bluuebunny/crossref_metadata_2025_split huggingface dataset:
PLASMA FIBRINOGEN IS A PROMISING FIRST-LINE SCREENING BIOMARKER FOR THE DIAGNOSIS OF PERIPROSTHETIC JOINT INFECTION AND TIMING OF REIMPLANTATION: A MULTICENTRE RETROSPECTIVE STUDY
Authors: Fang Hang , Cai Daozhang , Huang Lisi , He Qiuying 
Published: November 2023

AimThe diagnosis of periprosthetic joint infection (PJI) remains a clinical dilemma, since presentations of PJI usually greatly overlap with aseptic failure (AF). The aim of this study is to evaluate the values of plasma fibrinogen, individually or in combination with CRP, ESR and WBC, for distinguishing PJI from AF.MethodWe retrospectively enrolled 357 cases who underwent revision hip or knee arthroplasties in the Third Affiliated Hospital of Southern Medical University, Sun Yat-sen Memorial Hospital and the First Affiliated Hospital of Sun Yat-sen University from January 2013 to December 2021, including 197 AF, 116 PJI and 44 reimplantation. The diagnostic capacity of preoperative fibrinogen, CRP, ESR and WBC as well as their combinations for differentiating PJI from AF were assessed by ROC curves. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were calculated according to the optimal cutoff value based on the Youden index. All biomarkers were further investigated for their potential ability to predict optimal timing of reimplantation as well as their diagnostic capacity in the subgroups of the knee and hip PJI. Furthermore, the correlations among fibrinogen, CRP and ESR in the patients with PJI and AF were analyzed to further evaluate the potential capacity of fibrinogen in the diagnosis of PJI.ResultsThe levels of fibrinogen, CRP, ESR and WBC were significantly higher in PJI group than in AF group. ROC analyses showed that the AUCs of fibrinogen, CRP, ESR and WBC were 0.879, 0.903, 0.879 and 0.685, respectively. The optimal threshold of fibrinogen is 4.04 g/L (74.1% sensitivity, 85.6% specificity, 76.1% PPV, 85.0% NPV and 81.8% accuracy). Combining fibrinogen with CRP and/or ESR (AUC: 0.903∼0.914) yielded almost equivalent diagnostic efficiency compared with the combination of CRP and ESR (AUC: 0.910). Besides, fibrinogen yielded AUCs of 0.869 (cutoff: 3.44 g/L) and 0.887 (cutoff: 4.12 g/L) in the hip and knee subgroups, with higher specificity and PPV of 93.1% and 96.1% in the knee PJI. Intriguingly, as for the cases with CRP < 10mg/L and ESR ≧ 30 mm/h, the specificity and NPV of fibrinogen for diagnosing PJI were 92.2% and 83.9%.ConclusionsPlasma fibrinogen is considered as a potential first-line screening marker for PJI detection and timing of reimplantation. As for the patients with an increased ESR but normal CRP, a low fibrinogen level (below 4.04 g/L) is more likely to rule out PJI.
THE PREDICTIVE VALUE AND RELIABILITY OF ULTRASOUND-GUIDED BIOPSIES FOR DIAGNOSING PERIPROSTHETIC SHOULDER INFECTIONS
Authors: Heesterbeek Petra , Pruijn Nathalie , Boks Simone , van Bokhoven Steven , Dorrestijn Oscar , Schreurs Wim , Telgt Denise 
Published: November 2023

