bluuebunny/crossref_metadata_2025_split huggingface dataset:
Opioid Use in Athletes: A Systematic Review
Authors: Ekhtiari Seper , Yusuf Ibrahim , AlMakadma Yosra , MacDonald Austin , Leroux Timothy , Khan Moin 
Published: August 2020

Context: The opioid epidemic has been well-documented in the general population, but the literature pertaining to opioid use and misuse in the athletic population remains limited. Objectives: The objectives of this study were to seek answers to the following questions: (1) what are the rates of opioid use and misuse among athletes, (2) do these rates differ compared with the nonathletic population, and (3) are there specific subgroups of the athletic population (eg, based on sport, level of play) who may be at higher risk? Data Sources: The Embase, MEDLINE, and PubMed were used for the literature search. Study Selection: Records were screened in duplicate for studies reporting rates of opioid use among athletes. All study designs were included. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Data regarding rates of opioid use, medication types, prescription patterns, and predictors of future opioid use were collected. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria for clinical studies and 5 key domains previously identified for survey studies. Results: A total of 11 studies were eligible for inclusion (N = 226,256 athletes). Studies included survey studies and retrospective observational designs. Opioid use among professional athletes at any given time, as reported in 2 different studies, ranged from 4.4% to 4.7%, while opioid use over a National Football League career was 52%. High school athletes had lifetime opioid use rates of 28% to 46%. Risk factors associated with opioid use included Caucasian race, contact sports (hockey, football, wrestling), postretirement unemployment, and undiagnosed concussion. Use of opioids while playing predicted use of opioids in retirement. Conclusion: Overall, opioid use is prevalent among athletes, and use during a playing career predicts postretirement use. This issue exists even at the high school level, with similar rates to professional athletes. Further higher quality observational studies are needed to better define patterns of opioid use in athletes.
Investigating the Association of Metabolic Biomarkers With Knee Cartilage Composition and Structural Abnormalities Using MRI: A Pilot Study
Authors: Ashmeik Walid , Baal Joe D. , Foreman Sarah C. , Joseph Gabby B. , Bahroos Emma , Han Misung , Krug Roland , Link Thomas M. 
Published: August 2020

Objective The goal of this study was to explore the metabolic syndrome–associated phenotype of osteoarthritis by investigating the cross-sectional associations of glycemic markers and serum lipids with knee cartilage composition and structural abnormalities in middle-aged adults. Design Twenty participants between 40 to 70 years of age with Kellgren-Lawrence score 0-1 in at least one knee were recruited at a single center. Knee cartilage composition was assessed using 3.0 T cartilage T2 and T1ρ mapping. Evaluation of structural knee abnormalities was performed using the modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). Linear regression was used to assess the associations of standardized fasting glucose (FG), hemoglobin A1c (HbA1c), insulin, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), non-HDL cholesterol, and triglycerides with cartilage T2 and T1ρ as well as WORMS subscores, adjusting for body mass index. Results Higher FG and higher HbA1c were associated with higher WORMS meniscus sum (beta coefficient 1.31 [95% confidence interval (CI): 0.57, 2.05], P = 0.002 per standard deviation [SD] increase in FG; beta coefficient 0.90 [95% CI: 0.07, 1.73], P = 0.035 per SD increase in HbA1c). Also, higher total cholesterol and higher non-HDL cholesterol were associated with higher WORMS cartilage sum (beta coefficient 0.94 [95% CI: 0.01, 1.86], P = 0.048 per SD increase in total cholesterol; beta coefficient 1.05 [95% CI: 0.14, 1.96], P = 0.03 per SD increase in non-HDL cholesterol). Conclusions Higher FG and HbA1c were associated with increased meniscal degeneration while higher total and non-HDL cholesterol were associated with increased cartilage degeneration.
The corneal effects of intravitreal dexamethasone implantation
Authors: Bayat Alper Halil , Karataş Gamze , Kurt Muhammet Mustafa , Elçioğlu Mustafa Nuri 
Published: August 2020

