bluuebunny/crossref_metadata_2025_split huggingface dataset:
Jones Fracture Treatment: A Novel Surgical Technique and Case Series
Authors: Ryan Thomas J. , Tarrant Seth M. , Fraser Ethan J. , O’Sullivan James 
Published: October 2020

Background Jones fractures remain a challenging treatment entity in orthopaedics. Biomechanical stresses, including increased fifth metatarsal (5MT) lateral angle deviation (MLAD), are associated with increased fracture and refracture rates. Current fixation techniques produce good outcomes; however, they do not address metatarsal morphology, which can predispose to refracture. This study describes a novel surgical technique and case series utilizing intramedullary screw fixation and distal metatarsal corrective osteotomy for the management of Jones fractures. Methods A retrospective case series was undertaken, including 22 consecutive Jones fracture patients operated on by a single surgeon. Patient demographics, imaging, and operative information were obtained, with return to sport/previous function and radiological outcomes, including fracture union being the outcomes of interest. The surgical technique utilizes a distal osteotomy of the 5MT followed by retrograde guidewire and drilling utilizing the osteotomy. A cannulated screw is passed antegrade along the entire length of the 5MT with manual MLAD correction. Autograft or bone substitute (Augment) was then injected at the fracture site. Results Median age was 30 years (Q1, Q3: 18, 49 years). Median time from injury to operation was 13 weeks (Q1, Q3: 9, 30 weeks), and clinical follow-up period was 37 months (Q1, Q3: 14, 74 months). Radiological union was achieved at a median of 12 weeks (Q1, Q3: 8, 15 weeks) with clinical union at 11 weeks (Q1, Q3: 8, 14 weeks). All but one patient returned to preinjury functional levels, including 6 professional athletes who returned to preinjury national competition. No refractures were identified. Conclusion The technique described in this study is a viable and safe means of managing Jones fractures. The technique may be particularly useful in patients with excessive MLAD. Levels of Evidence Level IV: Retrospective case series
Mini-Invasive Endoscopic Approaches to the Maxillary Sinus Floor: A Comparative Anatomical Study
Authors: Felisati Elena , Saibene Alberto Maria , Borloni Roberto , Prades Jean Michel , Felisati Giovanni 
Published: October 2020

Background While middle antrostomy (MA) is the most common approach to the maxillary sinus (MS), it is known for not allowing to fully inspect the whole MS, especially in its inferior and anterior portions. To overcome this limitation, alternative approaches have been proposed, such as inferior antrotomy (IA) and canine fossa accesses (CFA). Objective Given the lack of studies on the MS floor visualization with different accesses, our study aims, in a cadaver lab setting, to systematically compare three different approaches (MA, IA and CFA) in these regards. Methods Eight cadaver heads, previously submitted to CTscan, were prepared inserting fixtures corresponding to teeth 2, 4, 6, 11, 13 and 15 and into the canine fossae. Three approaches were prepared: a wide MA, an IM and a CFA. We endoscopically evaluated, for each specimen, side, access type and scope angle (0°, 30°, 45°, and 70°), which fixtures were visible on the maxillary sinus floor and whether the canine fossa fixture was visible (MA and IA only). Results IA allowed to visualize all fixtures in nearly all cases (14/16 with 70° endoscope), while MA showed poor visualization results (3/16 with 70° endoscope); CFA failed to gain full visualization in most specimens (7/16 with 70°endoscope). Such difference was statistically significant. MA proved unable to visualize the canine fossa fixture in most cases while IA showed excellent possibilities. All differences were statistically significant (p < .001, Mcnemar’s test). Conclusions Our data show that the IA grants a statistically significant superior surgical field vision when compared to MA and CFA, though in vivo validation of these results is still required.
Mobilising intensive care patients early
Authors: Ling Xi Wern , Lim Yee Hua , Ong Hwee Kuan , Palanichamy Vimal , Leong Kenneth Bao Ren , Ling Xi Yun , Lee Ken Cheah Hooi , Ho Vui Kian 
Published: October 2020