AimDiagnosis of periprosthetic shoulder infections (PSI) is difficult as they are mostly caused by low-virulent bacteria and patients do not show typical infection signs, such as elevated blood markers, wound leakage, or red and swollen skin. Ultrasound-guided biopsies for culture may therefore be an alternative for mini-open biopsies as less costly and invasive method. The aim of this study was to determine the diagnostic value and reliability of ultrasound-guided biopsies for cultures alone and in combination polymerase chain reaction (PCR), and/or synovial markers for preoperative diagnosis of PSI in patients undergoing revision shoulder surgery.MethodA prospective explorative diagnostic cohort study was performed including patients undergoing revision shoulder replacement surgery. A shoulder puncture was taken preoperatively before incision to collect synovial fluid for interleukin-6 (IL-6), calprotectin, WBC, polymorphonuclear cells determination. Prior to revision surgery, six ultrasound-guided synovial tissue biopsies were collected for culture and two additional for PCR analysis. Six routine care tissue biopsies were taken during revision surgery and served as reference standard.Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV; primary outcome measure), and accuracy were calculated for ultrasound-guided biopsies, and synovial markers, and combinations of these.ResultsFifty-five patients were included. In 24 patients, routine tissue cultures were positive for infection. Cultures from ultrasound-guided biopsies diagnosed an infection in 7 of these patients, yielding a sensitivity, specificity, PPV, NPV, and accuracy of 29.2%, 93.5%, 77.8%, 63.0%, and 65.6%, respectively.Ultrasound-guided biopsies in combination with synovial WBC increased the NPV to 76.7% and accuracy to 73.8%. When synovial WBC and calprotectin were combined with ultrasound-guided biopsies, it resulted in a better diagnostic value: sensitivity 69.2%, specificity 80.0%, PPV 69.2%, NPV 80.0%, and accuracy 75.8%. Ultrasound-guided biopsies in combination with calprotectin and ESR yielded a sensitivity of 50.0%, specificity of 93.8%, PPV of 80.0%, NPV of 78.9%, and accuracy of 79.2%.Synovial fluid was obtained in 42 patients. Sensitivities of WBC, PMN, IL-6, and calprotectin were between 25.0% and 35.7%, specificities between 89.5% and 95.0%, PPVs between 60.0% and 83.3%, NPVs between 65.4% and 69.4%, and accuracies between 64.5% and 70.6%.ConclusionsIn this prospective study we showed that ultrasound-guided biopsies for cultures alone and in combination with PCR and/or synovial markers are not reliable enough to use in clinical practice for the preoperative diagnosis of low grade PSI.
TO SONICATE OR NOT TO SONICATE?
Authors: Hesselvig Anne Brun , Bjarnsholt Thomas , Jørgensen Ann , Gottlieb Hans 
Published: November 2023

AimTo evaluate whether sonication of implant material and subsequent culturing add clinical relevance to culturing of tissue biopsies for improved antibiotic treatment in treatment of bone and joint infection.MethodA retrospective examination of patients’ charts and microbiological analyses in patients who had explanted material (plates, screws, k-wires and prostheses) send for sonication between December 2020 and April 2022.Results77/143 (54 %) patients had complete agreement between the cultures from tissue biopsies and sonication fluid. 66/143 (46 %) patients had partial or no agreement between the cultures from tissue biopsies and sonication fluid.Of the 66 patients, 31 (47 %) had a culture positive sonication fluid and tissue biopsies that were positive with one or more bacterial isolates. 26/66 (39 %) patients had a culture positive sonication fluid and tissue biopsies that were negative. 9/66 (14 %) patients had negative sonication fluid and positive tissue biopsies.Of the 26 patients with culture positive sonication fluid and culture negative tissue biopsies, virulent bacteria were found in 5 (19 %) patients, making the diagnosis and treatment of infection straight forward. The remaining 21 (81 %) patients had C. acnes, S. epidermidis and CoNS in the sonication fluid, which made the diagnosis less evident but none the less gave the clinician a relevant treatment option.ConclusionIn this study a high concordance was found between cultures from tissue biopsies and sonication fluid. Additionally, in a small group of patients with culture negative tissue biopsy, the culture of sonication fluid was essential to the identification infections agent. This indicates that culture of sonication fluid is an important diagnostic tool in bone and joint infection, especially in the absence of positive tissue cultures.
IMPLANT RETENTION IN A RABBIT MODEL OF DELAYED FRACTURE-RELATED INFECTION: SUCCESSFUL ERADICATION BUT IMPAIRED BONE HEALING COMPARED TO EARLY INFECTION
Authors: Puetzler Jan , Vallejo Alejandro , Gosheger Georg , Schulze Martin , Arens Daniel , Zeiter Stephan , Siverino Claudia , Moriarty Fintan 
Published: November 2023

