechanical analysis, no significant differences were found between the groups after analysing the ultimate tensile load, stiffness, and elongation at the ultimate tensile load. During the in vivo evaluation, mononuclear cell infiltration was noted.

Conclusions
The evaluated decellularization protocol generated a tendon scaffold, maintained the most important biomechanical characteristics and permitted cell infiltration.
Epidemiology of Achilles tendon surgery in Italy: a nationwide registry study, from 2001 through 2015
Authors: Longo Umile Giuseppe , Salvatore Giuseppe , Risi Ambrogioni Laura , Cella Eleonora , Candela Vincenzo , Carnevale Arianna , Schena Emiliano , Ciccozzi Massimo , Maffulli Nicola , Denaro Vincenzo 
Published: October 2020

AbstractBackgroundThis study aims (1) to estimate the yearly number of Achilles tendon (AT) surgeries in Italy from 2001 to 2015 based on official hospitalization records; (2) to investigate the eventual presence of geographical variation in equity in access to AT surgery between three macroregions of Italy (North, Center and South); (3) to perform statistical projections of the number of AT procedure volumes and rates based on these data.MethodsWe analysed the National Hospital Discharge records (SDO) maintained at the Italian Ministry of Health for a 15-year period, from 2001 through 2015. These data are anonymous and include the patient’s age (evaluated in the class of age), sex, census region, the region of hospitalization, length of the hospitalization, public or private reimbursement and diagnosis.ResultsDuring the 15-year study period, 118,652 AT repair were performed in Italy, whose peak of incidence was in 2010. More than half of AT repairs was performed in the North of Italy (52.1%), while 27.2% was performed in the South of Italy and 20.6% Center of Italy. The projection model predicted a slight growth of 2.65% in 2025 in comparison with 2015.ConclusionThe current study provides detailed information about the national population-weighted incidence of AT surgery, distribution and projection. The peak of average age was 35–45 year. The majority of AT procedures was performed in the North of Italy. The projection model predicts a slight growth of AT surgery by 2025. Furthermore, this 15-year nationwide registry study shows that the age of incidence of AT injuries shifted from 30 to 40 to 35–45 years compared to the available literature. The higher prevalence of AT surgery was found in men during the working age. Moreover, a low rate of procedures in pediatric and elder age classes was observed.
Gossypiboma with perforation of the umbilicus mimicking a complicated urachal cyst: a case report
Authors: Kabba Mustapha S. , Forde Martha Y. , Beckley Kevin S. , Johnny Bernadette , Jah-Kabba Ann-Marie B. M. , Seisay Samuel B. , Dawoh Alusine M. , Ogundiran Temidayo 
Published: October 2020

Abstract
Background
A retained surgical sponge, also known as a gossypiboma, is a rare cause of serious postoperative complications. Diverse retained surgical materials including instruments such as clamps and sutures have been reported, but surgical sponges are the most common material. We report an unusual case of a gossypiboma mimicking a complicated urachal cyst that led to perforation of the umbilicus.

Case presentation
A 38-year-old female patient presented in our facility with a palpable periumbilical mass and discharge of pus from the umbilicus for 7 months after an open appendectomy. Since the onset of symptoms, the patient had been treated conservatively in a peripheral hospital where she had been operated on. As no improvement was seen, an ultrasound scan was performed that suggested an intraperitoneal abscess adjacent to the umbilicus. Consequently, the patient was referred to our specialist outpatient department for surgical intervention. Suspecting a complicated urachal cyst, an exploratory laparotomy was performed but revealed a retained surgical sponge as the underlying cause. The gossypiboma was resected, and the postoperative period was unremarkable.

