bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pectoralis Major Tendon Reconstruction at the Myotendinous Junction With Semitendinosus Allograft: An Operative Technique
Authors: Wickman John , Goltz Daniel , Lau Brian 
Published: March 2021

Background: Pectoralis major (PM) tendon tears are a relatively uncommon injury that typically occurs in a young, active population during weightlifting or recreational sports. Musculotendinous junction and chronic PM tears often require tendon reconstruction due to inadequate remnant tendon stump or inability to reduce the remnant tendon stump to humeral footprint. Indications: We favor operative repair or reconstruction of PM tears in all young and active patients medically appropriate for surgery as supported by the literature. We present a technique for PM tendon reconstruction with semitendinosus allograft. This technique is applicable to musculotendinous junction and chronic tears. Technique: A modified deltopectoral approach is used. The PM tear is identified at the musculotendinous junction and the retracted muscle belly is mobilized. The PM tendon is reconstructed with a semitendinosus allograft using a Pulvertaft weave technique. The humeral footprint is prepped and the reconstructed tendon is properly tensioned and reduced. Fixation is performed with fibertapes loaded on 3 unicortical buttons. Postoperatively, the patient follows a graduated rehabilitation protocol. Results: There is a paucity of literature regarding outcomes of PM tendon reconstructions for musculotendinous junction tears. One study reported outcomes on 6 patients who had musculotendinous junction tears and underwent semitendinosus allograft reconstruction with a technique similar to ours. They report good clinical outcomes with high patient satisfaction regarding cosmetic outcome, return of strength, and overall satisfaction postoperatively. Discussion: It is our experience that the described technique for reconstruction of the PM tendon with semitendinosus allograft provides a viable option with good clinical outcomes for patients with PM ruptures at the musculotendinous junction.
Site of relapse of ductal adenocarcinoma of the pancreas affects survival after multimodal therapy
Authors: Safi S. A. , Lehwald-Tywuschik N. , Rehders A. , Fluegen G. , Haeberle L. , Keitel V. , Knoefel W. T. 
Published: March 2021

Abstract
Background
Ductal adenocarcinoma of the pancreas (PDAC) remains one of the most lethal malignancies. To date, no guidelines exists for isolated resectable metachronous disease. It is still unknown, which patients may benefit from relapse surgery. The aim of our study was to compare disease free survival (DFS) and post relapse survival (PRS) in patients with isolated local recurrence, metachronous hepatic or pulmonary metastases.

Methods
Patients with isolated resectable local recurrence, metachronous hepatic or pulmonary metastases were included for survival analyses. PRS of surgically treated patients (local (n = 11), hepatic (n = 6) and pulmonary metastases (n = 9)) was compared to conservatively treated patients (local (n = 17), hepatic (n = 37) and pulmonary metastases (n = 8)).

Results
Resected PDAC patients suffering from isolated metachronous hepatic metastases initially had a higher T-stage and venous invasion (V1) compared to the other patients. DFS in the metachronous pulmonary metastases group was longer compared to DFS of the hepatic metastases and local recurrence groups. Surgical resection significantly improved PRS in patients with local recurrence and pulmonary metastases, when compared to patients receiving chemotherapy alone. Very-long term survivors (> 5 years) were detected following secondary resection of local recurrence and 45% of these patients were still alive at the end of our study period.

Conclusion
Although DFS in PDAC patients suffering from isolated local recurrence was dismal and comparable to that of patients with isolated hepatic metastases, very-long term survivors were present only in this group. These results indicate that a surgical approach for isolated local recurrence, if anatomically possible, should be considered.
Application of a double reverse traction repositor in the retrograde intramedullary nailing of distal femur fractures
Authors: Lian Xiaodong , Zhao Kuo , Chen Wei , Zhang Junzhe , Li Junyong , Meng Hongyu , Hou Zhiyong , Zhang Yingze 
Published: March 2021

Abstract
Objective
The purpose of this prospective study was to introduce the application of a double reverse traction repositor (DRTR) in the retrograde intramedullary nailing (RE-IMN) of AO/OTA 33A distal femur fractures.

Patients and methods
A total of 27 patients with AO/OTA type 33A distal femur fractures who were admitted from January 2015 to May 2017 to a level I trauma center of a tertiary university hospital were enrolled in this prospective study. A DRTR was used to facilitate RE-IMN for the reduction of distal femur fractures in all patients. The demographic and fracture characteristics, surgical data, postoperative complications, and prognostic indicators of 24 patients were recorded.

