bluuebunny/crossref_metadata_2025_split huggingface dataset:
Frailty as a risk factor for postoperative complications in adult patients with degenerative scoliosis administered posterior single approach, long-segment corrective surgery: a retrospective cohort study
Authors: Li Bin , Meng Xianglong , Zhang Xinuo , Hai Yong 
Published: April 2021

Abstract
Background
With the population aging worldwide, adult degenerative scoliosis (ADS) is receiving increased attention. Frailty, instead of chronological age, is used for assessing the patient’s overall physical condition. In ADS patients undergoing a posterior approach, long-segment corrective surgery, the association of frailty with the postsurgical outcomes remains undefined.

Methods
ADS patients who underwent a posterior approach, long-segment fusion at the Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University (CMU), Beijing, China, in 2014–2017 were divided into the frailty and non-frailty groups according to the modified frailty index. Major postoperative complications were recorded, including cardiac complications, pneumonia, acute renal dysfunction, delirium, stroke, neurological deficit, deep wound infection, gastrointestinal adverse events, and deep vein thrombosis. Radiographic measurements and health-related quality of life (HRQOL) parameters were recorded preoperatively and at 2 postoperative years.

Results
A total of 161 patients were included: 47 (29.2%) and 114 (70.8%) in the frailty and non-frailty groups, respectively. Major postoperative complications were more frequent in the frailty group than the non-frailty group (29.8% vs. 10.5%, P = 0.002). Multivariable logistic regression analysis showed that frailty was independently associated with major complications (adjusted odds ratio [aOR] = 2.77, 95% confidence interval [CI] 1.12–6.89, P = 0.028). Radiographic and HRQOL parameters were improved at 2 years but with no significant between-group differences.

Conclusions
Frailty is a risk factor for postoperative complications in ADS after posterior single approach, long-segment corrective surgery. Frailty screening should be applied preoperatively in all patients to optimize the surgical conditions in ADS.
The increased motion of lumbar induces ligamentum flavum hypertrophy in a rat model
Authors: Wang Baojian , Gao Chunyu , Zhang Ping , Sun Wu , Zhang Jingru , Gao Jinghua 
Published: April 2021

Abstract
Background
The purpose of this study was to establish a novel rat model for ligamentum flavum (LF) hypertrophy using increased motion of lumbar and to elucidate the etiology of (LFH).

Methods
A total number of 30 male rats were used. The increased motion of lumbar was induced by surgical resection of L5/6 posterior elements (n = 15). The other rats underwent a sham operation (n = 15). After 8 weeks, all rats were taken lateral plain X-rays. The LF from L5/6 in both groups were harvested to investigate histological, immunohistological, and real-time PCR analysis.

Results
According to radiological results, the disc height ratio, flexion ratio, and extension ratio were larger in the rats in the experimental group than that of in the sham group. The HE staining showed that the LF thickness in the experimental group significantly increased in comparison to the sham group. The Masson trichrome staining showed that the ratio of elastic fibers to collagen fibers in experimental group was lower than that in the sham group. The protein and gene expression of TGF-β1, TNF-α, IL-1β, and Col 1 were significantly higher in the experimental group than that in the sham group.

Conclusion
A relatively safe, simple, and rapid rat model of LFH using increased motion of lumbar was established. The increased motion of lumbar could lead to high expression of inflammatory and fibrotic factors in LF, causing the accumulation of collagen fibers and decreasing of elastic fibers.
Implementation of written structured feedback into a surgical OSCE
Authors: Sterz J. , Linßen S. , Stefanescu M. C. , Schreckenbach T. , Seifert L. B. , Ruesseler M. 
Published: April 2021

Abstract
Background
Feedback is an essential element of learning. Despite this, students complain about receiving too little feedback in medical examinations, e.g., in an objective structured clinical examination (OSCE). This study aims to implement a written structured feedback tool for use in OSCEs and to analyse the attitudes of students and examiners towards this kind of feedback.

Methods
The participants were OSCE examiners and third-year medical students.
This prospective study was conducted using a multistage design. In the first step, an unstructured interrogation of the examiners formed the basis for developing a feedback tool, which was evaluated and then adopted in the next steps.

