bluuebunny/crossref_metadata_2025_split huggingface dataset:
Globulin, the albumin-to-globulin ratio, and fibrinogen perform well in the diagnosis of Periprosthetic joint infection
Authors: Wang Huhu , Zhou Haikang , Jiang Rendong , Qian Zhenhao , Wang Fei , Cao Li 
Published: June 2021

Abstract
Background
Although periprosthetic joint infection (PJI) is a severe complication of total joint arthroplasty (TJA), the diagnosis of PJI remains challenging. Albumin (ALB), globulin (GLB), the albumin-to-globulin ratio (AGR), and fibrinogen could be indicators of the body’s inflammatory state. This study aimed to compare the diagnostic accuracy of these biomarkers with that of other inflammatory biomarkers in PJI patients.

Methods
We conducted a retrospective cohort study that included a consecutive series of patients undergoing debridement antibiotic irrigation and implant retention (DAIR), one-stage or the first stage of a two-stage revision total knee arthroplasty (TKA) or total hip arthroplasty (THA) for acute (n = 31) or chronic (n = 51) PJI, or revision TKA or THA for aseptic failures (n = 139) between January 2017 and December 2019 in our hospital. The 2013 criteria of the Musculoskeletal Infection Society (2013 MSIS) were used as the reference standard for the diagnosis of PJI. The preoperative ALB, GLB, AGR, fibrinogen, D-dimer, platelet count, fibrin degradation product (FDP), platelet-to-lymphocyte (PLR), platelet count to mean platelet volume ratio (PVR), neutrophil-to-lymphocyte ratio (NLR), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were assessed. The receiver operating characteristic curve (ROC), sensitivity, and specificity were utilized to compare different biomarkers.

Results
Compared with the aseptic patients, the GLB, D-dimer, fibrinogen, FDP, platelet count, PVR, PLR, NLR, ESR, and CRP levels of PJI patients were significantly higher (P < 0.01); however, the ALB and AGR levels were significantly lower (P < 0.01). The area under the curve (AUC), sensitivity and specificity were 0.774, 67.50, 77.54% for ALB; 0.820, 57.50, 89.86% for GLB; 0.845, 66.25, 93.48% for AGR; 0.832, 78.48, 78.95% for fibrinogen; 0.877, 81.48, 85.07% for ESR; 0.909, 83.95, 88.89% for CRP; 0.683, 55.22, 75.83% for D-dimer; 0.664, 38.81, 88.33% for FDP; 0.678, 52.44, 79.86% for platelet count; 0.707, 48.78, 86.33% for PVR; 0.700, 51.22, 80.58% for PLR; and 0.678, 52.44, 81.30% for NLR, respectively. In the clinic, GLB, AGR and fibrinogen could be used for diagnosis of patients suspected of having PJI.

Conclusion
Our study demonstrated that GLB, AGR, and fibrinogen were promising biomarkers in the diagnosis of PJI.
Alignment adjustment using the Valgus stress technique can increase the surgical accuracy of novice surgeons during medial opening-wedge high Tibial osteotomy
Authors: Kim Man Soo , Koh In Jun , Sung Yong Gyu , Park Dong Chul , Han Sung Bin , In Yong 
Published: June 2021

Abstract
Background
The purpose of this study was to compare the degree of accuracy of coronal alignment correction with use of the “alignment adjustment under valgus stress technique” between expert and novice surgeons during medial opening-wedge high tibial osteotomy (MOWHTO).

Methods
Forty-eight patients who underwent MOWHTO performed by an expert surgeon (expert group) and 29 by a novice surgeon (novice group) were enrolled in analysis. During surgery, lower-extremity alignment was corrected using the “alignment adjustment under valgus stress technique”. Normocorrection was defined as a weight-bearing line ratio between 55 and 70% and the correction accuracy was compared between expert and novice groups using the ratio of normocorrection to outliers. The clinical outcomes were also compared using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 1 year after surgery.

Results
The undercorrection rate was 14.6% in the expert group and 13.8% in the novice group, while the overcorrection rate was 2.1% in the expert group and 3.4% in the novice group. In the ratio of normocorrection to outliers, no difference was found between the two groups at the one-year follow-up visit (83.3% in the expert group vs. 82.8% in the novice group; p > 0.05). Also, no significant differences were seen in WOMAC subscores immediately preoperatively and at 1 year after surgery (all p > 0.05).

