bluuebunny/crossref_metadata_2025_split huggingface dataset:
Socioeconomic Factors and Health Status Disparities Associated with Difficulty in ADLs and IADLs among Long-Lived Populations in Brazil: A Cross-Sectional Study
Authors: Nóbrega Júlia Cristina Leite , Medeiros Juliana Barbosa , Santos Tácila Thamires de Melo , Alves Saionara Açucena Vieira , Freitas Javanna Lacerda Gomes da Silva , Silva Jaíza M.M. , Simões Raisa Fernandes Mariz , Brito Allisson de Lima , Weller Mathias , Santos Jair Lício de Ferreira , Menezes Tarciana Nobre , Duarte Yeda Aparecida de Oliveira , Zatz Mayana , Matheson David , Santos Silvana 
Published: April 2021

Objective: To evaluate the association between socioeconomic factors, health status, and Functional Capacity (FC) in the oldest senior citizens in a metropolis and a poor rural region of Brazil. Method: Cross-sectional study of 417 seniors aged ≥80 years, data collected through Brazil’s Health, Well-being and Aging survey. FC assessed by self-reporting of difficulties in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Chi-square tests and multiple logistic regression analyses were performed using “R” statistical software. Results: Socioeconomic and demographic inequalities in Brazil can influence FC in seniors aged 80 years and older. Comparatively, urban long-lived people had a higher prevalence of difficulties for ADLs and rural ones showed more difficulties for IADLs. Among urban oldest seniors, female gender and lower-income were correlated with difficulties for IADLs. Among rural oldest seniors, female gender, stroke, joint disease, and inadequate weight independently were correlated with difficulties for ADLs, while the number of chronic diseases was associated with difficulties for IADLs. Conclusion: Financial constraints may favor the development of functional limitations among older seniors in large urban centers. In poor rural areas, inadequate nutritional status and chronic diseases may increase their susceptibility to functional decline.
When is extra-anatomical bypass for the left subclavian artery required to prevent ischaemia after thoracic endovascular stent grafting?
Authors: Moore Katherine , Bailey Damian Miles , Lewis Michael Howard , Gordon Andrew , Thomas Rhodri , Wood Andrew , White Richard D , Bashir Mohamad , Williams Ian Michael 
Published: April 2021

Introduction Thoracic endovascular aortic repair (TEVAR) has become an accepted treatment for thoracic aortic disease. However, the principal complications relate to coverage of the thoracic aortic wall and deliberate occlusion of aortic branches over a potentially long segment. Complications include risk of stroke, spinal cord ischaemia (SCI) and arterial insufficiency to the left arm (left arm ischaemia (LAI)). This study specifically scrutinised the development of SCI and LAI after TEVAR for interventions for thoracic aortic disease from 1999 to 2020. In particular, those who underwent extra-anatomical bypass (both immediate and late) were compared to the length of thoracic aortic coverage by the stent graft. Materials and methods Ninety-eight patients underwent TEVAR. The presenting symptoms, pathology, procedural and follow-up data were collected prospectively with particular evidence of stroke, SCI and LAI both immediate onset and after 48 h of graft placement. Results Fifty underwent TEVAR for an aneurysm (thoracoabdominal aortic aneurysm), 22 for dissection, 19 for acute transection and 7 for intramural haematoma/pseudoaneurysm of the thoracic aorta. Twenty-nine (30%) required a debranching procedure to increase the proximal landing zone (1 aorto-carotid subclavian bypass, 10 carotid/carotid subclavian bypass and 18 carotid/subclavian bypass). Ten patients (10%) died within 30 days of TEVAR. Twenty-four grafts covered the left subclavian artery origin without a carotid/subclavian bypass. Five required a delayed carotid/subclavian bypass for LAI (4) and SCI (1). Six developed immediate signs of SCI after TEVAR and these 11 (group i) had a mean (SD) length of coverage of the thoracic aorta of 30.2 (10.6) cm compared to 21.5 (11.2) cm (group g) in those who had no LAI or SCI post TEVAR, p < 0.05. Conclusions In this series, delayed carotid/subclavian bypass may be required for chronic arm ischaemia and less so for SCI. The length of coverage of thoracic aorta during TEVAR is a factor in the development of delayed SCI and LAI occurrence. Carotid subclavian bypass is required for certain patients undergoing TEVAR (particularly if greater than 20 cm of thoracic aorta is covered).
Exploring the Causes of Obesity Among Adults in the Kurdish Regions of Iran: A Qualitative Study
Authors: Irandoost Seyed Fahim , Bayangani Bahman , Dehdari Tahereh , Yousefi Lebni Javad , Babasfari Nafe , Mehedi Nafiul , Taghdisi Mohammad Hosein 
Published: April 2021

