bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antibiotic cement coating in orthopedic surgery: a systematic review of reported clinical techniques
Authors: Ismat Abdullah , Walter Nike , Baertl Susanne , Mika Joerg , Lang Siegmund , Kerschbaum Maximilian , Alt Volker , Rupp Markus 
Published: December 2021

AbstractBackgroundAntibiotic-containing cement and bone graft substitute-coated orthopedic implants provide the advantages of simultaneous local antibiotic delivery and internal stable fixation, aiding in both infection eradication and osseous healing. Standardized protocols pertaining to implant coating techniques in various clinical and particularly intraoperative settings are scarce, and available literature is limited. This systematic review aims to provide a summary of the available current literature reporting on custom-made coating techniques of orthopedic implants, indications, outcomes, and associated complications in clinical use.MethodsA systematic search of the literature in PubMed, Medline, Embase, and Cochrane Library databases was performed in accordance with PRISMA guidelines. Articles reporting specifically on custom-made coating techniques of orthopedic implants in a clinical setting were eligible.ResultsA total of 41 articles with a cumulative total number of 607 cases were included. Indications for treatment mostly involved intramedullary infections after previous plate osteosynthesis or nailing. A variety of implants ranging from intramedullary nails, plates, wires, and rods served as metal cores for coating. Polymethylmethacrylate (PMMA) bone cement was most commonly used, with vancomycin as the most frequently added antibiotic additive. Chest tubes and silicone tubes were most often used to mold. Common complications are cement debonding and breakage of the metallic implant.ConclusionAdequate coating techniques can reduce the burden of treatment and be associated with favorable outcomes. Lack of general consensus and heterogeneity in the reported literature indicate that the perfect all-in-one implant coating method is yet to be found. Further efforts to improve implant coating techniques are warranted.Level of evidenceIII.
The impact of Ramadan on visits related to diabetes emergencies at a tertiary care center
Authors: AlZahrani Abdullah M. , Zawawi Mawaddah M. , Almutairi Naif A. , Alansari Ammar Y. , Bargawi Amina A. 
Published: December 2021

AbstractBackgroundRamadan is the ninth month of the Islamic calendar were Muslims fast from dawn until sunset. This prolonged fasting period might have an impact on patients with diabetes and their disease control. This study aimed to determine the variation in visits at the Emergency Room department (ER) during Ramadan in comparison with other lunar months at a tertiary care hospital in Jeddah city in relation to the diabetes emergencies.MethodologyA retrospective cross-sectional study was conducted using electronic medical record review of patients with diabetes emergencies who visited ER of a Military hospital, from 9th to 11th lunar months during 2017–2018. Diabetes patients who visited ER and aged more than 18 years old were included. Frequency of ER visits, sociodemographic characteristics and clinical features were determined. Chi-square test, Student ‘s t-test and one-way ANOVA atp < 0.05 were used in assessing associations between variables.ResultsWithin the selected study period, a total of 24,498 admissions were recorded in ER. The prevalence of diabetes emergencies visits was only 0.84%. Based on inclusion criteria, a total of 133 subjects were included in the study (54.1% men, 45.9% women). Majority of whom (73.7%) were on insulin therapy, and more than half of whom (51.9%) were type 2 diabetes. There was a significant difference (p = 0.001) in the prevalence of diabetes emergencies visits between the three lunar months Shaban, Ramadan and Shawal, 7, 5 and 4%, respectively. However, the highest prevalence was not in Ramadan. Despite some correlations were identified, the study found no significant differences between frequency of ER visits and various demographic, clinical factors and diabetes profile between Ramadan and other both preceding and succeeding lunar month.ConclusionIn contrary with previous studies, a downward trend of prevalence, from Shaban to Ramadan, to Shawal was found. This indicated that fasting during month of Ramadan does not impact negatively on the diabetes emergencies in comparison with other months. Hyperglycemia among type 2 diabetes and insulin treated patients were recorded the highest feature of diabetes emergences visits during the three months studied with no significant differences between the months. These findings highlight the need of type 2 and insulin treated patients to be thoroughly assess by the Primary Care physicians and in-depth health education and guidance should be given to them.
From urban neighbourhood environments to cognitive health: a cross-sectional analysis of the role of physical activity and sedentary behaviours
Authors: Cerin Ester , Barnett Anthony , Shaw Jonathan E. , Martino Erika , Knibbs Luke D. , Tham Rachel , Wheeler Amanda J. , Anstey Kaarin J. 
Published: December 2021

Abstract
Background
There is a dearth of studies on the effects of the neighbourhood environment on adults’ cognitive function. We examined how interrelated aspects of the built and natural neighbourhood environment, including air pollution, correlate with adults’ cognitive function, and the roles of physical activity and sedentary behaviours in these associations.

