bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term survival after cemented versus uncemented total hip arthroplasty for treatment of acute femoral neck fracture: a retrospective study with a mean 10-year follow-up
Authors: Zhang Chi , Chen Meiji , Yu Weiguang , Han Xiulan , Ye Junxing , Zhuang Jintao 
Published: September 2020

Objective To compare the long-term survivorship and Harris hip scores (HHSs) between cemented total hip arthroplasty (CTHA) and uncemented total hip arthroplasty (UTHA) for treatment of acute femoral neck fractures (FNFs). Methods Data of 224 hips (CTHA, n = 112; UTHA, n = 112) that underwent primary surgery in our medical institution from 2005 to 2017 were retrospectively analysed. The primary endpoint was the risk of all-cause revision. The difference in the risk of all-cause revision between the two groups was assessed by Kaplan–Meier survival analysis with a log-rank test and Cox regression analysis. Results The mean postoperative follow-up was 10 years (range, 3–13 years). The Kaplan–Meier estimated 10-year implant survival rate was significantly higher in the CTHA than UTHA group (98.1% vs. 96.2%, respectively). The adjusted Cox regression analysis demonstrated a significantly lower risk of revision in the CTHA than UTHA group. At the final follow-up, the mean HHS was significantly higher in the CTHA than UTHA group (85.10 vs. 79.11, respectively). Conclusion This retrospective analysis demonstrated that CTHA provided higher survival, lower revision risk, and higher functional outcome scores than UTHA. Further follow-up is necessary to verify whether these advantages of CTHA persist over time.
Radiographic Indices Are Not Predictive of Clinical Outcomes Among 1735 Patients Indicated for Hip Arthroscopic Surgery: A Machine Learning Analysis
Authors: Ramkumar Prem N. , Karnuta Jaret M. , Haeberle Heather S. , Sullivan Spencer W. , Nawabi Danyal H. , Ranawat Anil S. , Kelly Bryan T. , Nwachukwu Benedict U. 
Published: September 2020

Background: The relationship between the preoperative radiographic indices for femoroacetabular impingement syndrome (FAIS) and postoperative patient-reported outcome measure (PROM) scores continues to be under investigation, with inconsistent findings reported. Purpose: To apply a machine learning model to determine which preoperative radiographic indices, if any, among patients indicated for the arthroscopic correction of FAIS predict whether a patient will achieve the minimal clinically important difference (MCID) for 1- and 2-year PROM scores. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 1735 consecutive patients undergoing primary hip arthroscopic surgery for FAIS were included from an institutional hip preservation registry. Patients underwent preoperative computed tomography of the hip, from which the following radiographic indices were calculated by a musculoskeletal radiologist: alpha angle, beta angle, sagittal center-edge angle, coronal center-edge angle, neck shaft angle, acetabular version angle, and femoral version angle. PROM scores were collected preoperatively, at 1 year postoperatively, and at 2 years postoperatively for the modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS)–Activities of Daily Living (HOS-ADL) and –Sport Specific (HOS-SS), and the International Hip Outcome Tool (iHOT-33). Random forest models were created for each PROM at 1 and 2 years’ follow-up, with each PROM’s MCID used to establish clinical meaningfulness. Data inputted into the models included ethnicity, laterality, sex, age, body mass index, and radiographic indices. Comprehensive and separate models were built specifically to assess the association of the alpha angle, femoral version angle, coronal center-edge angle, McKibbin index, and hip impingement index with respect to each PROM. Results: As evidenced by poor area under the curves and P values >.05 for each model created, no combination of radiographic indices or isolated index (alpha angle, coronal center-edge angle, femoral version angle, McKibbin index, hip impingement index) was a significant predictor of a clinically meaningful improvement in scores on the mHHS, HOS-ADL, HOS-SS, or iHOT-33. The mean difference between 1- and 2-year PROM scores compared with preoperative values exceeded the respective MCIDs for the cohort. Conclusion: In patients appropriately indicated for FAIS corrective surgery, clinical improvements can be achieved, regardless of preoperative radiographic indices, such as the femoral version angle, coronal center-edge angle, and alpha angle. No specific radiographic parameter or combination of indices was found to be predictive of reaching the MCID for any of the 4 studied hip-specific PROMs at either 1 or 2 years’ follow-up.
Preliminary Validation of an Abbreviated Acute Concussion Symptom Checklist Using Item Response Theory
Authors: Wilmoth Kristin , Magnus Brooke E. , McCrea Michael A. , Nelson Lindsay D. 
Published: September 2020

