bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chronic kidney disease-related sarcopenia as a prognostic indicator in elderly haemodialysis patients
Authors: Elder Madeleine , Moonen Avalon , Crowther Sjorjina , Aleksova Jasna , Center Jacqueline , Elder Grahame J. 
Published: May 2023

Abstract
Background
The mortality of dialysis patients greatly exceeds that of the general population and identifying predictive factors for mortality may provide opportunities for earlier intervention. This study assessed the influence of sarcopenia on mortality in patients on haemodialysis.

Methods
This prospective, observational study enrolled 77 haemodialysis patients aged 60 years and over, of whom 33 (43%) were female, from two community dialysis centres. Baseline demographic and laboratory data were collected, and sarcopenia was diagnosed using grip strength, muscle mass by bioimpedance analysis (BIA) and muscle function by timed up-and-go according to European Working Group on Sarcopenia in Older People criteria. Nutritional status was assessed using a subjective nutritional assessment score, comprising functional changes in weight, appetite, gastrointestinal symptoms and energy.. A comorbidity score (maximum 7 points) was derived from the presence or absence of hypertension, ischaemic heart disease, vascular disease (cerebrovascular disease, peripheral vascular disease, and abdominal aortic aneurysm), diabetes mellitus, respiratory disease, a history of malignancy and psychiatric disease. Outcomes over six years were linked to the Australian and New Zealand Dialysis and Transplant Registry.

Results
The median participant age was 71 years (range 60–87). Probable and confirmed sarcopenia was present in 55.9% and severe sarcopenia with reduced functional testing in 11.7%. Over 6 years, overall mortality was 50 of the 77 patients (65%), principally from cardiovascular events, dialysis withdrawal and infection. There were no significant survival differences between patients with no, probable, confirmed, or severe sarcopenia, or between tertiles of the nutritional assessment score. After adjustment for age, dialysis vintage, mean arterial pressure (MAP) and the total comorbidity score, no sarcopenia category predicted mortality. However, the total comorbidity score [Hazard Ratio (HR) 1.27, Confidence Intervals (CI) 1.02, 1.58, p = 0.03] and MAP (HR 0.96, CI 0.94, 0.99, P = < 0.01) predicted mortality.

Conclusion
Sarcopenia is highly prevalent in elderly haemodialysis patients but is not an independent predictor of mortality. Haemodialysis patients have multiple competing risks for mortality which, in this study, was predicted by a lower MAP and a higher total comorbidity score.

Trial registration
Recruitment commenced December 2011. The study was registered 10.01.2012 with the Australian New Zealand Clinical Trials Registry (ACTRN12612000048886).
Copper and zinc deficiency to the risk of preterm labor in pregnant women: a case-control study
Authors: Gohari Haniyeh , Khajavian Nasim , Mahmoudian Azamsadat , Bilandi Roghaieh Rahmani 
Published: May 2023

Abstract
Objective
The present study explored the relationship between maternal copper and zinc levels and preterm labor.

Design
The design of the present study was a case-control. Two groups were matched in terms of early-pregnancy body mass index (BMI), pregnancy and childbirth rating, education level, income, and employment status. Blood samples were taken from mothers after meeting the inclusion criteria when admitted to the maternity ward to check copper and zinc serum levels. Demographic and midwifery data were also collected using a questionnaire and patient records. The data were analyzed in SPSS26 using independent-samples T-test, chi-square, Fisher exact test, and regression analysis, and the p < 0.05 was considered statistically significant.

Setting
Bohloul Hospital in Gonabad, Iran.

Participants
The subjects were 86 pregnant women visiting the hospital in two cases (preterm delivery) and control (term delivery) groups.

Results
The mean serum level of zinc in the case group (preterm delivery) (44.97 ± 13.06 µg/dl) was significantly lower than the control group (term) (52.63 ± 21.51 µg/dl), and the mean serum level of copper in the case group (149.82 ± 53.13 µg/dl) was significantly lower than the control group (183.97 ± 71.40 µg/dl).