Results
The DRTR helped achieve and maintain the reduction of all distal femur fractures in the present study. All surgeries were conducted by closed reduction, and excellent alignment was observed in the postoperative X-ray images. In the present study, 18 males and 6 females were included, and the average age of all patients was 51.3 years (range, 24–68 years). The mean operation time, intraoperative blood loss, intraoperative fluoroscopy time, and length of postoperative hospital stay were 137 min (range from 80 to 210 min), 320 ml (range from 200 to 600 ml), 28 (from 24 to 33), and 9 days (from 5 to 14 days), respectively. Eleven patients were found to have postoperative deep venous thrombosis before discharge. No cases of wound infection were observed. No cases of nonunion or malunion were observed. The average follow-up duration was 21 months (18–30 months). The average HHS, LKFS, and VAS scores at the 1-year follow-up were 89.9 (86–97), 79.1 (75–87), and 2.1 (from 0 to 5). No complications associated with DRTR were found.

Conclusions
A DRTR can be successfully applied in the treatment of distal femur fractures with RE-IMN, and it can not only help achieve or maintain the reduction of distal femur fractures with closed methods but also promote fixation with RE-IMN.
Analysis of Droplet Characteristics and Kinetic Energy Distribution for Fixed Spray Plate Sprinkler at Low Working Pressure
Authors: Chen Rui , Li Hong , Wang Jian , Guo Xin 
Published: March 2021

HighlightsAn experiment was conducted to investigate the hydraulic performance of a fixed spray plate sprinkler (FSPS).A model was developed for estimating the cumulative kinetic energy of the FSPS under a moving system.The droplet characteristics and kinetic energy distribution were affected by the working pressure and FSPS structure.A high cumulative kinetic energy could lead to a low water infiltration rate into the soil.Abstract. The kinetic energy of droplets from a fixed spray plate sprinkler (FSPS) has a substantial influence on runoff and soil erosion, as well as on the energy consumption of moving sprinkler irrigation systems. To determine the droplet characteristics and kinetic energy of an FSPS, an experiment was conducted to investigate the effects of working pressure, plate structure, and nozzle size on the droplet diameter, velocity, and kinetic energy. Two plates (the FSPSB with a concave trajectory and deep grooves in the blue plate, and the FSPSY with a flat trajectory and shallow grooves in the yellow plate) were used in the tests. The cumulative kinetic energy and water depth were calculated for a single sprinkler moving in a straight line. The results show that the FSPSB, which had deeper grooves in the plate, produced a larger droplet diameter than the FSPSY, with shallow grooves in the plate. The droplet landing velocities presented a logarithmic relationship with the droplet diameter, and velocities increased with an increase in droplet diameter. The peak specific power (SP) value of the FSPSB was 1.14 to 16.76 times that of the FSPSY. When the working pressure was less than 150 kPa, the peak SP of the FSPSB remained at a high level. With an increase in working pressure, the peak SP of the FSPSB initially increased and then decreased, while the peak SP of the FSPSY increased. The cumulative kinetic energy of the FSPSB was higher than that of the FSPSY under mobile spray conditions. Compared with the cumulative water depth, the cumulative kinetic energy of the FSPSB increased and then decreased as the working pressure increased for the same applied water volume. Because the soil had a lower infiltration rate under the FSPSB, surface ponding was more likely to occur with the FSPSB than with the FSPSY at low working pressure. Keywords: Cumulative kinetic energy, Droplet size, Specific power, Sprinkler irrigation, Working condition.
Influence of Constraint Method of Elastic Diaphragm on Numerical Simulation of Pressure-Compensating Emitter
Authors: Chen Xueli , Wei Zhengying , Wei Caixiang , Ma Jinpeng , Chen Zhuo 
Published: March 2021