Background Obesity is one of the most important public health problems in the world, which is occurred by various factors. The purpose of this study is to explore the causes of obesity in the Kurdish regions of Iran with a qualitative approach. Methods A qualitative content analysis study was conducted in the Kurdish regions of Iran from June 2019 to November 2019. The data were collected by holding focus group discussions and semi-structured interviews with 111 obese and thin men and women, and experts from different fields, who were selected through purposive sampling. Additionally, the data were analyzed by the conventional content analysis approach following the steps proposed by Graneheim and Lundman. The researchers used ATLAS.ti (Version 2019) software for data analysis and management. Lincoln and Guba’s criteria were used to assess the quality of the research. Results The results of the data analysis were classified into 5 categories and 16 sub-categories. The main categories included the modern lifestyle, sociocultural norms, indigenous culture of nutrition, lack of institutionalization of exercise, and low health literacy. Conclusion Changing people's beliefs and values ​​about obesity and thinness, changing the dietary habits of individuals, expanding and institutionalizing exercise and physical activity, and enhancing health literacy can prevent and control obesity.
Prostate cancer testicular metastasis: Are they underestimated? Case report and analysis of the literature
Authors: Smelzo Salvatore , Mantica Guglielmo , Lucianò Roberta , Tenace Nazario Pio , De Marchi Davide , Pini Giovannalberto , Passaretti Giovanni , Losa Andrea , Gaboardi Franco 
Published: April 2021

Introduction: We aim to present a rare case of a patient who developed a late testicular metastasis of PCa after radical prostatectomy. Case description: A 78 years old man presenting for left testicular swelling slowly increasing of size over the last 2 months. He underwent a retropubic radical prostatectomy and extended bilateral lymphadenectomy in 2007 for prostatic adenocarcinoma. At the time of the presentation the last PSA was 0.91 ng/mL. The patient underwent a standard left orchifunicolectomy in April 2019 without intra- or perioperative complications. The pathological analysis showed a testicular metastasis of acinar adenocarcinoma. Conclusions: In conclusion, testicular metastasis from PCa are uncommon conditions. PSA evaluation and physical examination of all sites of metastasis and accurate evaluation of all signs/symptoms during the clinical visit remains crucial to the diagnosis of recurrence.
Evaluation of the Modified Atkins Diet for the Treatment of Epileptic Spasms Refractory to Hormonal Therapy: A Randomized Controlled Trial
Authors: Sharma Suvasini , Goel Shaiphali , Kapoor Dipti , Garg Divyani , Panda Isha , Elwadhi Aman , Patra Bijoy , Mukherjee Sharmila B. , Pemde Harish 
Published: April 2021

Objectives: We aimed to evaluate the efficacy of the modified Atkins diet in children with epileptic spasms who had failed hormonal therapy. Methods: Children aged 9 months to 3 years having daily epileptic spasms despite a trial of ACTH or oral prednisolone and 1 additional anticonvulsant medication were enrolled. Children were randomly assigned to receive the modified Atkins diet either immediately or after a delay of 4 weeks. The ongoing anticonvulsant medications were continued unchanged. The primary outcome variable was the proportion of children who achieved spasm freedom as per parental reports at 4 weeks. Secondary outcomes included time to spasm cessation, proportion of children with electroclinical remission, the proportion of children with >50% reduction of spasms at 4 weeks, and adverse effects of the diet. ( ClinicalTrials.gov Identifier: NCT03807141). Results: A total of 91 children were enrolled in the study; 46 in the diet group and 45 in the control group. At the end of 4 weeks, 11 children in the diet group were spasm free compared with none in the control group ( P ≤ .001). The median time to achieve spasm cessation was 10 days (interquartile range 9-20). Nine of these had resolution of hypsarrhythmia on electroencephalography (EEG). Thirty (65.2%) in the diet group had >50% reduction in spasms, compared with none in the control group ( P < .001). The most common side effect was constipation, noted in 34.8% of the children. Conclusions: The modified Atkins diet was found to be effective and well tolerated in children with epileptic spasms refractory to hormonal therapy.
Design and operational assessment of a low-boom low-drag supersonic business jet
Authors: Sun Yicheng , Smith Howard 
Published: April 2021

