bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical correlates of hypothalamic functional changes in migraine patients
Authors: Messina Roberta , Rocca Maria A , Valsasina Paola , Misci Paolo , Filippi Massimo 
Published: October 2021

Objective To elucidate the hypothalamic involvement in episodic migraine and investigate the association between hypothalamic resting state functional connectivity changes and migraine patients’ clinical characteristics and disease progression over the years. Methods Ninety-one patients with episodic migraine and 73 controls underwent interictal resting state functional magnetic resonance imaging. Twenty-three patients and controls were re-examined after a median of 4.5 years. Hypothalamic resting state functional connectivity changes were investigated using a seed-based correlation approach. Results At baseline, a decreased functional interaction between the hypothalamus and the parahippocampus, cerebellum, temporal, lingual and orbitofrontal gyrus was found in migraine patients versus controls. Increased resting state functional connectivity between the hypothalamus and bilateral orbitofrontal gyrus was demonstrated in migraine patients at follow-up versus baseline. Migraine patients also experienced decreased right hypothalamic resting state functional connectivity with ipsilateral lingual gyrus. A higher migraine attack frequency was associated with decreased hypothalamic-lingual gyrus resting state functional connectivity at baseline, while greater headache impact at follow-up correlated with decreased hypothalamic-orbitofrontal gyrus resting state functional connectivity at baseline. At follow-up, a lower frequency of migraine attacks was associated with higher hypothalamic-orbitofrontal gyrus resting state functional connectivity. Conclusions During the interictal phase, the hypothalamus modulates the activity of pain and visual processing areas in episodic migraine patients. The hypothalamic-cortical interplay changes dynamically over time according to patients’ clinical features.
Treatment Decisions in Pediatric Sports Medicine: Do Personal and Professional Bias Affect Decision-Making?
Authors: Stinson Zachary S. , Davelaar Cassidy M. Foley , Kiebzak Gary M. , Edmonds Eric W. 
Published: October 2021

Background: Personal and professional biases can affect decision-making regarding important issues in pediatric sports medicine. Gaining insight into the opinions of health care professionals who specialize in pediatric sports medicine will provide information that may be useful for directing ongoing research in this field. Hypothesis: It was hypothesized that surgeons would demonstrate bias toward early surgical intervention versus nonsurgeons. In addition, it was hypothesized that youth sports medicine professionals who were parents of a child with a previous major sports injury or concussion would be less likely to allow their child to play American tackle football or return to football after a concussion. Study Design: Cross-sectional study. Methods: An online survey was provided to the active members of the Pediatric Research in Sports Medicine Society. We used both professional background information and responses to questions related to personal experiences with youth sports injuries to determine potential factors associated with underlying biases. Survey responses among subgroups were compared using the Fisher exact test. The Pearson correlation coefficient was used to evaluate years in practice versus opioid use. Results: Of the survey participants, 62.5% were pediatric surgeons, and 37.5% represented different nonsurgical youth sports medicine professions. Surgeons were less likely than nonsurgeons to agree to allow their child to return to football after sustaining a concussion and completing a concussion protocol (48% vs 76%, P = .013). Surgeons were more likely than nonsurgeons to agree to both elective shoulder stabilization after a first-time dislocation and elective drilling of a stable knee osteochondritis dissecans (OCD) before nonoperative treatment (41% vs 10%, P = .003 and 52% vs 23%, P = .013, respectively). Those who reported having a child with a concussion history were more likely to support him or her returning to football after a concussion (65% vs 33%, P = .026). Conclusion: Surgeons were more likely to favor elective shoulder-stabilization surgery after a first-time dislocation and drilling of a stable knee OCD instead of nonoperative management. Personal experience of having a child who sustained a major sports injury or concussion did not demonstrate a bias against participation in football or return to football after a concussion.
How is the way we spend our time related to psychological wellbeing? A cross-sectional analysis of time-use patterns in the general population and their associations with wellbeing and life satisfaction
Authors: Tomczyk Samuel , Altweck Laura , Schmidt Silke 
Published: October 2021

Abstract
Background
Time-use surveys can closely monitor daily activities, times of stress and relaxation, and examine predictors and trajectories with regard to health. However, previous studies have often neglected the complex interaction of daily activities when looking at health outcomes.