Background: Symptom assessment is a critical component of concussion diagnosis and management, with item selection primarily driven by clinical judgment or expert consensus. We recently demonstrated that concussion symptoms assessed by the Sport Concussion Assessment Tool (SCAT) are essentially unidimensional, implying that overall symptom severity may be accurately estimated with relatively few questions. Briefer, evidence-based forms for symptom assessment would provide clinicians flexibility. Purpose: To develop and validate an abbreviated assessment of general concussion symptom severity using item response theory analyses. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Broad clinical assessments (SCAT3, Immediate Post-concussion and Cognitive Testing, Balance Error Scoring System, and Brief Symptom Inventory–18 Global Severity Index) were completed by 265 injured athletes and 235 matched teammate controls at 24 to 48 hours and 8, 15, and 45 days after concussion. Symptom checklist short forms (3-14 items from the original 22) were selected using item response theory item information curves. Internal consistency reliability (Cronbach alpha), correlation with criterion measures assessed concurrently (ie, acute neurocognitive performance, balance, and emotional symptoms), predictive validity (correlations with symptom duration), and differences between concussed and control groups (Cohen d) were examined across forms. Sensitivity and false-positive rates of the forms were estimated and compared using reliable change indices derived from controls. Results: Across the 3- to 22-item forms, internal consistency was excellent (Cronbach alphas, 0.90-0.94). Clinical correlations were significant ( P≤ .017) and to similar degrees for all short forms. Group difference confidence intervals overlapped across forms at 24- to 48-hour (Cohen d, 1.27-1.51) and 8-day follow-up (Cohen d, 0.31-0.44). Sensitivity remained similar across short forms, with a low false-positive rate in controls. Conclusion: Our findings suggest that even an ultrashort (3-item) inventory provides sufficiently reliable and valid estimates of overall concussion symptom severity 24 to 48 hours after injury. Future revisions of the SCAT could eliminate inefficient items, although replication in larger samples and extension to other postinjury time points are warranted.
Human Milk Feeding Patterns at 6 Months of Age are a Major Determinant of Fecal Bacterial Diversity in Infants
Authors: Sugino Kameron Y. , Ma Tengfei , Kerver Jean M. , Paneth Nigel , Comstock Sarah S. 
Published: September 2020

Background Maternal pre-pregnancy obesity and human milk feeding have been associated with altered infant gut microbiota. Research aim Determine the relationships between maternal pre-pregnancy BMI, human milk exposure, and their influence on the infant microbiota simultaneously. Methods This was a cross-sectional study of infants at 6 months of age ( N = 36), a time when many infants are fed a mixed diet of human milk and other foods. Fecal samples and participant information were collected from a subset of dyads enrolled in two related prospective cohorts (ARCHGUT and BABYGUT) in Michigan. Sequencing the V4 region of the 16S gene was used to analyze fecal bacterial samples collected from 6-month-old infants. Participants were grouped into four categories designated by their extent of human milk exposure (100%, 80%, 50%–80%, ≤ 20% human milk in the infant diet) and by maternal pre-pregnancy BMI category (normal, overweight, obese). Results Fewer participants with pre-pregnancy obesity were breastfeeding at 6 months postpartum compared to non-obese participants (35.7% and 81.8%, respectively). In univariate analyses, maternal pre-pregnancy BMI and human milk exposure were both significantly associated with alpha and beta diversity of the infant microbiota. However, in multivariate analyses, human milk exposure accounted for 20% of the variation in alpha diversity, but pre-pregnancy BMI was not significantly associated with any form of microbiota diversity. Conclusions The proportion of the infant diet that was human milk at 6 months was the major determinant of alpha and beta diversity of the infant. Maternal obesity contributes to the gut microbiota by its association with the extent of human milk feeding.
Completing the RANZCP scholarly project in a rural/regional setting: a practical example
Authors: Hill Harry , Harvey Carol 
Published: September 2020

