bluuebunny/crossref_metadata_2025_split huggingface dataset:
Orthopaedic Faculty and Resident Sex Diversity Are Associated with the Orthopaedic Residency Application Rate of Female Medical Students
Authors: Okike Kanu , Phillips Donna P. , Swart Eric , O’Connor Mary I. 
Published: June 2019

Background:
The representation of women in orthopaedics in the United States remains among the lowest in all fields of medicine, and prior research has suggested that this underrepresentation may stem from lower levels of interest among female medical students. Of the many proposed reasons for this lack of interest, the male-dominated nature of the field is one of the most commonly cited. The purpose of this study was to determine the degree to which the representation of women among orthopaedic faculty and residents influences female medical students at that institution to apply for a residency in orthopaedics.

Methods:
Using data provided by the Association of American Medical Colleges, we identified all U.S. medical schools that were affiliated with an orthopaedic surgery department and an orthopaedic surgery residency program (n = 107). For each institution, data on the representation of women among the orthopaedic faculty and residents from 2014 through 2016 were collected, as well as data on the proportion of female medical school graduates who applied to an orthopaedic residency program from 2015 through 2017. The association between institutional factors and the female medical student orthopaedic application rate was assessed.

Results:
Of 22,707 women who graduated from medical school during the 3-year study period, 449 (1.98%) applied to an orthopaedic surgery residency program. Women who attended medical school at institutions with high orthopaedic faculty sex diversity were more likely to apply for a residency in orthopaedics (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.04 to 1.64; p = 0.023), as were women who attended medical school at institutions with high orthopaedic resident sex diversity (OR, 1.30; 95% CI, 1.05 to 1.61; p = 0.019).

Conclusions:
In this study, we found that increased sex diversity among orthopaedic faculty and residents was associated with a greater likelihood that female medical students at that institution would apply for an orthopaedic residency. These results suggest that at least some of the factors currently impeding female medical student interest in orthopaedics may be modifiable. These findings may have important implications for efforts to improve the sex diversity of the field of orthopaedics going forward.
Risk Factors for Failure After 1-Stage Exchange Total Knee Arthroplasty in the Management of Periprosthetic Joint Infection
Authors: Citak Mustafa , Friedenstab Jasmin , Abdelaziz Hussein , Suero Eduardo M. , Zahar Akos , Salber Jochen , Gehrke Thorsten 
Published: June 2019

Background:
One-stage exchange arthroplasty in the management of periprosthetic joint infection was introduced at our institution. The purpose of this study was to analyze the risk factors of failure after periprosthetic joint infection following total knee arthroplasty treated with 1-stage exchange.

Methods:
Ninety-one patients who underwent failed treatment following 1-stage exchange total knee arthroplasty due to periprosthetic joint infection from January 2008 to December 2017 were included. From the same period, we randomly selected a 1:1 matched control group without a subsequent revision surgical procedure. Bivariate analyses, including preoperative, intraoperative, and postoperative factors, as well as logistic regression, were performed to identify risk factors for failure.

Results:
Bivariate analysis yielded 10 predictors (variables with significance at p < 0.05) for failure involving re-revision for any reason and 11 predictors for failure involving re-revision for reinfection. The binary logistic regression model revealed the following risk factors for re-revision for any reason: history of a 1-stage exchange for infection (odds ratio [OR], 26.706 [95% confidence interval (CI), 5.770 to 123.606]; p < 0.001), history of a 2-stage exchange (OR, 3.948 [95% CI, 1.869 to 8.339]; p < 0.001), and isolation of enterococci (OR, 16.925 [95% CI, 2.033 to 140.872]; p = 0.009). The risk factors for reinfection in the binary logistic regression analysis were history of 1-stage or 2-stage exchange arthroplasty, isolation of enterococci, and isolation of streptococci (OR, 6.025 [95% CI, 1.470 to 24.701]; p = 0.013).

