bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associations of overweight, obesity and osteoporosis with ankle fractures
Authors: Hjelle Anja M. , Apalset Ellen M. , Gjertsen Jan-Erik , Nilsen Roy M. , Lober Anja , Tell Grethe S. , Mielnik Pawel F. 
Published: August 2021

Abstract
Background
Studies exploring risk factors for ankle fractures in adults are scarce, and with diverging conclusions. This study aims to investigate whether overweight, obesity and osteoporosis may be identified as risk factors for ankle fractures and ankle fracture subgroups according to the Danis-Weber (D-W) classification.

Methods
108 patients ≥40 years with fracture of the lateral malleolus were included. Controls were 199 persons without a previous fracture history. Bone mineral density of the hips and spine was measured by dual-energy x-ray absorptiometry, and history of previous fracture, comorbidities, medication, physical activity, smoking habits, body mass index and nutritional factors were registered.

Results
Higher body mass index with increments of 5 gave an adjusted odds ratio (OR) of 1.30 (95% confidence interval (CI) 1.03–1.64) for ankle fracture, and an adjusted OR of 1.96 (CI 0.99–4.41) for sustaining a D-W type B or C fracture compared to type A. Compared to patients with normal bone mineral density, the odds of ankle fracture in patients with osteoporosis was 1.53, but the 95% CI was wide (0.79–2.98). Patients with osteoporosis had reduced odds of sustaining a D-W fracture type B or C compared to type A (OR 0.18, CI 0.03–0.83).

Conclusions
Overweight increased the odds of ankle fractures and the odds of sustaining an ankle fracture with possible syndesmosis disruption and instability (D-W fracture type B or C) compared to the stable and more distal fibula fracture (D-W type A). Osteoporosis did not significantly increase the odds of ankle fractures, thus suffering an ankle fracture does not automatically warrant further osteoporosis assessment.
Can low-intensity pulsed ultrasound (LIPUS) accelerate bone healing after intramedullary screw fixation for proximal fifth metatarsal stress fractures? A retrospective study
Authors: Murakami Ryo , Sanada Takaki , Inagawa Miyu , Yoshitomi Hiroki , Honda Eisaburo , Fukai Atsushi , Iwaso Hiroshi 
Published: August 2021

Abstract
Background
Intramedullary screw fixation is considered the standard treatment for proximal fifth metatarsal stress fractures. Low-intensity pulsed ultrasound (LIPUS) is a well-known bone-healing enhancement device. However, to the best of our knowledge, no clinical study has focused on the effect of LIPUS for postoperative bone union in proximal fifth metatarsal stress fractures. This study aimed to investigate the effect of LIPUS treatment after intramedullary screw fixation for proximal fifth metatarsal stress fractures.

Methods
Between January 2015 and March 2020, patients who underwent intramedullary screw fixation for proximal fifth metatarsal stress fractures were investigated retrospectively. All patients underwent intramedullary screw fixation using a headless compression screw with autologous bone grafts from the base of the fifth metatarsal. The time to restart running and return to sports, as well as that for radiographic bone union, were compared between groups with or without LIPUS treatment. LIPUS treatment was initiated within 3 weeks of surgery in all cases.

Results
Of the 101 ft analyzed, 57 ft were assigned to the LIPUS treatment group, and 44 ft were assigned to the non-LIPUS treatment group. The mean time to restart running and return to sports was 6.8 and 13.7 weeks in the LIPUS treatment group and was 6.2 and 13.2 weeks in the non-LIPUS treatment group, respectively. There were no significant differences in these parameters between groups. In addition, the mean time to radiographic bone union was not significantly different between the LIPUS treatment group (11.9 weeks) and the non-LIPUS treatment group (12.0 weeks). The rate of postoperative nonunion in the LIPUS treatment group was 0% (0/57), while that in the non-LIPUS treatment group was 4.5% (2/44). However, this difference was not statistically significant.

Conclusions
There were no statistically significant differences regarding the time to start running, return to sports, and radiographic bone union in patients with or without LIPUS treatment after intramedullary screw fixation for proximal fifth metatarsal stress fractures. Therefore, we cannot recommend the routine use of LIPUS to shorten the time to bone union after intramedullary screw fixation for proximal fifth metatarsal stress fractures.
A new roadmap for social medicine curriculum design based on mixed methods student and faculty evaluations of the preclinical curriculum
Authors: Finnie Sheridan M. , Brach Richard J. , Dawson Christina A. , Epstein Samuel B. , Goyal Raghav K. , Lounsbury Karen M. , Eldakar-Hein Shaden T. , Lahey Timothy 
Published: August 2021

Abstract
Background
To support the development of social medicine curricula that empower medical school graduates to redress health inequities, we conducted a mixed methods student and faculty evaluation of an expanded and innovative preclinical social medicine curriculum.

