bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atlantoaxial Non-Fusion Using Biomimetic Artificial Atlanto-Odontoid Joint
Authors: Zang Quanjin , Li Jiaxi , Liu Yanming , Li Haopeng , Cao Kai , Guo Shuai , Li Ke , Sun Lei , He Xijing 
Published: October 2021

Study Design.
A biomechanical in vitro investigation.

Objective.
To evaluate the function and stability of self-designed biomimetic artificial atlanto-odontoid joint (BAAOJ) replacement on the atlantoaxial joint.

Summary of Background Data.
Upper cervical fusion surgery is a common treatment for various atlantoaxial disorders, and favorable clinical outcome has been achieved. However, the fusion surgery results in loss of atlantoaxial motion as well as adjacent segments degeneration, reducing the quality of life of patients and might produce severe neurological symptoms. Non-fusion technology is expected to solve the above problems, but various designed devices have certain defects and are still in the exploratory phase.

Materials and Methods.
Biomechanical tests were conducted on 10 fresh human cadaveric craniocervical specimens in the following sequence: 1) intact condition, 2) after the BAAOJ arthroplasty, 3) after BAAOJ fatigue test, 4) after odontoidect-omy, and 5) after anterior rigid plate fixation. Three-dimensional movements of the C1-C2 segment were evaluated to investigate the function and stability of BAAOJ arthroplasty compared with the intact condition after the BAAOJ fatigue test, odontoidect-omy, and rigid plate fixation.

Results.
Comparing the BAAOJ implantation to the intact state, the range of motion and neutral zone were slightly reduced in all directions (P > 0.05). Compared with the rigid plate fixation, the BAAOJ implantation significantly increased the range of motion and neutral zone in all directions, especially in the axial rotation (P < 0.05).

Conclusion.
We designed a BAAOJ for correcting atlantoaxial disorders arising from atlantoaxial instability. As a non-fusion device, the most critical feature of BAAOJ replacement is the retention of flexion-extension, lateral bending, and axial rotation range of motion similar to the normal state. It can also stabilize the atlantoaxial complex, and the BAAOJ itself has a good initial stability.

Level of Evidence: 4
Facet Joint Opening on Computed Tomography Is a Predictor of Poor Clinical Outcomes After Minimally Invasive Decompression Surgery for Lumbar Spinal Stenosis
Authors: Yamada Kentaro , Toyoda Hiromitsu , Takahashi Shinji , Tamai Koji , Suzuki Akinobu , Hoshino Masatoshi , Terai Hidetomi , Nakamura Hiroaki 
Published: October 2021

Study Design.
Retrospective longitudinal cohort study.

Objective.
To investigate the impact of facet joint opening (FJO) on clinical outcomes after minimally invasive decompression surgery for lumbar spinal stenosis.

Summary of Background Data.
Although FJOs have previously been identified as indicators of segmental spinal instability, their impact on clinical outcomes after decompression alone surgery has yet to be investigated.

Methods.
This study included 296 patients from a single institution who underwent minimally invasive surgery for lumbar spinal stenosis and were followed up for ≥5 years. Our analysis focused on identifying FJOs at the index decompression level (d-FJO) and at multiple levels (m-FJO) (i.e., ≥3 levels within the lumbar segment) using preoperative computed tomography. Clinical outcomes including reoperations, improvement ratio for Japanese Orthopaedic Association score, and achievement of a minimal clinically important difference in visual analogue scale scores for low back pain or leg pain at 5 years were compared between patients with and without d-FJO or m-FJO.

Results.
There were 129 (44%) and 62 (21%) patients with d-FJO (more common with lateral olisthesis) and m-FJO (less common with spondylolisthesis), respectively. Reoperations were more common in patients with d-FJO than in those without (16% vs. 5%). On Cox proportional hazards analysis, d-FJO was identified as a predictor for revision at the index decompression level (hazard ratio 4.04, P = 0.03), whereas m-FJO was a predictor for revision at other lumbar levels (hazard ratio 3.71, P = 0.03). Patients with m-FJO had slightly lower rates of achieving minimal clinically important difference in visual analogue scale scores for low back pain (34% vs. 52%, P = 0.03) and poorer improvement ratio for Japanese Orthopaedic Association scores (74% vs. 80%, P = 0.03) than those without.