Results
In total, 351 students and 51 examiners participated in this study.
A baseline was created for each category of OSCE station and was supplemented with station-specific items. Each of these items was rated on a three-point scale. In addition to the preformulated answer options, each domain had space for individual comments.
A total of 87.5% of the students and 91.6% of the examiners agreed or rather agreed that written feedback should continue to be used in upcoming OSCEs.

Conclusion
The implementation of structured, written feedback in a curricular, summative examination is possible, and examiners and students would like the feedback to be constant.
Cost-effectiveness analysis of flucytosine as induction therapy in the treatment of cryptococcal meningitis in HIV-infected adults in South Africa
Authors: Miot Jacqui , Leong Trudy , Takuva Simbarashe , Parrish Andrew , Dawood Halima 
Published: April 2021

Abstract
Background
Cryptococcal meningitis in HIV-infected patients in sub-Saharan Africa accounts for three-quarters of the global cases and 135,000 deaths per annum. Current treatment includes the use of fluconazole and amphotericin B. Recent evidence has shown that the synergistic use of flucytosine improves efficacy and reduces toxicity, however affordability and availability has hampered access to flucytosine in many countries. This study investigated the evidence and cost implications of introducing flucytosine as induction therapy for cryptococcal meningitis in HIV-infected adults in South Africa.

Methods
A decision analytic cost-effectiveness and cost impact model was developed based on survival estimates from the ACTA trial and local costs for flucytosine as induction therapy in HIV-infected adults with cryptococcal meningitis in a public sector setting in South Africa. The model considered five treatment arms: (a) standard of care; 2-week course amphotericin B/fluconazole (2wk AmBd/Flu), (b) 2-week course amphotericin B/flucytosine (2wk AmBd/5FC), (c) short course; 1-week course amphotericin B/flucytosine (1wk AmBd/5FC) (d) oral course; 2-week oral fluconazole/flucytosine (oral) and e) 1-week course amphotericin B/fluconazole (1wk AmBd/Flu). A sensitivity analysis was conducted on key variables.

Results
The highest total treatment costs are in the 2-week AmBd/5FC arm followed by the 2-week oral regimen, the 1-week AmBd/5FC, then standard of care with the lowest cost in the 1-week AmBd/Flu arm. Compared to the lowest cost option the 1-week flucytosine course is most cost-effective at USD119/QALY. The cost impact analysis shows that the 1-week flucytosine course has an incremental cost of just over USD293 per patient per year compared to what is currently spent on standard of care. Sensitivity analyses suggest that the model is most sensitive to life expectancy and hospital costs, particularly infusion costs and length of stay.

Conclusions
The addition of flucytosine as induction therapy for the treatment of cryptococcal meningitis in patients infected with HIV is cost-effective when it is used as a 1-week AmBd/5FC regimen. Savings could be achieved with early discharge of patients as well as a reduction in the price of flucytosine.
Understanding inequities in health and health systems in Latin America and the Caribbean: a thematic series
Authors: Ruano Ana Lorena , Rodríguez Daniela , Rossi Pablo Gaitán , Maceira Daniel 
Published: April 2021

AbstractLatin America, with its culturally and ethnically diverse populations, its burgeoning economies, high levels of violence, growing political instability, and its striking levels of inequality, is a region that is difficult to define and to understand. The region’s health systems are deeply fragmented and segmented, which poses great challenges related to the provision of quality of care and overall equity levels in health and in Latin American society at large. Market, social, and political forces continue to push towards the poorly regulated privatization of public health care in many countries within the region, in detriment of public healthcare services where management capacities are limited.In this first collection of papers, we showcase how the region has tackled, with different levels of success, the incorporation of innovative health system reforms aimed at strengthening governance, participation, and the response to the growing epidemiological and demographic demands of its diverse population. We are delighted that this Special Collection will remain open to house future papers from Latin America and the Caribbean. The region has important experiences and lessons to share with the world. We look forward to learning more about how researchers and practitioners continue to experiment and innovate in their struggle to reach equity in health for all. This thematic series is a platform where the region’s lessons and approaches can be shared with the global community of Health Policy and Systems Researchers.
The good, the bad, and the environment: developing an area-based measure of access to health-promoting and health-constraining environments in New Zealand
Authors: Marek Lukas , Hobbs Matthew , Wiki Jesse , Kingham Simon , Campbell Malcolm 
Published: April 2021