Conclusion
Adhering to the “alignment adjustment under valgus stress technique” protocol enabled novice surgeons to achieve similar surgical accuracy as that of an expert surgeon in coronal alignment during MOWHTO.

Level of evidence
Level III.
How do breastfeeding workplace interventions work?: a realist review
Authors: Litwan Kathrin , Tran Victoria , Nyhan Kate , Pérez-Escamilla Rafael 
Published: June 2021

AbstractBackgroundWomen are representing an increasing share of the labor force, thus, raising the need to accommodate breastfeeding working mothers at the workplace. While there is an emerging body of evidence supporting the positive influence of workplace lactation programs on breastfeeding outcomes, there is a lack of literature on the mechanisms underlying those interventions. Aims of this realist review were three-fold: to uncover underlying mechanisms, determine who benefits the most from such interventions and important contextual factors influencing uptake.MethodsPurposive bibliographic searches on Medline, Web of Science Core Collection, CINAHL, Global Health, LILACS, Global Index Medicus, Business Source Complete, Proquest Dissertations and Theses and Open Access Theses and Dissertations were conducted to identify relevant publications. Included publications (qualitative and quantitative) described interventions aiming to improve the breastfeeding behavior of working mothers, that were initiated by the employer, reported on breastfeeding outcomes and had a clearly defined workplace. Publications only focusing on maternity leave or that were not published in English, Spanish, Portuguese or German were excluded. A realist approach was followed to identify how workplace interventions work, who benefits the most and the important contextual factors.ResultsThe bibliographic search yielded a total of 4985 possible publications of which 37 publications were included in the realist analysis. Effective workplace breastfeeding interventions activate three mechanisms: 1) awareness of the intervention, 2) changes in workplace culture, manager/supervisor support, co-worker support and physical environments, and 3) provision of time. Contextual factors such as the distance between the workplace and the infant and the type of workplace may influence the degree of activation of the underlying mechanisms for programs to positively impact breastfeeding outcomes.ConclusionsIn order to be effective, workplace breastfeeding interventions need to: raise awareness of the intervention(s) available among working mothers as well as their work environment, change the workplace culture, foster manager/supervisor support and co-workers support, provide enough time and adequate space and facilities for women to breastfeed or express breastmilk during the workday.
Risk factors of symptomatic anastomotic leakage and its impacts on a long-term survival after laparoscopic low anterior resection for rectal cancer: a retrospective single-center study
Authors: Qi Xinyu , Liu Maoxing , Xu Kai , Gao Pin , Tan Fei , Yao Zhendan , Zhang Nan , Yang Hong , Zhang Chenghai , Xing Jiadi , Cui Ming , Su Xiangqian 
Published: June 2021

Abstract
Background
Postoperative symptomatic anastomotic leakage (AL) is a serious complication after low anterior resection (LAR) for rectal cancer. AL can potentially affect short-term patient outcomes and long-term prognosis. This study aimed to explore the risk factors and long-term survival of symptomatic AL after laparoscopic LAR for rectal cancer.

Methods
From May 2009 to May 2015, 298 consecutive patients who underwent laparoscopic LAR for rectal cancer with or without a defunctioning stoma were included in this study. Univariate and multivariate logistic regression analyses were used to explore independent risk factors for symptomatic AL. Survival analysis was performed using Kaplan–Meier curves, and log-rank tests were used for group comparisons.

Results
Among the 298 patients enrolled in this study, symptomatic AL occurred in eight (2.7%) patients. The univariate analysis showed that age of ≤65 years (P = 0.048), neoadjuvant therapy (P = 0.095), distance from the anal verge (P = 0.078), duration of operation (P = 0.001), and pathological tumor (T) category (P = 0.004) were associated with symptomatic AL. The multivariate analysis demonstrated that prolonged duration of operation (P = 0.010) was an independent risk factor for symptomatic AL after laparoscopic LAR for rectal cancer. No statistically significant differences were observed in the 3-year (P = 0.785) and 5-year (P = 0.979) overall survival rates.

Conclusions
A prolonged duration of operation increased the risk of symptomatic AL after laparoscopic LAR for rectal cancer. An impact of symptomatic AL on a long-term survival was not observed in this study; however, further studies are required.