Objective: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) scholarly project (SP) is a major hurdle for trainees completing psychiatric training – intensified for those working in rural settings. Whilst strategies to overcome this challenge have been proposed, there are few examples of how these have been successfully implemented. This report will describe the completion of a RANZCP SP in a regional setting, with supervision and support provided by an academic psychiatrist working within a metropolitan research centre. Conclusion: Trainees in remote geographical locations can utilise expert supervision from academic psychiatrists to successfully complete the SP. Key components are support from both the trainee and supervisor’s employers, utilisation of a range of supervision modalities and a clear pragmatic memorandum of understanding between the supervisor and trainee. This initiative had widespread benefits beyond completion of the SP for all parties involved.
Defective CD19+CD24hiCD38hi transitional B-cell function in patients with relapsing-remitting MS
Authors: Cencioni Maria T , Ali Rehiana , Nicholas Richard , Muraro Paolo A 
Published: September 2020

Background: Multiple sclerosis (MS) is characterized by central nervous system (CNS) infiltration of T and B cells, excess inflammatory cytokine and chemokine production and failure of immune regulation. CD19+CD24hiCD38hi transitional B cells producing interleukin (IL)-10 have been shown to suppress interferon-γ (IFNγ) and tumour necrosis factor-α (TNFα) production by CD4+ T cells and to be dysfunctional in autoimmune arthritis and systemic lupus erythematosus. Objective: We hypothesized that transitional B-cell-dependent immune regulation could be defective in MS and examined their function in healthy subjects and patients with relapsing-remitting multiple sclerosis (RRMS). Methods: A total of 62 healthy donors and 21 RRMS subjects donated peripheral blood for the study. IL-10-producing B cells, IFNγ and TNFα-producing T cells and proliferating T cells were quantified by flow cytometry. Results: In healthy individuals, CD19+CD24hiCD38hi transitional B cells produce more IL-10 than CD19+CD24+CD38+ naive and CD19+CD24hiCD38− memory B cells and are able to suppress CD4+ T-cell proliferation and IFNγ and TNFα-production. In subjects with RRMS, CD19+CD24hiCD38hi transitional B cells produce significantly less IL-10 and to fail to suppress effector T-cell function. Conclusion: CD19+CD24hiCD38hi transitional B cells physiologically represent the most potent regulatory B-cell subset and are functionally defective in patients with RRMS, an abnormality that may contribute to the immune pathological process.
The Effect of Nasoseptal Flap Elevation on Post-Operative Olfaction and Sinonasal Quality of Life: A Prospective Double-Blinded Randomized Controlled Trial
Authors: Chou Courtney T. , Valappil Benita , Mattos Jose L. , Snyderman Carl H. , Gardner Paul A. , Fernandez-Miranda Juan C. , Wang Eric W. 
Published: September 2020

Background The use of nasoseptal flaps (NSF) for defect reconstruction in endoscopic endonasal approaches (EEA) to cranial base pathology has markedly reduced rates of cerebrospinal fluid leak. However, the effect of NSF use on post-operative olfaction remains unclear. Objective To evaluate the impact of NSF use during EEA on binarial and uninarial olfaction, and sinonasal quality of life (QOL). Methods This was a prospective double-blinded randomized controlled trial. Patients undergoing EEA for sellar pathology were recruited from the University of Pittsburgh Medical Center from December 2014 to May 2017. Subjects were randomized pre-operatively to a side of NSF harvest. Olfaction and QOL were assessed pre-operatively and 6 to 12 months post-operatively using the University of Pennsylvania Smell Identification Test, “Sniffin’ Sticks,” and Sinonasal Outcomes Test 22. The side of dominant uninarial olfaction was determined using “Sniffin’ Sticks.” Results Thirty-one patients were enrolled. Sixteen underwent EEA without NSF (control group) and 15 with NSF. A dominant side of olfaction was identified in 14 patients with NSF; 8 patients were randomized to NSF harvest on the dominant side and the remaining 6 on the non-dominant side. NSF elevation resulted in a 4% decrease in University of Pennsylvania Smell Identification Test scores, but was not statistically significant compared to controls. Similarly, NSF elevation on the side of dominant olfaction resulted in a 6% decrease, but was not statistically significant when compared to the non-dominant elevation group. Change in rhinologic QOL as determined by the Sinonasal Outcomes Test 22 was not significantly different between any of the groups. Conclusions The use of NSF during EEA for sellar pathology does not have a significant effect on olfaction or rhinologic QOL. The presence of a dominant side of olfaction is not a primary consideration when deciding the side of NSF harvest.
MRI predictors for brain invasion in meningiomas
Authors: Ong Thomas , Bharatha Aditya , Alsufayan Reema , Das Sunit , Lin Amy Wei 
Published: September 2020