Methods
We implemented a longitudinal, interactive preclinical social medicine curriculum that was closely integrated with foundational science teaching then conducted a survey-based mixed methods student and faculty curriculum evaluation. Based on these results, we propose a novel conceptual roadmap for social medicine curriculum design.

Results
Student and faculty evaluations of an expanded and innovative longitudinal preclinical social medicine curriculum were strongly favorable. Both student and faculty respondents indicated a particular desire for deeper coverage of race and poverty among other social medicine domains. Qualitative student evaluations highlighted the importance of faculty champions to social medicine teaching as well as the educational impact of stories that exemplify the practical impact of the social determinants of health on specific patient experiences. Qualitative faculty evaluations pointed to the challenges of curriculum integration and the need for faculty career development in social medicine teaching.

Conclusions
Based on mixed methods student and faculty curriculum evaluation data, we propose a novel conceptual roadmap for the design of social medicine curricula at other institutions.
The impact of clinical pharmacist services on patient health outcomes in Pakistan: a systematic review
Authors: Ahmed Ali , Saqlain Muhammad , Tanveer Maria , Blebil Ali Qais , Dujaili Juman Abdulelah , Hasan Syed Shahzad 
Published: August 2021

Abstract
Background
The pharmacist’s role shifts from dispensing to bedside care, resulting in better patient health outcomes. Pharmacists in developed countries ensure rational drug use, improve clinical outcomes, and promote health status by working as part of a multidisciplinary team of healthcare professionals. However, clinical pharmacist services on healthcare utilization in low-and middle-income countries (LMICs) like Pakistan are unclear. As a result, we aim to systematically review pharmacists’ clinical roles in improving Pakistani patients’ therapeutic, safety, humanistic, and economic outcomes.

Methods
We searched PubMed, Scopus, EMBASE, CINAHL, and Cochrane Library for relevant articles published from inception to 28th February 2021. All authors were involved in the screening and selection of studies. Original studies investigating the therapeutic, humanistic, safety, and economic impact of clinical pharmacists in Pakistani patients (hospitalised or outpatients) were selected. Two reviewers independently assessed the risk of bias in studies, and discrepancies were resolved through mutual consensus. All of the included studies were descriptively synthesised, and PRISMA reporting guidelines were followed.

Results
The literature search found 751 articles from which nine studies were included; seven were randomized controlled trials (RCTs), and two were observational studies. Three RCTs included were having a low risk of bias (ROB), two RCTs were having an unclear ROB, while two RCTs were having a high ROB. The nature of clinical pharmacist interventions included one or more components such as disease-related education, lifestyle changes, medication adherence counselling, medication therapy management, and discussions with physicians about prescription modification if necessary. Clinical pharmacist interventions reduce medication-related errors, improve therapeutic outcomes such as blood pressure, glycemic control, lipid control, CD4 T lymphocytes, and renal functions, and improve humanistic outcomes such as patient knowledge, adherence, and health-related quality of life. However, no study reported the economic outcomes of interventions.

Conclusions
The findings of the studies included in this systematic review suggest that clinical pharmacists play important roles in improving patients’ health outcomes in Pakistan; however, it should be noted that the majority of the studies have a high risk of bias, and more research with appropriate study designs is needed.
Upregulation of leukocyte immunoglobulin-like receptor B4 on interstitial macrophages in COPD; their possible protective role against emphysema formation
Authors: Mitsune Ayumi , Yamada Mitsuhiro , Fujino Naoya , Numakura Tadahisa , Ichikawa Tomohiro , Suzuki Ayumi , Matsumoto Shuichiro , Mitsuhashi Yoshiya , Itakura Koji , Makiguchi Tomonori , Koarai Akira , Tamada Tsutomu , Endo Shota , Takai Toshiyuki , Okada Yoshinori , Suzuki Satoshi , Ichinose Masakazu , Sugiura Hisatoshi 
Published: August 2021

Abstract
Background
Leukocyte immunoglobulin-like receptor B4 (LILRB4) is one of the inhibitory receptors in various types of immune cells including macrophages. Previous reports suggested that LILRB4 could be involved in a negative feedback system to prevent excessive inflammatory responses. However, its role has been unclear in chronic obstructive pulmonary disease (COPD), in which macrophages play a crucial role in the pathogenesis. In this study, we aimed to examine the changes of LILRB4 on macrophages both in the lung specimens of COPD patients and the lungs of a mouse emphysema model. We then tried to compare the differences in both inflammation and emphysematous changes of the model between wild-type and LILRB4-deficient mice in order to elucidate the role of LILRB4 in the pathogenesis of COPD.

