bluuebunny/crossref_metadata_2025_split huggingface dataset:
Osteoporosis and the Nature of Fragility Fracture: An Overview
Authors: van Oostwaard Marsha , Marques Andréa 
Published: November 2023

AbstractOsteoporosis is a common, chronic, systemic skeletal disease that is characterised by low bone mass and deterioration of the microarchitecture of bone tissue, with a consequent increase in bone fragility and risk of fracture. The number of people suffering from osteoporosis and high risk of fractures is increasing globally, probably as a result of global ageing and longer life expectancy.Typically, fractures in patients with osteoporosis occur at the following locations: vertebral (spine), proximal femur (hip), distal forearm (wrist) and proximal humerus (upper arm). Bone loss occurs silently and progressively without signs or symptoms until fractures occur, so patients are often unaware that they may have osteoporosis and are at risk of fractures.Osteoporosis is a devastating condition that can lead to pain, severe disability and premature death from fracture. Nurses, alongside other practitioners, play a key role in the prevention of osteoporosis and fragility fractures and can be envisaged in case finding, risk assessment and management and education after diagnosis. The aim of this chapter is to provide an overview of the link between osteoporosis and fractures and explore the diagnosis and treatment of osteoporosis.
Experimental investigations and numerical modelling: a fruitful interaction for the nonlinear dynamical analysis of masonry structures
Authors: Azzara Riccardo Mario , Girardi Maria , Padovani Cristina , Pellegrini Daniele 
Published: November 2023

AbstractThis paper describes the experiments carried out on a mediaeval masonry tower in the historic centre of Lucca and some finite element numerical simulations of the tower’s experimental response. The Guinigi Tower, one of the most iconic monuments in Lucca, has been continuously monitored by high-sensitivity seismic stations that recorded the structure’s response to the dynamic actions of the surrounding environment. The monitoring campaign results have been analysed to show the effectiveness of dynamic monitoring as a valuable source of information on the structural properties of the tower. The dynamic analyses of the tower and the surrounding palace subjected to some seismic events recorded during the experiments have highlighted the capabilities of experiment-based finite element modelling. The calibration of the finite element model and the numerical analysis have been carried out by resorting to procedures developed at ISTI-CNR and able to consider the nonlinear behaviour of masonry materials.
Targeted LC-MS/MS profiling of bile acids reveals primary/secondary bile acid ratio as a novel biomarker for necrotizing enterocolitis
Authors: Gao Tingting , Hu Shaohua , Xu Weijue , Wang Zhiru , Guo Ting , Chen Feng , Ma Yingxuan , Zhu Linlin , Chen Faling , Wang Xiaomei , Zhou Jin , Lv Zhibao , Lu Li 
Published: November 2023

AbstractBile acids (BAs) are involved in the development of necrotizing enterocolitis (NEC), which mainly occurs in preterm infants. We aim to identify the change of BAs in preterm infants and validate its potential value in the detection of NEC. Targeted liquid chromatography–tandem mass spectrometry (LC-MS/MS) was performed to measure the plasma BAs in healthy preterm infants and patients with NEC. By analyzing the level of BAs in healthy preterm infants, we found that the plasma concentrations of BAs were related to sex, gestational/postnatal age, birth weight, mode of birth, and feeding type after birth. The plasma levels of TCA, GCA, TCDCA, GCDCA, primary BAs, and total BAs and the primary/secondary BA ratio were decreased, while DCA, UDCA, and secondary BAs were increased in NEC. The primary/secondary BA ratio (cutoff point 62.9) can effectively differentiate NEC from healthy preterm infants, with an AUC of 0.9, a sensitivity of 94.5%, and a specificity of 78.1%. Combining the ratio with high-risk factors of NEC can better distinguish between NEC and control, with an AUC of 0.95. Importantly, significantly lower levels of primary/secondary BA ratio were found in infants with surgical NEC than in nonsurgical NEC cases. The cutoff point of 28.7 identified surgical NEC from nonsurgical NEC with sensitivity and specificity of 76.9% and 100%. Thus, our study identified that the primary/secondary BA ratio in the plasma can differentiate NEC from healthy preterm infants and effectively differentiate the surgical NEC from nonsurgical NEC. Therefore, LC-MS/MS was expected to be a novel measurement platform used to distinguish infants who are most in need of close monitoring or early surgical intervention.
The impact of household structure on disease-induced herd immunity
Authors: Ball Frank , Critcher Liam , Neal Peter , Sirl David 
Published: November 2023

