bluuebunny/crossref_metadata_2025_split huggingface dataset:
Charlson comorbidity index is predictive of postoperative clinical outcome after single-level posterior lumbar interbody fusion surgery
Authors: Shinonara Kensuke , Ugawa Ryo , Arataki Shinya , Nakahara Shinnosuke , Takeuchi Kazuhiro 
Published: March 2021

Abstract
Background
In several previous studies, Charlson comorbidity index (CCI) score was associated with postoperative complications, mortality, and re-admission. There are few reports about the influence of CCI score on postoperative clinical outcome. The purpose of this study was to investigate the influence of comorbidities as calculated with CCI on postoperative clinical outcomes after PLIF.

Methods
Three hundred sixty-six patients who underwent an elective primary single-level PLIF were included. Postoperative clinical outcome was evaluated with the Japanese Orthopaedic Association lumbar score (JOA score). The correlation coefficient between the CCI score and postoperative improvement in JOA score was investigated. Patients were divided into three groups according to their CCI score (0, 1, and 2+). JOA improvement rate, length of stay (LOS), and direct cost were compared between each group. Postoperative complications were also investigated.

Results
There was a weak negative relationship between CCI score and JOA improvement rate (r = − 0.20). LOS and direct cost had almost no correlation with CCI score. The JOA improvement rate of group 0 and group 1 was significantly higher than group 2+. LOS and direct cost were also significantly different between group 0 and group 2+. There were 14 postoperative complications. Adverse postoperative complications were equivalently distributed in each group, and not associated with the number of comorbidities.

Conclusions
A higher CCI score leads to a poor postoperative outcome. The recovery rate of patients with two or more comorbidities was significantly higher than in patients without comorbidities. However, the CCI score did not influence LOS and increased direct costs. The surgeon must take into consideration the patient’s comorbidities when planning a surgical intervention in order to achieve a good clinical outcome.
From toilet to table: value-tailored messages influence emotional responses to wastewater products
Authors: Judge Madeline , de Hoog Olivia , Perlaviciute Goda , Contzen Nadja , Steg Linda 
Published: March 2021

AbstractBackgroundProducts made from recycled organic materials are an important part of a circular economy, but the question is whether they will be adopted by the public. Such products can elicit strong emotional responses and public resistance. As a case in point, we studied products made from sewage waste, such as recycled toilet paper, which can serve as material alternative to wood and plastic when making household items (e.g., tables). In an experimental study, we investigated the role of values in emotional responses to such wastewater products, and whether emotional responses were influenced by value-tailored messages. We expected that people would experience positive emotions towards products that supported their values, especially when the messages emphasised the benefits of these products for their values (e.g., when the products were presented as good for the environment). We presented participants with one of two messages describing wastewater products as having positive implications for either biospheric values (i.e. positive consequences for the environment) or hedonic values (i.e. positive consequences for personal enjoyment). We predicted that the relationship between values and positive emotions would be stronger when the messages emphasised the positive implications of wastewater products for one’s core values. Additionally, we predicted that emotions would be associated with acceptability and intentions to purchase the products.ResultsThe more strongly people endorsed biospheric values, the more positive emotions they reported towards wastewater products. As expected, this relationship was stronger when the environmental benefits of products were emphasised. Hedonic values were significantly but weakly associated with more negative and more positive emotions, and this did not depend on the message framing. However, we found that emphasising pleasurable benefits of wastewater products reduced positive emotions in people with weaker hedonic values. Positive and negative emotions were significantly associated with higher and lower acceptability of the products and intentions to purchase the products, respectively.ConclusionsOur findings have implications for the effective marketing of wastewater products. For people with strong biospheric values, emphasising the positive environmental consequences may promote wastewater products. Such biospheric messages do not seem to make the products less (or more) appealing for people with strong hedonic values, who do not generally have strong emotional responses to these products. We discuss the theoretical implications of our findings and avenues for future research.
Treatment of intestinal tuberculosis with small bowel perforation: a case report
Authors: Sasse Daniel , Spinner Christoph D. , Rothe Kathrin , Schneider Jochen , Gaa Jochen , Würstle Silvia 
Published: March 2021

Abstract
Background
Diagnosis of intestinal tuberculosis poses a dilemma to physicians due to nonspecific symptoms like abdominal pain, fever, nausea, and a change in bowel habit. In particular, the distinction between inflammatory bowel disease and intestinal tuberculosis remains challenging.