HighlightsDeformation of the elastic diaphragm can affect the flow field characteristics of a pressure-compensating emitter.The contact constraint method’s simulation of the elastic diaphragm were consistent with its actual deformation.The contact constraint method can reduce the relative errors between simulated and experimental results.Abstract. Numerical simulation is an important method for revealing the working principle and optimizing the design of drip emitters. The hydraulic performance of pressure-compensating (PC) emitters is determined by the interaction between the elastic diaphragm and the flow field; therefore, correct deformation of the elastic diaphragm is one of the factors determining the accuracy of numerical simulation of PC emitters. This study investigated the effects of three constraint methods of the elastic diaphragm on the numerical simulation of PC emitters. The three methods were fully fixed constraint (FFC), upper surface fixed constraint (UFC), and contact constraint (CC). Fluid-structure interaction (FSI) simulation was used to analyze the deformation characteristics of the elastic diaphragm, the flow field characteristics, and the flow rate of the PC emitter. The simulated diaphragm deformation and flow rates were compared with the results of a visual experiment and a hydraulic performance experiment, respectively. The simulation results showed that the constraint method affected the diaphragm deformation and flow field of the PC emitter. In comparing the simulation results with the experimental results, the CC method had the highest accuracy among the three constraint methods, but an extremely long computation time was required. The FFC method had the lowest accuracy but required less computation time. The accuracy of the UFC method was lower than CC and higher than FFC, but its computation time decreased by 60.03% compared with CC. This study provides a foundation for further research on the numerical simulation and design of PC emitters. Keywords: Constraint method, Deformation characteristics, Flow field characteristics, Fluid-structure interaction, Visual experiment.
Predicting major bleeding among hospitalized patients using oral anticoagulants for atrial fibrillation after discharge
Authors: Qazi Jakub Z. , Schnitzer Mireille E. , Côté Robert , Martel Marie-Josée , Dorais Marc , Perreault Sylvie 
Published: March 2021

Aim
Real-world predictors of major bleeding (MB) have been well-studied among warfarin users, but not among all direct oral anticoagulant (DOAC) users diagnosed with atrial fibrillation (AF). Thus, our goal was to build a predictive model of MB for new users of all oral anticoagulants (OAC) with AF.

Methods
We identified patients hospitalized for any cause and discharged alive in the community from 2011 to 2017 with a primary or secondary diagnosis of AF in Quebec’s RAMQ and Med-Echo administrative databases. Cohort entry occurred at the first OAC claim. Patients were categorized according to OAC type. Outcomes were incident MB, gastrointestinal bleeding (GIB), non-GI extracranial bleeding (NGIB) and intracranial bleeding within 1 year of follow-up. Covariates included age, sex, co-morbidities (within 3 years before cohort entry) and medication use (within 2 weeks before cohort entry). We used logistic-LASSO and adaptive logistic-LASSO regressions to identify MB predictors among OAC users. Discrimination and calibration were assessed for each model and a global model was selected. Subgroup analyses were performed for MB subtypes and OAC types.

Results
Our cohort consisted of 14,741 warfarin, 3,722 dabigatran, 6,722 rivaroxaban and 11,196 apixaban users aged 70–86 years old. The important MB predictors were age, prior MB and liver disease with ORs ranging from 1.37–1.64. The final model had a c-statistic of 0.63 (95% CI 0.60–0.65) with adequate calibration. The GIB and NGIB models had similar c-statistics of 0.65 (95% CI 0.63–0.66) and 0.67 (95% CI 0.64–0.70), respectively.

Conclusions
MB and MB subtype predictors were similar among DOAC and warfarin users. The predictors selected by our models and their discriminative potential are concordant with published data. Thus, these models can be useful tools for future pharmacoepidemiologic studies involving older oral anticoagulant users with AF.
Trends in heart failure-related cardiovascular mortality in rural versus urban United States counties, 2011–2018: A cross-sectional study
Authors: Pierce Jacob B. , Shah Nilay S. , Petito Lucia C. , Pool Lindsay , Lloyd-Jones Donald M. , Feinglass Joe , Khan Sadiya S. 
Published: March 2021

Background
Adults in rural counties in the United States (US) experience higher rates broadly of cardiovascular disease (CVD) compared with adults in urban counties. Mortality rates specifically due to heart failure (HF) have increased since 2011, but estimates of heterogeneity at the county-level in HF-related mortality have not been produced. The objectives of this study were 1) to quantify nationwide trends by rural-urban designation and 2) examine county-level factors associated with rural-urban differences in HF-related mortality rates.