Methods
Using latent profile analysis, this study examined patterns of self-reported daily time use (0–12h hours) for nine types of behaviour (work, errands, housework, childcare, care of persons in need, education, repairs and gardening, physical activity, and hobbies/leisure-time activities) in the 2018 wave of the German Socio-Economic Panel (N = 30,152; 51.9% female; M = 46.87 years). Sociodemographic variables, affective wellbeing, general and domain-specific life satisfaction, and self-rated health were inspected as predictors via multinomial logistic regression models.

Results
Six latent profiles emerged: full-time work (47.2%), leisure (33.8%), childcare (8.9%), education (7.0%), part-time work & care (2.6%), and care (0.5%). Overall, the care and part-time work & care profiles showed the lowest wellbeing scores, lower subjective health, and life satisfaction. Women were more likely to be members of the care and childcare profiles. Men were more likely to belong to the full-time work profile, and they reported significantly higher wellbeing than women.

Conclusions
The analysis revealed distinct patterns of time use and a burden on women, given their investment in care and childcare. Part-time work, and care seemed particularly demanding, and thus, are important areas for prevention, for instance, regarding mental health problems. However, time use was assessed via self-reports, therefore future studies could implement objective measures like digital trackers to validate findings.
Quality of life and complications in elderly patients after pronation rotation type III ankle fractures treated with a cast and early weight-bearing
Authors: Lorente Alejandro , Gandía Antonio , Mariscal Gonzalo , Palacios Pablo , Lorente Rafael 
Published: October 2021

Abstract
Background
Early weight-bearing is becoming increasingly common because it can positively affect the quality of life of patients. Therefore, the efficacy and safety of this conservative treatment should be assessed for different types of ankle fractures. The goal of this study was to compare early weight-bearing and non-weight-bearing in terms of effectiveness and safety in patients with pronation rotation type III ankle fractures treated nonsurgically.

Methods
A prospective multicenter cohort study was conducted over two years. Elderly patients with a nondisplaced pronation rotation type III ankle fracture were included. The main variables were the Barthel Index and SF-12 scores. The patients completed the questionnaires at six weeks, one year and two years. We also compared the complications associated with the two interventions.

Results
30 patients were included in the weight-bearing group, while 32 patients were included in the non-weight-bearing (WB) group. The mean ages were 82.6 ± 2.6 years and 83.1 ± 2.6 years, respectively. Quality of life, measured with the SF-12 scale, increased significantly in both the short and long term in the WB group (53.5 ± 5.8 points vs 65.2 ± 4.4 points at 6 weeks and 70.1 ± 4.2 points vs. 80.9 ± 3.7 points at 2 years; p<0.001). The WB group also showed a higher quality of life, as measured by the Barthel Index (54.5 ± 5.2 points vs. 64.3 ± 4.0 points at 6 weeks and 71.0 ± 4.3 points vs. 80.7 ± 3.4 points at 2 years; p<0.001).

Conclusions
Elderly patients with pronation rotation type III fractures could benefit from an early weight-bearing protocol in terms of quality of life and functionality.
Risk and protective factors of Leishmaniasis in the rural area of the western border region of Rio Grande do Sul, Brazil
Authors: Pradella Gabriela Döwich , Duarte Claudia Acosta , Escobar Taiane Acunha , Zuravski Luísa , Góss Geórgia Camargo , Skupien Jovito Adiel , Lübeck Irina 
Published: October 2021

Abstract
Background
The Leishmaniases are on the top of the global list of tropical neglected diseases. The number of infected dogs in South America is estimated in millions and correlated to disease cases in humans, especially in Brazil. Equines may get infected too and can play a role in the epidemiological chain. Thus, the aim of the present study was to evaluate risk and protective factors of leishmaniasis in rural areas of the western border region of Rio Grande do Sul state, Brazil by Leishmania spp. protozoa molecular detection and serological evaluation (ELISA) in equine and canine blood samples. This work included nine farms around the city of Uruguaiana. Epidemiologic information regarding farm characteristics and biologic material collection of canine (22) and equine (91), totalizing 113 samples was collected. The polymerase chain reaction (PCR) technique was used to detect Leishmania spp. in biological samples. Variables related to the farm were collected and evaluated through descriptive analysis followed by chi-square test and a logistic regression analysis.