AimThe time to onset of symptoms after fracture fixation is still commonly used to classify fracture-related infections (FRI). Early infections (<2 weeks) can often be treated with debridement, systemic antibiotics, irrigation, and implant preservation (DAIR). Late infections (>10 weeks) typically require implant removal as mature, antibiotic-tolerant biofilms have formed. However, the recommendations for delayed infections (2–10 weeks) are not clearly defined. Here, infection healing and bone healing in early and delayed FRI is investigated in a rabbit model with a standardized DAIR procedure.MethodStaphylococcus aureus was inoculated into 17 rabbits after plate osteosynthesis in a humerus osteotomy. The infection developed either one week (early group, n=6) or four weeks (delayed group, n=6) before a standardized DAIR procedure and microbiological analysis were performed. Systemic antibiotics were administered for six weeks (two weeks: Nafcillin+Rifampin, four weeks: Levofloxacin+Rifampin). A control group (n=5) also underwent a revision operation (debridement and irrigation) after four weeks, but received no antibiotic treatment. Rabbits were euthanized seven weeks after the revision operation. Bone healing was assessed using a modified radiographic union score for tibial fractures (mRUST). After euthanasia, a quantitative microbiological examination of the entire humerus, adjacent soft tissues, and implants was performed.ResultsAll animals were infected at the time of revision surgery, with the bacterial load in the early group (especially in soft tissues) being greater than in the delayed group and control group. This indicates infiltration of bacteria into areas that are more difficult to reach after four weeks of debridement. The infection was eradicated in all animals in both the early and delayed groups at euthanasia, but not in the control group (CFU median (IQR): 2.1×107 (1.3×107-2.6×107). The osteotomy healed in the early group, while bone healing was significantly impaired in both the delayed group and control group (mRUST median (IQR): early group: 16 (14–16), delayed group: 7.5 (6–10), control: 7 (5.5–9); early vs. delayed: p=0.0411, early vs. control p=0.0065).ConclusionThe maturation of the infection between the first and fourth week does not affect the success of infection eradication in this rabbit FRI model. However, bone healing appears to be impaired with increasing duration of infection.
SEPSIS IN PERIPROSTHETIC JOINT INFECTIONS: EPIDEMIOLOGY, RISK FACTORS, AND OUTCOMES
Authors: Bärtl Susanne , Lovasz David , Li Jing , Alt Volker , Rupp Markus 
Published: November 2023

AimSepsis is a life-threatening complication of periprosthetic joint infections (PJI) that requires early and effective therapy. This study aims to investigate the epidemiology, associated risk factors, and outcome of sepsis in the context of periprosthetic joint infections (PJI).MethodThis single-center retrospective cohort study included patients treated for PJI from 2017 to 2020. Patients were classified based on the criteria of the European Bone and Joint Infection Society. The presence of sepsis was determined using the SOFA score and SIRS criteria. The cohort with PJI and sepsis (sepsis) was compared to patients with PJI without sepsis (non-sepsis). Risk factors considered were patient characteristics, affected joints, surgical therapy, microbiological findings, preexisting medical conditions, clinical symptoms, and symptom duration. Outcome parameters were mortality, length of hospital stay, and length of stay in the intensive care unit.ResultsA total of 109 patients with PJI were identified, of whom 45 patients (41.3%) met the criteria for sepsis. Patients with sepsis had more severe preexisting diseases compared with the non-sepsis cohort (Charlson Comorbidity Index 3.8 vs. 2.8; p≤0.001). An increased odds ratio (OR) for a septic course was found for the comorbidities pneumonia (8.2; p=0.001), myocardial infarction (2.0; p=0.02), atrial fibrillation (3.3; p=0.01), diabetes mellitus (1.2; p=0.04), endocarditis (5.5; p=0.01), and renal disease (2.0; p≤0.001). Infection with Staphylococcus aureus (sepsis 20 vs. non-sepsis 10; p=0.002), Streptococcus dysgalactiae (sepsis 7 vs. non-sepsis 2; p=0.002) and Candida albicans (sepsis 5 vs. non-sepsis 0; p=0.01) were more prevalent in patients with sepsis. In the sepsis cohort, further infectious foci were present in addition to PJI in 57.8% of patients, compared to 18.8% in the non-sepsis cohort. The presence of sepsis was associated with a longer hospital stay (sepsis 68 days vs. non-sepsis 38 days; p=0.001) and longer intensive care unit stay (sepsis 12 days vs. non-sepsis 2 days; p=0.001). In-hospital mortality was ten times higher in the sepsis cohort compared to non-septic patients (sepsis 11/42 vs. non-sepsis 2/64; OR 10.3; p=0.01).ConclusionsIn a relevant proportion of patients, PJI can lead to a septic course of disease associated with increased mortality. Particularly in patients with preexisting diseases, increased attention is required, and comprehensive screening for other foci of infection seems mandatory. In addition to highly virulent pathogens such as staphylococci and streptococci, fungal infections should be considered as causative pathogens in septic patients with PJI.
The incidence and risk factors for abnormal postoperative blood tests following primary total joint replacement
Authors: Orfanos Georgios , Nantha Kumar Nakulan , Redfern Daniel , Burston Ben , Banerjee Robin , Thomas Geraint 
Published: November 2023

