bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and external validation of a nomogram for neurosyphilis diagnosis among non-HIV patients: a cross-sectional study
Authors: Ge Wenjing , Zhang Yang , Peng Chao , Li Dongdong , Gao Lijie , Bao Jiajia , Li Changling , Chen Ning , Zhou Dong , He Li 
Published: November 2021

Abstract
Background
The diagnosis of neurosyphilis is challenging due to the requirement of a lumbar puncture and cerebrospinal fluid (CSF) laboratory tests. Therefore, a convenient diagnostic nomogram for neurosyphilis is warranted. This study aimed to construct diagnostic models for diagnosing neurosyphilis.

Methods
This cross-sectional study included data of two patient cohorts from Western China Hospital of Sichuan University between September 2015 and April 2021 and Shangjin Hospital between September 2019 and April 2021 as the development cohort and the external validation cohort, respectively. A diagnostic model using logistic regression analysis was constructed to readily provide the probability of diagnosis at point of care and presented as a nomogram. The clinical usefulness of the diagnostic models was assessed using a receiver operating characteristic (ROC) and Harrell concordance (Harrell C) index for discrimination and calibration plots for accuracy, which adopted bootstrap resampling 500 times.

Results
One hundred forty-eight and 67 patients were included in the development and validation cohorts, respectively. Of those, 131 were diagnosed as having reactive neurosyphilis under the criteria of positive results in both CSF treponemal and non-treponemal tests. In the development cohort, male, psychiatric behaviour disorders, and serum toluidine red unheated serum test were selected as diagnostic indicators applying a stepwise procedure in multivariable logistic model. The model reached 80% specificity, 79% sensitivity, and 0·85 area under the curves (AUC) (95% confidence interval, 0·76–0·91). In the validation cohorts, the Harrell C index for the diagnostic possibility of reactive neurosyphilis was 0·71.

Conclusions
A convenient model using gender, presence of psychiatric behaviour disorders, and serum TRUST titre was developed and validated to indicate diagnostic results in patients suspected of neurosyphilis. Checking the model value of factors on nomogram is a feasible way to assist clinicians and primary health servers in updating patients’ medical charts and making a quantitatively informed decision on neurosyphilis diagnosis.

Trial registration
This research was retrospectively registered in the Ethics committee on biomedical research, West China Hospital of Sichuan University. The research registration and committee’s reference number was 1163 in 2020 approval.
Factors associated with self-medication in children and the decomposition of rural-urban disparities in China
Authors: Ge Jingjing , Sun Xiaxia , Meng Hongdao , Risal Punam Ghimire , Liu Danping 
Published: November 2021

Abstract
Background
Self-medication in children is one of the greatest threats to children health in China.

Objectives
The purpose of this study was to examine the potential factors associated with self-medication in children and explore rural-urban disparities.

Methods
A total of 2798 children enrolled in the study. Informed consent was obtained from each primary caregiver following a detail explanation about the purpose of the study. Multivariable logistic regression analysis and Oaxaca–Blinder decomposition analysis were used.

Results
The results showed that 38.2% primary caregivers of rural areas self-medicated their children, compared to 18.7% of those in urban areas. The urban primary caregivers with college or above education were more likely to self-medicate their children, while rural primary caregivers with college or above education were less likely to self-medicate their children. Children having unhealthy eating habits were more likely to have been self-medicated by their primary caregivers in urban and rural areas. Urban primary caregivers who spend more than 10 min from home to the nearest medical institution were more likely to self-medicate their children. In rural areas, children aged 3–6 years old, primary caregivers with monthly household income per capita of 1001–3000 Yuan, and children with chronic diseases are another set of enabling factors which impacted on self-medication. Unhealthy eating habits of children were the largest contributor to the rural-urban self-medication gap.

Conclusions
Children’s factors explained the largest portion of the rural-urban difference in self-medication among children. The evidence presented in this study suggests that public health policies addressing rural-urban differences in children’ s factors could serve as an effective method for reducing rural-urban disparities in self-medication among children.
Education, household income, and depressive symptoms in middle-aged and older Japanese adults
Authors: Hinata Aya , Kabasawa Keiko , Watanabe Yumi , Kitamura Kaori , Ito Yumi , Takachi Ribeka , Tsugane Shoichiro , Tanaka Junta , Sasaki Ayako , Narita Ichiei , Nakamura Kazutoshi 
Published: November 2021

Abstract
Background
Income inequality has dramatically increased worldwide, and there is a need to re-evaluate the association between socio-economic status (SES) and depression. Relative contributions of household income and education to depression, as well as their interactions, have not been fully evaluated. This study aimed to examine the association between SES and depressive symptoms in Japanese adults, focusing on interactions between education and household income levels.