There has been a worldwide interest to develop a supersonic business jet (SSBJ) for a minimum range of 4000 nm with low sonic boom intensity and high fuel efficiency. An SSBJ design model is developed in the GENUS aircraft conceptual design environment. With the design model, a low-boom low-drag SSBJ concept is designed and optimized. This article studies the design concept for its operational performances. The sustained supersonic cruise flight is studied to find out the fuel-efficient Mach number and altitude combinations. The combined supersonic and subsonic cruise flight scenarios are studied to evaluate the feasibility of boom-free flight routes. The one-stop supersonic cruise flight scenario is studied to compare the fuel consumption and time advantage over subsonic airliners. The off-design sonic boom intensity is studied to explore the operational space assuming there would be a sonic boom intensity limit in the future. Through the studies, it is revealed that there is a corresponding most fuel-efficient operating altitude for a specific cruise Mach number. To operate the aircraft near the cutoff Mach number leads to both increases in the fuel consumption (6.3%–8.1%) and the mission time (11.7%–13.1%). The business-class supersonic transport (231 g/PAX/km) consumes nearly three times fuel as the economic-class supersonic transport (77 g/PAX/km), which is still far more than the economic-class subsonic transport (20 g/PAX/km). Off-design sonic boom intensity studies reveal different trends against the common understanding: the sonic boom intensity does not necessarily decrease as the altitude increases; the sonic boom intensity does not necessarily decrease as the Mach number decreases.
Perinatal exposure to di-(2-ethylhexyl) phthalate induces hepatic lipid accumulation mediated by diacylglycerol acyltransferase 1
Authors: An SJ , Lee EJ , Jeong S-H , Hong Y-p , Ahn S , Yang Y-J 
Published: April 2021

Introduction: Di-(2-ethylhexyl) phthalate (DEHP) is a commonly used plasticizer in consumer products and medical devices. It is also suspected to exacerbate the development of fatty liver. However, the mechanisms underlying excessive lipid synthesis and its deposition in the liver are yet to be identified. This study was aimed to evaluate the molecular mechanisms of hepatic lipid accumulation in adult male offspring after perinatal exposure to DEHP. Method: Corn oil and DEHP (0.75 mg/kg/day) were administered once per day to dam from gestation day 6 to postnatal day (PND) 21 by oral gavage. After the weaning period, DEHP treated male pups were categorized into early life stage- and lifelong period group. Male rats both control and early life stage group administered corn oil, and lifelong period group administered DEHP from PND 22 to 70. Histological examination and triglyceride (TG) levels in the liver were analyzed. Expressions of transcription factors associated with lipid accumulation in the liver were analyzed. Results: Both early life stage- and lifelong period group, hepatic TG levels, and mRNA and protein expression of diacylglycerol acyltransferase 1 (DGAT1) were significantly higher than control (TG: all p < 0.05, mRNA & protein: p < 0.05 and p < 0.001, respectively). The average body weight from PND 35 to 63, and mRNA and protein expression of sterol regulatory element binding protein 1c in lifelong period group were significantly lower than control (all p < 0.05); however, alanine transaminase were significantly higher than control (p < 0.01). Conclusion: Perinatal exposure to DEHP may induce the hepatic lipid accumulation through up-regulation of DGAT1 expression.
Dry eye and Meibomian gland dysfunction evaluation in sarcoidosis patients
Authors: Kiyat Pelin , Palamar Melis , Gerceker Turk Bengu 
Published: April 2021