Methods
We used data from 4,141 adult urban dwellers who participated in the Australian Diabetes, Obesity and Lifestyle 3 study on socio-demographic characteristics, neighbourhood self-selection, physical activity and sedentary behaviours, and cognitive function. Neighbourhood environmental characteristics included population density, intersection density, non-commercial land use mix, and percentages of commercial land, parkland and blue space, all within 1 km residential buffers. We also calculated annual mean concentrations of NO2 and PM2.5. Generalised additive mixed models informed by directed acyclic graphs were used to estimate the total, direct and indirect effects of environmental attributes on cognitive functions and the joint-significance test was used to examine indirect effects via behaviours.

Results
In the total effects models, population density and percentage of parkland were positively associated with cognitive function. A positive association of PM2.5 with memory was also observed. All neighbourhood environmental attributes were directly and/or indirectly related to cognitive functions via other environmental attributes and/or physical activity but not sedentary behaviours. Engagement in transportation walking and gardening frequency partially mediated the positive effects of the neighbourhood environment on cognitive function, while frequency of transportation walking mediated the negative effects.

Conclusions
In the context of a low-density country like Australia, denser urban environments with access to parkland may benefit residents’ cognitive health by providing opportunities for participation in a diversity of activities. A more fine-grained characterisation of the neighbourhood environment may be necessary to tease out the negative and positive impacts of inter-related characteristics of urban neighbourhood environments on cognitive function.
On-site personal protective equipment signage and use by road construction workers in Ghana: a comparative study of foreign- and locally-owned companies
Authors: Yankson Isaac Kofi , Nsiah-Achampong Nana Kwame , Okyere Paul , Afukaar Francis , Otupiri Easmon , Donkor Peter , Mock Charles , Owusu-Dabo Ellis 
Published: December 2021

AbstractBackgroundRoad construction work has specific risks and safety issues which have not been adequately addressed in most low- and middle-income countries, especially Africa. The objective of this study was to determine the prevalence of personal protective equipment (PPE) use during road construction activities by workers in foreign- owned against locally-owned road construction companies in Ghana.MethodsAn institution-based cross-sectional survey was undertaken during January – March, 2020 to study 389 road construction workers who were actively working on site. They were unobtrusively observed to capture whether or not they wore the appropriate PPE at the time of the survey. The PPE of interest were: hard hat, goggles, shoes, nose masks, hearing protection, gloves and reflective vests/apparel. On-site posted PPE signage was also checked.ResultsMajority of workers were males (96.9%) and labourers (53.5%). Similar numbers of workers in locally-owned (195) and foreign-owned (194) companies were studied. Use of PPE varied considerably by type: shoes (78.7%), reflective vest (44.5%), gloves (30.6%), hard hat (27.0%), nose mask (17.2%), goggles (11.3%) and hearing protection (10.8%). For all types of PPE, use was higher for workers in foreign-owned companies compared with locally-owned companies: goggles (Odds ratio [OR] 55.2), hearing protection (OR 52.0), gloves (OR 23.7), hard hat (OR 20.2), nose mask (OR 17.8), reflective vest (OR 5.3) and shoes (OR 4.1), (p<0.001 for all ORs). No site had any signage to promote PPE use.ConclusionsMajority of workers used shoes. Less than half of workers used other types of PPE and use of some types (goggles and hearing protection) was minimal. Workers in foreign-owned companies were significantly more likely to use all the seven types of PPE than locally-owned companies. Although there is still room for improvement in foreign-owned companies, locally-owned companies should be able to attain similar PPE use to that in foreign-owned companies. Necessary PPE should be provided and site supervisors should encourage workers to wear PPE when on site.
Cecal volvulus in rural Kenya: delayed presentation contributes to high mortality
Authors: Sylvester Kimutai R. , Ooko Philip B. , Mwachiro Michael M. , Parker Robert K. 
Published: December 2021

Abstract
Background
Cecal volvulus, which is a torsion involving the cecum, terminal ileum, and ascending colon around its own mesentery, results in a closed-loop obstruction. It is a rare reported cause of adult intestinal obstruction. This study aimed to review the clinical presentation, management, and outcomes at a rural, resource-limited referral center.