Trial registration
This study was registered in the Chinese Clinical Trial Registry (ChiCTR2000033413) on May 31, 2020.
Is hypnosis a valid alternative to spontaneous breathing general anesthesia for claustrophobic patients undergoing MR exams? A preliminary retrospective study
Authors: Rizzo Stefania , Ferrera Nicole , Pravatà Emanuele , Guggenberger Roman , Stern Steven , Del Grande Filippo 
Published: June 2021

Abstract
Background
The purpose of our retrospective study was to assess the termination rate and the image quality of MR exams performed in claustrophobic patients under medical hypnosis, as compared to patients undergoing MR under spontaneous breathing general anesthesia.

Methods
Our study was approved by the ethics committee. The “hypnosis group” included consecutive patients that had previously interrupted an MR exam because of claustrophobia. The “control group” included patients undergoing MR under pharmacologic sedation. Two experienced radiologists assessed, randomly, independently and blinded the image quality of the two groups using a symmetrical Likert scale: 0 = non-diagnostic images; 1 = bad image quality; 2 = fair image quality; 3 = good image quality; 4 = very good image quality. Descriptive statistics was performed.

Results
Eighty patients were included, equally distributed between the two groups. Every patient was able to complete the MR exam. Ratings 3 and 4 represented the majority of ratings. Both readers rated the MR exams with score 3 or 4 in 66.25% (53/80) of MR exams. Only 5% (4/80) of MR exams were rated below score 2. The majority of the MR exams showed good or very good image quality. No significant difference was found in image quality between the two (p = 0.06) groups. The agreement between the two readers according to the k score was 0.105.

Conclusions
Medical hypnosis is a valid alternative to spontaneous breathing general anesthesia in patients unable to undergo MR due to claustrophobia, allowing good quality images.
Nicotinamide promotes pancreatic differentiation through the dual inhibition of CK1 and ROCK kinases in human embryonic stem cells
Authors: Zhang Yumeng , Xu Jiaqi , Ren Zhili , Meng Ya , Liu Weiwei , Lu Ligong , Zhou Zhou , Chen Guokai 
Published: June 2021

Abstract
Background
Vitamin B3 (nicotinamide) plays important roles in metabolism as well as in SIRT and PARP pathways. It is also recently reported as a novel kinase inhibitor with multiple targets. Nicotinamide promotes pancreatic cell differentiation from human embryonic stem cells (hESCs). However, its molecular mechanism is still unclear. In order to understand the molecular mechanism involved in pancreatic cell fate determination, we analyzed the downstream pathways of nicotinamide in the derivation of NKX6.1+ pancreatic progenitors from hESCs.

Methods
We applied downstream modulators of nicotinamide during the induction from posterior foregut to pancreatic progenitors, including niacin, PARP inhibitor, SIRT inhibitor, CK1 inhibitor and ROCK inhibitor. The impact of those treatments was evaluated by quantitative real-time PCR, flow cytometry and immunostaining of pancreatic markers. Furthermore, CK1 isoforms were knocked down to validate CK1 function in the induction of pancreatic progenitors. Finally, RNA-seq was used to demonstrate pancreatic induction on the transcriptomic level.

Results
First, we demonstrated that nicotinamide promoted pancreatic progenitor differentiation in chemically defined conditions, but it did not act through either niacin-associated metabolism or the inhibition of PARP and SIRT pathways. In contrast, nicotinamide modulated differentiation through CK1 and ROCK inhibition. We demonstrated that CK1 inhibitors promoted the generation of PDX1/NKX6.1 double-positive pancreatic progenitor cells. shRNA knockdown revealed that the inhibition of CK1α and CK1ε promoted pancreatic progenitor differentiation. We then showed that nicotinamide also improved pancreatic progenitor differentiation through ROCK inhibition. Finally, RNA-seq data showed that CK1 and ROCK inhibition led to pancreatic gene expression, similar to nicotinamide treatment.

Conclusions
In this report, we revealed that nicotinamide promotes generation of pancreatic progenitors from hESCs through CK1 and ROCK inhibition. Furthermore, we discovered the novel role of CK1 in pancreatic cell fate determination.
Non-protected carotid artery stenting for symptomatic carotid stenosis in low resource settings
Authors: El-Sudany Ayman H. , Georgy Shady S. , Zaki Amr S. , Bedros Rady Y. , El-Bassiouny Ahmed 
Published: June 2021

Abstract
Background
The use of a distal cerebral protection device during extracranial carotid artery stenting is still a matter of debate. The aim of this work was to evaluate the safety of performing carotid artery stenting procedure without the use of cerebral protection device in patients with symptomatic carotid stenosis. A retrospective study was performed during the period from September 2015 till March 2020 including 91 patients with symptomatic carotid artery stenosis. All patients were treated with a single stent type (Wall stent® - Boston scientific) without the use of cerebral protection device. Pre- and post-procedural clinical assessment with the national institute of health stroke scale (NIHSS). Post procedure brain diffusion-weighted magnetic resonance imaging (DW-MRI) if clinically indicated within 24 h was used to determine periprocedural cerebral embolization.