Objectives: To evaluate the corneal effects of the intravitreal dexamethasone implantation using corneal topography and specular microscopy. Material and methods: 27 eyes of the 27 patients who received a single intravitreal dexamethasone implantation dose for diabetic macular edema were enrolled in this study. Sirius topography and EM-3000 specular microscopic examinations were performed at the initial examination (baseline), and then on the first day, during the first week, and 1 month after IDI. Changes in corneal parameters were investigated. Results: The mean age was 58.66 ± 6.59 years. 15 patients were men, and 12 were women. The mean disease duration was 12.2 ± 2.4 months, and mean glycosylated hemoglobin (HbA1c) was 7.2 ± 1.1. After dexamethasone injection, the mean central corneal thickness, endothelial cell density, and coefficient variation of cell area presented a statistically significant decrease ( p < 0.05). Anterior segment parameters, such as anterior chamber depth, iridocorneal angle, sim K1 and K2 keratometry, pupillary diameter, horizontal visible iris diameter, and corneal astigmatism did not change ( p > 0.05). Conclusion: Intravitreal dexamethasone implantation affects corneal endothelial cell structure but does not appear to affect corneal topography parameters.
The Role of Growth Directors in Controlling the Morphology of Hematite Nanorods
Authors: Allender Christopher J. , Bowen Jenna L. , Celorrio Veronica , Davies-Jones Josh A. , Davies Philip R. , Guan Shaoliang , O’Reilly Padraic , Sankar Meenakshisundaram 
Published: August 2020

AbstractThe control of the growth of hematite nanoparticles from iron chloride solutions under hydrothermal conditions in the presence of two different structure promoters has been studied using a range of both structural and spectroscopic techniques including the first report of photo induced force microscopy (PiFM) to map the topographic distribution of the structure-directing agents on the developing nanoparticles. We show that the shape of the nanoparticles can be controlled using the concentration of phosphate ions up to a limit determined to be ~6 × 10−3 mol. Akaganéite (β-FeOOH) is a major component of the nanoparticles formed in the absence of structure directors but only present in the very early stages (< 8 h) of particle growth when phosphate is present. The PiFM data suggest a correlation between the areas in which phosphate ions are adsorbed and areas where akaganéite persists on the surface. In contrast, goethite (α-FeOOH) is a directly observed precursor of the hematite nanorods when 1,2-diamino propane is present. The PiFM data shows goethite in the center of the developing particles consistent with a mechanism in which the iron hydroxide re-dissolves and precipitates at the nanorod ends as hematite.
Assessment of left ventricular energy loss using vector flow mapping in patients with stages 1–3 chronic kidney disease
Authors: Chen Xiaoxue , Wang Yueheng , Wang Wei , Yuan Lijun , Qi Zhengqin , Song Degang 
Published: August 2020

Abstract
Background
Patients with chronic kidney disease (CKD) experience abnormality of intracardiac blood flow status during early-stages of disease. Left ventricular energy loss (EL) derived from vector flow mapping (VFM) represents fluid energy lost as heat in left ventricle and had been used to detect intracardiac blood flow efficiency. We aimed to evaluate the left ventricular EL in stage 1–3 CKD patients, and explored whether hypertension, a main cardiovascular risk, deteriorate the abnormality of intracardiac blood flow status.

Methods
Transthoracic echocardiography was performed in 41 controls and 48 patients with stages 1–3 CKD. CKD patients consisted a subgroup with no hypertension, a subgroup with well-controlled hypertension and a subgroup with poorly controlled hypertension. The EL were calculated in the left ventricle using VFM analysis from the apical 3-chamber view. Furthermore, the correlation and stepwise multiple regression analysis were used to explore the potential independent predictors of left ventricular EL.

Results
Compared with controls, stage 1–3 CKD patients showed increased left ventricular EL during total diastole, late diastole, total systole, isovolumic contraction and ejection. CKD patients with poorly controlled hypertension had higher left ventricular EL compared to the other CKD subgroups. Additionally, the ratio of mitral early filling wave peak velocity and early mitral annular peak velocity on septal side, mitral early filling wave peak velocity, and left ventricular mass index were independent predictors of the diastolic EL; whereas systolic blood pressure and left ventricular mass index were independent predictors of the systolic EL.