AimsWe aim to evaluate the usefulness of postoperative blood tests by investigating the incidence of abnormal results following total joint replacement (TJR), as well as identifying preoperative risk factors for abnormal blood test results postoperatively, especially pertaining to anaemia and acute kidney injury (AKI).MethodsThis is a retrospective cohort study of patients who had elective TJR between January and December 2019 at a tertiary centre. Data gathered included age at time of surgery, sex, BMI, American Society of Anesthesiologists (ASA) grade, preoperative and postoperative laboratory test results, haemoglobin (Hgb), white blood count (WBC), haematocrit (Hct), platelets (Plts), sodium (Na+), potassium (K+), creatinine (Cr), estimated glomerular filtration rate (eGFR), and Ferritin (ug/l). Abnormal blood tests, AKI, electrolyte imbalance, anaemia, transfusion, reoperation, and readmission within one year were reported.ResultsThe study included 2,721 patients with a mean age of 69 years, of whom 1,266 (46.6%) were male. Abnormal postoperative bloods were identified in 444 (16.3%) patients. We identified age (≥ 65 years), female sex, and ASA grade ≥ III as risk factors for developing abnormal postoperative blood tests. Preoperative haemoglobin (≤ 127 g/dl) and packed cell volume (≤ 0.395 l/l) were noted to be significant risk factors for postoperative anaemia, and potassium (≤ 3.7 mmol/l) was noted to be a significant risk factor for AKI.ConclusionThe costs outweigh the benefits of ordering routine postoperative blood tests in TJR patients. Clinicians should risk-stratify their patients and have a lower threshold for ordering blood tests in patients with abnormal preoperative haemoglobin (≤ 127 g/l), blood loss > 300 ml, chronic kidney disease, ASA grade ≥ III, and clinical concern.Cite this article: Bone Jt Open 2023;4(11):899–905.
Causal discourse structures in medical referral materials: a humanistic insight
Authors: Chinaguh Emmanuel C. , Akeredolu-Ale Bolanle I. , Adeosun Kehinde G. , Adejumobi Hannah O. 
Published: November 2023

Humanistic studies on medical causality from language studies have hardly explored how causality is constructed in medical referral materials, which is the research gap this study intends to fill. For data, forty completed National Health Insurance Authority (NHIA) medical referral forms, comprising 842 words and medical signs, were purposively selected from a healthcare provider in Abeokuta, Ogun State, Nigeria, and subjected to discourse analysis with insights from the causal coherence categories of Mann/Thompson’s (1987) Rhetorical Structure Theory.
The paper identified two causal relations/structures – nonvolitional cause and nonvolitional result – in the data. Each structure reveals the primacy of diagnosis among the medical processes of diagnosing, investigating and treating or referring. The diagnosis proposition is primed as the consequence of pathophysiological causation in a diagnostic schema; while in the medical referral process, it is elevated as the causation for a medical referral, for instance for further specialist review and management, in a medical-referral schema. The construal of the semantic parameter of non-volition in the coherence relations is aided by the reality that illness is not intended, except caused by self-harm or suicide. The relations were signalled by four signal types, which are genre, semantic, syntactic, and semiotic; and six specific signals – mapping, lexical overlap, lexical chain, adverbials, semiotic overlap, and lexical-semiotic chain. These are implicit signals that complement the concise presentation of the medical processes. To conclude, this research provides the causal modeling of some medical processes, which highlights the prominence of diagnosis in medical referrals.
Das Leo Baeck Institute New York | Berlin: Eine Spezialsammlung zur deutsch-jüdischen Kultur und Geschichte stellt sich vor
Authors: Evers Renate 
Published: November 2023

Zusammenfassung
Das Leo Baeck Institute – New York | Berlin ist eine Forschungsbibliothek und ein Forschungsarchiv zur Geschichte und Kultur der deutschsprachigen Juden, das 1955 von deutsch-jüdischen Wissenschaftlern und Intellektuellen gegründet wurde. Die umfangreichen Bibliotheks-, Archiv- und Kunstbestände des Instituts stellen eine der bedeutendsten Sammlungen von Primärquellenmaterial und Forschungsliteratur zu den Jahrhunderten jüdischen Lebens in Mitteleuropa vor der Shoah dar.
Small breast epithelial mucin as a useful prognostic marker for breast cancer patients
Authors: Hao Hui , Yang Lin , Wang Bingsheng , Sang Yinzhou , Liu Xueliang 
Published: November 2023