Background: Early mobilisation in the intensive care unit has been suggested to improve outcomes. However, safety and practical concerns have led to the slow uptake of early mobilisation. Objectives: We designed a study to evaluate the practicability and efficacy of an early mobilisation protocol in intensive care unit patients. Methods: We performed a prospective non-blinded observational cohort study based on a quality improvement project. We implemented a protocol for early mobilisation of suitable patients admitted to medical and surgical intensive care units of a tertiary care hospital. All other aspects of patient care were managed as usual. Patients were followed up to discharge. Data were collected from July to August 2016 pre-implementation and from November 2016 to February 2017 following protocol implementation. The primary outcome measure was the mobilisation rate, defined as the number of days mobilised divided by the number of days each patient met mobilisation criteria. Secondary outcome measures included adverse event rate, length of mechanical ventilation, intensive care unit and hospital stay, intensive care unit and inhospital mortality and discharge destination. Results: A total of 312 patients were analysed, of which 60% were men with a mean age of 63.4 years. Following early mobilisation implementation, the mobilisation rate increased from 39% to 65% ( P=0.006). The percentage of patients discharged home increased from 49.0% to 75.9% ( P<0.001). Mortality, length of mechanical ventilation, length of stay and adverse event rate did not differ significantly. Conclusion: The implementation of an early mobilisation protocol in our intensive care unit was both safe and effective without requiring additional staffing. Efforts are ongoing to increase compliance with the protocol.
Growth differentiation factor‐15 levels in the blood around the pulmonary artery is associated with hospitalization for heart failure in patients with pulmonary arterial hypertension
Authors: Chang Wei‐Ting , Shih Jhih‐Yuan , Lin Yu‐Wen , Chen Zhih‐Cherng , Roan Jun‐Neng , Hsu Chih‐Hsin 
Published: October 2020

Despite no significant differences of growth differentiation factor‐15 expressions in peripheral, right atrial, and right ventricular blood, in the pulmonary arterial blood, there was a significantly high level of growth differentiation factor‐15 in Group I pulmonary arterial hypertension patients subsequently developing heart failure. During right heart catheterization, collecting pulmonary blood samples is suggested to measure growth differentiation factor‐15.
Radial artery access is associated with lower mortality in patients undergoing primary PCI: a report from the SWEDEHEART registry
Authors: Dworeck Christian , Redfors Björn , Völz Sebastian , Haraldsson Inger , Angerås Oskar , Råmunddal Truls , Ioanes Dan , Myredal Anna , Odenstedt Jacob , Hirlekar Geir , Koul Sasha , Fröbert Ole , Linder Rickard , Venetsanos Dimitrios , Hofmann Robin , Ulvenstam Anders , Petursson Petur , Sarno Giovanna , James Stefan , Erlinge David , Omerovic Elmir 
Published: October 2020

Objectives
The purpose of this observational study was to evaluate the effects of radial artery access versus femoral artery access on the risk of 30-day mortality, inhospital bleeding and cardiogenic shock in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Methods
We used data from the SWEDEHEART registry and included all patients who were treated with primary percutaneous coronary intervention in Sweden between 2005 and 2016. We compared patients who had percutaneous coronary intervention by radial access versus femoral access with regard to the primary endpoint of all-cause death within 30 days, using a multilevel propensity score adjusted logistic regression which included hospital as a random effect.

Results
During the study period, 44,804 patients underwent primary percutaneous coronary intervention of whom 24,299 (54.2%) had radial access and 20,505 (45.8%) femoral access. There were 2487 (5.5%) deaths within 30 days, of which 920 (3.8%) occurred in the radial access and 1567 (7.6%) in the femoral access group. After propensity score adjustment, radial access was associated with a lower risk of death (adjusted odds ratio (OR) 0.70, 95% confidence interval (CI) 0.55–0.88, P = 0.025). We found no interaction between access site and age, gender and cardiogenic shock regarding 30-day mortality. Radial access was also associated with a lower adjusted risk of bleeding (adjusted OR 0.45, 95% CI 0.25–0.79, P = 0.006) and cardiogenic shock (adjusted OR 0.41, 95% CI 0.24–0.73, P = 0.002).

Conclusions
In patients with ST-elevation myocardial infarction, primary percutaneous coronary intervention by radial access rather than femoral access was associated with an adjusted lower risk of death, bleeding and cardiogenic shock. Our findings are consistent with, and add external validity to, recent randomised trials.
Retroperitoneoscopic nephrectomy: current status
Authors: Garg Harshit , Yadav Siddharth , Singh Prabhjot , Hemal Ashok , Kumar Rajeev 
Published: October 2020