AbstractThe disease-induced herd immunity level $$h_D$$

h
D

is the fraction of the population that must be infected by an epidemic to ensure that a new epidemic among the remaining susceptible population is not supercritical. For a homogeneously mixing population $$h_D$$

h
D

equals the classical herd immunity level $$h_C$$

h
C

, which is the fraction of the population that must be vaccinated in advance of an epidemic so that the epidemic is not supercritical. For most forms of heterogeneous mixing $$h_D<h_C$$

h
D

<

h
C

, sometimes dramatically so. For an SEIR (susceptible $$\rightarrow $$
→
exposed $$\rightarrow $$
→
infective $$\rightarrow $$
→
recovered) model of an epidemic among a population that is partitioned into households, in which individuals mix uniformly within households and, in addition, uniformly at a much lower rate in the population at large, we show that $$h_D>h_C$$

h
D

>

h
C

unless variability in the household size distribution is sufficiently large. Thus, introducing household structure into a model typically has the opposite effect on disease-induced herd immunity than most other forms of population heterogeneity. We reach this conclusion by considering an approximation $${\tilde{h}}_D$$

h
~

D

of $$h_D$$

h
D

, supported by numerical studies using real-world household size distributions. For $$n=2, 3$$

n
=
2
,
3

, we prove that $${\tilde{h}}_D>h_C$$

h
~

D

>

h
C

when all households have size n, and conjecture that this inequality holds for any common household size n. We prove results comparing $${\tilde{h}}_D$$

h
~

D

and $$h_C$$

h
C

for epidemics which are highly infectious within households, and also for epidemics which are weakly infectious within households.
Epithelium-on versus epithelium-off corneal collagen crosslinking for keratoconus: a systematic review and meta-analysis
Authors: Borchert Grace A. , Kandel Himal , Watson Stephanie L. 
Published: November 2023

Abstract
Purpose
Corneal collagen crosslinking (CXL) is the primary treatment for progressive keratoconus which has a significant impact on vision and quality of life. Our study aimed to compare the efficacy and safety of epithelium-on versus epithelium-off CXL to treat keratoconus.

Methods
We searched PubMed, Medline, Embase, Web of Science, and Scopus databases. We included studies that compared standard epithelium-off with epithelium-on CXL. The primary outcome measures were changes in corrected distance visual acuity (CDVA) and maximum keratometry (Kmax), and the secondary outcomes were uncorrected distance visual acuity (UDVA), central corneal thickness (CCT), and adverse events. A meta-analysis was performed on the primary and secondary outcomes based on the weighted mean differences between baseline to 12-month follow-up.

Results
The search retrieved 887 publications with 27 included in the systematic review. A total of 1622 eyes (1399 patients; age 25.51 ± 4.02 years) were included in comparisons of epithelium-off to epithelium-on CXL in keratoconus. Epithelium-off CXL treated 800 eyes and epithelium-on CXL for 822 eyes. At 12-month follow-up, CDVA and Kmax showed no significant difference between the epithelium-off and epithelium-on CXL. The secondary outcomes showed that UDVA was better in epithelium-off CXL (− 0.11D, 95% CI − 0.12, − 0.1; p < 0.001) and there was more thinning in CCT in epithelium-off CXL (− 3.23 μm, 95% CI − 4.64, − 1.81; p <0.001).

Conclusion
Epithelium-off and epithelium-on CXL were both effective to treat progressive keratoconus. Further research is needed to compare the long-term outcomes and safety of both CXL protocols for adaptation into clinical practice.
Local fractal dimension of collagen detects increased spatial complexity in fibrosis
Authors: Casey Dylan T. , Lahue Karolyn G. , Mori Vitor , Herrmann Jacob , Hall Joseph K. , Suki Béla , Janssen-Heininger Yvonne M. W. , Bates Jason H. T. 
Published: November 2023