Methods
We performed a retrospective review of all patients with a diagnosis of cecal volvulus between January 1st, 2009 and December 31st, 2019 at Tenwek Hospital in Bomet, Kenya. The outcome of survival was compared by the time to presentation. Mortality was also compared with prior reports of intestinal obstruction at our institution.

Results
Thirteen patients were identified with a mean age of 52 years and a mean symptom duration of 5 days. All patients presented with abdominal pain and distension. Seven patients (54%) presented with perforation, gangrene, or gross peritoneal contamination. Identified risk factors were Ladds bands with malrotation, adhesions, and a sigmoid tumor. Procedures included primary resection and anastomosis (7), damage control (3) with anastomosis on second-look in 2 of these, simple surgical detorsion (1), and surgical detorsion and cecopexy (2). There were four mortalities (31%), of which all had delayed presentation with perforation and fecal contamination. Delays to presentation were associated with mortality (p = 0.03). Cecal volvulus resulted in increased perioperative mortality compared to all intestinal obstructions presenting to the institution (p < 0.0001).

Conclusions
Cecal volvulus carries a high risk of mortality. A high index of suspicion and early consideration in the differential diagnosis of intestinal obstruction should be considered to reduce the mortality associated with the delay in preoperative diagnosis.
Process mining framework with time perspective for understanding acute care: a case study of AIS in hospitals
Authors: Pang Jianfei , Xu Haifeng , Ren Jun , Yang Jun , Li Mei , Lu Dan , Zhao Dongsheng 
Published: December 2021

Abstract
Background
Acute care for critical illness requires very strict treatment timeliness. However, healthcare providers usually cannot accurately figure out the causes of low efficiency in acute care process due to the lack of effective tools. Besides, it is difficult to compare or conformance processes from different patient groups.

Methods
To solve these problems, we proposed a novel process mining framework with time perspective, which integrates four steps: standard activity construction, data extraction and filtering, iterative model discovery, and performance analysis.

Results
It can visualize the execution of actual clinical activities hierarchically, evaluate the timeliness and identify bottlenecks in the treatment process. We take the acute ischemic stroke as a case study, and retrospectively reviewed 420 patients’ data from a large hospital. Then we discovered process models with timelines, and identified the main reasons for in-hospital delay.

Conclusions
Experiment results demonstrate that the framework proposed could be a new way of drawing insights about hospitals’ clinical process, to help clinical institutions increase work efficiency and improve medical service.
Predictors of patients’ choice of hospitals under universal health coverage: a case study of the Nicaraguan capital
Authors: Monfared Ida G. , Garcia Jonathan , Vollmer Sebastian 
Published: December 2021

Abstract
Background
This study looks at the factors that can shape patients’ choice of healthcare providers. Understanding this process can help with making high quality healthcare more accessible for all. We focus on distance, patient’s health status, (perceived) quality of healthcare facility, and referrals to investigate how these factors compete in shaping patients’ choice of hospitals.

Methods
This study was carried out in Managua, the capital of Nicaragua. Utilizing an exit-survey, patients were interviewed across five public hospitals in 2017 and then six in 2019 when a new highly-equipped hospital was added to the system. We used a multinomial logit model to investigate patients’ preference of a specific hospital over the rest within each wave.

Results
Our results show that being referred to a hospital is the strongest predictor and in some cases, it can increase the relative risk ratio of choosing a facility by a factor of 49 (p < 0.01; 95% CI: 27.39–87.17). For the remaining factors, the hierarchy of importance was less clear-cut yet all these factors remained significantly important at various levels.