Conclusion
This case demonstrates that gossypibomas, even though rare, continue to occur. They may clinically and radiologically mimic other pathologies, especially abscesses and tumors. Preventive measures as well as the inclusion of gossypibomas in the differential diagnosis of intraabdominal masses or fistulation detected in patients with a history of surgery are of utmost importance to minimize morbidity, mortality, and potential medicolegal implications.
Association between early childhood oral health impact scale (ECOHIS) scores and pediatric dental surgery wait times
Authors: Lee Victor H. K. , Grant Cameron G. , Mittermuller Betty-Anne , Singh Sarbjeet , Weiss Brenda , Edwards Jeanette M. , Schroth Robert J. 
Published: October 2020

Abstract
Background
Severe Early Childhood Caries (S-ECC) is an aggressive form of tooth decay that often requires pediatric dental rehabilitative surgery. The Early Childhood Oral Health Impact Scale (ECOHIS) measures oral health-related quality of life (OHRQL). The purpose of this study was to determine whether there is an association between ECOHIS scores and surgery wait times for children undergoing dental treatment for S-ECC under general anesthesia (GA).

Methods
The hypothesis was that there is no present association between wait times and ECOHIS score. Children under 72 months of age with S-ECC were recruited on the day of their slated dental surgery under GA. Parents/caregivers completed a questionnaire that included the ECOHIS. Data were merged with other ECOHIS scores from a previous study. Wait times were acquired from the Patient Access Registry Tool (PART) database. Data analysis included descriptive statistics and bivariate analyses. A p-value of ≤0.05 was considered statistically significant; 95% confidence intervals (CIs) were reported for each correlation coefficient. This study was approved by the University of Manitoba’s Health Research Ethics Board.

Results
Overall, 200 children participated, the majority of whom were Indigenous (63%) and resided in Winnipeg (52.5%). The mean age was 47.6 ± 13.8 months and 50.5% were female. Analyses showed ECOHIS scores were not significantly correlated with children’s wait times. Observed correlations between ECOHIS and children’s wait times were low and not statistically significant, ranging from ρ = 0.11 for wait times and child impact section (CIS) scores (95% CI: − 0.04, 0.26; p = 0.14), ρ = − 0.08 for family impact section (FIS) scores (95% CI: − 0.23, 0.07; p = 0.28), and ρ = 0.04 for total ECOHIS scores (95% CI: − 0.11, 0.19; p = 0.56).

Conclusion
No significant associations were observed between ECOHIS scores and wait times. In fact, those with worse OHRQL appeared to wait longer for surgery. ECOHIS scores could, however, still be used to help prioritize children for dental surgery to ensure that they receive timely access to dental care under GA. This is essential given the challenges posed by COVID-19 on timely access to surgical care.
Network analysis of autistic disease comorbidities in Chinese children based on ICD-10 codes
Authors: Li Xiaojun , Liu Guangjian , Chen Wenxiong , Bi Zhisheng , Liang Huiying 
Published: October 2020

AbstractBackgroundAutism is a lifelong disability associated with several comorbidities that confound diagnosis and treatment. A better understanding of these comorbidities would facilitate diagnosis and improve treatments. Our aim was to improve the detection of comorbid diseases associated with autism.MethodsWe used an FP-growth algorithm to retrospectively infer disease associations using 1488 patients with autism treated at the Guangzhou Women and Children’s Medical Center. The disease network was established using Cytoscape 3.7. The rules were internally validated by 10-fold cross-validation. All rules were further verified using the Columbia Open Health Data (COHD) and by literature search.ResultsWe found 148 comorbid diseases including intellectual disability, developmental speech disorder, and epilepsy. The network comprised of 76 nodes and 178 directed links. 158 links were confirmed by literature search and 105 links were validated by COHD. Furthermore, we identified 14 links not previously reported.ConclusionWe demonstrate that the FP-growth algorithm can detect comorbid disease patterns, including novel ones, in patients with autism.
Cell-specific toxicity of short-term JUUL aerosol exposure to human bronchial epithelial cells and murine macrophages exposed at the air–liquid interface
Authors: Pinkston Rakeysha , Zaman Hasan , Hossain Ekhtear , Penn Arthur L. , Noël Alexandra 
Published: October 2020