AbstractBackgroundAccounting for the co-occurrence of multiple environmental influences is a more accurate reflection of population exposure than considering isolated influences, aiding in understanding the complex interactions between environments, behaviour and health. This study examines how environmental ‘goods’ such as green spaces and environmental ‘bads’ such as alcohol outlets co-occur to develop a nationwide area-level healthy location index (HLI) for New Zealand.MethodsNationwide data were collected, processed, and geocoded on a comprehensive range of environmental exposures. Health-constraining ‘bads’ were represented by: (i) fast-food outlets, (ii) takeaway outlets, (iii) dairy outlets and convenience stores, (iv) alcohol outlets, (v) and gaming venues. Health-promoting ‘goods’ were represented by: (i) green spaces, (ii) blue spaces, (iii) physical activity facilities, (iv) fruit and vegetable outlets, and (v) supermarkets. The HLI was developed based on ranked access to environmental domains. The HLI was then used to investigate socio-spatial patterning by area-level deprivation and rural/urban classification.ResultsResults showed environmental ‘goods’ and ‘bads’ co-occurred together and were patterned by area-level deprivation. The novel HLI shows that the most deprived areas of New Zealand often have the most environmental ‘bads’ and less access to environmental ‘goods’.ConclusionsThe index, that is now publicly available, is able to capture both inter-regional and local variations in accessibility to health-promoting and health-constraining environments and their combination. Results in this study further reinforce the need to embrace the multidimensional nature of neighbourhood and place not only when designing health-promoting places, but also when studying the effect of existing built environments on population health.
Study problems and depressive symptoms in adolescents during the COVID-19 outbreak: poor parent-child relationship as a vulnerability
Authors: Wang Jingyi , Wang Hao , Lin Haijiang , Richards Marcus , Yang Shuyue , Liang Hongbiao , Chen Xiaoxiao , Fu Chaowei 
Published: April 2021

Abstract
Background
Little is known about the prevalence of and risk factors for adolescent mental health problems during the COVID-19 outbreak. We aimed to investigate the prevalence of depressive symptoms, their association with study-relevant problems, and the moderating effect of parent-child relationship among Chinese adolescents during the school closures.

Methods
We performed a cross-sectional analysis with data collected in middle and high schools in Taizhou, China. Students completed an online survey between April 16 and May 14, 2020. Depressive symptoms were assessed using the Children’s Depression Inventory. Three types of study problems were recorded, including having difficulty in studying at home, dislike of remote learning, and excessive screen entertainment time. Parental relationships were categorized into good or normal relationship and poor relationship. Linear regression and logistic regression analyses were conducted to investigate the associations between study-relevant problems and depressive symptoms.

Results
Using data from 6435 adolescents, we found that the prevalence of depressive symptoms was 17.7%. All the study problem measures were associated with more severe depressive symptoms. There was a moderating effect of the parental relationship on the associations between study problems and depressive symptoms. The association between number of study problems and depressive symptoms was stronger in adolescents with a poor parent-child relationship (regression coefficient 4.34 [95% CI 2.97, 5.72]) than those with a good or normal relationship (2.55 [2.35, 2.75]), p for interaction 0.002, on multivariable adjustment.

Conclusions
Study problems due to school closures were particularly problematic for adolescents who had poor parent-child relationships. Public health initiatives could help students to adjust study habits and improve parent-child relationships, thereby protecting against the development of depression.
Reduced spatial resolution MRI suffices to image and quantify drought induced embolism formation in trees
Authors: Meixner Marco , Foerst Petra , Windt Carel W. 
Published: April 2021

Abstract
Background
Magnetic resonance imaging (MRI) is uniquely suited to non-invasively and continuously monitor embolism formation in trees. Depending on the MRI method used, quantitative parameter maps of water content and MRI signal relaxation behavior can be generated. The ability to measure dynamic differences in water content and relaxation behavior can be used to detect xylem embolism formation, even if xylem conduits are too small to be spatially resolved. This is especially advantageous when using affordable small-scale low-field MRI scanners. The amount of signal that can be obtained from an object strongly depends on the strength of the magnetic field of the imager’s magnet. Imaging at lower resolutions thus would allow to reduce the cost, size and weight of the MRI scanner and to shorten image acquisition times.