Methods and findings
We queried CDC WONDER to identify HF deaths between 2011–2018 defined as CVD (I00-78) as the underlying cause of death and HF (I50) as a contributing cause of death. First, we calculated national age-adjusted mortality rates (AAMR) and examined trends stratified by rural-urban status (defined using 2013 NCHS Urban-Rural Classification Scheme), age (35–64 and 65–84 years), and race-sex subgroups per year. Second, we combined all deaths from 2011–2018 and estimated incidence rate ratios (IRR) in HF-related mortality for rural versus urban counties using multivariable negative binomial regression models with adjustment for demographic and socioeconomic characteristics, risk factor prevalence, and physician density. Between 2011–2018, 162,314 and 580,305 HF-related deaths occurred in rural and urban counties, respectively. AAMRs were consistently higher for residents in rural compared with urban counties (73.2 [95% CI: 72.2–74.2] vs. 57.2 [56.8–57.6] in 2018, respectively). The highest AAMR was observed in rural Black men (131.1 [123.3–138.9] in 2018) with greatest increases in HF-related mortality in those 35–64 years (+6.1%/year). The rural-urban IRR persisted among both younger (1.10 [1.04–1.16]) and older adults (1.04 [1.02–1.07]) after adjustment for county-level factors. Main limitations included lack of individual-level data and county dropout due to low event rates (<20).

Conclusions
Differences in county-level factors may account for a significant amount of the observed variation in HF-related mortality between rural and urban counties. Efforts to reduce the rural-urban disparity in HF-related mortality rates will likely require diverse public health and clinical interventions targeting the underlying causes of this disparity.
Radiographic differences in the concomitant deformities in two types of medial ankle osteoarthritis
Authors: Choi Wooyoung , Chung Chin Youb , Park Moon Seok , Lee Sanghoon , Lee Kyoung Min 
Published: March 2021

Objectives
Motion preserving surgeries could be unsuccessful because of underestimation of deformities of the foot and knee in ankle osteoarthritis. This study aimed to investigate the concomitant deformities in medial ankle osteoarthritis and the difference between the two types, varus angulation and medial translation.

Methods
A retrospective study was conducted using medical records and radiographic data. Patients with medial ankle osteoarthritis that underwent weight-bearing X ray imaging and radiographic measurements including tibial plafond inclination (TPI), tibiotalar tilt angle (TT), lateral talo-first metatarsal angle, naviculo-cuboid overlap, and mechanical tibiofemoral angle (mTFA) were studied. The patients were categorized into two groups, the varus angulation group (TT ≥4°) and medial translation group (TT <4°). The radiographic measurements were compared between the two groups.

Results
A total of 102 patients (male = 44; female = 58) were included; the mean age was 64.9 years (SD 8.3 years). The varus rotation group (N = 66) showed a significantly smaller lateral talo-first metatarsal angle (p<0.001), naviculo-cuboid overlap (p<0.001), and mTFA (p = 0.019) compared to the medial displacement group (N = 36). The TT showed a significant correlation with lateral talo-first metatarsal angle (r = -0.520, p<0.001), naviculo-cuboid overlap (r = -0.501, p<0.001), and mTFA (r = -0.243, p = 0.014). Lateral talo-first metatarsal angle was found to be the significant factor (p = 0.018) discriminating varus angulation and medial translation types in the binary logistic analysis.

Conclusions
Varus angulation of the ankle was correlated with knee alignment and foot deformity. Radiographic indices were different between the varus angulation and medial translation groups. The role of concomitant deformities needs to be further investigated in terms of a causal relationship. Surgeons need to pay attention to concomitant deformities in the treatment of medial ankle osteoarthritis.
Assessing the likelihood of contracting COVID-19 disease based on a predictive tree model: A retrospective cohort study
Authors: Marin-Gomez Francesc X. , Fàbregas-Escurriola Mireia , Seguí Francesc López , Pérez Eduardo Hermosilla , Camps Mència Benítez , Peña Jacobo Mendioroz , Comellas Anna Ruiz , Vidal-Alaball Josep 
Published: March 2021

Background
Primary care is the major point of access in most health systems in developed countries and therefore for the detection of coronavirus disease 2019 (COVID-19) cases. The quality of its IT systems, together with access to the results of mass screening with Polymerase chain reaction (PCR) tests, makes it possible to analyse the impact of various concurrent factors on the likelihood of contracting the disease.