Case presentation
A 27-year-old man from Colombia presented with fever, night sweats, and progressive lower abdominal pain. Computed tomography revealed a thickening of the bowel wall with a mesenterial lymphadenopathy, ascites ,and a pleural tumor mass. Histology of intestinal and pleural biopsy specimens showed a granulomatous inflammation. Although microscopy and polymerase chain reaction (PCR) for Mycobacterium tuberculosis (MTB) were negative, empirical MTB treatment was initiated on suspicion. Due to a massive post-stenotic atrophied intestinal bowel, MTB medications were administered parenterally in the initial phase of treatment to guarantee adequate systemic resorption. The complicated and critical further course included an intra-abdominal abscess and bowel perforation requiring a split stoma, before the patient could be discharged in good condition after 3 months of in-hospital care.

Conclusions
This case highlights the clinical complexity and diagnostic challenges of intestinal MTB infection. A multidisciplinary team of physicians should be sensitized to a timely diagnosis of this disease, which often mimics inflammation similar to inflammatory bowel disease, other infections, or malignancies. In our case, radiological findings, histological results, and migratory background underpinned the suspected diagnosis and allowed early initiation of tuberculostatic treatment.
Midbrain atrophy related to parkinsonism in a non-coding repeat expansion disorder: five cases of spinocerebellar ataxia type 31 with nigrostriatal dopaminergic dysfunction
Authors: Norioka Ryohei , Sugaya Keizo , Murayama Aki , Kawazoe Tomoya , Tobisawa Shinsuke , Kawata Akihiro , Takahashi Kazushi 
Published: March 2021

Abstract
Background
Spinocerebellar ataxia type 31 (SCA31) is caused by non-coding pentanucleotide repeat expansions in the BEAN1 gene. Clinically, SCA31 is characterized by late adult-onset, pure cerebellar ataxia. To explore the association between parkinsonism and SCA31, five patients with SCA31 with concomitant nigrostriatal dopaminergic dysfunction (NSDD) development, including three cases of L-DOPA responsive parkinsonism, were analyzed.

Methods
To assess regional brain atrophy, cross-sectional and longitudinal imaging analyses were retrospectively performed using magnetic resonance imaging (MRI) planimetry. The midbrain-to-pons (M/P) area ratio and cerebellar area were measured on midsagittal T1-weighted MRI in five patients with SCA31 with concomitant NSDD (NSDD(+)), 14 patients with SCA31 without NSDD (NSDD(−)), 32 patients with Parkinson’s disease (PD), and 15 patients with progressive supranuclear palsy (PSP). Longitudinal changes in the M/P area ratio were assessed by serial MRI of NSDD(+) (n = 5) and NSDD(−) (n = 9).

Results
The clinical characteristics assessed in the five patients with NSDD were as follows: the mean age at NSDD onset (72.0 ± 10.8 years), prominence of bradykinesia/akinesia (5/5), rigidity (4/5), tremor (2/5), dysautonomia (0/5), vertical gaze limitation (1/5), and abnormalities on 123I-ioflupane dopamine transporter scintigraphy (3/3) and 3-Tesla neuromelanin MRI (4/4). A clear reduction in the midbrain area and the M/P area ratio was observed in the NSDD(+) group (p < 0.05) while there was no significant difference in disease duration or in the pons area among the NSDD(+), NSDD(−), and PD groups. There was also a significant difference in the midbrain and pons area between NSDD(+) and PSP (p < 0.05). Thus, mild but significant midbrain atrophy was observed in NSDD(+). A faster rate of decline in the midbrain area and the M/P area ratio was evident in NSDD(+) (p < 0.05).