Conclusion.
FJO at both index decompression level and multiple level were predictors of poor outcomes; patients with FJOs require careful surgical planning or special follow-up.

Level of Evidence: 3
UBE2C affects breast cancer proliferation through the AKT/mTOR signaling pathway
Authors: Lu Zi-Nan , Song Jia , Sun Tong-Hui , Sun Gang 
Published: October 2021

Background:
Ubiquitin-conjugating enzyme E2C (UBE2C) has been shown to be associated with the occurrence of various cancers and involved in many tumorigenic processes. This study aimed to investigate the specific molecular mechanism through which UBE2C affects breast cancer (BC) proliferation.

Methods:
BC-related datasets were screened according to filter criteria in the Gene Expression Omnibus (GEO) database and The Cancer Genome Atlas (TCGA) database. Then differentially expressed genes (DEGs) were identified using Venn diagram analysis. By using DEGs, we conducted the following analyses including Gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), protein–protein interaction (PPI), and survival analysis, and then validated the function of the hub gene UBE2C using quantitative reverse transcription-polymerase chain reaction (RT-qPCR), cell counting kit-8 (CCK-8) assay, transwell assay, and Western blot assay.

Results:
In total, 151 DEGs were identified from the GEO and TCGA databases. The results of GO analysis demonstrated that the DEGs were significantly enriched with mitotic nuclear division, lipid droplet, and organic acid-binding. KEGG analysis showed that the peroxisome proliferators-activated receptor (PPAR) signaling pathway, regulation of lipolysis in adipocytes, and proximal tubule bicarbonate reclamation were significantly enriched in the signal transduction pathway category. The top three hub genes that resulted from the PPI network were FOXM1, UBE2C, and CDKN3. The results of survival analysis showed a close relationship between UBE2C and BC. The results of CCK-8 and transwell assays suggested that the proliferation and invasion of UBE2C knockdown cells were significantly inhibited (P < 0.050). The results of Western blot assay showed that the level of phosphorylated phosphatase and tensin homology deleted on chromosome 10 (p-PTEN) was obviously increased (P < 0.050), whereas the levels of phosphorylated protein kinase B (p-AKT), phosphorylated mammalian target of rapamycin (p-mTOR), and hypoxia-inducible factor-1 alpha (HIF-1α) were dramatically decreased (P < 0.050) in the UBE2C knockdown cell.

Conclusion:
UBE2C can promote BC proliferation by activating the AKT/mTOR signaling pathway.
Proteomic Biomarker Analysis of Serum from Japanese Field Mice (Apodemus Speciosus) Collected within the Fukushima Difficult-to-return Zone
Authors: Sproull Mary , Hayes Joshua , Ishiniwa Hiroko , Nanba Kenji , Shankavaram Uma , Camphausen Kevin , Johnson Thomas E. 
Published: October 2021

Abstract
The environmental impact of the Fukushima Daiichi nuclear power plant accident is a source of ongoing concern as there is uncertainty regarding the effects of chronic radiation exposure on local plant and animal life from Fukushima-derived radionuclides. In the current study, changes in proteomic biomarker expression due to chronic environmentally-derived radiation exposures was examined in wild field mice. Serum from 10 wild field mice (Apodemus speciosus) native to the Fukushima difficult-to-return zone and from eight wild field mice native to the Soma area (control) were collected. External dose estimations were completed using measurements of ambient radiation levels and calculating 137Cs concentrations in soil. Internal dose was estimated by counting whole mice using an HPGe detector. Age of the mice was estimated using molar wear. Serum was screened using the aptamer-based SOMAscan proteomic assay technology for changes in expression of 1,310 protein analytes. A subset panel of protein biomarkers that demonstrated significant changes in expression between control and exposed mice was determined and analyzed using Ingenuity Pathway Analysis (IPA). Control animals had a calculated lifetime dose range from 0.001 to 0.007 Gy, and exposed animals had a calculated lifetime dose range from 0.01 to 0.64 Gy. No discernable effect of dose rate was seen as relative dose rate correlated with dose for all samples. Detectable values were obtained for all 1,310 proteins included in the SOMAscan assay. Subset panels of proteins demonstrating significant (p < 0.05) changes in expression with either an upregulated or downregulated 1.5-fold change over control were identified for both the sample cohort inclusive of all exposed samples and the sample cohort restricted to samples from animals receiving “low” dose exposures. These panels of proteins from exposed animals were analyzed using IPA, which highlighted changes in key biological pathways related to injury, respiratory, renal, urological, and gastrointestinal disease, and cancer. Significant changes in expression of proteomic biomarkers were seen in the serum of wild field mice that received environmental exposure to Fukushima-derived radionuclides. Our findings demonstrate novel biomarkers of radiation exposure in wildlife within the Fukushima difficult-to-return zone.
Development and Validation of a Model to Predict Anterior Segment Vision-Threatening Eye Disease Using Primary Care Clinical Notes
Authors: Singh Karandeep , Thibodeau Alexa , Niziol Leslie M. , Nakai Tejpreet K. , Bixler Jill E. , Khan Mariam , Woodward Maria A. 
Published: October 2021