AbstractIncrease of collagen content and reorganization characterizes fibrosis but quantifying the latter remains challenging. Spatially complex structures are often analyzed via the fractal dimension; however, established methods for calculating this quantity either provide a single dimension for an entire object or a spatially distributed dimension that only considers binary images. These neglect valuable information related to collagen density in images of fibrotic tissue. We sought to develop a fractal analysis that can be applied to 3-dimensional (3D) images of fibrotic tissue. A fractal dimension map for each image was calculated by determining a single fractal dimension for a small area surrounding each image pixel, using fiber thickness as the third dimension. We found that this local fractal dimension increased with age and with progression of fibrosis regardless of collagen content. Our new method of distributed 3D fractal analysis can thus distinguish between changes in collagen content and organization induced by fibrosis.
Cleaved caspase-3 is present in the majority of glial cells in the intact rat spinal cord during postnatal life
Authors: Holota R. , Dečmanová V. , Alexovič Matiašová A. , Košuth J. , Slovinská L. , Pačut L. , Tomori Z. , Daxnerová Z. , Ševc J. 
Published: November 2023

AbstractCell death is an essential process that occurs during the development of the central nervous system. Despite the availability of a wide range of commercially produced antibodies against various apoptotic markers, data regarding apoptosis in intact spinal cord during postnatal development and adulthood are mostly missing. We investigated apoptosis in rat spinal cord at different stages of ontogenesis (postnatal days 8, 29, and 90). For this purpose, we applied immunofluorescent detection of two widely used apoptotic markers, cleaved caspase-3 (cC3) and cleaved poly(ADP-ribose) polymerase (cPARP). Surprisingly, we found significant discrepancy between the number of cC3+ cells and PARP+ cells, with a ratio between 500:1 and 5000:1 in rat spinal cord at all postnatal time points. The majority of cC3+ cells were glial cells and did not exhibit an apoptotic phenotype. In contrast with in vivo results, in vitro analysis of primary cell cultures derived from neonatal rat spinal cord and treated with the apoptotic inductor staurosporine revealed a similar onset of occurrence of both cC3 and cPARP in cells subjected to apoptosis. Gene expression analysis of spinal cord revealed elevated expression of the Birc4 (XIAP), Birc2, and Birc5 (Survivin) genes, which are known potent inhibitors of apoptosis. Our data indicate that cC3 is not an exclusive marker of apoptosis, especially in glial cells, owing its possible presence in inhibited forms and/or its participation in other non-apoptotic roles. Therefore, cPARP appears to be a more appropriate marker to detect apoptosis.
Revisiting the development of cerebellar inhibitory interneurons in the light of single-cell genetic analyses
Authors: Schilling Karl 
Published: November 2023

AbstractThe present review aims to provide a short update of our understanding of the inhibitory interneurons of the cerebellum. While these cells constitute but a minority of all cerebellar neurons, their functional significance is increasingly being recognized. For one, inhibitory interneurons of the cerebellar cortex are now known to constitute a clearly more diverse group than their traditional grouping as stellate, basket, and Golgi cells suggests, and this diversity is now substantiated by single-cell genetic data. The past decade or so has also provided important information about interneurons in cerebellar nuclei. Significantly, developmental studies have revealed that the specification and formation of cerebellar inhibitory interneurons fundamentally differ from, say, the cortical interneurons, and define a mode of diversification critically dependent on spatiotemporally patterned external signals. Last, but not least, in the past years, dysfunction of cerebellar inhibitory interneurons could also be linked with clinically defined deficits. I hope that this review, however fragmentary, may stimulate interest and help focus research towards understanding the cerebellum.
Neoadjuvant radiochemotherapy with cisplatin/5-flourouracil or carboplatin/paclitaxel in patients with resectable cancer of the esophagus and the gastroesophageal junction — comparison of postoperative mortality and complications, toxicity, and pathological tumor response
Authors: Lorenz Eric , Weitz Anna , Reinstaller Therese , Hass Peter , Croner Roland S. , Benedix Frank 
Published: November 2023

Abstract
Purpose
In 2012, the CROSS trial implemented a new neoadjuvant radiochemotherapy protocol for patients with locally advanced, resectable cancer of the esophagus prior to scheduled surgery. There are only limited studies comparing the CROSS protocol with a PF-based (cisplatin/5-fluorouracil) nRCT protocol.

Methods
In this retrospective, monocentric analysis, 134 patients suffering from esophageal cancer were included. Those patients received either PF-based nRCT (PF group) or nRCT according to the CROSS protocol (CROSS group) prior to elective en bloc esophagectomy. Perioperative mortality and morbidity, nRCT-related toxicity, and complete pathological regression were compared between both groups. Logistic regression analysis was performed in order to identify independent factors for pathological complete response (pCR).