Conclusions
Overall, our results highlight the importance of referral systems in making quality healthcare more equitable. Moreover, with distance also being a key predictor and in the absence of an organized referral system, those with low-income would either be further deprived by having to settle with locally available healthcare (regardless of its quality) or face high amounts of out-of-pocket expenditure when seeking help from the private sector.
The effect of steam sterilization on different 3D printable materials for surgical use in veterinary medicine
Authors: Dautzenberg Philipp , Volk Holger A. , Huels Nikolaus , Cieciora Lena , Dohmen Katharina , Lüpke Matthias , Seifert Herman , Harms Oliver 
Published: December 2021

Abstract
Background
Different 3D-printed materials polyactic acid (PLA), polyamide (PA), polycarbonates (PC), acrylonitrile butadiene styrene (ABS) and GreenTEC Pro®I have been considered for surgical templates, but there is a sparity of data about how these materials are affected by steam sterilization. The aim of the current study was to test if and how these materials change morphologically when high temperature, pressure and humidity are applied during the steam sterilization process. The overall aim is to create patient-specific sawing templates for performing corrective osteotomies. After the designing process, test-specimens with five different materials: PLA, PC, ABS, PA and GreenTEC Pro® were 3D-printed in two filling grades (30 and 100%). The FDM method was used for printing. After 3D-printing, the test-specimens were steam sterilized with a standard program lasting 20 min, at a temperature of 121 °C and a pressure of 2–3 bar. In order to measure the deviation of the printed model, we measured the individual test-specimens before and after steam sterilization using a sliding gauge.

Results
PC, PA and ABS showed great morphological deviations from the template after 3D-printing and steam sterilization (> 1%) respectively. ABS proved unsuitable for steam sterilization. PLA and GreenTEC Pro® demonstrated fewer morphological deviations both before and after sterilization. Therefore, we decided to perform a second test just with PLA and Green-TEC Pro® to find out which material has the highest stability and is probably able to be used for clinical application. The smallest deviations were found with the GreenTEC Pro® solid body. After autoclaving, the specimens showed a deviation from the planned body and remained below the 1% limit.

Conclusion
Steam sterilization causes morphological deviations in 3D printed objects. GreenTEC Pro® seems to be a suitable material for clinical use, not only for intraoperative use, but also for precise modeling. Microbiological examination, as well as biomechanical tests, should be performed to further assess whether intraoperative use is possible.
Production of 9,21-dihydroxy-20-methyl-pregna-4-en-3-one from phytosterols in Mycobacterium neoaurum by modifying multiple genes and improving the intracellular environment
Authors: Yuan Chen-Yang , Ma Zhi-Guo , Zhang Jing-Xian , Liu Xiang-Cen , Du Gui-Lin , Sun Jun-Song , Shi Ji-Ping , Zhang Bao-Guo 
Published: December 2021

Abstract
Background
Steroid drugs are essential for disease prevention and clinical treatment. However, due to intricated steroid structure, traditional chemical methods are rarely implemented into the whole synthetic process for generating steroid intermediates. Novel steroid drug precursors and their ideal bacterial strains for industrial production have yet to be developed. Among these, 9,21-dihydroxy-20-methyl-pregna-4-en-3-one (9-OH-4-HP) is a novel steroid drug precursor, suitable for the synthesis of corticosteroids. In this study, a combined strategy of blocking Δ1-dehydrogenation and the C19 pathway as well as improving the intracellular environment was investigated to construct an effective 9-OH-4-HP-producing strain.

Results
The Δ1-dehydrogenation-deficient strain of wild-type Mycobacterium neoaurum DSM 44074 produces 9-OH-4-HP with a molar yield of 4.8%. Hsd4A, encoding a β-hydroxyacyl-CoA dehydrogenase, and fadA5, encoding an acyl-CoA thiolase, were separately knocked out to block the C19 pathway in the Δ1-dehydrogenation-deficient strain. The two engineered strains were able to accumulate 0.59 g L−1 and 0.47 g L−1 9-OH-4-HP from 1 g L−1 phytosterols, respectively. Furthermore, hsd4A and fadA5 were knocked out simultaneously in the Δ1-dehydrogenation-deficient strain. The 9-OH-4-HP production from the Hsd4A and FadA5 deficient strain was 11.9% higher than that of the Hsd4A deficient strain and 40.4% higher than that of the strain with FadA5 deficiency strain, respectively. The purity of 9-OH-4-HP obtained from the Hsd4A and FadA5 deficient strain has reached 94.9%. Subsequently, the catalase katE from Mycobacterium neoaurum and an NADH oxidase, nox, from Bacillus subtilis were overexpressed to improve the intracellular environment, leading to a higher 9-OH-4-HP production. Ultimately, 9-OH-4-HP production reached 3.58 g L−1 from 5 g L−1 phytosterols, and the purity of 9-OH-4-HP improved to 97%. The final 9-OH-4-HP production strain showed the best molar yield of 85.5%, compared with the previous reported strain with 30% molar yield of 9-OH-4-HP.