Conclusion
The clinical characteristics of the five patients with SCA31 with concomitant NSDD, together with the topographical pattern of atrophy, were inconsistent with PD, PSP, and multiple system atrophy, suggesting that SCA31 may manifest NSDD in association with the pathomechanisms underlying SCA31.
Exploring community engaged research experiences and preferences: a multi-level qualitative investigation
Authors: Han Hae-Ra , Xu Ashley , Mendez Kyra J. W. , Okoye Safiyyah , Cudjoe Joycelyn , Bahouth Mona , Reese Melanie , Bone Lee , Dennison-Himmelfarb Cheryl 
Published: March 2021

Abstract
Background
Community engagement may make research more relevant, translatable, and sustainable, hence improving the possibility of reducing health disparities. The purpose of this study was to explore strategies for community engagement adopted by research teams and identify areas for enhancing engagement in future community engaged research.

Methods
The Community Engagement Program of the Johns Hopkins Institute for Clinical and Translational Research hosted a forum to engage researchers and community partners in group discussion to reflect on their diverse past and current experiences in planning, implementing, and evaluating community engagement in health research. A total of 50 researchers, research staff, and community partners participated in five concurrent semi-structured group interviews and a whole group wrap-up session. Group interviews were audiotaped, transcribed verbatim, and analyzed using content analysis.

Results
Four themes with eight subthemes were identified. Main themes included: Community engagement is an ongoing and iterative process; Community partner roles must be well-defined and clearly communicated; Mutual trust and transparency are central to community engagement; and Measuring community outcomes is an evolving area. Relevant subthemes were: engaging community partners in various stages of research; mission-driven vs. “checking the box”; breadth and depth of engagement; roles of community partner; recruitment and selection of community partners; building trust; clear communication for transparency; and conflict in community engaged research.

Conclusion
The findings highlight the benefits and challenges of community engaged research. Enhanced capacity building for community engagement, including training and communication tools for both community and researcher partners, are needed.
Treatment of corticosteroid refractory immune checkpoint inhibitor myocarditis with Infliximab: a case series
Authors: Zhang Robert S. , Padegimas Allison , Murphy Kathleen M. , Evans Peter T. , Peters Carli J. , Domenico Christopher M. , Vidula Mahesh K. , Mather Paul J. , Cevasco Marisa , Cohen Roger B. , Carver Joseph R. , O’Quinn Rupal P. 
Published: March 2021

Abstract
Background
Glucocorticoid treatment remains the cornerstone of therapy for immune checkpoint inhibitor (ICI) myocarditis, but data supporting the use of additional immunotherapy for steroid refractory cases remains limited. We investigate the safety and efficacy of infliximab in patients with ICI myocarditis who are refractory to corticosteroids. Additionally, we highlight the importance of a multi-disciplinary approach in the care for these complex patients.

Methods
We retrospectively identified consecutive patients who developed ICI myocarditis at our institution between January 2017 and January 2020. Baseline characteristics, laboratory data and clinical outcomes were compared between patients who received infliximab and those who did not.

Results
Of a total of 11 patients who developed ICI myocarditis, 4 were treated with infliximab. Aside from age, there were no significant differences in baseline patient characteristics between the two groups including total number of ICI doses received and duration from initial ICI dose to onset of symptoms. The time to troponin normalization was 58 vs. 151.5 days (p = 0.25). The duration of prednisone taper was longer in the infliximab group (90 vs. 150 days p = 0.32). All patients survived initial hospital admission. Over a median follow-up period of 287 days, two of the 4 patients died from sepsis 2 and 3 months after initial treatment of their myocarditis; one of these patients was on a steroid taper and the other patient had just completed a steroid taper.

Conclusions
Infliximab, despite its black box warning in patients with heart failure, may be a safe and effective treatment for ICI myocarditis.
A comparison of the different anthropometric indices for assessing malnutrition among older people in Turkey: a large population-based screening
Authors: Başıbüyük Gülüşan Özgün , Ayremlou Parvin , Saeidlou Sakineh Nouri , Ay Faruk , Dalkıran Akgül , Simzari Wida , Vitályos Gábor Áron , Bektaş Yener 
Published: March 2021

Abstract
Objective
Due to an increase in aging worldwide, assessment of the nutritional status of older people becomes an important matter. Malnutrition in older people increases the risk of infections, disease period and hospitalization rates. This study aimed to compare the different anthropometric indices for detecting malnutrition among older people and comparing these indices among males and females to explain the possible differences.