Results
Thirty-day/hospital mortality showed no significant differences between both groups. Postoperative complications ≥ grade 3 according to Clavien-Dindo classification were experienced in 58.8% (PF group) and 47.6% (CROSS group) (p = 0.2) respectively. nRCT-associated toxicity ≥ grade 3 was 30.8% (PF group) and 37.2% (CROSS group) (p = 0.6). There was no significant difference regarding the pCR rate between both groups (23.5% vs. 30.5%; p = 0.6). In multivariate analysis, SCC (OR 7.7; p < 0.01) and an initial grading of G1/G2 (OR 2.8; p = 0.03) were shown to be independent risk factors for higher rates of pCR.

Conclusion
We conclude that both nRCT protocols are effective and safe. There were no significant differences regarding toxicity, pathological tumor response, and postoperative morbidity and mortality between both groups. Squamous cell carcinoma (SCC) and favorable preoperative tumor grading (G1 and G2) are independent predictors for higher pCR rate in multivariate analysis.
Prognostic value of HPV-PCR, p16 and p53 immunohistochemical status on local recurrence rate and survival in patients with vulvar squamous cell carcinoma
Authors: Pouwer A. W. , te Grootenhuis N. C. , Hinten F. , de Bock G. H. , van der Zee A. G. J. , Melchers W. J. G. , Oonk M. H. M. , de Hullu J. A. , Hollema H. , Bulten J. 
Published: November 2023

AbstractThe primary aim of this study was to assess the association between human papilloma virus (HPV) and p53 expression and local recurrence (LR), disease specific survival (DSS), and overall survival (OS) in patients with vulvar squamous cell carcinoma (VSCC). Secondary, the accuracy of p16 immunohistochemistry for HPV status was assessed. The tumor tissue of 255 patients, surgically treated for primary unifocal VSCC between 2000 and 2010, was analyzed. HPV-PCR and P16 and p53 immunohistochemical stainings were performed. All histologic slides were independently reviewed by two expert gyneco-pathologists. Time to first LR, DSS, and OS for the variables p16, p53, and HPV-PCR were compared using univariable and multivariable Cox-regression analyses. In 211/255 (83.5%) patients, HPV-PCR was negative. The local recurrence rate was significantly lower in patients positive with HPV-PCR (10-year LR rate 24.6%) versus negative tumors (47.5%), p = 0.004. After multivariable analyses, this difference remained significant (HR 0.23 (95% CI 0.08–0.62) p = 0.004). There was no difference in LR rate correlated to the p53 expression. DSS and OS did not significantly differ after multivariable analyses for all different subgroups. Sensitivity and specificity of p16 staining for presence of HPV detected by HPV-PCR were 86.4% and 93.8%, respectively. In conclusion, patients with HPV-negative VSCCs have significantly more LR compared to patients with HPV-positive VSCCs, and p16 immunohistochemistry is a reliable surrogate marker for HPV status. No relevant subgroup for LR or survival based on HPV/p53 status could be identified. We advise to perform an HPV-PCR or p16 IHC staining in all patients with VSCC.
Implementation feasibility of animal-assisted therapy in a pediatric intensive care unit: effectiveness on reduction of pain, fear, and anxiety
Authors: López-Fernández Eduardo , Palacios-Cuesta Alba , Rodríguez-Martínez Alicia , Olmedilla-Jodar Marta , Fernández-Andrade Rocío , Mediavilla-Fernández Raquel , Sánchez-Díaz Juan Ignacio , Máximo-Bocanegra Nuria 
Published: November 2023

Abstract
Animal-assisted therapies are an innovative strategy within health care humanization initiatives, and they could play a role in the reduction of pain or anxiety. The main objective of this work was to evaluate the feasibility of implementing animal-assisted therapy in a pediatric intensive care unit and its effectiveness for the reduction of pain, fear, and anxiety. A prospective, quasi-experimental study of animal-assisted therapy was designed in the pediatric intensive care unit of the Hospital Universitario 12 de Octubre of Madrid, from January 2019 to December 2019. The study sample included patients who had been admitted to the unit and were over 3 years old. Satisfaction surveys were collected from the patients, family, and health personnel involved. Physiological variables and the level of pain (visual analog scale or Wong-Baker scale), fear (Child Medical Fear Scale), and anxiety (modified Yale Preoperatory Anxiety Scale) were evaluated before and after each session. Any existence of adverse events was recorded. A total of 74 therapy sessions were performed on 61 patients. All sessions were completed without any adverse effects. A total of 164 surveys were collected, providing an overall project rating of 9.69 out of a possible 10. The survey comments were found to be positive in most cases. No differences were found in the physiological variables measured before and after each session. There was a statistically significant decrease in pain, fear, and anxiety levels (p < 0.01).
Conclusion: The implementation of an animal-assisted therapy project in a pediatric intensive care unit is feasible and safe and has a high degree of acceptance among both participants and healthcare staff. Animal-assisted therapy is effective for the reduction of pain, fear, and anxiety, and therefore, it could be considered an adjunct to non-pharmacological therapy.