Purpose: To analyze the relation between Meibomian gland dysfunction, dry eye, and sarcoidosis. Materials and Methods: Twenty eyes of 10 sarcoidosis patients (Group 1) and 20 left eyes of 20 age-sex matched healthy volunteers (Group 2) were included. Presence of dry eye was evaluated with Schirmer 1 test, tear film break-up time (T-BUT), Oxford scale scoring, Ocular Surface Disease Index (OSDI) score assessments. A slit-lamp biomicroscope infrared filter (Topcon, SL-D701, IJssel, The Netherlands) was used to evaluate Meibomian glands. The drop-out ratio according to meibography was scored for each eyelid from grade 0 (no loss) through grade 3 (lost area >2/3 of the total Meibomian gland area). Results: Among dry eye tests mean Schirmer 1 and T-BUT values were lower and OSDI score was higher in Group 1 compared to Group 2 and the differences were statistically significant ( p = 0.017, p = 0.039, p = 0.003, respectively). In addition, the upper, lower and total meiboscores were statistically significantly higher in Group 1 ( p = 0.047, p = 0.003, p = 0.005, respectively). Conclusion: A significantly higher presence of dry eye and Meibomian gland drop out ratios was detected in sarcoidosis patients. It is important to monitor sarcoidosis patients for dry eye and Meibomian gland dysfunction and when detected, to treat adequately to prevent ocular surface damage.
Dissociation of polyethylene liners with the Depuy Pinnacle cup: a report of 26 cases
Authors: Perkins Thomas J , Kop Alan M , Whitewood Colin , Pabbruwe Moreica B 
Published: April 2021

Background: Although the Pinnacle Acetabular Hip System (DePuy Synthes) has demonstrated excellent survivorship results since it was first introduced in 2003, there have been a growing number of cases indicating that Pinnacle liners may be subject to a higher-than-expected rate of early dissociation failure. Between 2006 and 2020, our Centre received 212 retrieved Pinnacle liners from Western Australian hospitals. Of these, 26 were removed due to liner dissociation. Methods: To better understand the frequency and cause of this complication we assessed all retrieved Pinnacle acetabular components for type, damage modes and patient demographics. The leverage force required to dissociate Pinnacle liners was also measured and compared with another commonly used acetabular system, the Trident (Stryker Orthopaedics). Results: The estimated minimum incidence of liner dissociation from our data was 0.35%. Characterisation of dissociated Pinnacle cases (n = 26) revealed 73% were female with an average age of 59 compared to all retrieved Pinnacle cases (n = 212) where 58% were female with an average age of 66. Retrieval analysis indicated plastic deformation of the liner into an ovoid shape, signs of impingement on the rim postero-superiorly and shearing of the liner’s anti-rotation tabs was common. Mechanical testing indicated that the dissociation strength of Pinnacle cups decreases at approximately 6.6 N/year in situ (p = 0.01). Conclusion: The survival rate of Pinnacle acetabular cups is exceptional with only 5% revised at 10 years. However, surgeons should be aware of the clinical symptoms and high-risk demographics when assessing patients with polyethylene Pinnacle liners.
Changes in Noninvasive Arterial Stiffness and Central Blood Pressure After Endovascular Abdominal Aneurysm Repair
Authors: Holewijn Suzanne , Vermeulen Jenske J. M. , van Helvert Majorie , van de Velde Lennart , Reijnen Michel M. P. J. 
Published: April 2021

Purpose: To evaluate the impact of elective endovascular aneurysm repair (EVAR) on the carotid-femoral pulse wave velocity (cfPWV) and central pressure waveform, through 1-year follow-up. Materials and Methods: A tonometric device was used to measure cfPWV and estimate the central pressure waveform in 20 patients with an infrarenal abdominal aortic aneurysm scheduled for elective EVAR. The evaluated central hemodynamic parameters included the central pressures, the augmentation index (AIx), and the subendocardial viability ratio (SEVR). AIx quantifies the contribution of reflected wave to the central systolic pressure, whereas SEVR describes the myocardial perfusion relative to the cardiac workload. Measurements were performed before EVAR, at discharge, and 6 weeks and 1 year after EVAR. Results: CfPWV was increased at discharge (12.4±0.4 vs 11.3±0.5 m/s at baseline; p=0.005) and remained elevated over the course of 1-year follow-up (6 weeks: cfPWV = 12.2±0.5 m/s; 1 year: cfPWV = 12.2±0.7 m/s, p<0.05). After an initial drop in systolic central pressure at discharge, all the central pressures increased thereafter up to 1 year, without significant differences compared with baseline. The same was observed for the AIx and SEVR. Conclusion: Endovascular aortic aneurysm repair caused an increase in pulse wave velocity compared with baseline, which remained elevated through 1 year follow-up, which may be related to an increased cardiovascular risk. However, no differences in central pressure, augmentation index, and subendocardial viability ration were observed during follow-up.
Incidence of Loss of Reduction After Open Reduction Internal Fixation of Metacarpal Shaft Fractures
Authors: Allen Scott T. , Wang Olivia J. , Erickson Lauren O. , Ward Christina M. 
Published: April 2021