Abstract
This study aimed to evaluate the clinical utility of small breast epithelial mucin (SBEM) as a prognostic biomarker in an independent patient cohort. The paraffin-embedded tissues and clinicopathological data of 105 patients with breast cancer were collected, and the expression of SBEM in breast cancer samples was detected by immunohistochemical staining. The correlations between clinicopathological variables and the expression of SBEM were analyzed, and its significance as a prognostic indicator for breast cancer patients was determined. Immunohistochemical staining revealed that SBEM was expressed mostly in the cytomembrane and cytoplasm, with markedly increased SBEM expression (≥4 points on staining intensity) observed in 34 of 105 breast cancer tissues (32.4%). Elevated expression of SBEM was found to be significantly associated with larger tumor size (P = 0.002), more frequent lymph node metastasis (P = 0.029), advanced tumor node metastasis stage (P = 0.005), reduced expression of the progesterone receptor (PR) (P = 0.002), and a higher Ki-67 index (P = 0.006). Survival analysis indicated that patients with elevated SBEM expression had worse overall survival (OS) (5-year OS rate: 50.5 vs 93.9% for high and low SBEM expression, respectively, P < 0.001) and disease-free survival (DFS) (5-year DFS rate: 52.8 vs 81.7% for high and low SBEM expression, respectively, P = 0.001) rates than those with low expression of SBEM. Univariate and multivariate Cox analyses demonstrated that elevated expression of SBEM (hazard ratio [HR] = 1.994, 95% confidence interval [CI]: 1.008–3.945, P = 0.047), tumor size (HR = 2.318, 95% CI: 1.071–5.017, P = 0.033), and PR status (HR = 0.195, 95% CI: 0.055–0.694, P = 0.012) were independent predictors of OS in breast cancer patients. Elevated expression of SBEM was associated with both aggressive tumor characteristics and poor survival, indicating its potential as a useful prognostic biomarker for breast cancer patients.
Discontinuous Galerkin Two-Grid Method for the Transient Navier–Stokes Equations
Authors: Ray Kallol , Goswami Deepjyoti , Bajpai Saumya 
Published: November 2023

Abstract
In this paper, we apply a two-grid scheme to the DG formulation of the 2D transient Navier–Stokes model.
The two-grid algorithm consists of the following steps: Step 1 involves solving the nonlinear system on a coarse mesh with mesh size 𝐻, and Step 2 involves linearizing the nonlinear system by using the coarse grid solution on a fine mesh of mesh size ℎ and solving the resulting system to produce an approximate solution with desired accuracy.
We establish optimal error estimates of the two-grid DG approximations for the velocity and pressure in energy and

L
2

L^{2}

-norms, respectively, for an appropriate choice of coarse and fine mesh parameters.
We further discretize the two-grid DG model in time, using the backward Euler method, and derive the fully discrete error estimates.
Finally, numerical results are presented to confirm the efficiency of the proposed scheme.
The Human Rights-Based Constitutionalization of Global Environmental Protection: A Framework for Action and Understanding
Authors: Qerimi Qerim 
Published: November 2023

Abstract
The underlying premise of a global constitutional order is dictated by the singular, unitary nature of the environment, a deeply interdependent whole. This premise aside, international environmental law, as we know it today, is far from constituting an international constitutional order. Rather, it presents a broad set of principles and mixed legal and political commitments of states dispersed in a myriad of international instruments possessing varying degrees of formality, legal status, scope of regulation, and effect. Its unparalleled dispersion, organizational and regulatory flexibility, and overall indeterminate features of normative content and procedure are neither improbable nor inconceivable for a relatively new genre of international legal regulation, namely the environment. Simply put, a consolidated international legal order as it ordinarily exists in other arenas is missing in the case of the environment. In shaping its contents and effects, a new institutional ally is found in national and regional judicial bodies, which instead rely on human rights to ground their decisions in pursuit of climate goals and aspirations. The ensuing result is that framing the order that will govern the global environmental change, resort must be made to the models already fashioned by the practice of national and regional systems. Ultimately, this article proposes the principal parameters of a constitutional order for the environment.
Methodological Paradigms in Representing African Law: The Stratigraphic Approach and the Notion of Legal Pluralism
Authors: Pes Luca 
Published: November 2023

Abstract
The contribution deals with the representation of African law in comparative legal literature. It aims at moving forward from an understanding of African legal systems as bounded entities, frequently dubbed “pluralistic” but too often described as derivative from western law, that is the law of the former colonial powers. The paper reacts to common representations of African law based on the “stratigraphic approach” and on the notion of legal pluralism. While remaining a valuable tool for the study of African legal systems in a structuralist fashion, the stratigraphic approach ultimately fails to capture the more dynamic dimension of legal relations and the agency of legal subjects better conveyed by the notion of legal pluralism. The notion of legal pluralism, in turn, points at the existence of plural normative orders in all legal systems, therefore it seems to have lost its specificity to post-colonial African societies. Moreover, research on legal pluralism has become progressively dominated by academic lawyers adopting a normative and theoretical approach with little regard for empirical observation of law in society.