Conclusions:
We identified several risk factors of failure after 1-stage exchange arthroplasty for periprosthetic joint infection, most of which were not related to the patient comorbidities. Among them, previous exchange due to periprosthetic joint infection and the isolation of Enterococcus or Streptococcus species were associated with a higher risk of failure. Besides a multidisciplinary approach, being aware of the identified risk factors when evaluating patients with periprosthetic joint infection could lead to better outcomes.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
EMTALA (Emergency Medical Treatment and Active Labor Act) Obligations
Authors: Zhou Joanne Y. , Amanatullah Derek F. , Frick Steven L. 
Published: June 2019

Background:
The Emergency Medical Treatment and Active Labor Act (EMTALA) was enacted in 1986 in the United States to address “patient dumping,” or refusing to provide emergency care to patients and instead transferring them to other hospitals. Under EMTALA, the “reverse-dumping” provision prevents hospitals from refusing patients who require specialized capabilities or facilities if the hospital has the capacity to treat them. Despite this provision, patients continue to be transferred to distant tertiary care centers.

Methods:
We reviewed the literature on EMTALA in the context of a critically ill woman with an infection associated with an orthopaedic implant who was rejected from 2 geographically closer tertiary care centers and was ultimately transferred by helicopter ambulance to an academic teaching hospital that was 169 miles away from her home.

Results:
After transfer to our tertiary care, level-I trauma center, the patient spent 61 days in the intensive care unit; she required 9 operative procedures, which totaled 1,520 minutes of operative time. Eighteen medical specialties and 8 ancillary medical consulting teams were involved in her care. She underwent 1,436 laboratory and 83 radiographic studies. The total reimbursement from Medi-Cal (California’s Medicaid program) for her care in our tertiary care center was $463,753; the hospital charges were more than tenfold higher.

Conclusions:
Dumping and reverse dumping continue despite compromise of patient care and the high financial burden of the accepting institutions. This may be due to ineffective monitoring and enforcement, lack of uniformity among the courts, and lack of incentive to receive uninsured or poorly funded patients. Under EMTALA, it is difficult for tertiary care centers to argue lack of specialized capabilities or capacity to accept patients, and neither hospitals nor physicians are compensated for the charges of providing care to uninsured or underinsured patients. Moving forward, efforts to better align financial incentives through cost-sharing between community hospitals and tertiary care centers, increased clinician literacy regarding the provisions of EMTALA, and increased transparency with hospital transfers may help improve EMTALA compliance and patient care.
At a 10-Year Follow-up, Tendon Repair Is Superior to Physiotherapy in the Treatment of Small and Medium-Sized Rotator Cuff Tears
Authors: Moosmayer Stefan , Lund Gerty , Seljom Unni S. , Haldorsen Benjamin , Svege Ida C. , Hennig Toril , Pripp Are H. , Smith Hans-Jørgen 
Published: June 2019

Background:
Tendon repair and physiotherapy are frequently used treatment methods for small and medium-sized rotator cuff tears. In 2 previous publications of the 1 and 5-year results of this study, we reported significant but small between-group differences in favor of tendon repair. Long-term results are needed to assess whether the results in both groups remain stable over time.

Methods:
In this study, 103 patients with a rotator cuff tear not exceeding 3 cm were randomly assigned to primary tendon repair or physiotherapy with optional secondary repair. Blinded follow-up was performed after 6 months and 1, 2, 5, and 10 years. Outcome measures included the Constant score; the self-report section of the American Shoulder and Elbow Surgeons score; the measurement of shoulder pain, motion, and strength; and patient satisfaction. Magnetic resonance imaging (MRI) was performed on surgically treated shoulders after 1 year, and ultrasound was performed on all shoulders after 5 and 10 years. The main analysis was by 1-way analysis of covariance and by intention to treat.

Results:
Ninety-one of 103 patients attended the last follow-up. After 10 years, the results were better for primary tendon repair, by 9.6 points on the Constant score (p = 0.002), 15.7 points on the American Shoulder and Elbow Surgeons score (p < 0.001), 1.8 cm on a 10-cm visual analog scale for pain (p < 0.001), 19.6° for pain-free abduction (p = 0.007), and 14.3° for pain-free flexion (p = 0.01). Fourteen patients had crossed over from physiotherapy to secondary surgery and had an outcome on the Constant score that was 10.0 points inferior compared with that of the primary tendon repair group (p = 0.03).

Conclusions:
At 10 years, the differences in outcome between primary tendon repair and physiotherapy for small and medium-sized rotator cuff tears had increased, with better results for primary tendon repair.