Methods
This cross-sectional study used data from baseline surveys of two cohort studies. Participants were 38,499 community-dwelling people aged 40–74 years who participated in baseline surveys of the Murakami cohort study (2011–2012) and Uonuma cohort study (2012–2015) conducted in Niigata Prefecture, Japan. Information regarding marital status, education level, household income, occupation, activities of daily living (ADL), and history of cancer, myocardial infarction, stroke, and diabetes was obtained using a self-administered questionnaire. Depressive symptoms were examined using the Center for Epidemiologic Studies Depression Scale (CES-D). Logistic regression analysis was used to obtain odds ratios (ORs). Covariates included age, sex, marital status, education, household income, occupation, ADL, and disease history.

Results
Individuals with higher education levels had lower ORs (adjusted P for trend = 0.0007) for depressive symptoms, independently of household income level. The OR of the university-or-higher group was significantly lower than that of the junior high school group (adjusted OR = 0.79). Individuals with lower household income levels had higher ORs (adjusted P for trend< 0.0001) for depressive symptoms, independently of education level. The type of occupation was not associated with depressive symptoms. In subgroup analyses according to household income level, individuals with higher education levels had significantly lower ORs in the lowest- and lower-income groups (adjusted P for trend = 0.0275 and 0.0123, respectively), but not in higher- and highest-income groups (0.5214 and 0.0915, respectively).

Conclusions
Both education and household income levels are independently associated with the prevalence of depressive symptoms, with household income levels showing a more robust association with depressive symptoms than education levels. This suggests that a high household income level may offset the risk of depressive symptoms from having a low education level.
Association between diffuse idiopathic skeletal hyperostosis and thoracic kyphosis in patients with cervical myelopathy: a retrospective observational study
Authors: Takayuki Motoyoshi , Takashi Hirai , Toshitaka Yoshii , Hiroyuki Inose , Yu Matsukura , Satoru Egawa , Yutaka Kobayashi , Kurando Utagawa , Jun Hashimoto , Atsuyuki Kawabata , Takuya Takahashi , Tomoyuki Tanaka , Atsushi Okawa 
Published: November 2021

Abstract
Background
Diffuse idiopathic skeletal hyperostosis (DISH) is a structural abnormality of the thoracic spine that is known to impair posture. However, the relationship between DISH and sagittal balance in the whole spine is unclear. The aims of this study were to investigate the prevalence of DISH in patients with cervical myelopathy caused by cervical ossification of the posterior longitudinal ligament (OPLL) or cervical spondylosis and to compare sagittal alignment of the spine between patients with and without DISH.

Methods
A total of 103 consecutive patients with a diagnosis of cervical myelopathy due to cervical OPLL or spondylosis were retrospectively enrolled in this single-center study. DISH was defined as an ossified lesion that was seen to be completely bridging at least four contiguous adjacent vertebral bodies in the thoracic spine on computed tomography scans. Cervical and spinopelvic sagittal parameters were measured in whole spine radiographs.

Results
The study population included 28 cases with DISH [DISH (+) group] and 75 without DISH [DISH (−) group]. OPLL was more prevalent in the DISH (+) group than in the DISH (−) group; however, there were no significant differences in other clinical findings. Propensity score matching produced 26 pairs. C7 slope, C2-7 sagittal vertical axis (C-SVA), whole thoracic kyphotic angles, upper thoracic kyphosis, and T5-T12 thoracic kyphosis values were significant higher in the DISH (+) group than in the DISH (−) group. There was no significant between-group difference in the other sagittal spinopelvic parameters.