Conclusions
Left ventricular EL was a useful echocardiographic parameter to evaluate the impaired intracardiac blood flow efficiency in patients with stages 1–3 CKD. Hypertension was a crucial contributor for intracardiac blood flow abnormality. This study might provide valuable clinical data to discern cardiac dysfunction and reduce the cardiovascular risk in early-stage CKD.
Changing relative risk of clinical factors for hospital-acquired acute kidney injury across age groups: a retrospective cohort study
Authors: Wu Lijuan , Hu Yong , Zhang Xiangzhou , Chen Weiqi , Yu Alan S. L. , Kellum John A. , Waitman Lemuel R. , Liu Mei 
Published: August 2020

Abstract
Background
Likelihood of developing acute kidney injury (AKI) increases with age. We aimed to explore whether the predictability of AKI varies between age groups and assess the volatility of risk factors using electronic medical records (EMR).

Methods
We constructed a retrospective cohort of adult patients from all inpatient units of a tertiary care academic hospital and stratified it into four age groups: 18–35, 36–55, 56–65, and > 65. Potential risk factors collected from EMR for the study cohort included demographics, vital signs, medications, laboratory values, past medical diagnoses, and admission diagnoses. AKI was defined based on the Kidney Disease Improving Global Outcomes (KDIGO) serum creatinine criteria. We analyzed relative importance of the risk factors in predicting AKI using Gradient Boosting Machine algorithm and explored the predictability of AKI across age groups using multiple machine learning models.

Results
In our cohort, older patients showed a significantly higher incidence of AKI than younger adults: 18–35 (7.29%), 36–55 (8.82%), 56–65 (10.53%), and > 65 (10.55%) (p < 0.001). However, the predictability of AKI decreased with age, where the best cross-validated area under the receiver operating characteristic curve (AUROC) achieved for age groups 18–35, 36–55, 56–65, and > 65 were 0.784 (95% CI, 0.769–0.800), 0.766 (95% CI, 0.754–0.777), 0.754 (95% CI, 0.741–0.768), and 0.725 (95% CI, 0.709–0.737), respectively. We also observed that the relative risk of AKI predictors fluctuated between age groups.

Conclusions
As complexity of the cases increases with age, it is more difficult to quantify AKI risk for older adults in inpatient population.
Does hypothyroidism increase the risk of breast cancer: evidence from a meta-analysis
Authors: Wang Bolin , Lu Zhong , Huang Yan , Li Ruobao , Lin Tao 
Published: August 2020

Abstract
Purpose
At present, the relationship between hypothyroidism and the risk of breast cancer is still inconclusive. This meta-analysis was used to systematically assess the relationship between hypothyroidism and breast cancer risk, and to assess whether thyroid hormone replacement therapy can increase breast cancer risk.

Methods
The relevant articles about hypothyroidism and the risk of breast cancer were obtained on the electronic database platform. Relevant data were extracted, and odd ratios (OR) with corresponding 95% confidence intervals (CI) were merged using Stata SE 12.0 software.

Results
A total of 19 related studies were included in the meta-analysis, including 6 cohort studies and 13 case-control studies. The results show that hypothyroidism was not related to the risk of breast cancer (odd ratios = 0.90, 95% CI 0.77–1.03). In the European subgroup, we observed that patients with hypothyroidism have a lower risk of breast cancer(odd ratios = 0.93, 95% CI 0.88–0.99). Furthermore, no significant correlation was observed between thyroid hormone replacement therapy and the risk of breast cancer. (odd ratios = 0.87, 95% CI 0.65–1.09).

Conclusion
Hypothyroidism may reduce the risk of breast cancer in the European population, and no significant correlation was observed between hypothyroidism and breast cancer risk in non-European populations. Due to the limited number of studies included, more large-scale, high-quality, long-term prospective cohort studies are needed.
The value of bronchial and cavity contraction rates in differentiating benign and malignant pulmonary cavities
Authors: Zhang Hua , Qian Xia , Liu Zheng-Hua , Gong Yi 
Published: August 2020

Abstract
Background
The present study aimed to assess the value of bronchial and cavity contraction percentages in differentiating benign and malignant pulmonary cavities.

Methods
Forty-two patients with pulmonary cavities were scanned by dual-phase computed tomography (CT). Then, the cavity and bronchial contraction percentages were respectively measured, the differences between the benign and malignant cavities were compared, and the best diagnostic critical point for differentiating benign and malignant cavities was obtained through the receiver operator characteristic (ROC) curve of the diagnostic test.