Purpose:
The purpose of this study was to develop a decision-support tool to predict anterior segment vision-threatening disease (asVTD) to aid primary care physicians (PCPs) with patient triage and referral.

Methods:
The University of Michigan electronic health record data between January 1, 2016, and May 31, 2019, were obtained from patients presenting to a PCP with anterior eye symptoms and then saw an ophthalmologist within 30 days. asVTD included diagnosis of corneal ulcer, iridocyclitis, hyphema, anterior scleritis, or scleritis with corneal involvement by an ophthalmologist. Elastic net logistic regression with 10-fold cross-validation was used for prediction modeling of asVTD. Predictors evaluated included patient demographics and PCP notes processed using clinical natural language processing software (clinspacy).

Results:
Two thousand nine hundred forty-two patients met the inclusion criteria, of which 133 patients (4.5%) had asVTD. The age was significantly lower among those with asVTD versus those without (median = 42 vs. 53 yrs, P < 0.001). Sex (P = 0.8) and race (P = 0.9) were not significantly different between groups. The final prediction model had an area under the curve of 0.72 (95% confidence interval 0.67–0.77). At a threshold achieving a sensitivity of 90%, the specificity was 30%, the positive predictive value was 5.8%, and the negative predictive value was 99%.

Conclusions:
The use of the prediction model increased the positive predictive value for asVTD compared with referral based on prevalence probabilities (17 patients vs. 22 patients needing to be evaluated to identify 1 case of asVTD). A prediction algorithm has potential to improve triage and initial management decision-making for PCPs because it performs better than probabilities in the absence of such a tool.
Severe Congenital Syphilis in the Neonatal Intensive Care Unit: A Retrospective Case Series
Authors: Aleem Samia , Walker LaShawndra S. , Hornik Chi D. , Smith Michael J. , Grotegut Chad A. , Weimer Kristin E. D. 
Published: October 2021

Background:
There has been a 291% relative increase in congenital syphilis (CS) cases in the United States from 2015 to 2019. Although the majority of affected fetuses/infants are stillborn or are asymptomatic, a subset is born with severe clinical illness. We describe a series of severe CS cases in the neonatal intensive care unit.

Methods:
Retrospective review of infants with CS, admitted to the Duke Intensive Care Nursery from June 2016 to February 2020. We recorded birthweight, gestational age, medications, procedures, diagnoses, laboratory data and outcomes. Severe symptoms included: birth depression, hypoxic ischemic encephalopathy (HIE), disseminated intravascular coagulopathy and/or persistent pulmonary hypertension (PPHN).

Results:
Seven infants with CS were identified and 5 with severe presentations were included. Median gestational age was 35.1 weeks (range: 29–37 weeks, median: 35 weeks). All infants required intubation at birth, 2 required chest compressions and epinephrine in the delivery room. One had hydrops fetalis and died in the delivery room. All 4 surviving infants had HIE, severe PPHN, hepatitis and seizures. All infants had a positive rapid plasma reagin, and were treated with penicillin G. Maternal rapid plasma reagin was pending for 3 of 5 infants at delivery, and later returned positive; 2 were positive during pregnancy but not treated. Other infectious work-up was negative. Three infants survived to discharge.