Conclusions
This study is the first to compare sagittal alignment in patients with cervical myelopathy according to whether or not they have DISH. Patients with DISH are more likely to have excessive kyphosis in the thoracic spine, a high C7 slope, and a high C2-7 SVA.
Changes of adenosine deaminase activity in serum and saliva around parturition in sows with and without postpartum dysgalactia syndrome
Authors: Kaiser Marianne , Dahl Jan , Jacobsen Stine , Jacobson Magdalena , Andersen Pia Haubro , Bækbo Poul , Escribano Damián , Cerón José Joaquín , Tecles Fernando 
Published: November 2021

AbstractBackgroundPostpartum dysgalactia syndrome (PDS) is associated with a significantly higher activation of the inflammatory and stress response at parturition than in the healthy sow. Therefore, reliable and possibly non-invasive biomarkers for substantial increases of inflammation are searched to support the PDS diagnosis. This report studies the possible changes of the inflammatory marker enzyme adenosine deaminase (ADA) in serum and saliva of 38 PDS positive sows (PDS+) and 38 healthy sows (PDS-). Sampling was performed every 24 h from 60 h before to 36 h after parturition. Isoenzyme 1 (ADA1) and isoenzyme 2 (ADA2), as well as total ADA (tADA), were measured and their statistical association with several serum and saliva biomarkers of inflammation and stress was investigated.ResultsCompared to a baseline (60 to 36hprepartum), salivary activities of ADA1, ADA2 and tADA increased significantly over time in both PDS+ and PDS- sows, reaching their peaks after parturition. In serum from PDS- sows, no changes were observed over time in either ADA1, ADA2 or tADA. In PDS+ sows, serum ADA2 activity decreased temporarily after parturition followed by a significant increase compared to baseline. ADA1, ADA2 and tADA were all significantly associated with several inflammatory biomarkers and ADA1 in serum was associated with serum cortisol. Although serum activity was higher in PDS+ than in PDS- sows, the differences were not statistically significant. Further, no difference was noted between the groups in the analyses of saliva.ConclusionsSalivary ADA1 and ADA2 increased in all sows after parturition, potentially as a response to the postpartum inflammation. However, no difference in the activity of ADA1, ADA2 and tADA were found between PDS+ and PDS- sows indicating inability to diagnose PDS under the conditions described in this report.
New resilience instrument for family caregivers in cancer: a multidimensional item response theory analysis
Authors: Liang Mu Zi , Tang Ying , Chen Peng , Liang Jian , Sun Zhe , Hu Guang Yun , Yu Yuan Liang , Ye Zeng Jie 
Published: November 2021

Abstract
Objective
Resilience instruments specific to family caregivers (FCs) in cancer are limited. This study was designed to validate the 10-item Resilience Scale Specific to Cancer (RS-SC-10) in FCs using multidimensional item response theory (MIRT) analysis.

Methods
382 FCs were enrolled from Be Resilient to Cancer Program (BRCP) and administered with RS-SC-10 and 36-item Short Form Health Survey (SF-36). MIRT was performed to evaluate item parameters while Generalized Additive Model (GAM) and Latent Profile Analysis (LPA) were performed to test the non-linear relationship between resilience (RS-SC-10) and Quality of Life (QoL, SF-36).

Results
RS-SC-10 retained 10 items with high multidimensional discrimination, monotonous thresholds and its original two-factor structure (Generic and Shift-Persist). Four latent resilience subgroups were identified and a non-linear dose–response pattern between resilience and QoL was confirmed (per-SD increase OR = 1.62, 95% CI 1.16–2.13, p = 0.0019).

Conclusion
RS-SC-10 is a brief and suitable resilience instrument for FCs in cancer. The resilience screening of patients and FCs can be performed simultaneously in clinical practice.
The origin of cost–benefit analysis: a comparative view of France and the United States
Authors: Jiang Wei , Marggraf Rainer 
Published: November 2021

Abstract
Background
Cost–benefit analysis (CBA), as a common instrument in the decision making process on how to allocate financial resources, has been widely used in various research areas and in almost all of countries over the world. However, the origin and the historical development of CBA has long been subject to neglect. We attempt to fill this gap and clarify the origin and the early development of CBA.

Methods
A comparative analysis is used to investigate the origin and the early development of CBA in France and the USA. The comparison is focused on two questions: (1) which criteria should be applied to decide whether or not a project should be carried out, and (2) with which procedure these criteria can be used for real projects.

Results
The origin of CBA can be dated back to the work of Saint-Pierre in France in 1708. Dupuit introduces the concept of consumer’s surplus that founds the economic basis of CBA. These works are not taken seriously in France and do not draw attention from other countries. Hence, until the 1930s, the principle of CBA is newly proposed in the US and the Green Book marks the mature of CBA.