Abstract
Backgroud
JUUL, an electronic nicotine delivery system (ENDS), which first appeared on the US market in 2015, controled more than 75% of the US ENDS sales in 2018. JUUL-type devices are currently the most commonly used form of ENDS among youth in the US. In contrast to free-base nicotine contained in cigarettes and other ENDS, JUUL contains high levels of nicotine salt (35 or 59 mg/mL), whose cellular and molecular effects on lung cells are largely unknown. In the present study, we evaluated the in vitro toxicity of JUUL crème brûlée-flavored aerosols on 2 types of human bronchial epithelial cell lines (BEAS-2B, H292) and a murine macrophage cell line (RAW 264.7).

Methods
Human lung epithelial cells and murine macrophages were exposed to JUUL crème brûlée-flavored aerosols at the air–liquid interface (ALI) for 1-h followed by a 24-h recovery period. Membrane integrity, cytotoxicity, extracellular release of nitrogen species and reactive oxygen species, cellular morphology and gene expression were assessed.

Results
Crème brûlée-flavored aerosol contained elevated concentrations of benzoic acid (86.9 μg/puff), a well-established respiratory irritant. In BEAS-2B cells, crème brûlée-flavored aerosol decreased cell viability (≥ 50%) and increased nitric oxide (NO) production (≥ 30%), as well as iNOS gene expression. Crème brûlée-flavored aerosol did not affect the viability of either H292 cells or RAW macrophages, but increased the production of reactive oxygen species (ROS) by ≥ 20% in both cell types. While crème brûlée-flavored aerosol did not alter NO levels in H292 cells, RAW macrophages exposed to crème brûlée-flavored aerosol displayed decreased NO (≥ 50%) and down-regulation of the iNOS gene, possibly due to increased ROS. Additionally, crème brûlée-flavored aerosol dysregulated the expression of several genes related to biotransformation, inflammation and airway remodeling, including CYP1A1, IL-6, and MMP12 in all 3 cell lines.

Conclusion
Our results indicate that crème brûlée-flavored aerosol causes cell-specific toxicity to lung cells. This study contributes to providing scientific evidence towards regulation of nicotine salt-based products.
Improved thermostability of creatinase from Alcaligenes Faecalis through non-biased phylogenetic consensus-guided mutagenesis
Authors: Bai Xue , Li Daixi , Ma Fuqiang , Deng Xi , Luo Manjie , Feng Yan , Yang Guangyu 
Published: October 2020

Abstract
Background
Enzymatic quantification of creatinine has become an essential method for clinical evaluation of renal function. Although creatinase (CR) is frequently used for this purpose, its poor thermostability severely limits industrial applications. Herein, we report a novel creatinase from Alcaligenes faecalis (afCR) with higher catalytic activity and lower KM value, than currently used creatinases. Furthermore, we developed a non-biased phylogenetic consensus method to improve the thermostability of afCR.

Results
We applied a non-biased phylogenetic consensus method to identify 59 candidate consensus residues from 24 creatinase family homologs for screening afCR mutants with improved thermostability. Twenty-one amino acids of afCR were selected to mutagenesis and 11 of them exhibited improved thermostability compared to the parent enzyme (afCR-M0). Combination of single-site mutations in sequential screens resulted in a quadruple mutant D17V/T199S/L6P/T251C (M4-2) which showed ~ 1700-fold enhanced half-life at 57 °C and a 4.2 °C higher T5015 than that of afCR-M0. The mutant retained catalytic activity equivalent to afCR-M0, and thus showed strong promise for application in creatinine detection. Structural homology modeling revealed a wide range of potential molecular interactions associated with individual mutations that contributed to improving afCR thermostability.

Conclusions
Results of this study clearly demonstrated that the non-biased-phylogenetic consensus design for improvement of thermostability in afCR is effective and promising in improving the thermostability of more enzymes.