Results
A low complication rate was found as only one case (1%) showed mild deterioration in NIHSS and new acute cerebral emboli were detected with brain DW-MRI.

Conclusion
Carotid artery stenting can be performed safely without the use of cerebral protection device.
Parenthood Rates and Use of Assisted Reproductive Techniques in Younger Hodgkin Lymphoma Survivors: A Danish Population-Based Study
Authors: Øvlisen Andreas K. , Jakobsen Lasse H. , Eloranta Sandra , Kragholm Kristian H. , Hutchings Martin , Frederiksen Henrik , Kamper Peter , Dahl-Sørensen Rasmus Bo , Stoltenberg Danny , Weibull Caroline E. , Entrop Joshua P. , Glimelius Ingrid , Smedby Karin E. , Torp-Pedersen Christian , Severinsen Marianne T. , El-Galaly Tarec C. 
Published: June 2021

PURPOSE The majority of young adults with Hodgkin lymphoma (HL) are cured, but chemotherapy-induced infertility can have profound psychosocial consequences. Providing data on parenthood rates and use of assisted reproductive techniques (ARTs) after contemporary HL treatment is important for patient counseling and survivorship care. MATERIALS AND METHODS All Danish patients with HL diagnosed during 2000-2015 at the ages 18-40 years who achieved remission after first-line therapy were included and matched on age, sex, and parenthood status to five random persons from the general population. Parenthood rates were defined as the rate of first live birth per 1,000 person years, starting 9 months after HL diagnosis. Nationwide birth and patient registers were used to capture parenthood outcomes and ARTs use. RESULTS A total of 793 HL survivors and 3,965 comparators were included (median follow-up 8.7 years). Similar parenthood rates were observed for male and female HL survivors when compared with matched comparators (56.2 v 57.1; P = .871 for males and 63.8 v 61.2; P = .672 for females). For male HL survivors, BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) therapy was associated with lower parenthood rates as compared to the matched comparators (28.1 v 60.8; P = .020). Live birth after ARTs were more common for HL survivors than for comparators (males 21.6% v 6.3%; P < .001; females 13.6% v 5.5%; P = .001). There were no differences in gestational age, Apgar score, or newborn measurements between HL survivors and matched comparators. CONCLUSION The parenthood rates for HL survivors who have not experienced relapse were generally similar to the general population. However, ARTs were used more often before the first live birth in HL survivors, which is relevant information when discussing possible long-term side effects and fertility-preserving treatment options.
High-fat Diet Alters Male Seminal Plasma Composition to Impair Female Immune Adaptation for Pregnancy in Mice
Authors: Schjenken John E , Moldenhauer Lachlan M , Sharkey David J , Chan Hon Y , Chin Peck Y , Fullston Tod , McPherson Nicole O , Robertson Sarah A 
Published: June 2021

Abstract
Paternal experiences and exposures before conception can influence fetal development and offspring phenotype. The composition of seminal plasma contributes to paternal programming effects through modulating the female reproductive tract immune response after mating. To investigate whether paternal obesity affects seminal plasma immune-regulatory activity, C57Bl/6 male mice were fed an obesogenic high-fat diet (HFD) or control diet (CD) for 14 weeks. Although HFD consumption caused only minor changes to parameters of sperm quality, the volume of seminal vesicle fluid secretions was increased by 65%, and the concentrations and total content of immune-regulatory TGF-β isoforms were decreased by 75% to 80% and 43% to 55%, respectively. Mating with BALB/c females revealed differences in the strength and properties of the postmating immune response elicited. Transcriptional analysis showed &gt;300 inflammatory genes were similarly regulated in the uterine endometrium by mating independently of paternal diet, and 13 were dysregulated by HFD-fed compared with CD-fed males. Seminal vesicle fluid factors reduced in HFD-fed males, including TGF-β1, IL-10, and TNF, were among the predicted upstream regulators of differentially regulated genes. Additionally, the T-cell response induced by mating with CD-fed males was blunted after mating with HFD-fed males, with 27% fewer CD4+ T cells, 26% fewer FOXP3+CD4+ regulatory T cells (Treg) cells, and 19% fewer CTLA4+ Treg cells, particularly within the NRP1+ thymic Treg cell population. These findings demonstrate that an obesogenic HFD alters the composition of seminal vesicle fluid and impairs seminal plasma capacity to elicit a favorable pro-tolerogenic immune response in females at conception.
Single-cell transcriptomics of the early developing mouse cerebral cortex disentangle the spatial and temporal components of neuronal fate acquisition
Authors: Moreau Matthieu X. , Saillour Yoann , Cwetsch Andrzej W. , Pierani Alessandra , Causeret Frédéric 
Published: June 2021