Methods
In this cross-sectional study, 2721 aged 65 years and older in Turkey were enrolled. Anthropometric measurements weight, height, hip circumference (HC), and waist circumference (WC), abdominal circumference (AC), mid-upper arm circumference (MUAC), triceps skinfold thickness (TST), calf circumference (CC)) were measured. Body mass index (BMI), abdominal volume index (AVI), body roundness index (BRI) and body adiposity index (BAI), and waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) indices were calculated using standardized formulas. The receiver operator characteristic curves (ROCs) were conducted in detecting the best anthropometric parameters. Adjusted odds ratios (OR) (stratified by sex) calculated for each anthropometric index.

Results
Participants with both BMI < 18.5 (1.1%) and BMI > 25 (80%) defined as the malnourished group and BMI of 18.5–24.99 (18.9%) defined as the normal group. In both sexes, the area under the curve (AUC) was > 0.7 for all anthropometric indices except WHR in females (AUC 0.66). BRI, WHR, WHtR, and AVI indices strongly predict the risk of malnutrition among both sexes. In males, the ORs were for BRI (6.83, 95% CI 5.39–8.66), WHR (6.43, 95% CI 5.9–6.9), AVI (2.02, 95% CI 1.86–2.12). In females, the ORs were for BRI (3.72, 95% CI 3.09–4.48), WtHR (2.63, 95% CI 1.3–3.5), and WHR (2.45, 95% CI 1.9–3.06).

Discussion
The presence of a large AUC in almost all anthropometric indices suggests that they can be used to assess the risk of malnutrition among older persons in both sexes.
Impact of village health volunteer support on postnatal depressive symptoms in the remote rural areas of Lao People’s Democratic Republic: a cross-sectional study
Authors: Toyama Noriko , Vongphoumy Inthanomchanh , Uehara Manami , Sato Chika , Nishimoto Futoshi , Moji Kazuhiko , Pongvongsa Tiengkham , Shirai Kokoro , Takayama Tomomi , Takahara Misuzu , Tamashiro Yoko , Endo Yumiko , Kounnavong Sengchanh , Kobayashi Jun 
Published: March 2021

AbstractBackgroundVillage health volunteers (VHVs) are responsible for providing primary care in the communities of Laos. Unlike other districts, in Xepon more than 90% of VHVs are male and therefore experience difficulties interacting with pregnant women. To improve outreach to pregnant women, especially among ethnic minorities, a new project was implemented by local municipalities in 2017: newly selected female VHVs were paired to work with existing male VHVs. The objective of this study was to compare the postnatal depressive symptoms of ethnic minority mothers supported by pair-VHVs and single-VHVs in remote rural areas of Lao People’s Democratic Republic (PDR).MethodsA cross-sectional study was conducted in March 2019. Mothers who had delivered a baby within 1 year preceding the study were recruited from 36 villages. Of the 305 mothers, 227 responded. The questionnaires included (1) demographic characteristics such as age, economic status, and birth experience; (2) self-decision to go to a health center/hospital to receive antenatal care; (3) type of VHVs (pair or single), support, and information from VHVs during pregnancy, support from husband and relationship with husband; (4) the Edinburgh Postnatal Depression Scale (EPDS). A Mann-WhitneyUtest, chi-square test, and multiple linear regression analysis were performed. Ethical approval was obtained from the University of the Ryukyus and National Ethics Committee for Health Research of Lao PDR.ResultsThe average total EPDS score was 5.5 among mothers supported by pair-VHV and 7.0 among mothers supported by single-VHV. Results of the multiple linear regression analysis showed that the EPDS score was significantly lower among mothers supported by pair-VHV (β=−1.18,p<0.05) even after adjusting for economic and biological factors.ConclusionsMothers supported by pair-VHV had a significantly lower EPDS score than those supported by single-VHVs in this study area, suggesting that the support of male and female VHV pairs contributed to improving mental health status among ethnic minority mothers in remote rural areas of Lao PDR. Expanding the program to train female VHVs working with male VHVs is necessary for improving maternal and child health in a rural district of Lao PDR.
In vivo bioactivity-guided isolation of antifertility fraction of Waltheria indica Linn. root in male Wistar rats
Authors: Afisu Basiru , Abdulfatah Aremu , Mistura Azeez Oyebisi , Olugboyega Soetan Kehinde , Olakitike Olayemi Funsho 
Published: March 2021