Methods
We prepared single-cell suspensions of resected lung specimens of never-smokers (n = 21), non-COPD smokers (n = 16), and COPD patients (n = 14). The identification of LILRB4-expressing cells and the level of LILRB4 expression were evaluated by flow cytometry. We analyzed the relationships between the LILRB4 expression and clinical characteristics including respiratory function. In the experiments using an elastase-induced mouse model of emphysema, we also analyzed the LILRB4 expression on lung macrophages. We compared inflammatory cell accumulation and emphysematous changes induced by elastase instillation between wild-type and LILRB4-deficient mice.

Results
The levels of surface expression of LILRB4 are relatively high on monocyte linage cells including macrophages in the human lungs. The percentage of LILRB4+ cells in lung interstitial macrophages was increased in COPD patients compared to non-COPD smokers (p = 0.018) and correlated with the severity of emphysematous lesions detected by CT scan (rs = 0.559, p < 0.001), whereas the amount of smoking showed no correlation with LILRB4 expression. Increased LILRB4 on interstitial macrophages was also observed in elastase-treated mice (p = 0.008). LILRB4-deficient mice showed severer emphysematous lesions with increased MMP-12 expression in the model.

Conclusions
LILRB4 on interstitial macrophages was upregulated both in human COPD lungs and in a mouse model of emphysema. This upregulated LILRB4 may have a protective effect against emphysema formation, possibly through decreasing MMP-12 expression in the lungs.
Predictors of knowledge and use of long-lasting insecticidal nets for the prevention of malaria among the pregnant women in Pakistan
Authors: Kumar Ramesh , Farzeen Midhat , Ahmed Jamil , Lal Manohar , Somrongthong Ratana 
Published: August 2021

Abstract
Background
Malaria is endemic to Pakistan with high prevalence among pregnant women and linked with maternal anaemia, intrauterine growth retardation, preterm birth, and low birth weight. The use of long-lasting insecticidal nets (LLINs) is a proven and cost-effective intervention preventing malaria among pregnant women. The present study aimed to explore predictors of knowledge and use of LLINs among pregnant women in Pakistan.

Methods
This was part of a quasi-experimental study of 200 pregnant women conducted in a rural district of Sindh province in Pakistan. Data were collected using Malaria Indicator Survey questionnaires developed by Roll Back Malaria Partnership to end Malaria Monitoring and Evaluation Reference Group. Pregnant women and mothers with newborns of six months of age were interviewed in their homes.

Results
The age of the women was from 18 to 45, two thirds of the respondents (72.5%) were uneducated and married (77%). Majority (92%) of the women had received antenatal care during pregnancy, and 29.5% women had received counseling on malaria during their antenatal care visits. Multiple linear regression showed that the type of latrine was the most significant (β = 0.285, p < 0.001) determinant of knowledge about malaria among pregnant women followed by the death of a newborn (β = 0.271, p < 0.001). The use of mobile phone was the most significant (β = 0.247, p < 0.001) predictor of usage of LLINs among pregnant women followed by the death of a newborn (β = 0.232, p < 0.05).

Conclusions
Maternal education, type of latrine, use of mobile phone, malaria during previous pregnancy and newborn death were strong predictors of knowledge and use of LLINs in pregnant women in Pakistan. There is a need to scale-up programmes that aim to create awareness regarding malaria among pregnant women. Mobile phone technology can be used to implement awareness programmes focusing on malaria prevention among women.
Short-term PM2.5 and cardiovascular admissions in NY State: assessing sensitivity to exposure model choice
Authors: He Mike Z. , Do Vivian , Liu Siliang , Kinney Patrick L. , Fiore Arlene M. , Jin Xiaomeng , DeFelice Nicholas , Bi Jianzhao , Liu Yang , Insaf Tabassum Z. , Kioumourtzoglou Marianthi-Anna 
Published: August 2021

Abstract
Background
Air pollution health studies have been increasingly using prediction models for exposure assessment even in areas without monitoring stations. To date, most studies have assumed that a single exposure model is correct, but estimated effects may be sensitive to the choice of exposure model.