Results
Nineteen positive samples (19/113 – 16,81%) were detected, being 18 equines and 1 canine, in six of the nine farms included in the study. No animal showed clinical signs of the disease. According to the variables analyzed, when compared each characteristic separately, the presence of abundant vegetation and poor hygiene demonstrated to be risk factors to Leishmania infection in rural areas. The logistic regression showed that excellent general hygiene, proximity to the weir and trimmed grass were protective factors (p=0.038, p=0.001 and p=0.014, respectively). Having excellent hygiene represents a 70% lower chance of getting infected, keeping the grass cut protects the animal by more than 90% and the proximity of the weir represents a protective factor of 96%.

Conclusions
The presence of Leishmania infection in the western border region of Rio Grande do Sul was 16,81% and it was influenced by farm characteristics. The role of the excellent general hygiene as a protective factor is extremely relevant in the leishmaniases prevention.
The benefits and risks of pembrolizumab in combination with chemotherapy as first-line therapy in small-cell lung cancer: a single-arm meta-analysis of noncomparative clinical studies and randomized control trials
Authors: Liu Qiangyun , Zhang Yixuan , Liu Miaowen , Xu Ruoxin , Yi Fengming , Wei Yiping , Zhu Shuqiang , Zhang Wenxiong 
Published: October 2021

Abstract
Background
Although pembrolizumab has shown clinical benefit in patients with small-cell lung cancer (SCLC), its actual efficacy in combination with a conventional chemotherapy drug has not been determined. We performed this study to discern the efficacy and risk of pembrolizumab in combination with chemotherapy as first-line therapy in SCLC patients.

Methods
We systematically searched the PubMed, ScienceDirect, Cochrane Library, Scopus, Ovid MEDLINE, Embase, Web of Science, and Google Scholar databases for relevant studies. The main outcomes were overall survival (OS) and progression-free survival (PFS).

Results
We identified 2980 articles and included 6 studies (5 were noncomparative open-label studies and 1 was a randomized controlled trial [RCT]) involving 396 patients in our meta-analysis. The pooled median OS (mOS) was 9.6 months (95% CI, 8.0-11.2), and the pooled median PFS (mPFS) was 4.2 months (95% CI, 2.2-6.1). The 1-year overall survival rate (OSR-1y) and 6-month progression-free survival rate (PFSR-6m) were 45.1% (95% CI, 33-57.2%) and 41.6% (95% CI, 24.3-59%), respectively. The objective response rate (ORR) was 38.8% (95% CI, 11.9-65.67%), disease control rate (DCR) was 69.30% (95% CI, 51.6-87.0%), complete response (CR) was 2.20% (95% CI, 0.8-3.7%), partial response (PR) was 34.70% (95% CI, 7.8-61.5%), and stable disease (SD) was 20.90% (95% CI, 9.1-32.6%). The grade 3-4 adverse effect (AE) rate was 20.88% (95% CI, 1.22-54.85%). The most common AEs were neutropenia (90.16%), anemia (53.21%), dysphagia (41.96%), platelet count decrease (34.87%), and esophagitis (32.89%); severe AEs included neutropenia, respiratory failure, pneumonitis, acute coronary syndrome, and colitis/intestinal ischemia.

Conclusions
The combination of pembrolizumab with conventional chemotherapy is an effective therapeutic schedule with acceptable and manageable efficacy and toxicity in patients with SCLC. More high-quality and well-designed RCTs with large sample sizes are warranted to further validate our findings.
Generating synthetic CT from low-dose cone-beam CT by using generative adversarial networks for adaptive radiotherapy
Authors: Gao Liugang , Xie Kai , Wu Xiaojin , Lu Zhengda , Li Chunying , Sun Jiawei , Lin Tao , Sui Jianfeng , Ni Xinye 
Published: October 2021

Abstract
Objective
To develop high-quality synthetic CT (sCT) generation method from low-dose cone-beam CT (CBCT) images by using attention-guided generative adversarial networks (AGGAN) and apply these images to dose calculations in radiotherapy.

Methods
The CBCT/planning CT images of 170 patients undergoing thoracic radiotherapy were used for training and testing. The CBCT images were scanned under a fast protocol with 50% less clinical projection frames compared with standard chest M20 protocol. Training with aligned paired images was performed using conditional adversarial networks (so-called pix2pix), and training with unpaired images was carried out with cycle-consistent adversarial networks (cycleGAN) and AGGAN, through which sCT images were generated. The image quality and Hounsfield unit (HU) value of the sCT images generated by the three neural networks were compared. The treatment plan was designed on CT and copied to sCT images to calculated dose distribution.