Conclusion:
CS can be associated with HIE, PPHN and disseminated intravascular coagulopathy in affected infants. Clinicians should have a high index of suspicion and include CS in their differential diagnoses. This study also highlights the importance of adequate treatment of identified cases and screening during the third trimester and at delivery.
Radiofrequency in Facial Rejuvenation
Authors: Lyu Jia-Jie , Liu Sheng-Xiu 
Published: October 2021

Abstract
Rhytides and striae are prominent clinical signs of skin aging. Photoaging, characterized by a thinning epidermis and a decrease in collagens, is the main form of skin aging. Delaying the aging process is a concerning issue for dermatologists. Radiofrequency (RF) is a non-ablative technology used for skin rejuvenation, body contouring, and weight reduction. The selective electro-thermolysis stimulates collagen contraction and neocollagenesis. Compared to traditional cosmetic treatment, it has the advantages of fewer side effects and short patient downtime. This review aims to summarize the efficacy and safety of different RF devices and the limitations during RF treatments. Combinations of RF and other cosmetic technologies are demonstrated. Results have been approving for the various uses of RF, including skin laxity and wrinkles smoothening. However, many studies use subjective ways of evaluation. Further studies are needed to determine the optimization of RF treatments for facial rejuvenation.
The Effect of Early Traumatic Experiences on Attachment Styles in Sexual Gender Minority Individuals
Authors: Keskin Gülseren , Yig˘itog˘lu Gülay Taşdemir 
Published: October 2021

ABSTRACT

Purpose
This study was carried out to specify the attachment characteristics of sexual gender minority individuals and to determine the effects of childhood traumatic experiences on attachment styles.

Design and Methods
A descriptive cross-sectional study was conducted on 141 sexual gender minority individuals from 2016 to 2017.

Findings
The number of childhood physical and sexual trauma episodes was found to be high in sexual minorities; in particular, the traumatized narratives were found to be associated with an avoidant attachment style (p > 0.05).

Practice Implications
The study results may contribute to healthcare professionals' understanding of childhood trauma as it relates to sexual identity development and attachment disorders sexual identity development and attachment disorders.
HIV Treatment Adherence Strategies Among Virally Suppressed Black Sexual Minority Men in Baltimore, Maryland, and Los Angeles, California: A Theory-Based Qualitative Study
Authors: Dangerfield Derek T. , Ober Allison J. , Li Michael J. , Allen Sophia , Bluthenthal Ricky N. 
Published: October 2021

Abstract
The goals and strategies of Black sexual minority men living with HIV (BSMMLWH) who achieve viral suppression require further investigation. This study explored treatment adherence strategies among BSMMLWH with sustained viral suppression. We conducted 27 in-depth qualitative interviews with BSMMLWH in Baltimore, Maryland, and Los Angeles, California, between December 2018 and May 2019. Interviews included questions guided by Positive Deviance and Life Course theoretical frameworks regarding multilevel factors and explicit strategies for antiretroviral therapy adherence. Themes regarding intentional, age group–specific strategies such as using technology (among younger men) and taking HIV medications with other daily pills (among older men) were identified. Participants also reported symbiotic goals and values that encouraged adherence, such as having a desire to live, strong familial relationships with clinicians, and support networks. Identifying personal goals and having supportive clinical and social relationships could be key to improving treatment adherence and viral suppression among BSMMLWH.
Not Quite Out of the Woods
Authors: Scott Erika , Hirabayashi Liane , Graham Judy , Krupa Nicole , Jenkins Paul 
Published: October 2021

Objective:
This research reports on the health status, including chronic disease risk factors, among Maine loggers.

Methods:
Loggers completed a survey and health screenings were held across Maine, collecting data on a variety of health endpoints.

Results:
Seventy-five loggers participated. The majority were men (97.1%) with a median age of 46, and a mean BMI of 30.6 kg/m2 (SD 4.9). Nearly half of those screened (45.9%) had blood pressure at the level of stage II hypertension. Loggers with at least a single joint abnormality were 38.4%. The health screening cohort was similar to the non-health screening cohort for many attributes.