Conclusions
The early development of CBA in France and the US is independent from the aspects of historical background, personnel, approaches and standardization. This study could help researchers of various disciplines be sure about the history of CBA when they perform this analysis in their research areas.
Predictors of the chest CT score in COVID-19 patients: a cross-sectional study
Authors: Yazdi Niloofar Ayoobi , Ghadery Abdolkarim Haji , SeyedAlinaghi SeyedAhmad , Jafari Fatemeh , Jafari Sirous , Hasannezad Malihe , Koochak Hamid Emadi , Salehi Mohammadreza , Manshadi Seyed Ali Dehghan , Meidani Mohsen , Hajiabdolbaghi Mahboubeh , Ahmadinejad Zahra , Khalili Hossein , Mehrabi Nejad Mohammad-Mehdi , Abbasian Ladan 
Published: November 2021

Abstract
Background
Since the COVID-19 outbreak, pulmonary involvement was one of the most significant concerns in assessing patients. In the current study, we evaluated patient’s signs, symptoms, and laboratory data on the first visit to predict the severity of pulmonary involvement and their outcome regarding their initial findings.

Methods
All referred patients to the COVID-19 clinic of a tertiary referral university hospital were evaluated from April to August 2020. Four hundred seventy-eight COVID-19 patients with positive real-time reverse-transcriptase-polymerase chain reaction (RT-PCR) or highly suggestive symptoms with computed tomography (CT) imaging results with typical findings of COVID-19 were enrolled in the study. The clinical features, initial laboratory, CT findings, and short-term outcomes (ICU admission, mortality, length of hospitalization, and recovery time) were recorded. In addition, the severity of pulmonary involvement was assessed using a semi-quantitative scoring system (0–25).

Results
Among 478 participants in this study, 353 (73.6%) were admitted to the hospital, and 42 (8.7%) patients were admitted to the ICU. Myalgia (60.4%), fever (59.4%), and dyspnea (57.9%) were the most common symptoms of participants at the first visit. A review of chest CT scans showed that Ground Glass Opacity (GGO) (58.5%) and consolidation (20.7%) were the most patterns of lung lesions. Among initial clinical and laboratory findings, anosmia (P = 0.01), respiratory rate (RR) with a cut point of 25 (P = 0.001), C-reactive protein (CRP) with a cut point of 90 (P = 0.002), white Blood Cell (WBC) with a cut point of 10,000 (P = 0.009), and SpO2 with a cut point of 93 (P = 0.04) was associated with higher chest CT score. Lung involvement and consolidation lesions on chest CT scans were also associated with a more extended hospitalization and recovery period.

Conclusions
Initial assessment of COVID-19 patients, including symptoms, vital signs, and routine laboratory tests, can predict the severity of lung involvement and unfavorable outcomes.
3D printing-assisted extended lateral approach for displaced intra-articular calcaneal fractures: a systematic review and meta-analysis
Authors: Shi Guang , Liu Wei , Shen Ying , Cai Xiyu 
Published: November 2021

Abstract
Background
Three-dimensional (3D) printing technology has developed rapidly in orthopaedic surgery and effectively achieves precise and personalized surgery. The purpose of this meta-analysis was to assess the efficacy of 3D printing technology in the management of displaced intra-articular calcaneal fractures (DICFs) by extended lateral approach (ELA).

Methods
We searched PubMed, Web of Science, Embase, Cochrane Library, CNKI, VIP, and VANFUN databases were searched up to October 2020. All clinical studies comparing traditional surgery and 3D printing-assisted surgery in the management of DICFs were obtained, evaluating the quality of the included studies and extracting data. For each study, we assessed odds ratios (ORs), standard mean difference (SMD), and 95% confidence interval (95% CI) to assess and synthesize the outcomes.

Results
Three RCTs and nine retrospective studies involving 732 patients were included met our inclusion criteria with 366 patients in the 3D group and 366 patients in the conventional group. The meta-analysis showed that there were significant differences of the operative time in the 3D group [SMD =  − 1.86, 95% CI (− 2.23, − 1.40), P < 0.001], intraoperative blood loss [SMD =  − 1.26, 95% CI (− 1.82, − 0.69), P < 0.001], the number of intraoperative X-ray exposures [SMD =  − 0.66, 95% CI (− 1.20, − 0.12), P < 0.001], postoperative complications [OR = 0.49, 95% CI (0.31, 0.79), P < 0.001], excellent and good rate of calcaneal fracture outcome [OR = 4.09, 95% CI (2.03, 8.22), P < 0.001].