Background This study compared the incidence of loss of reduction (LOR) between metacarpal fractures fixed with screws alone and those fixed with plates and screws. Secondary aims included identifying patient or fracture characteristics associated with increased risk of LOR. Methods We retrospectively reviewed 138 metacarpal fractures in 106 patients treated with open reduction internal fixation with screws (60 fractures) or plates and screws (78 fractures) with a mean radiographic follow-up of 50 days for evidence of LOR. We compared the incidence of LOR between the screw and plate groups using a χ2 test. We performed logistic regression analysis to determine whether patient age, sex, metacarpal location (index, long, ring, small), the presence of multiple metacarpal fractures, or fracture pattern were associated with increased incidence of LOR. Results Loss of reduction occurred in 19 (13.8%) of 138 fractures, with no statistically significant difference between lag screw (7 of 60, 11.6%) and plate fixation (12 of 78, 15.4%). Neither fracture pattern nor the presence of multiple metacarpal fractures was associated with an increased incidence of LOR, but patients experienced a 7% increase in the risk of LOR for each additional year of age. Loss of reduction occurred most frequently in index metacarpal fractures (4 of 12, 33%), although this did not reach statistical significance. Conclusions We found no difference in LOR incidence between lag screw fixation and plate fixation. The overall incidence of LOR was higher in this study than previously reported and increased with increasing patient age.
The S-STARTS Test: Validation of a Composite Test for the Assessment of Readiness to Return to Sport After Shoulder Stabilization Surgery
Authors: Juré Dimitri , Blache Yoann , Degot Matthieu , Vigne Grégory , Nové-Josserand Laurent , Godenèche Arnaud , Collotte Philippe , Franger Gabriel , Borel Florent , Rogowski Isabelle , Neyton Lionel 
Published: April 2021

Background: The time elapsed since surgery is the primary criterion for allowing athletes to return to sport after shoulder stabilization surgery using the Latarjet procedure. The objective assessment of shoulder functional status through the return-to-sport continuum demands a scoring instrument that includes psychological and physical dimensions. This study aimed to statistically validate the Shoulder-SanTy Athletic Return To Sport (S-STARTS) score in patients who have undergone primary shoulder stabilization surgery. Hypothesis: The S-STARTS score fulfils the criteria for statistical validation for assessing return-to-sport readiness after shoulder stabilization surgery. Study Design: Diagnostic study. Level of Evidence: Level 4. Methods: Fifty patients and 50 controls completed the Shoulder Instability-Return to Sport after Injury questionnaire and performed 4 physical performance tests, from which 8 outcome measures were extracted to provide a composite score, named S-STARTS, according to a scoring procedure. The statistical validation of the S-STARTS score was based on construct validity, discriminant validity, sensitivity to change, internal consistency, reliability, agreement, and feasibility. Results: The 8 components of the S-STARTS score provided additional information (0.01 ≤ | r| ≤ 0.59). The S-STARTS score exhibited good reliability (intraclass coefficient of correlation [3,k] = 0.74), no ceiling or floor effects, and high discrimination and sensitivity to change. The S-STARTS score was significantly lower in patients than in controls (13.5 ± 3.8 points vs 16.1 ± 2.7 points, respectively; P < 0.001). A significant increase was reported between 4.5 and 6.5 months postoperatively (12.8 ± 2.3 points vs 17.2 ± 2.4 points, respectively; P < 0.001). Conclusions: The S-STARTS score meets statistical validation criteria for the assessment of shoulder functional status after shoulder stabilization surgery using the Latarjet procedure. Clinical Relevance: Using an S-STARTS score–based assessment to monitor an athlete’s progression through the return-to-sport continuum may help clinicians and strength and conditioning coaches in return-to-sport decision-making.