Results
The contraction percentage of the bronchial end with benign cavities was significantly higher than that of the bronchial end with malignant cavities (P < 0.001). The contraction percentage was significantly higher in the benign group than in the malignant group (P < 0.001). The ROC analysis revealed that the sensitivity and specificity of the bronchial contraction percentage was 90.50 and 86.40%, respectively, while the sensitivity and specificity of the cavity contraction percentage was 90.50 and 90.90%, respectively.

Conclusion
The dual-phase CT scanning of the bronchial and cavity contraction percentage can distinguish between benign and malignant cavities.
Can clinical and urodynamic parameters predict the occurrence of neutralizing antibodies in therapy failure of intradetrusor onabotulinumtoxin A injections in patients with spinal cord injury?
Authors: Tiburtius Christian , Böthig Ralf , Kowald Birgitt , Hirschfeld Sven , Thietje Roland 
Published: August 2020

Abstract
Background
The aim of the study was to clarify whether clinical and/or urodynamic parameters could be used to infer the probability of neutralizing antibody (NAb) formation as a possible cause of therapy failure (non-response, NR) in patients with neurogenic detrusor overactivity (NDO) due to acquired spinal cord injury/disease (SCI/D) treated with intradetrusor botulinum neurotoxin A (BoNT-A) injections.

Methods
A retrospective chart review was performed of all patients with SCI/D who underwent both intradetrusor onabotulinumtoxin A injections and the determination of neutralizing antibodies against BoNT-A between January 1, 2002, and December 31, 2018. NR was defined as urodynamically confirmed persistent or reappearing NDO.

Results
A total of 2700 BoNT-A injections in 414 patients were ascertained. In 69 patients with primary NR after the first BoNT-A injection (n = 6) or with secondary NR after more than one BoNT-A injection (n = 63), an antibody analysis was performed. Antibody examination showed 36 (52.2%) negative, 5 (7.2%) borderline and 14 (each 20.3%) each of positive and highly positive values. Subgroup analysis indicated a correlation between NAb formation and the duration of BoNT-A therapy (p = 0.015), the mean number of BoNT-A injections (p = 0.011) and the time interval between BoNT-A applications (< 7 months, p = 0.022). Urodynamic data analysis indicate significant differences with cut-off values of MCC (< 225 ml, p = 0.038) and MDP (> 45 cmH2O, p = 0.040). However, in the regression analysis models, the predictive value for the occurrence of NAb was too low (MCC: ROC AUC 0.62, MDP: ROC AUC 0.52) to distinguish with sufficient certainty between NAb-positive and NAb-negative NR patients.

Conclusions
Despite significant correlations, clinical and urodynamic parameters are only partially suitable for predicting antibody formation against BoNT-A.
Evaluation of vacuum phenomenon in dogs with coxofemoral degenerative joint disease using computed tomography
Authors: Kanthavichit Kanokporn , Klaengkaew Auraiwan , Srisowanna Naparee , Chaivoravitsakul Nardtiwa , Horoongruang Kongthit , Thanaboonnipat Chutimon , Soontornvipart Kumpanart , Choisunirachon Nan 
Published: August 2020