Background and purpose In the 2016 revision of the World Health Organization classification of central nervous system tumours, brain invasion was added as an independent histological criterion for the diagnosis of a World Health Organization grade II atypical meningioma. The aim of this study was to assess whether magnetic resonance imaging characteristics can predict brain invasion for meningiomas. Materials and methods We conducted a retrospective review of all meningiomas resected at our institution between 2005 and 2016 which had preoperative magnetic resonance imaging and included brain tissue within the pathology specimen. One hundred meningiomas were included in the study, 60 of which had histopathological brain invasion, 40 of which did not. Magnetic resonance imaging characteristics of tumours were evaluated for potential predictors of brain invasion. Tumour location, size, perilesional oedema, contour, cerebrospinal fluid cleft, peritumoral cyst, dural venous sinus invasion, bone invasion, hyperostosis and the presence of enlarged pial arteries and veins were evaluated. Data were analysed using conventional chi-square, Fisher’s exact test and logistic regression. Results The volume of peritumoral oedema was significantly higher in the brain-invasive meningioma group compared to the non-brain-invasive group. The presence of a complete cleft was a rare finding that was only found in non-brain-invasive meningiomas. The presence of enlarged pial feeding arteries was a rare finding that was only found in brain-invasive meningiomas. Conclusions An increased volume of perilesional oedema is associated with the likelihood of brain invasion for meningiomas.
Predictors of preconception care behaviour among women of reproductive age using a behaviour-change model
Authors: Bayrami Roghieh , Didarloo Alireza , Asadinejad Afsaneh 
Published: September 2020

Purpose: Although preconception care (PCC) has been integrated into women’s care programmes in the country for more than a decade, it has not yet been welcomed by Iranian women, and the rate of PCC uptake is very low. Therefore, this study aims to determine predictors of uptake of PCC based on the Beliefs, Attitudes, Subjective Norms and Enabling Factors (BASNEF) model among women of reproductive age referred to health centres in Urmia, Northwest Iran, in 2019. Methods: This cross-sectional study was carried out on 230 women of childbearing age at Urmia health centres during 2019. Subjects were selected using a multistage sampling method. A valid reliable researcher-made questionnaire, including demographic information, items related to the BASNEF model constructs regarding PCC and items related to PCC behaviour, was used to collect data. Data were analysed using descriptive and inferential statistics (frequencies, means and standard deviations, independent t-test, chi-square test, logistic and linear regression). Results: The findings showed that the rate of receiving PCC was 19.6%. Overall, the BASNEF model predicted 42% of the intention to receive health care. Among the model constructs, enabling factors (β=0.32, p<0.001) and attitude (β=0.41, p<0.001) significantly explained women’s behavioural intention towards receiving PCC. In the logistic regression model, intention (β=0.15, p<0.001) and enabling factors (β=0.12, p=0.034) had a significant role in predicting PCC. Conclusion: The low uptake of PCC by women of childbearing age in Urmia suggests the need to design and implement interventions based on women’s attitudes, intentions and enabling factors in order to stimulate and maintain women’s health-promoting behaviours during childbearing age.
The state of the art of sound therapy for subjective tinnitus in adults
Authors: Wang Haiyan , Tang Dongmei , Wu Yongzhen , Zhou Li , Sun Shan 
Published: September 2020