Methods and findings
Through data mining techniques with the sociodemographic and clinical variables recorded in patient’s medical histories, a decision tree-based logistic regression model has been proposed which analyses the significance of demographic and clinical variables in the probability of having a positive PCR in a sample of 7,314 individuals treated in the Primary Care service of the public health system of Catalonia. The statistical approach to decision tree modelling allows 66.2% of diagnoses of infection by COVID-19 to be classified with a sensitivity of 64.3% and a specificity of 62.5%, with prior contact with a positive case being the primary predictor variable.

Conclusions
The use of a classification tree model may be useful in screening for COVID-19 infection. Contact detection is the most reliable variable for detecting Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases. The model would support that, beyond a symptomatic diagnosis, the best way to detect cases would be to engage in contact tracing.
Enhancement of graphene oxide through β-cyclodextrin composite to sensitive analysis of an antidepressant: Sulpiride
Authors: Urcuk Ayca , Karadurmus Leyla , Bakirhan Nurgul K. , Ozkan Sibel A. 
Published: March 2021

AbstractIn this study, the electrochemical behavior of sulpiride (SUL) was examined deeply by using pyrolytic graphite electrode modified with graphene oxide (GO) and β-cyclodextrin (β-CD). The developed nanosensor indicated considerable impact by significantly increasing the signal of SUL compared with the bare electrode. Cyclic voltammetry (CV), differential pulse voltammetry (DPV), and square wave voltammetry (SWV) methods were utilized to investigate the SUL electrochemical analysis in aqueous solutions. Under optimum experimental conditions, calibration plot for SUL with a limit of detection of 2.83 × 10−9 M was obtained at accumulation time of the 30 s using square wave adsorptive stripping voltammetric technique (AdSSWV) in the range of 1.0 × 10−7to 5.0 × 10−5 M. The effects of accumulation potential, accumulation time, pH, scan rate, electrolyte, and interfering agents were studied to obtain the intensive peak signal of the analyte. The presented method is validated and successfully performed for the determination of the SUL tablet and capsule. The fabricated nanosensor was carried out for the detection of SUL in the urine. Excellent recoveries among 104.37, 103.82, and 101.95% were obtained for tablet and capsule forms and urine analysis.
Vitamin D and new insights into pathophysiology of type 2 diabetes
Authors: Vondra Karel , Hampl Richard 
Published: March 2021

Abstract
Deficiency in vitamin D plays a role in the onset and development of insulin resistance (IR) and type 2 diabetes (T2DM). A normal level of vitamin D is able to reduce low grade inflammation, which is a major process in inducing insulin resistance. It is also engaged in maintaining low resting levels of reactive species and radicals, normal Ca2+ signaling, a low expression of pro-inflammatory cytokines but increased formation of anti-inflammatory cytokines. Vitamin D is also able to prevent hypermethylation (of DNA) and consequent functional inactivation of many genes, as well as other epigenetic alterations in β cells and in other insulin-sensitive peripheral tissues, mainly liver, adipose tissue and muscle. Vitamin D deficiency thus belongs to key factors accelerating the development of IR and consequently T2DM as well. However, vitamin D supplementation aimed at the control of glucose homeostasis in humans showed controversial effects. As a result, further studies are running to gain more detailed data needed for the full clinical utilization of vitamin D supplementation in the prevention and treatment of T2DM. Until new results are published, supplementation with high doses of vitamin D deficiency is not recommended. However, prevention of vitamin D deficiency and its correction are highly desired.
The emerging role of the chondroitin sulfate proteoglycan family in neurodegenerative diseases
Authors: Lin Jia-zhe , Duan Ming-rui , Lin Nuan , Zhao Wei-jiang 
Published: March 2021

Abstract
Chondroitin sulfate (CS) is a kind of linear polysaccharide that is covalently linked to proteins to form proteoglycans. Chondroitin sulfate proteoglycans (CSPGs) consist of a core protein, with one or more CS chains covalently attached. CSPGs are precisely regulated and they exert a variety of physiological functions by binding to adhesion molecules and growth factors. Widely distributed in the nervous system in human body, CSPGs contribute to the major component of extracellular matrix (ECM), where they play an important role in the development and maturation of the nervous system, as well as in the pathophysiological response to damage to the central nervous system (CNS). While there are more than 30 types of CSPGs, this review covers the roles of the most important ones, including versican, aggrecan, neurocan and NG2 in the pathogenesis of neurodegenerative diseases, including Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis and multiple sclerosis. The updated reports of the treatment of neurodegenerative diseases are involving CSPGs.