Methods
We obtained county-level daily cardiovascular (CVD) admissions from the New York (NY) Statewide Planning and Resources Cooperative System (SPARCS) and four sets of fine particulate matter (PM2.5) spatio-temporal predictions (2002–2012). We employed overdispersed Poisson models to investigate the relationship between daily PM2.5 and CVD, adjusting for potential confounders, separately for each state-wide PM2.5 dataset.

Results
For all PM2.5 datasets, we observed positive associations between PM2.5 and CVD. Across the modeled exposure estimates, effect estimates ranged from 0.23% (95%CI: -0.06, 0.53%) to 0.88% (95%CI: 0.68, 1.08%) per 10 µg/m3 increase in daily PM2.5. We observed the highest estimates using monitored concentrations 0.96% (95%CI: 0.62, 1.30%) for the subset of counties where these data were available.

Conclusions
Effect estimates varied by a factor of almost four across methods to model exposures, likely due to varying degrees of exposure measurement error. Nonetheless, we observed a consistently harmful association between PM2.5 and CVD admissions, regardless of model choice.
Inhibition of P2X4R attenuates white matter injury in mice after intracerebral hemorrhage by regulating microglial phenotypes
Authors: Fu Xiongjie , Zhou Guoyang , Wu Xinyan , Xu Chaoran , Zhou Hang , Zhuang Jianfeng , Peng Yucong , Cao Yang , Zeng Hanhai , Li Yin , Li Jianru , Gao Liansheng , Chen Gao , Wang Lin , Yan Feng 
Published: August 2021

Abstract
Background
White matter injury (WMI) is a major neuropathological event associated with intracerebral hemorrhage (ICH). P2X purinoreceptor 4 (P2X4R) is a member of the P2X purine receptor family, which plays a crucial role in regulating WMI and neuroinflammation in central nervous system (CNS) diseases. Our study investigated the role of P2X4R in the WMI and the inflammatory response in mice, as well as the possible mechanism of action after ICH.

Methods
ICH was induced in mice via collagenase injection. Mice were treated with 5-BDBD and ANA-12 to inhibit P2X4R and tropomyosin-related kinase receptor B (TrkB), respectively. Immunostaining and quantitative polymerase chain reaction (qPCR) were performed to detect microglial phenotypes after the inhibition of P2X4R. Western blots (WB) and immunostaining were used to examine WMI and the underlying molecular mechanisms. Cylinder, corner turn, wire hanging, and forelimb placement tests were conducted to evaluate neurobehavioral function.

Results
After ICH, the protein levels of P2X4R were upregulated, especially on day 7 after ICH, and were mainly located in the microglia. The inhibition of P2X4R via 5-BDBD promoted neurofunctional recovery after ICH as well as the transformation of the pro-inflammatory microglia induced by ICH into an anti-inflammatory phenotype, and attenuated ICH-induced WMI. Furthermore, we found that TrkB blockage can reverse the protective effects of WMI as well as neuroprotection after 5-BDBD treatment. This result indicates that P2X4R plays a crucial role in regulating WMI and neuroinflammation and that P2X4R inhibition may benefit patients with ICH.

Conclusions
Our results demonstrated that P2X4R contributes to WMI by polarizing microglia into a pro-inflammatory phenotype after ICH. Furthermore, the inhibition of P2X4R promoted pro-inflammatory microglia polarization into an anti-inflammatory phenotype, enhanced brain-derived neurotrophic factor (BDNF) production, and through the BDNF/TrkB pathway, attenuated WMI and improved neurological function. Therefore, the regulation of P2X4R activation may be beneficial for the reducing of ICH-induced brain injury.
Replication of cowpox virus in macrophages is dependent on the host range factor p28/N1R
Authors: Bourquain Daniel , Schrick Livia , Tischer Bernd Karsten , Osterrieder Klaus , Schaade Lars , Nitsche Andreas 
Published: August 2021