AbstractBackgroundDegenerative joint disease (DJD) is a common orthopedic lesion in the coxofemoral joint of canine patients. Concurrent with the sign of degeneration, the vacuum phenomenon (VP), or intra-articular gas, has been observed in several locations in both human and canine patients. A cadaveric study described VP in small breed dogs without DJD but with hip laxity. However, none of the canine VP reports mentioned coxofemoral DJD. Therefore, the aim of this retrospective study was to describe the distribution of coxofemoral VP revealed on computed tomography (CT) imaging in canine patients with DJD.ResultsA total of 282 dogs (564 coxofemoral joints), comprising 142 small, 85 large, and 55 medium breeds, were included in the present study. DJD was found in 31.02% of all dogs. The incidence of DJD was highest in large breed dogs (50%), followed by medium (31.81%) and small (19.36%) breed dogs. In addition, VP was detected with CT using the pulmonary window in 31 joints of 25 dogs that received a diagnosis of hip degenerative disease. VP was found most frequently at the laterodorsal area of the acetabulum. The incidences of VP in large, small, and medium breed dogs were 35.94%, 17.14% and 8.33%, respectively. The presence of coxofemoral VP was significantly and positively correlated with DJD (odds ratio = 17.58, 95% CI 2.32–133.42).ConclusionsThe presence of coxofemoral joint DJD and VP was more likely to be detected in large breed dogs, especially in those with established DJD. CT is an advanced diagnostic imaging modality that can be used to reveal VP lesions, most of which are reported at the laterodorsal acetabulum. Further studies, including comparisons of different patient positions, may reveal more information regarding coxofemoral VP.
Investigating the association between physicians self-efficacy regarding communication skills and risk of “burnout”
Authors: Messerotti Andrea , Banchelli Federico , Ferrari Silvia , Barbieri Emiliano , Bettelli Francesca , Bandieri Elena , Giusti Davide , Catellani Hillary , Borelli Eleonora , Colaci Elisabetta , Pioli Valeria , Morselli Monica , Forghieri Fabio , Galeazzi Gian Maria , Marasca Roberto , Bigi Sarah , D’Amico Roberto , Martin Peter , Efficace Fabio , Luppi Mario , Potenza Leonardo 
Published: August 2020

Abstract
Background
Breaking bad news (BBN) may be associated with increasing risk of burnout in practising physicians. However, there is little research on the association between the way bad news is broken and burnout. We investigated the association between physicians’ self-efficacy regarding communication to patients and risk of burnout.

Methods
We performed a cross-sectional study by proposing an ad-hoc survey exploring attitudes and practice regarding BBN and the Maslach Burnout Inventory - Human Service Survey to 379 physicians from two University Hospitals in Italy. Associations were assessed by multivariable logistic regression models.

Results
Two-hundred twenty-six (60%) physicians returned the questionnaires. 76% of physicians acquired communication skills by observing mentors or colleagues, 64% considered BBN as discussing a poor prognosis, 56% reported discussing prognosis as the most difficult task, 38 and 37% did not plan a BBN encounter and considered it stressful. The overall burnout rate was 59%. Considering BBN a stressful task was independently associated with high risk of burnout (OR 3.01; p = 0.013). Planning the encounter (OR = 0.43, p = 0.037), mastering communication skills (OR = 0.19, p = 0.034) and the self-evaluation as good or very good at BBN (OR 0.32; 0.15 to 0.71; p = 0.0) were associated with low risk of burnout.

Conclusions
Our findings suggest that some physicians’ BBN attitudes and knowledge of conceptual frameworks may influence the risk of burnout and support the notion that increasing knowledge about communication skills may protect clinicians from burnout. Further research is needed in this area.
Influence of human chorionic gonadotrophin during ovarian stimulation: an overview
Authors: Smitz Johan , Platteau Peter 
Published: August 2020

AbstractIt is widely known that luteinising hormone (LH) and human chorionic gonadotrophin (hCG) are integral in the female reproductive lifecycle. Due to the common binding site and similarity in molecular structure, they were previously thought to have overlapping roles. However, with the development of both purified urinary-derived and recombinant gonadotrophins, the individual characteristics of these molecules have begun to be defined. There is evidence to suggest that LH and hCG preferentially activate different signalling cascades and display different receptor-binding kinetics. The data generated on the two molecules have led to an improved understanding of their distinct physiological functions, resulting in a debate among clinicians regarding the most beneficial use of LH- and hCG-containing products for ovarian stimulation (OS) in assisted reproductive technologies (ARTs). Over the past few decades, a number of trials have generated data supporting the use of hCG for OS in ART. Indeed, the data indicated that hCG plays an important role in folliculogenesis, leads to improved endometrial receptivity and is associated with a higher quality of embryos, while presenting a favourable safety profile. These observations support the increased use of hCG as a method to provide LH bioactivity during OS. This review summarises the molecular and functional differences between hCG and LH, and provides an overview of the clinical trial data surrounding the use of products for OS that contain LH bioactivity, examining their individual effect on outcomes such as endometrial receptivity, oocyte yield and embryo quality, as well as key pregnancy outcomes.