Results
The image quality of sCT images by all the three methods are significantly improved compared with original CBCT images. The AGGAN achieves the best image quality in the testing patients with the smallest mean absolute error (MAE, 43.5 ± 6.69), largest structural similarity (SSIM, 93.7 ± 3.88) and peak signal-to-noise ratio (PSNR, 29.5 ± 2.36). The sCT images generated by all the three methods showed superior dose calculation accuracy with higher gamma passing rates compared with original CBCT image. The AGGAN offered the highest gamma passing rates (91.4 ± 3.26) under the strictest criteria of 1 mm/1% compared with other methods. In the phantom study, the sCT images generated by AGGAN demonstrated the best image quality and the highest dose calculation accuracy.

Conclusions
High-quality sCT images were generated from low-dose thoracic CBCT images by using the proposed AGGAN through unpaired CBCT and CT images. The dose distribution could be calculated accurately based on sCT images in radiotherapy.
The combined effect of vitamin K and calcium on bone mineral density in humans: a meta-analysis of randomized controlled trials
Authors: Hu Liyou , Ji Jindou , Li Dong , Meng Jing , Yu Bo 
Published: October 2021

Abstract
Background
With the increasing incidence of osteoporosis, vitamin K and calcium have been linked to bone mineral density (BMD) and undercarboxylated osteocalcin (UcOC) in many studies, but the results of studies of the combined effect of vitamin K and calcium on BMD and UcOC in humans have been inconsistent. We conducted a systematic review of randomized controlled trials to assess the effect of this combination treatment on BMD and UcOC in humans.

Methods
A search for articles was conducted using PubMed, Embase, and the Cochrane Library database up to March 2021 (no language restrictions). We also reviewed the reference lists of the relevant publications and reviews to locate additional publications. The standard mean difference (SMD) was used as the primary measure of effect size. Our main endpoints were lumbar BMD, femoral neck BMD, hip BMD, total femoral BMD, and UcOC from baseline to end point. We performed subgroup analysis, heterogeneity testing, and assessment of publication bias.

Results
A total of 1346 patients from 10 randomized controlled trials were included in the meta-analysis. The forest plot analysis revealed that vitamin K combined with calcium was associated with a higher lumbar spine BMD compared to controls. The SMD was 0.20 [95% confidence interval (CI): 0.07 to 0.32]. Vitamin K and calcium supplementation led to a significant decrease in UcOC (SMD: − 1.71, 95% CI: − 2.45 to − 0.96). Subgroup analysis showed that vitamin K2 and vitamin K1 had SMDs of 0.30 (95% CI: 0.10 to 0.51) and SMDs of 0.14 (95% CI: − 0.02 to 0.29), and calcium dosages of ≤ 1000 mg/d or > 1000 mg/d had SMDs of 0.19 (95% CI: 0.05 to 0.32) and 0.26 (95% CI: − 0.04 to 0.55).

Conclusion
The combination of vitamin K and calcium has a positive effect on lumbar BMD and decreases the level of UcOC.
Registration: The protocol for this meta-analysis was registered at the International Prospective Register of Systematic Reviews (CRD42021251825).
Evaluation of the feasibility of acetabular cup pre-determination in revision total hip arthroplasty via X-ray of the bone stock of the anterosuperior acetabulum
Authors: Zhang Jingwei , Kong Keyu , Chi Yingjun , Liu Xiaoliang , Zeng Yiming , Li Huiwu 
Published: October 2021