ABSTRACT
In the developing cerebral cortex, how progenitors that seemingly display limited diversity end up producing a vast array of neurons remains a puzzling question. The prevailing model suggests that temporal maturation of progenitors is a key driver in the diversification of the neuronal output. However, temporal constraints are unlikely to account for all diversity, especially in the ventral and lateral pallium where neuronal types significantly differ from their dorsal neocortical counterparts born at the same time. In this study, we implemented single-cell RNAseq to sample the diversity of progenitors and neurons along the dorso-ventral axis of the early developing pallium. We first identified neuronal types, mapped them on the tissue and determined their origin through genetic tracing. We characterised progenitor diversity and disentangled the gene modules underlying temporal versus spatial regulations of neuronal specification. Finally, we reconstructed the developmental trajectories followed by ventral and dorsal pallial neurons to identify lineage-specific gene waves. Our data suggest a model by which discrete neuronal fate acquisition from a continuous gradient of progenitors results from the superimposition of spatial information and temporal maturation.
Superradiant lasing in inhomogeneously broadened ensembles with spatially varying coupling
Authors: Bychek Anna , Hotter Christoph , Plankensteiner David , Ritsch Helmut 
Published: June 2021

Background: Theoretical studies of superradiant lasing on optical clock transitions predict a superb frequency accuracy and precision closely tied to the bare atomic linewidth. Such a superradiant laser is also robust against cavity fluctuations when the spectral width of the lasing mode is much larger than that of the atomic medium. Recent predictions suggest that this unique feature persists even for a hot and thus strongly broadened ensemble, provided the effective atom number is large enough. Methods: Here we use a second-order cumulant expansion approach to study the power, linewidth and lineshifts of such a superradiant laser as a function of the inhomogeneous width of the ensemble including variations of the spatial atom-field coupling within the resonator. Results: We present conditions on the atom numbers, the pump and coupling strengths required to reach the buildup of collective atomic coherence as well as scaling and limitations for the achievable laser linewidth. Conclusions: We show how sufficiently large numbers of atoms subject to strong optical pumping can induce synchronization of the atomic dipoles over a large bandwidth. This generates collective stimulated emission of light into the cavity mode leading to narrow-band laser emission at the average of the atomic frequency distribution. The linewidth is orders of magnitudes smaller than that of the cavity as well as the inhomogeneous gain broadening and exhibits reduced sensitivity to cavity frequency noise.
Reducing variations in clinical nurse educator roles: a service improvement project standardising roles and career pathways
Authors: Lanada Jose Ariel , Forde-Johnston Carol 
Published: June 2021

Background: There is limited research evaluating the implementation and effectiveness of clinical nurse educator (CNE) roles in clinical practice. UK employers tend to use generic nursing job profiles, although the definition, expectations and implementation of nurse educator roles are interpreted differently between employers. Aim: This project intended to reduce variation and standardise job titles, job descriptions and job plans for CNEs ranging from band 5 to band 7 and identify the academic requirements and professional experience required of each band. Methods: An evaluative service review of existing CNE roles was conducted across a large division of a major NHS hospital trust. Focus group interviews were conducted to identify CNEs' and matrons' perceptions of the role. Findings: Themes identified from the coding of narrative data included: the importance of the role; variations in expectations of the role, job titles, job descriptions and plans; and a lack of career progression pathways. Conclusion: This service improvement project demonstrates that a standardised approach to the implementation of CNE roles can be achieved with the support of a unified senior nursing team. Clearer role definition and career progression pathways would improve job satisfaction and may help retain CNEs in post.