Background: Sound therapy is a clinically common method of tinnitus management. Various forms of sound therapy have been developed, but there are controversies regarding the selection criteria and the efficacy of different forms of sound therapy in the clinic. Our goal was to review the types and forms of sound therapy and our understanding of how the different characteristics of tinnitus patients influence their curative effects so as to provide a reference for personalized choice of tinnitus sound therapy. Method: Using an established methodological framework, a search of six databases including PubMed identified 43 records that met our inclusion criteria. The search strategy used the following key words: tinnitus AND (acoustic OR sound OR music) AND (treatment OR therapy OR management OR intervention OR measure). Results: There are various forms of sound therapy, and most of them show positive therapeutic effects. The effect of customized sound therapy is generally better than that of non-customized sound therapy, and patients with more severe initial tinnitus respond better to sound therapy. Conclusion: Sound therapy can effectively suppress tinnitus, at least in some patients. However, there is a lack of randomized controlled trials to identify effective management strategies. Further studies are needed to identify the most effective form of sound therapy for individualized therapy, and large, multicenter, long-term follow-up studies are still needed in order to develop more effective and targeted sound-therapy protocols. In addition, it is necessary to analyze the characteristics of individual tinnitus patients and to unify the assessment criteria of tinnitus.
Prostate adenocarcinoma and cutaneous metastases
Authors: John Jeff , Wantenaar Tanya , Lazarus John , Kesner Ken 
Published: September 2020

Prostate cancer is the second most frequently diagnosed cancer in men and the fifth leading cause of mortality worldwide. Men of African descent with prostate adenocarcinoma tend to present late with advanced, aggressive and often metastatic disease. Cutaneous metastases are extremely rare, with the incidence reported to be as low as 0.36%. We report a case of prostate adenocarcinoma with cutaneous metastases. A 69-year-old African male known to the urology unit, with metastatic adenocarcinoma of the prostate, presented with a two-week history of pale-to-purple large nodular lesions on the skin of his left hemiscrotum and smaller nodules on the penile shaft. Punch biopsies of the scrotal nodules revealed metastatic prostate adenocarcinoma. Bilateral orchidectomy and excision of the cutaneous lesions were performed. Although cutaneous metastases are rare, more so in patients with adenocarcinoma of the prostate, any skin lesions in patients with a known primary malignancy should raise a suspicion of metastasis. All physicians should therefore have a low threshold for the biopsy of any unusual skin lesion in patients with known prostate cancer. Level of evidence: 5.
The evolution of an evidence based intervention designed to improve prescribing and reduce polypharmacy in older people with multimorbidity and significant polypharmacy in primary care (SPPiRE)
Authors: McCarthy Caroline , Moriarty Frank , Wallace Emma , Smith Susan M ,   Barbara Clyne for the SPPiRE Study Team
Published: September 2020

Introduction:By the time an intervention is ready for evaluation in a definitive RCT the context of the evidence base may have evolved. To avoid research waste, it is imperative that intervention design and evaluation is an adaptive process incorporating emerging evidence and novel concepts. The aim of this study is to describe changes that were made to an evidence based intervention at the protocol stage of the definitive RCT to incorporate emerging evidence.Methods:The original evidence based intervention, a GP delivered web guided medication review, was modified in a five step process: Identification of core components of the original intervention. Literature review. Modification of the intervention. Pilot study. Final refinements. A framework, developed in public health research, was utilised to describe the modification process.Results:The population under investigation changed from older people with a potentially inappropriate prescription (PIP) to older people with significant polypharmacy, a proxy marker for complex multimorbidity. An assessment of treatment priorities and brown bag medication review, with a focus on deprescribing were incorporated into the original intervention. The number of repeat medicines was added as a primary outcome measure as were additional secondary patient reported outcome measures to assess treatment burden and attitudes towards deprescribing.Conclusions:A framework was used to systematically describe how and why the original intervention was modified, allowing the new intervention to build upon an effective and robustly developed intervention but also to be relevant in the context of the current evidence base.