Results
We investigated how much spatial resolution can be sacrificed without losing the ability to monitor embolism formation in coniferous softwood (spruce, Picea abies) and diffuse porous beech (Fagus sylvatica). Saplings of both species were bench dehydrated, while they were continuously imaged at stepwise decreasing spatial resolutions. Imaging was done by means of a small-scale MRI device, utilizing image matrix sizes of 128 × 128, 64 × 64 and 32 × 32 pixels at a constant FOV of 19 and 23 mm, respectively. While images at the lowest resolutions (pixel sizes 0.59 × 0.59 mm and 0.72 × 0.72 mm) were no longer sufficient to resolve finer details of the stem anatomy, they did permit an approximate localization of embolism formation and the generation of accurate vulnerability curves.

Conclusions
When using MRI, spatial resolution can be sacrificed without losing the ability to visualize and quantify embolism formation. Imaging at lower spatial resolution to monitor embolism formation has two advantages. Firstly, the acquisition time per image can be reduced dramatically. This enables continuous imaging at high time resolution, which may be beneficial to monitor rapid dynamics of embolism formation. Secondly, if the requirements for spatial resolution are relaxed, much simpler MRI devices can be used. This has the potential to make non-invasive MR imaging of embolism formation much more affordable and more widely available.
Differential methylation EPIC analysis discloses cisplatin-resistance related hypermethylation and tumor-specific heterogeneity within matched primary and metastatic testicular germ cell tumor patient tissue samples
Authors: Lobo João , Constâncio Vera , Leite-Silva Pedro , Guimarães Rita , Cantante Mariana , Braga Isaac , Maurício Joaquina , Looijenga Leendert H. J. , Henrique Rui , Jerónimo Carmen 
Published: April 2021

AbstractTesticular germ cell tumors (TGCTs) are among the most common solid malignancies in young-adult men, and currently most mortality is due to metastatic disease and emergence of resistance to cisplatin. There is some evidence that increased methylation is one mechanism behind this resistance, stemming from individual studies, but approaches based on matched primary and metastatic patient samples are lacking. Herein, we provide an EPIC array-based study of matched primary and metastatic TGCT samples. Histology was the major determinant of overall methylation pattern, but some clustering of samples related to response to cisplatin was observed. Further differential analysis of patients with the same histological subtype (embryonal carcinoma) disclosed a remarkable increase in net methylation levels (at both promoter and CpG site level) in the patient with cisplatin-resistant disease and poor outcome compared to the patient with complete response to chemotherapy. This further confirms the recent results of another study performed on isogenic clones of sensitive and resistant TGCT cell lines. Differentially methylated promoters among groups of samples were mostly not shared, disclosing heterogeneity in patient tissue samples. Finally, gene ontology analysis of cisplatin-resistant samples indicated enrichment of differentially hypermethylated promoters on pathways related to regulation of immune microenvironment, and enrichment of differentially hypomethylated promoters on pathways related to DNA/chromatin binding and regulation. This data supports not only the use of hypomethylating agents for targeting cisplatin-resistant disease, but also their use in combination with immunotherapies and chromatin remodelers.
Imitation and recognition of facial emotions in autism: a computer vision approach
Authors: Drimalla Hanna , Baskow Irina , Behnia Behnoush , Roepke Stefan , Dziobek Isabel 
Published: April 2021