Level of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
The National External Quality Assessment Scheme for Diagnostic Medical Parasitology in the Philippines, 2009–2015
Authors: Galit Sherwin , Tangcalagan Dave , Rapanut Julius Matt , Sadiasa Alexander , Bautista Prince Ninja , Dominguez Kim Joshua , Bañaga Jahra , Roxas Celine Bernice , Navarro Rafael , Bugayong Mark Philip , Luchavez Jennifer , Mondoy Melisa , Sombrero Lydia , Lupisan Socorro 
Published: June 2019

OBJECTIVE The Research Institute for Tropical Medicine (RITM)–National Reference Laboratory (NRL) for Malaria and Other Parasites, mandated by the Department of Health–Philippines (DOH), administers an annual Proficiency Test (PT) in diagnostic medical parasitology to clinical laboratories throughout the Philippines through the National External Quality Assessment Scheme (NEQAS). The PT in Parasitology aims to monitor and evaluate the capability of Philippine laboratories in the identification of blood and intestinal parasites, and the estimation of malaria parasite density in malaria-infected blood films. As of 2018, participation in the NEQAS is an annual requirement by the Department of Health–Health Facilities and Services Regulatory Bureau (DOH-HFSRB) for each clinical laboratory to obtain a license to operate. This report aims to summarize the results of the PT for Parasitology and assess the performance of participating laboratories in malaria and fecal parasite microscopy from 2009 to 2015. METHODOLOGY RITM–NRL oriented clinical laboratories in the NEQAS in 2008. Laboratories submitted their accomplished enrolment forms to RITM–NRL and paid fees to enroll in the PT in 2009 to 2015. Participating laboratories identified the species of malaria in blood films and the parasite/s in formalin-preserved fecal specimens. Estimation of parasite density in malaria blood films was performed as well. RESULTS One thousand five hundred forty laboratories participated in 2009 to 2015. Mean and median scores in all seven years were below the cut-off score of 80. Schistosoma japonicum was the most difficult to identify with only 7.7% of laboratories having correct identification result. Majority of participants in 2010 to 2014 gave malaria parasite density estimates outside the acceptable range. CONCLUSION Microscopy requires skill that is honed through training and refresher courses in order to enhance and maintain the quality of performance of laboratorians in diagnostic parasitology.
Ethylene signaling transcription factor promote grape growth induced by exogenous carbon
Authors: Zhao Xin , Wang Ying , Li Wen-Fang , Li Meng-Fei , Ma Zong-Huan , Dawuda Mujitaba , Zuo Cun-Wu , Chu Ming-Yu , Chen Bai-Hong , Mao Juan 
Published: June 2019

Abstract
Background

The carbon can be converted into sugar which is not only important for plant growth and development, but also for plant signal transduction, especially in plant hormone response. The objective of this work was to build available genomic and proteomic resource to investigate the molecular mechanisms of exogenous carbon regulating plant growth and development.

Results

Grape (Vitis vinifera L. cv. ‘Pinot Noir’) plantlets cultured with exogenous carbon (2% sucrose, 1000 μmol·mol-1 CO2 and with both 2% sucrose and 1000 μmol·mol-1 CO2 were designated as S1, C0 and Cs, respectively). We used S0 (without sucrose, ambient CO2) as CK to analyze the differential expression genes and proteins induced by exogenous carbon. Through the transcriptomic and proteomic analysis, with pooled data for Cs, C0 and S1 compared with CK, 70 differentially expressed genes (DEGs) and 65 differentially expressed proteins (DEPs) were identified. Based on biological functions and physiological characteristics, we identified 8 DEGs and 2 DEPs related to ethylene signaling process. Amongst the DEGs we focussed on ERF TFs, including ERF5 (LOC100244353, LOC100247763, LOC100254616 and LOC100261260), ERF105 (LOC100249507 and LOC100259725), ERF2 (LOC100254640) and CTr (CTr7). Also, there were 2 DEPs related to ethylene metabolism, such as S-adenosylmethionine synthase 5 (SAM synthase 5; XP_002280106.1) and 1-aminocyclopropane-1-carboxylic acid oxidase 2 (ACC oxidase 2; NP_001267871.1) were also identified. The transcriptome and proteome results suggested that exogenous carbon inhibits ethylene biosynthesis through ACC oxidase 2. Additionally, CTr7 and ERF5, which were up-regulated, are related to the ethylene signaling pathway. We speculate that exogenous carbon regulates plant growth through ethylene signaling pathways, but which inhibit ethylene biosynthesis.