The classic retroperitoneal open surgical access to the kidney has been duplicated while performing laparoscopy but is less common than transperitoneal laparoscopy. We reviewed minimally invasive retroperitoneoscopic nephrectomy as a part of the international consultation on urological diseases and European Association of Urology international consultation on minimally invasive surgery in urology. A Pubmed/Medline search was performed to identify studies assessing the feasibility, safety and efficacy of laparoscopic and robotic retroperitoneoscopic nephrectomy. The articles were reviewed to assess outcomes after simple, radical and donor nephrectomy and comparative trials between retroperitoneoscopic versus the open and transperitoneal route were evaluated. Retroperitoneoscopic nephrectomy is feasible for most cases of benign non-functioning kidneys. Retroperitoneoscopic radical nephrectomy is also feasible for most tumours and may be better suited for posteriorly located tumours. Both retroperitoneoscopic and transperitoneal nephrectomy have similar outcomes but the operative time may be shorter for the former. The data are insufficient for robotic retroperitoneoscopic nephrectomy probably because of limited space and lack of benefit of a robot in ablative surgeries. Level of evidence: 3a
Prediction of genetic merit for growth rate in pigs using animal models with indirect genetic effects and genomic information
Authors: Poulsen Bjarke G. , Ask Birgitte , Nielsen Hanne M. , Ostersen Tage , Christensen Ole F. 
Published: October 2020

Abstract
Background
Several studies have found that the growth rate of a pig is influenced by the genetics of the group members (indirect genetic effects). Accounting for these indirect genetic effects in a selection program may increase genetic progress for growth rate. However, indirect genetic effects are small and difficult to predict accurately. Genomic information may increase the ability to predict indirect genetic effects. Thus, the objective of this study was to test whether including indirect genetic effects in the animal model increases the predictive performance when genetic effects are predicted with genomic relationships. In total, 11,255 pigs were phenotyped for average daily gain between 30 and 94 kg, and 10,995 of these pigs were genotyped. Two relationship matrices were used: a numerator relationship matrix ($${\mathbf{A}}$$
A
) and a combined pedigree and genomic relationship matrix ($${\mathbf{H}}$$
H
); and two different animal models were used: an animal model with only direct genetic effects and an animal model with both direct and indirect genetic effects. The predictive performance of the models was defined as the Pearson correlation between corrected phenotypes and predicted genetic levels. The predicted genetic level of a pig was either its direct genetic effect or the sum of its direct genetic effect and the indirect genetic effects of its group members (total genetic effect).

Results
The highest predictive performance was achieved when total genetic effects were predicted with genomic information (21.2 vs. 14.7%). In general, the predictive performance was greater for total genetic effects than for direct genetic effects (0.1 to 0.5% greater; not statistically significant). Both types of genetic effects had greater predictive performance when they were predicted with $${\mathbf{H}}$$
H
rather than $${\mathbf{A}}$$
A
(5.9 to 6.3%). The difference between predictive performances of total genetic effects and direct genetic effects was smaller when $${\mathbf{H}}$$
H
was used rather than $${\mathbf{A}}$$
A
.

Conclusions
This study provides evidence that: (1) corrected phenotypes are better predicted with total genetic effects than with direct genetic effects only; (2) both direct genetic effects and indirect genetic effects are better predicted with $${\mathbf{H}}$$
H
than $${\mathbf{A}}$$
A
; (3) using $${\mathbf{H}}$$
H
rather than $${\mathbf{A}}$$
A
primarily improves the predictive performance of direct genetic effects.
Molecular evolutionary and structural analysis of human UCHL1 gene demonstrates the relevant role of intragenic epistasis in Parkinson’s disease and other neurological disorders
Authors: Nawaz Muhammad Saqib , Asghar Razia , Pervaiz Nashaiman , Ali Shahid , Hussain Irfan , Xing Peiqi , Bao Yiming , Abbasi Amir Ali 
Published: October 2020

Abstract
Background
Parkinson’s disease (PD) is the second most common neurodegenerative disorder. PD associated human UCHL1 (Ubiquitin C-terminal hydrolase L1) gene belongs to the family of deubiquitinases and is known to be highly expressed in neurons (1–2% in soluble form). Several functions of UCHL1 have been proposed including ubiquitin hydrolyze activity, ubiquitin ligase activity and stabilization of the mono-ubiquitin. Mutations in human UCHL1 gene have been associated with PD and other neurodegenerative disorders. The present study aims to decipher the sequence evolutionary pattern and structural dynamics of UCHL1. Furthermore, structural and interactional analysis of UCHL1 was performed to help elucidate the pathogenesis of PD.