AbstractZoonotic orthopoxvirus infections continue to represent a threat to human health. The disease caused by distinct orthopoxviruses differs in terms of symptoms and severity, which may be explained by the unique repertoire of virus factors that modulate the host’s immune response and cellular machinery. We report here on the construction of recombinant cowpox viruses (CPXV) which either lack the host range factor p28 completely or express truncated variants of p28. We show that p28 is essential for CPXV replication in macrophages of human or mouse origin and that the C-terminal RING finger domain of p28 is necessary to allow CPXV replication in macrophages.
Barriers and challenges of infant feeding in disasters in middle- and high-income countries
Authors: Hwang Cindy H. , Iellamo Alessandro , Ververs Mija 
Published: August 2021

Abstract
Background
Global evidence from the past 35 years confirmed the protective effect of breastfeeding and supported the guidance to protect, promote, and support breastfeeding practices, particularly in natural disaster and conflict settings. This study aimed to summarize the difficulties faced by disaster responders and mothers for optimal infant feeding during disasters in middle and high-income countries.

Methods
A scoping literature review was conducted by searching databases for peer-reviewed literature and grey literature published between January 2010 and December 2018 that focused on infant feeding in the aftermath of disasters. Only disasters that occurred in middle or high-income countries as defined by the World Bank for the 2018 fiscal year were included.

Results
The study found that a major challenge faced by organizations establishing infant feeding in emergencies (IFE) programs is the violation of The International Code of Marketing of Breastmilk Substitutes by other aid organizations and governments, such as acceptance of donated infant formula and untargeted distribution of formula. Additionally, many disaster responders were unfamiliar with IFE protocols. Mothers faced other barriers to breastfeed their infants during disasters. They often lacked privacy or spaces conducive to breastfeeding. Limited fluid and energy intake, stress, and exhaustion also deterred mothers from breastfeeding. Many challenges for responders and barriers mothers face for optimal infant feeding practices persist despite existing guidelines.

Conclusions
The findings of this study reveal the lack of IFE preparedness and response capacity in middle and high-income countries, and the need for governments and aid organizations to adapt guidelines and establish policies and programs to support infant feeding in emergencies.
Administration of breast milk cell fractions to neonates with birthweight equal to or less than 1800 g: a randomized controlled trial
Authors: Fallahi Minoo , Shafiei Seyed Masoud , Taleghani Naeeme Taslimi , Shariati Maryam Khoshnood , Noripour Shamsollah , Pajouhandeh Fatemeh , Kazemian Sina , Hajipour Mahmood , Kazemian Mohammad 
Published: August 2021

Abstract
Background
Most premature and very low birthweight infants cannot tolerate breast milk feeding in the first few days of life and are deprived of its benefits. This study evaluates the clinical outcomes of administering breast milk cell fractions to neonates with a birthweight of ≤1800 g.

Methods
We conducted a randomized controlled trial on 156 infants in the neonatal intensive care unit of Mahdieh Maternity Hospital in Tehran, Iran, from May 2019 to April 2020. All neonates with a birthweight ≤1800 g were enrolled and divided into intervention and control groups using stratified block randomization. Neonates in the intervention group received the extracted breast milk cell fractions (BMCFs) of their own mother’s milk after being centrifuged in the first 6 to 12 h after birth. The control group received routine care, and breastfeeding was started as soon as tolerated in both groups. Study outcomes were necrotizing enterocolitis (NEC), death, and in-hospital complications.

Results
We divided participants into two groups: 75 neonates in the intervention group and 81 neonates in the control group. The mean birthweight of neonates was 1390.1 ± 314.4 g, and 19 (12.2%) neonates deceased during their in-hospital stay. The incidence of NEC was similar in both groups. After adjustment for possible confounders in the multivariable model, receiving BMCFs were independently associated with lower in-hospital mortality (5 [26.3%] vs. 70 (51.1%]; odds ratio (OR): 0.24; 95% confidence interval [CI] 0.07, 0.86). Also, in a subgroup analysis of neonates with birthweight less than 1500 g, in-hospital mortality was significantly lower in the intervention group (4 [9.5%] vs. 13 [30.2%]; OR: 0.24; 95% CI 0.07, 0.82). There were no differences in major complications such as bronchopulmonary dysplasia and retinopathy of prematurity between the two groups. No adverse effects occurred.

Conclusions
Our research demonstrated a significantly lower mortality rate in neonates (with a birthweight of ≤1800 g) who received breast milk cell fractions on the first day of life. Since this is a novel method with minimal intervention, we are looking forward to developing and evaluating this method in larger studies.

Trial registration
IIranian Registry of Clinical Trials. Registered 25 May 2019, IRCT20190228042868N1.