Conclusions

Exogenous carbon regulates the expression of ethylene biosynthesis and signaling related genes, which may improve plant growth through the ethylene signaling pathway.
The precursor for nerve growth factor (proNGF) is not a serum or biopsy-rinse biomarker for thyroid cancer diagnosis
Authors: Rowe Christopher W , Faulkner Sam , Paul Jonathan W , Tolosa Jorge M , Gedye Craig , Bendinelli Cino , Wynne Katie , McGrath Shaun , Attia John , Smith Roger , Hondermarck Hubert 
Published: June 2019

Abstract
Background: Nerves and neurotrophic growth factors are emerging promoters of cancer growth. The precursor for Nerve Growth Factor (proNGF) is overexpressed in thyroid cancer, but its potential role as a clinical biomarker has not been reported. Here we have examined the value of proNGF as a serum and biopsy-rinse biomarker for thyroid cancer diagnosis.
Methods: Patients presenting for thyroid surgery or biopsy were enrolled in separate cohorts examining serum (n=204, including 46 cases of thyroid cancer) and biopsy-rinse specimens (n=188, including 26 cases of thyroid cancer). ProNGF levels in clinical samples were analysed by ELISA. Multivariate statistical analyses testing for potential confounders were used to compare proNGF levels with clinicopathological parameters.
Results: ProNGF was not detected in the majority of serum samples 176/204 (86%) and the detection of proNGF was not associated with thyroid cancer diagnosis. In the few cases where proNGF was detected in the serum, thyroidectomy did not affect proNGF concentration, demonstrating that the thyroid was not the source of serum proNGF. Intringuingly, an association between hyperthyroidism and serum proNGF was observed (OR 3.3, 95%CI 1.6-8.7 p=0.02). In biopsy-rinse, proNGF was detected in 73/188 (39%) cases, with no association between proNGF and thyroid cancer. However, a significant positive association between follicular lesions and biopsy-rinse proNGF was found (OR 3.3, 95% CI 1.2-8.7, p=0.02).
Conclusions: ProNGF levels in serum and biopsy-rinse are not increased in thyroid cancer and therefore proNGF is not a clinical biomarker for this condition.
Renal involvement as the first symptom of multiple myeloma
Authors: Du Yongjing , Zhang Ping , Zhong Xiang , Chen Shasha , Li Guisen , Wang Li , Wang Wei 
Published: June 2019

Abstract
Background

Renal involvement is a common complication of multiple myeloma (MM). However, most studies have focused on renal failure in MM, and little information is available about the other renal manifestations in MM and their association with immunophenotypes and renal pathology.

Methods

We retrospectively analyzed the clinical, laboratory and pathology data of 283 MM patients treated in Sichuan Provincial People’s Hospital, West China, between January 1990 and May 2017. The patients were divided into a renal involvement group (n = 200) and a non-renal involvement group (n = 83).

Results

In the renal involvement group, 90 (45.0%) patients were diagnosed with MM in the Nephrology department, and isolated proteinuria, renal failure and nephrotic syndrome were detected in 90(45.0%), 94 (47.0%) and 53 (27.0%) patients, respectively. 135 patients with renal involvement underwent immunofixation electrophoresis, and IgG, IgA, IgD, IgE, pure light chain and nonsecretory MM were detected in 52 (38.5%), 32 (23.7%), 1 (0.7%), 1 (0.7%), 45(33.3%) and 4 (3.0%) patients, respectively. 47 patients without renal involvement also underwent immunofixation electrophoresis, and IgG and IgA MM were found in 24 (51.0%) and 18 (38.3%) patients, respectively. Severe anemia and hypertension, hypercalcemia and pure light chain disease were more frequent in patients with renal involvement (P < 0.05). 9 patients with renal involvement were performed renal biopsy, and cast nephropathy and renal amyloidosis were proved in 5(55.6%) and 4(44.4%) patients, respectively.