Conclusions:
Future research should focus on tailored interventions to improve cardiovascular and musculoskeletal risk factors among loggers.
Stress-Buffering and Health-Protective Effect of Job Autonomy, Good Working Climate, and Social Support at Work Among Health Care Workers in Switzerland
Authors: Hämmig Oliver , Vetsch Anders 
Published: October 2021

Objective:
The relationship between work stress, job resources, and health has not yet been investigated among health professionals in Switzerland.

Methods:
Cross-sectional survey data, collected among hospital employees in German-speaking Switzerland, have been used for this study. Established measures were used to assess work stress as the main predictor and self-rated health and work-related burnout as the outcome variables. Validated measures for job autonomy, work climate, and social support at work were used as intervening variables.

Results:
The studied job resources were all found to be quite strongly and negatively associated with the two health outcomes but only partly explained and reduced the extraordinary strong positive association and clear dose–response relationship between work stress and poor self-rated health or burnout.

Conclusion:
Job resources like these cannot completely prevent health professionals from negative health-related consequences of work stress.
Trauma-informed care in the primary care setting: An evolutionary analysis
Authors: Varghese Latha , Emerson Amanda 
Published: October 2021

Background:
The high prevalence of trauma in the United States and its adverse effects on patient wellbeing has led to the adoption of trauma-informed care (TIC) in some specialized health care services. However, the implementation of TIC in primary care, where many nurse practitioners (NPs) provide services, is relatively uncommon and the concept not well-defined. Trauma includes physically and emotionally devastating experiences that have a lasting impact on individuals.

Objectives:
To synthesize a definition of TIC in the primary care setting for NPs to guide future practice and research.

Data Sources:
We searched CINAHL, PsycINFO, Social Work Abstracts, Scopus, and PubMed for articles published 2010–2020 that described the use of TIC in primary care. Rodgers' evolutionary method and the framework method of analysis were used to identify attributes and contexts of TIC in primary care and synthesize a definition. Thirty-one articles from nursing, medical, and social work sources were selected, including data-based studies (n = 15) and thought pieces (n = 16). Attributes, antecedents, and consequences were combined to provide a definition grounded in the literature.

Conclusion:
Trauma-informed care in primary care is a strengths-based approach in which trained, trauma-aware health care professionals provide services that prioritize safety, empowerment, and support, resulting in improved patient satisfaction and health care engagement in individuals who have experienced trauma.

Implications for practice:
A clearly defined concept provides a starting point for developing strategies to help NPs recognize and respond more effectively to the needs of patients who have experienced trauma.
Long-Term Outcome With an Active Middle Ear Implant in Patients to Bilateral Aural Atresia
Authors: Lourençone Luiz Fernando Manzoni , Matuella Marina , da Silveira Sassi Tyuana Sandim , Dutka Jeniffer de Cássia Rillo , Brito Rubens 
Published: October 2021

Objective:
To describe the audiological results and complications following active middle ear implant (AMEI) surgery in users with bilateral ear atresia.

Study Design:
Observational and retrospective longitudinal follow-up.

Setting:
A tertiary referral hospital for hearing rehabilitation and craniofacial malformations.

Patients:
Medical records of 27 patients with bilateral congenital aural atresia (34 ears) who underwent surgery for AMEI were reviewed. Data were analyzed using descriptive and inferential statistics. The alpha error was assumed to be 5%.

Outcome Measures:
Medical and technical complications and audiological results were observed during follow-up.

Results:
The median postoperative follow-up was 37.5 months (27.7–75.5 mo). Medical or technical complications occurred in 35.3% (n = 12) of patients during follow-up, 14.7% (n = 5) required surgical revision. The auditory thresholds in the free field improved from 53.75 dB (46.87–56.25) to 25 dB (21.25–32.5) after 6 months using the AMEI (p < 0.001) and remained stable till the last audiological evaluation (22.5: 21.25 26.25). Compared with the preoperative results, all speech perception tests also showed the benefits of AMEI at 6 months postoperatively and in the last audiological evaluation.

Conclusions:
Monitoring the use of AMEI in this sample demonstrated the safety of these implants compared with data available in the literature. The rates of medical and technical complications were consistent with data published by other groups. Finally, the audiological results remained stable during follow-up.