Conclusion
KstD, Hsd4A, and FadA5 are key enzymes for phytosterol side-chain degradation in the C19 pathway. Double deletion of hsd4A and fadA5 contributes to the blockage of the C19 pathway. Improving the intracellular environment of Mycobacterium neoaurum during phytosterol bioconversion could accelerate the conversion process and enhance the productivity of target sterol derivatives.
Efficacy and safety of various primary treatment strategies for very early and early hepatocellular carcinoma: a network meta-analysis
Authors: Yang Sha , Lin Huapeng , Song Jianning 
Published: December 2021

Abstract
Background
Several treatments are available for treatment of early and very early-stage Hepatocellular Carcinoma, also known as small Hepatocellular Carcinoma (SHCC). However, there is no consensus with regards to the efficacies of these methods. We aimed at identifying the most effective initial treatment strategy for SHCC through Bayesian network meta-analyses.

Methods
Studies published between January, 2010, and February, 2021 were searched in EMBASE, Cochrane Library, PubMed and Web of science databases, and conference proceedings for trials. The included studies reported the survival outcomes of very early and early Hepatocellular Carcinoma patients subjected to radiofrequency ablation (RFA), microwave ablation (MWA), surgical resection (SR), transarterial chemoembolization (TACE), percutaneous ethanol injection (PEI), minimally invasive liver surgery (MIS), stereotactic body radiotherapy (SBRT) and cryoablation (CA). Then, data were extracted from studies that met the inclusion criteria. Patient survival data were retrieved from the published Kaplan–Meier curves and pooled. A Bayesian random-effects model was used to combine direct and indirect evidence.

Results
A total of 2058 articles were retrieved and screened, from which 45 studies assessing the efficacies of 8 different treatments in 11,364 patients were selected. The included studies had high methodological quality. Recurrence free survival* (progression/recurrence/relapse/disease/tumor-free survival were combined and redefined as RFS*) and overall survival (OS) outcomes were highest in MIS-treated patients (HR 0·57, 95% confidence intervals [CI] 0·38–0·85; HR 0.48,95% CI 0.36–0.64, respectively), followed by SR-treated patients (HR 0.60, 95% CI 0.50–0.74; HR 0.62, 95% CI 0.55–0.72, respectively). TACE was highly efficacious (58.9%) at decreasing the rates of major complications. Similar findings were obtained through sensitivity analysis, and in most of the prognostic subgroups.

Conclusions
MIS and SR exhibited the highest clinical efficacies, however, they were associated with higher rates of complications. Ablation is effective in small tumors, whereas SBRT is a relatively promising treatment option for SHCC. More well-designed, large-scale randomized controlled trials should be performed to validate our findings.
Prognostic significance of the neutrophil-to-lymphocyte ratio in peripheral T-cell lymphoma: a meta-analysis
Authors: Liu Jia , Zhang Shengnan , Mi Ruihua , Chen Lin , Yin Qingsong 
Published: December 2021

AbstractThe neutrophil-to-lymphocyte ratio (NLR) as an inflammatory marker may represent changes between inflammation and host immunity that affect the prognosis of peripheral T-cell lymphoma (PTCL). To comprehensively evaluate the NLR in PTCL, we performed a meta-analysis to investigate the relationship between the NLR and overall survival (OS) and progression-free survival (PFS). PubMed, Embase, Cochrane library, and China National Knowledge Infrastructure (CNKI) were searched for all relevant studies. Hazard ratios (HRs) and 95% confidence intervals (CIs) were obtained from each study. Heterogeneity among the included studies was checked to determine whether fixed or random effects model was used. In total, 8 studies with 921 patients were included for the meta-analysis. High NLR significantly correlated with worse OS (HR = 2.20, 95% CI 1.71–2.83, P < 0.05) regardless of region (Asian or non-Asian), sample size (< 60 or ≥ 60), median age (< 60 or ≥ 60), disease type, or cut-off value (NLR < 3.9 or NLR ≥ 3.9). In terms of PFS, the NLR had no prognostic impact for patients with PTCL (HR = 1.12, 95% CI 0.57–2.20, P = 0.742). Our findings suggest that PTCL patients with high NLR are more likely to have worse OS compared to those with low NLR. Therefore, the NLR can serve as a prognostic marker in PTCL.