AbstractPurposeThis study was aimed to explore (1) location on AP pelvic X-ray that displayed bone stock in anterosuperior acetabulum; (2) whether X-ray could provide enough evidence to evaluate whether bone stock could provide support for acetabular cup; (3) criteria to determine whether anterosuperior bone stock could provide sufficient support for cup on X-ray.MethodsOur study retrospectively collected 43 patients who underwent revision THA for cup loosening from 2014 to 2019. The position of anterosuperior acetabular bone stock was compared between X-ray and CT-based 3-D reconstruction. Seventy-millimeter acetabular cup was implanted simulatively to obtain the contact line between acetabular cup and superolateral remaining bone stock. The contact line length and the angle were measured. Patients were divided into cup group and cage group, and ROC curves of both contact line length and angle were drawn.ResultsThe superolateral part of acetabulum on X-ray could reflect the anterosuperior host bone stock of acetabulum according to the comparison of anteroposterior pelvic X-ray and 3-D reconstruction. Critical point was chosen when we got the highest sensitivity with a 100% specificity in ROC curves. The critical values of contact length and angle were 15.58 mm and 25.5°.ConclusionsSurgeons could assess the anterosuperior bone stock of acetabulum by AP pelvic X-ray to decide whether revision could be done merely using cup or need customized cage. Clinically, when contact line length was larger than 16 mm or contact angle was larger than 25.5°, adoption of cup could obtain primary stability in the revision surgery in most cases.
The risk for complications and reoperations with the use of mega prostheses in bone reconstructions
Authors: Berger Christina , Larsson Sofia , Bergh Peter , Brisby Helena , Wennergren David 
Published: October 2021

Abstract
Background
Despite a relatively high risk for complications and reoperations, mega prostheses are considered a useful method for reconstruction of bone defects after tumour resections. The total number of reoperations has not previously been described, and little is known about the complication rate of mega prostheses used for other indications than primary bone tumours.

Questions/purposes
The current retrospective observational study aimed to describe the patient population treated with mega prostheses at Sahlgrenska University Hospital, Sweden, during 14 consecutive years, reports the complications leading to reoperation and the number and type of reoperations for different kinds of complications, and reports on implant survival.

Methods
All patients treated with a mega prosthesis, regardless of surgical indication and anatomical location, at Sahlgrenska University Hospital during the period 2006–2019 were identified. The medical records for all patients were reviewed. Data regarding age, sex, diagnosis, site of disease, bone resection length, chemotherapeutical treatment and postoperative complications including infections and oncological outcome, were collected and evaluated.

Results
One hundred and fourteen patients treated with 116 mega prostheses were included in the study. The predominant indication for primary surgery with a mega prosthesis was sarcoma of either bone or soft tissue (53.5% of the patients). In total 51 prostheses (44%) did not require any reoperation after the primary surgery. The most common reason for reoperation was infection (22%) followed by soft tissue failure (13%). The risk for prosthetic infection was significantly higher in the group of patients operated due to sarcoma compared with all other indications for surgery regardless of surgical site (p = 0.004).

Conclusion
The study reveals a total reoperation rate of 56% after reconstructive surgery using mega prostheses. Despite the high reoperation rates, at the end of the study period, 83% of the patients had still a functioning prosthesis. Therefore, the use of mega prostheses can be considered a reliable method for reconstruction of large bone defects in selected patients.

Level of Evidence
Level IV, therapeutic study.
Investigation of anti-osteoporosis mechanisms of Rehmanniae Radix Preparata based on network pharmacology and experimental verification
Authors: Ou Li , Kang Wenqian , Liang Ziyi , Gao Feng , Dong Taiwei , Wei Peifeng , Li Min 
Published: October 2021

Abstract
Background
Rehmanniae Radix Preparata (RRP) can effectively improve the symptoms of osteoporosis, but its molecular mechanism for treating osteoporosis is still unclear. The objective of this study is to investigate the anti-osteoporosis mechanisms of RRP through network pharmacology.

Methods
The overlapping targets of RRP and osteoporosis were screened out using online platforms. A visual network diagram of PPI was constructed and analyzed by Cytoscape 3.7.2 software. Molecular docking was used to evaluate the binding activity of ligands and receptors, and some key genes were verified through pharmacological experiments.

Results
According to topological analysis results, AKT1, MAPK1, ESR1, and SRC are critical genes for RRP to treat osteoporosis, and they have high binding activity with stigmasterol and sitosterol. The main signal pathways of RRP in the treatment of osteoporosis, including the estrogen signaling pathway, HIF-1 signal pathway, MAPK signal pathway, PI3K-Akt signal pathway. Results of animal experiments showed that RRP could significantly increase the expression levels of Akt1, MAPK1, ESR1, and SRC1 mRNA in bone tissue to increase bone density.

Conclusion
This study explained the coordination between multiple components and multiple targets of RRP in the treatment of osteoporosis and provided new ideas for its clinical application and experimental research.