What is Known:• Animal assisted therapies (AAT) are an innovative strategy that could be beneficial to help pediatrics patients cope with admission difficulties and could even play a role in reducing pain, anxiety and/or delirium.• To date there are not studies to analyze the effectiveness of AAT in the field of Pediatric Intesive Care.

What is New:• Our study confirms the feasibility and effectiveness of the implementation of an AAT in the field of Pediatric Intensive Care with a high degree of acceptance by participants, caregivers and healthcare personnel.• AAT demonstrated a reduction in pain, fear and anxiety in pediatrics patients admitted to Pediatric Intensive Care Unit.
Detection and quantification of preferential flow using artificial rainfall with multiple experimental approaches
Authors: Caputo Maria C. , De Carlo Lorenzo , Masciale Rita , Perkins Kim , Turturro Antonietta C. , Nimmo John R. 
Published: November 2023

AbstractPreferential flow in the unsaturated zone strongly influences important hydrologic processes, such as infiltration, contaminant transport, and aquifer recharge. Because it entails various combinations of physical processes arising from the interactions of water, air, and solid particles in a porous medium, preferential flow is highly complex. Major research is needed to improve the ability to understand, quantify, model, and predict preferential flow. Toward a solution, a combination of diverse experimental measurements at multiple scales, from laboratory scale to mesoscale, has been implemented to detect and quantify preferential paths in carbonate and karstic unsaturated zones. This involves integration of information from (1) core samples, by means of mercury intrusion porosimeter, evaporation, quasi-steady centrifuge and dewpoint potentiometer laboratory methods, to investigate the effect of pore-size distribution on hydraulic characteristics and the potential activation of preferential flow, (2) field plot experiments with artificial sprinkling, to visualize preferential pathways related to secondary porosity, through use of geophysical measurements, and (3) mesoscale evaluation of field data through episodic master recession modeling of episodic recharge. This study demonstrates that preferential flow processes operate from core scale to two different field scales and impact on the qualitative and quantitative groundwater status, by entailing fast flow with subsequent effects on recharge rate and contaminant mobilizing. The presented results represent a rare example of preferential flow detection and numerical modeling by reducing underestimation of the recharge and contamination risks.
Variability in the distance between the suprascapular notch with the spine of the scapulae and the acromion
Authors: Filkin Jesse , Massy-Westropp Nicola , Wechalekar Harsha 
Published: November 2023

Abstract
Introduction
The suprascapular notch lies in the superior border of the scapula and is a passageway for the suprascapular nerve that is sensory to the shoulder joint. Suprascapular nerve block involves injection of local anaesthetic into the suprascapular notch, either ultrasound guided or blind, using the spine of scapula and/or the medial border of the acromion as surface landmarks.

Aim
To investigate the anatomic variations that exist between the distance of the notch from the spine of scapula and acromion.

Method
Ninety-two dry scapulae were measured with a digital calliper for their length of the spine, distance between the midpoint of the spine and base of the suprascapular notch and distance between the medial border of the acromion and the base of the suprascapular notch. These measurements were compared for variations in the scapular bony landmarks, the spine and the acromion to determine the site for the injection.

Results
Measurement reliability was assessed by intraclass correlation, Cronbach’s alpha being 0.99, 0.97 and 0.91 for length of spine, distance from spine and distance from acromion respectively. The distance from the acromion had less variation in measurement (3.73 ± 0.42 cm) but a flatter distribution when compared to distance from the spine of the scapula (3.32 ± 0.39 cm).

Conclusion
Length of the spine of the scapula appeared not to influence either distance from the acromion or distance from the spine of scapula. There is potential for greater variability in placement of nerve blocks that use acromion as the bony reference.

Key Points• Dry scapular measurement using electronic Vernier callipers is accurate (0.91–0.97).• There is potential for greater variability in placement of blind nerve blocks that use acromion as the bony reference to locate the suprascapular notch.