Results
The phylogenetic tree topology suggests that the UCHL1 gene had originated in early gnathostome evolutionary history. Evolutionary rate analysis of orthologous sequences reveals strong purifying selection on UCHL1. Comparative structural analysis of UCHL1 pinpoints an important protein segment spanning amino acid residues 32 to 39 within secretion site with crucial implications in evolution and PD pathogenesis through a well known phenomenon called intragenic epistasis. Identified critical protein segment appears to play an indispensable role in protein stability, proper protein conformation as well as harboring critical interaction sites.

Conclusions
Conclusively, the critical protein segment of UCHL1 identified in the present study not only demonstrates the relevant role of intraprotein conformational epistasis in the pathophysiology of PD but also offers a novel therapeutic target for the disease.
The flattened and needlelike leaves of the pine family (Pinaceae) share a conserved genetic network for adaxial-abaxial polarity but have diverged for photosynthetic adaptation
Authors: Du Hong , Ran Jin-Hua , Feng Yuan-Yuan , Wang Xiao-Quan 
Published: October 2020

Abstract
Background
Leaves have highly diverse morphologies. However, with an evolutionary history of approximately 200 million years, leaves of the pine family are relatively monotonous and often collectively called “needles”, although they vary in length, width and cross-section shapes. It would be of great interest to determine whether Pinaceae leaves share similar morpho-physiological features and even consistent developmental and adaptive mechanisms.

Results
Based on a detailed morpho-anatomical study of leaves from all 11 Pinaceae genera, we particularly investigated the expression patterns of adaxial-abaxial polarity genes in two types of leaves (needlelike and flattened) and compared their photosynthetic capacities. We found that the two types of leaves share conserved spatial patterning of vasculatures and genetic networks for adaxial-abaxial polarity, although they display different anatomical structures in the mesophyll tissue differentiation and distribution direction. In addition, the species with needlelike leaves exhibited better photosynthetic capacity than the species with flattened leaves.

Conclusions
Our study provides the first evidence for the existence of a conserved genetic module controlling adaxial-abaxial polarity in the development of different Pinaceae leaves.
“I lost my happiness, I felt half dead and half alive” - a qualitative study of the long-term aftermath of obstetric near-miss in the urban district of Zanzibar, Tanzania
Authors: Herklots Tanneke , Yussuf Suhaila Salum , Mbarouk Khairat Said , O’Meara Molly , Carson Emma , Plug Sebastiaan Beschoor , van Acht Fleur , Terpstra Pleun , Prebevšek Deja , Franx Arie , Meguid Tarek , Jacod Benoit 
Published: October 2020

Abstract
Background
This study aims to explore the stories of three women from Zanzibar, Tanzania, who survived life-threatening obstetric complications. Their narratives will increase understanding of the individual and community-level burden masked behind the statistics of maternal morbidity and mortality in Tanzania. In line with a recent systematic review of women-centred, qualitative maternal morbidity research, this study will contribute to guidance of local and global maternal health agendas.

Methods
This two-phased qualitative study was conducted in July-August 2017 and July-August 2018, and involved three key informants, who were recruited from a maternal near-miss cohort in May 2017 in Mnazi Mmoja Hospital, Zanzibar. The used methods were participant observation, interviews (informal, unstructured and semi-structured), participatory methods and focus group discussions. Data analysis relied primarily on grounded theory, leading to a theoretical model, which was validated repeatedly by the informants and within the study team. The findings were then positioned in the existing literature. Approval was granted by Zanzibar’s Medical Ethical Research Committee (reference number: ZAMREC/0002/JUN/17).

Results
The impact of severe maternal morbidity was found to be multi-dimensional and to extend beyond hospital discharge and thus institutionalized care. Four key areas impacted by maternal morbidities emerged, namely (1) social, (2) sexual and reproductive, (3) psychological, and (4) economic well-being.

Conclusions
This study showed how three women’s lives and livelihoods were profoundly impacted by the severe obstetric complications they had survived, even up to 16 months later. These impacts took a toll on their physical, social, economic, sexual and psychological well-being, and affected family and community members alike. These findings advocate for a holistic, dignified, patient value-based approach to the necessary improvement of maternal health care in low-income settings. Furthermore, it emphasizes the need for strategies to be directed not only towards quality of care during pregnancy and delivery, but also towards support after obstetric complications.
The impact of stage of labor on adverse maternal and neonatal outcomes in multiparous women: a retrospective cohort study
Authors: Wang Li , Wang Hongxia , Jia Lu , Qing Wenjie , Li Fan , Zhou Jie 
Published: October 2020

Abstract
Background
The correlation between stage of labor and adverse delivery outcomes has been widely studied. Most of studies focused on nulliparous women, it was not very clear what impact the stage of labor duration had on multiparous women.