AbstractBackgroundImitation of facial expressions plays an important role in social functioning. However, little is known about the quality of facial imitation in individuals with autism and its relationship with defining difficulties in emotion recognition.MethodsWe investigated imitation and recognition of facial expressions in 37 individuals with autism spectrum conditions and 43 neurotypical controls. Using a novel computer-based face analysis, we measured instructed imitation of facial emotional expressions and related it to emotion recognition abilities.ResultsIndividuals with autism imitated facial expressions if instructed to do so, but their imitation was both slower and less precise than that of neurotypical individuals. In both groups, a more precise imitation scaled positively with participants’ accuracy of emotion recognition.LimitationsGiven the study’s focus on adults with autism without intellectual impairment, it is unclear whether the results generalize to children with autism or individuals with intellectual disability. Further, the new automated facial analysis, despite being less intrusive than electromyography, might be less sensitive.ConclusionsGroup differences in emotion recognition, imitation and their interrelationships highlight potential for treatment of social interaction problems in individuals with autism.
Bacteremic cholangitis due to Raoultella planticola complicating intrahepatic bile duct stricture 5 years post-laparoscopic cholecystectomy: a case report
Authors: Blihar David , Phuu Phenyo , Kotelnikova Svetlana , Johnson Edward 
Published: April 2021

Abstract
Background
Raoultella Planticola is a facultative anaerobic, gram-negative, water- and soil-dwelling rod bacterium rarely reported as a cause of human disease. However, the number of reported R. planticola infections is growing, without a concomitant increase in research on the microbe or its pathogenesis. Previous genomic studies demonstrating genetic similarities between R. planticola and Klebsiella pneumoniae suggest that capsule biosynthesis, mucoid phenotype, biofilm production, and lipopolysaccharide (endotoxin) synthesis may all be potential virulence factors of R. planticola. We present a unique case of R. planticola infection of the biliary tract 5 years after biliary surgery in a patient with no previously documented risk factors. We also use in silico techniques to predict virulence factors of R. planticola.

Case presentation
This case report is the first to discuss a R. planticola infection in the biliary tract of late onset post-surgery (5 years) in a Caucasian patient with no previously documented risk factors.

Conclusions
An in-depth search of the current literature did not yield other similar cases of R. planticola infections. Moreover, to the best of our knowledge, our case is the first case of R. planticola isolated from post-endoscopic retrograde cholangiopancreatography (ERCP) as part of biliary sepsis not associated with gastroenteritis. The late onset of the infection in our patient and the results of the in silico analysis suggest that R. planticola may have survived exposure to the host immune system through the creation of an intracellular biofilm or in a non-culturable but viable state (NCBV) for the 5-year period. The in silico analysis also suggests that biofilms, enterobactin, and mucoid phenotype may play a role in the pathogenesis of R. planticola. However, further research is needed to illuminate the significance of pili, capsule biosynthesis, and lipopolysaccharide (LPS) in the virulence of R. planticola. Lastly, as our patient did not have any risk factors previously associated with R. planticola, we suggest that biliary tract stricture, cholecystitis, and prior surgery may be possible novel risk factors.
Adipose-derived stem cells combined with platelet-rich plasma enhance wound healing in a rat model of full-thickness skin defects
Authors: Ni Xuejun , Shan Xiuying , Xu Lili , Yu Wenjun , Zhang Mingliang , Lei Chen , Xu Nating , Lin Junyu , Wang Biao 
Published: April 2021

Abstract
Background
Wound healing is impaired in patients with diabetes due to the multifactorial etiology of the disease, which limits the therapeutic efficacy of various approaches. This study hypothesizes that the combination of adipose-derived stem cells (ADSCs) and platelet-rich plasma (PRP) might achieve optimally efficient diabetic wound healing.

Methods
ADSCs were isolated from the adipose tissues of Sprague-Dawley (SD) rats. PRP was prepared by using a two-step centrifugation technique. A diabetic wound model was established on the backs of SD rats to evaluate the effect of ADSCs incorporated into PRP. Hematoxylin and eosin staining, immunofluorescence, and immunohistochemistry were performed to observe the changes in neovascularization. ELISA and Western blot were utilized to detect the angiogenesis-related protein expression levels. The proliferation of endothelial cells was assessed by the MTS assay.

Results
ADSCs incorporated into PRP induced a higher wound closure rate than ADSCs, PRP, and negative control. The expression levels of VEGF, p-STAT3, and SDF-1 in the ADSC+PRP group were higher than those in the other groups. Moreover, the proliferation of endothelial cells was strongly stimulated by treatment with the combination of ADSC-conditioned medium (ADSC-CM) and PRP.

Conclusions
PRP enhanced diabetic wound healing induced by ADSCs, and its promoting effect involved neovascularization.