Conclusion
The current study indicates that 3D printing-assisted ELA surgery showed a better rate of excellent and good outcome, shorter operation time, less intraoperative blood loss, fewer intraoperative fluoroscopies, fewer complications. Besides, there is still a need for large-sample, high-quality, long-term randomized controlled trials to confirm the conclusion.
Chronic locked posterior gleno-humeral dislocation: technical note on fibular grafting for restoration of humeral head sphericity
Authors: Kandeel Amr Abdel-Mordy 
Published: November 2021

Abstract
Background
Reconstruction of reverse Hill-Sachs defect using osteo-chondral allograft has the advantages of spherical re-contouring and provision of smooth biological articular surface of the reconstructed humeral head. However, worldwide availability and risk of disease transmission of osteo-chondral allograft remain points of increasing concerns. As an alternative to lacking osteo-chondral allograft, the current technical note describes a reconstructive technique of reverse Hill-Sachs defect using autologous fibular grafting.

Methods
Following open reduction of the dislocated humeral head, reverse Hill-Sachs defect was reconstructed using 3–4 autologous fibular pieces (each is of 10 mm in length) fixed in flush with the articular cartilage using 4-mm cancellous screws. Defect reconstruction was then followed by modified McLaughlin’s transfer and posterior capsulorrhaphy.

Results
Spherical contour of the humeral head and gleno-humeral range of motion were restored. Intra-operative dynamic testing of the reconstruct revealed no residual posterior gleno-humeral instability.

Conclusion
Currently reported technique might offer advantages of graft availability, technical simplicity, familiarity and reproducibility, safety (i.e. no disease transmission) and bone preservation facilitating future revision management (if needed). Nevertheless, long-term outcomes of this technique should be investigated via further cohort clinical studies.
Preventing maternal phenylketonuria (PKU) syndrome: important factors to achieve good metabolic control throughout pregnancy
Authors: Rohde Carmen , Thiele Alena Gerlinde , Baerwald Christoph , Ascherl Rudolf Georg , Lier Dinah , Och Ulrike , Heller Christina , Jung Alexandra , Schönherr Kathrin , Joerg-Streller Monika , Luttat Simone , Matzgen Sabine , Winkler Tina , Rosenbaum-Fabian Stefanie , Joos Oxana , Beblo Skadi 
Published: November 2021

AbstractBackgroundInsufficient metabolic control during pregnancy of mothers with phenylketonuria (PKU) leads to maternal PKU syndrome, a severe embryo-/fetopathy. Since maintaining or reintroducing the strict phenylalanine (Phe) limited diet in adults with PKU is challenging, we evaluated the most important dietary and psychosocial factors to gain and sustain good metabolic control in phenylketonuric women throughout pregnancy by a questionnaire survey with 38 questions concerning therapy feasibility. Among them, the key questions covered 5 essential items of PKU care as follows: General information about maternal PKU, PKU training, diet implementation, individual metabolic care, personal support. In addition, all participating PKU mothers were asked to estimate the quality of their personal metabolic control of the concluded pregnancies. 54 PKU mothers with 81 pregnancies were approached at 12 metabolic centers in Germany and Austria were included. According to metabolic control, pregnancies of PKU women were divided in two groups: group “ideal” (not more than 5% of all blood Phe concentrations during pregnancy > 360 µmol/l; n = 23) and group “suboptimal” (all others; n = 51).ResultsThe demand for support was equally distributed among groups, concerning both amount and content. Personal support by the direct social environment (partner, family and friends) (“suboptimal” 71% vs “ideal” 78%) as well as individual metabolic care by the specialized metabolic center (both groups around 60%) were rated as most important factors. The groups differed significantly with respect to the estimation of the quality of their metabolic situation (p < 0.001). Group “ideal” presented a 100% realistic self-assessment. In contrast, group “suboptimal” overestimated their metabolic control in 53% of the pregnancies. Offspring of group “suboptimal” showed clinical signs of maternal PKU-syndrome in 27%.ConclusionThe development of training programs by specialized metabolic centers for females with PKU in child bearing age is crucial, especially since those mothers at risk of giving birth to a child with maternal PKU syndrome are not aware of their suboptimal metabolic control. Such programs should provide specific awareness training for the own metabolic situation and should include partners and families.