Conclusions

Renal involvement was common at MM diagnosis and had diverse clinical manifestations. Nephrologists should rule out MM in patients presenting with renal involvement.
Monitoring of serum TWEAK levels guides glucocorticoid dosages in the treatment of systemic lupus erythematosus
Authors: Chen Jingyun , Wang Huixia , Wu Yi , Wu Xiaokang , Wang Li , Xiao Tong , Tan Fei , Luo Mai , Xiao Shengxiang , Xia Yumin 
Published: June 2019

Abstract
Background

Accurate assessment of systemic lupus erythematosus (SLE) disease activity is critical. Currently existing indices or measures for assessment are either expensive, intricate, or inaccurate. The novel indices with higher sensitivity and specificity have become one of the aims of the investigators. This study was designed to explore the relationship between serum tumor necrosis factor-like weak inducer of apoptosis (TWEAK) and systemic lupus erythematosus disease activity index (SLEDAI) as well as its role in guiding glucocorticoid dosages in the treatment of SLE. Of 59 patients with SLE, 20 patients with subacute cutaneous lupus erythematosus (SCLE), 13 patients with discoid lupus erythematosus (DLE) and 32 healthy volunteers, soluble TWEAK level was determined in both serum and urine. Monomeric C-reactive protein, antinuclear antibody, interleukin 6, complements, erythrocyte sedimentation rate, and white blood cells were measured in serum samples. Moreover, SLEDAI-2K was used for evaluating the disease. Finally, methylprednisolone was administrated orally to SLE patients with the doses depending on serum TWEAK levels.

Results

We found that serum TWEAK levels are higher in patients with SLE (383.0 ± 45.37 ng/ml, p < 0.001 for both) or SCLE (129.1 ± 25.73 ng/ml, p < 0.05 for both) than in patients with DLE (78.38 ± 22.85 ng/ml) or in healthy controls (78.38 ± 22.85 ng/ml). Also, serum TWEAK levels correlate positively with SLEDAI-2K in patients with SLE (r2 = 0.101, p < 0.001), whereas urine TWEAK levels reflect renal damage in patients with lupus nephritis. Moreover, serum TWEAK levels had a higher correlation coefficient with SLEDAI-2K scores compared with the other serum parameters. Furthermore, TWEAK-based glucocorticoid therapy is associated with lower SLEDAI-2K scores and fewer flares in patients with SLE.

Conclusions

Serum TWEAK is a useful biomarker reflecting SLE disease, and monitoring of serum TWEAK levels can improve the outcomes of glucocorticoid therapy for patients with SLE.
Prognostic Value of Pretreatment Inflammatory Biomarkers in Primary Small Cell Carcinoma of the Esophagus
Authors: Wang Nan , Li Xue , Luo Hui , Sun Yanan , Zheng Xiaoli , Fan Chengcheng , Wang Hao , Ye Ke , Ge Hong 
Published: June 2019

Abstract
Background: Growing evidence indicates that several inflammatory biomarkers may predict survival in patients with malignant tumors. The aim of this study is to evaluate the prognostic value of pretreatment biomarkers in patients with primary small-cell carcinoma of the esophagus（PSCCE）.
Methods: There were 73 PSCCE patients enrolled between January 2009 and December 2017 at the Affiliated Cancer Hospital of Zhengzhou University. The total lymphocyte counts (TLC), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) prior to anticancer therapy were collected as inflammation biomarkers. The cut-off value was determined by Receiver operating characteristic (ROC). The Kaplan–Meier method was utilized to analysis overall survival (OS). Cox proportional hazards regression was used to identify univariate and multivariate prognostic factors.
Results: Univariate analysis showed that high NLR group(hazard ratio (HR) ＝1.685; 95% CI: 1.001–2.838; P＝0.047) and high PLR group (hazard ratio (HR) ＝1.716; 95% CI: 1.039–2.834; P＝0.033) were associated with poor OS, and TLC was not correlated with OS. On multivariate analysis, high PLR(hazard ratio (HR) ＝1.751; 95% CI: 1.042–2.945; P＝0.035) was an independent prognostic factor of unfavorable OS.
Conclusions: Pre-treatment PLR and NLR are correlated with OS. These biomarkers are easily accessible, cost effective, and can serve as a marker to identify high-risk patients for further designing personalized treatment and predicting treatment outcomes.