Abstract
Background
Waltheria indica is a multipurpose medicinal plant with abundance of phytochemical compounds. Antifertility effect of Waltheria indica Linn. root and leaves have been reported. However, the fraction responsible for this antifertility effect needs to be isolated for possible male contraceptive purpose. Therefore, this research was designed to isolate the antifertility fraction of Waltheria indica Linn. root (WILR) in an in vivo model using male Wistar rats. Crude ethanol extract of WILR was sequentially dissolved in hexane, dichloromethane, and ethyl acetate. Rats (n = 5) were administered with 200, 500, or 1000 μg/kg of hexane, dichloromethane, and ethyl acetate soluble extracts of WILR, while control received distilled water, daily for 15 days to determine the soluble extract with most antifertility effect. Thereafter, fractions were separated from dichloromethane soluble WILR extract by column and thin-layer chromatography. Rats (7 groups, n = 5) were administered with each of the fractions (DF1 to DF7; at 1000 μg/kg) to determine the fraction with the highest antifertility. Rats were thereafter sacrificed, and sperm parameters, reproductive hormones, testicular cholesterol, and protein were determined according to standard procedure. Histology of the testis was also done. Data were analyzed using ANOVA at p ≤ 0.05.

Results
Dichloromethane soluble fraction (500 μg/kg) significantly decreased sperm concentration (137.00 ± 9.85 to 107.00 ± 13.08 × 106 cells/mL), levels of testosterone (2.90 ± 0.65 to 1.50 ± 0.37 ng/mL), and FSH (0.08 ± 0.08 to 0.99 ± 0.08 IU/L). The dichloromethane soluble fraction also caused the loss of testicular interstitium and spermatogenic cells. DF5 significantly reduced sperm motility (92.00 ± 2.74 to 76.00 ± 5.48%) and LH (2.86 ± 0.52 to 1.47 ± 0.18 IU/L). DF5 also significantly increased levels of prolactin (1.22 ± 0.10 to 1.88 ± 0.48 ng/mL), testicular total protein (7.36 ± 0.35 to 8.54 ± 1.06 g/dL), and testicular cholesterol (34.17 ± 3.65 to 55.76 ± 6.08 mg/mL).

Conclusion
The results indicate that the DF5 is the bioactive fraction of WILR responsible for its antifertility effect. The possible antifertility mechanisms are through the reduction in sperm parameters, reproductive hormones, and histological changes in the testis.
The network structure of depressive symptomatology in Peruvian adults with arterial hypertension
Authors: Ramos-Vera Cristian , Banos-Chaparro Jonatan , Ogundokun Roseline Oluwaseun 
Published: March 2021

Background: Globally, arterial hypertension (AH) has increased by 90% over the last four decades, and has increased by 1.6% in Peru over the previous four years. Scientific evidence indicates the prevalence of depressive symptoms in patients with AH and its importance in the comprehensive evaluation of the adult for adherence to clinical treatment. Previous studies carried out in the Peruvian population with AH mostly report the prevalence and associations, but do not indicate which depressive symptoms are more relevant in patients with AH. This study involved a network analysis of depressive symptomatology in Peruvian patients with AH using network estimation. Network analysis is used in this study for analysis, control, and monitoring purposes. Method: A representative cross-sectional study at the national level, using secondary data from 2019 Demographic and Family Health Survey (ENDES) was performed. The sample used included men and women of age over 17 years diagnosed with AH and was able to respond to Patient Health Questionnaire-9 (PHQ-9). Results: The symptoms of depressive mood (bridging force and centrality) and energy fatigue or loss (bridge centrality) play an essential role in the network structure, as does the feeling of uselessness in terms of closeness and intermediation. Conclusion: The study highlighted the symptoms related to depressive mood and energy fatigue or loss as bridging symptoms, which could trigger a depressive episode in patients diagnosed with AH. The results will contribute to developing personalized treatments aimed at patients with specific depressive symptoms who have also been diagnosed with AH. The study analysis presents statistical coefficients of effect size (≤ 0,1 = small; > 0,1 to < 0,5 = moderate; ≥ 0,5 = large) to determine network connections.