Methods
A retrospective cohort study was conducted among all the multiparous women of cephalic, term, singleton births, who planned vaginal delivery. The total stage of labor covered the first stage and the second stage in this study, and they were divided into subgroups. Adverse maternal outcomes were defined as referral cesarean delivery, instrumental delivery, postpartum hemorrhage, perineal laceration (III and IV degree), hospitalization stay ≥90th, and adverse neonatal outcomes as NICU, shoulder dystocia, Apgar score ≤ 7(5 min), neonatal resuscitation, assisted ventilation required immediately after delivery.

Results
There were 7109 parturients included in this study. The duration of first stage was 6.2(3.6–10.0) hours, the second stage was 0.3(0.2–0.7) hour, the total stage was 6.9(4.1–10.7) hours in multiparous women. At the first stage, the rates of overall adverse outcome were 21, 23.4, 28.8, 35.5, 38.4% in subgroups < 6 h, 6–11.9 h, 12–17.9 h, 18–23.9 h, ≥24 h, which increased significantly (X2 = 57.64, P < 0.001), and ARR (95% CI) were 1.10 (0.92,1.31), 1.33 (1.04,1.70), 1.80 (1.21,2.68), 2.57 (1.60,4.15) compared with subgroup < 6 h (ARR = 1); At the second stage, the rates of overall adverse outcome were 20.0, 30.7, 38.5, 61.2, 69.6% in subgroups < 1 h, 1–1.9 h, 2–2.9 h, 3–3.9 h, ≥4 h (X2 = 349.70, P < 0.001), and ARR (95% CI) were 1.89 (1.50, 2.39), 2.22 (1.55, 3.18), 10.64 (6.09, 18.59), 11.75 (6.55, 21.08) compared with subgroup < 1 h (ARR = 1)). At the total stage, the rates of overall adverse outcome were 21.5, 30.8, 42.4% in subgroups < 12 h, 12–23.9 h, ≥24 h (X2 = 84.90, P < 0.001), and ARR (95% CI) were 1.41 (1.16,1.72), 3.17 (2.10,4.80) compared with subgroup < 12 h (ARR = 1).

Conclusions
The prolonged stage of labor may lead to increased adverse outcomes in multiparous women, it was an independent risk factor of adverse maternal and neonatal outcomes.
Assessment of choriocapillary blood flow changes in response to half-dose photodynamic therapy in chronic central serous chorioretinopathy using optical coherence tomography angiography
Authors: Liu Juejun , Chen Changzheng , Li Lu , Xu Yishuang , Yi Zuohuizi , He Lu , Zheng Hongmei 
Published: October 2020

Abstract
Background
Optical coherence tomography angiography (OCTA) is a newly developed imaging quantitative technique for analysis of choriocapillaris (CC) flow changes, thereby exploring the pathological mechanism of chronic central serous chorioretinopathy (CCSC) and the therapeutic effects of photodynamic therapy (PDT). In this study, we sought to quantify the blood flow changes in CC of CCSC patients receiving half-dose PDT using OCTA.

Methods
A total of 28 affected eyes and 24 unaffected eyes of 26 CCSC patients receiving half-dose PDT, and 40 eyes of 20 healthy gender- and age-matched subjects were retrospectively enrolled in this study. The proportion of total areas of flow signal voids (FSV, %) in CC level of OCTA was assessed in both eyes of the CCSC patients at baseline and repeated in multiple sections at 1-week, 1-month, 3-month and 6-month intervals after PDT. In addition, the CC patterns in response to PDT at early stage and the subsequent morphologic changes were qualitatively documented using OCTA.

Results
For affected eyes, FSV at 6-m follow-up was significantly lower than that at 1-m follow-up (p = 0.036). When compared to normal control eyes, FSV in affected eyes was significantly higher at 1-m, 3-m and 6-m follow-up (p < 0.05 for all), and FSV in unaffected eyes was significantly higher at baseline, 1-w, 1-m and 3-m follow-up (p < 0.05 for all). Three CC patterns of early response to PDT were identified, including signs of recovery with more even flow signals, transient appearance of worse ischemia and secondary neovascularization within CC level.

Conclusion
Abnormal CC flow attenuation remains in completely resolved eyes of CCSC patients treated with half-dose PDT.