Conclusion
As the findings showed, copper and zinc serum levels in mothers with preterm delivery were significantly lower than mothers with term delivery, which shows the biological role of these elements in the pathogenesis of preterm delivery.
Estrogen receptor beta expression in triple negative breast cancers is not associated with recurrence or survival
Authors: Takano Elena A. , Younes Melissa M. , Meehan Katie , Spalding Lisa , Yan Max , Allan Prue , Fox Stephen B. , Redfern Andy , Clouston David , Giles Graham G. , Christie Elizabeth L. , Anderson Robin L. , Zethoven Magnus , Phillips Kelly-Anne , Gorringe Kylie , Britt Kara L. 
Published: May 2023

Abstract
Background
Triple negative BCa (TNBC) is defined by a lack of expression of estrogen (ERα), progesterone (PgR) receptors and human epidermal growth factor receptor 2 (HER2) as assessed by protein expression and/or gene amplification. It makes up ~ 15% of all BCa and often has a poor prognosis. TNBC is not treated with endocrine therapies as ERα and PR negative tumors in general do not show benefit. However, a small fraction of the true TNBC tumors do show tamoxifen sensitivity, with those expressing the most common isoform of ERβ1 having the most benefit. Recently, the antibodies commonly used to assess ERβ1 in TNBC have been found to lack specificity, which calls into question available data regarding the proportion of TNBC that express ERβ1 and any relationship to clinical outcome.

Methods
To confirm the true frequency of ERβ1 in TNBC we performed robust ERβ1 immunohistochemistry using the specific antibody CWK-F12 ERβ1 on 156 primary TNBC cancers from patients with a median of 78 months (range 0.2–155 months) follow up.

Results
We found that high expression of ERβ1 was not associated with increased recurrence or survival when assessed as percentage of ERβ1 positive tumor cells or as Allred > 5. In contrast, the non-specific PPG5-10 antibody did show an association with recurrence and survival.

Conclusions
Our data indicate that ERβ1 expression in TNBC tumours does not associate with prognosis.
Multi-vendor evaluation of artificial intelligence as an independent reader for double reading in breast cancer screening on 275,900 mammograms
Authors: Sharma Nisha , Ng Annie Y. , James Jonathan J. , Khara Galvin , Ambrózay Éva , Austin Christopher C. , Forrai Gábor , Fox Georgia , Glocker Ben , Heindl Andreas , Karpati Edit , Rijken Tobias M. , Venkataraman Vignesh , Yearsley Joseph E. , Kecskemethy Peter D. 
Published: May 2023

Abstract
Background
Double reading (DR) in screening mammography increases cancer detection and lowers recall rates, but has sustainability challenges due to workforce shortages. Artificial intelligence (AI) as an independent reader (IR) in DR may provide a cost-effective solution with the potential to improve screening performance. Evidence for AI to generalise across different patient populations, screening programmes and equipment vendors, however, is still lacking.

Methods
This retrospective study simulated DR with AI as an IR, using data representative of real-world deployments (275,900 cases, 177,882 participants) from four mammography equipment vendors, seven screening sites, and two countries. Non-inferiority and superiority were assessed for relevant screening metrics.

Results
DR with AI, compared with human DR, showed at least non-inferior recall rate, cancer detection rate, sensitivity, specificity and positive predictive value (PPV) for each mammography vendor and site, and superior recall rate, specificity, and PPV for some. The simulation indicates that using AI would have increased arbitration rate (3.3% to 12.3%), but could have reduced human workload by 30.0% to 44.8%.

Conclusions
AI has potential as an IR in the DR workflow across different screening programmes, mammography equipment and geographies, substantially reducing human reader workload while maintaining or improving standard of care.

Trial registration
ISRCTN18056078 (20/03/2019; retrospectively registered).
Efficacy of customized corneal crosslinking versus standard corneal crosslinking in patients with progressive keratoconus (C-CROSS study): study protocol for a randomized controlled trial
Authors: Vandevenne Magali M. S. , Berendschot Tos T. J. M. , Winkens Bjorn , van den Biggelaar Frank J. H. M. , Visser Nienke , Dickman Mor M. , Wisse Robert P. L. , Wijdh Robert-Jan H. J. , Roy Abhijit Sinha , Shetty Rohit , Nuijts Rudy M. M. A. 
Published: May 2023

Abstract
Background
Keratoconus is a degenerative disorder of the cornea leading to a protrusion and thinning with loss of visual acuity. The only treatment to halt the progression is corneal crosslinking (CXL), which uses riboflavin and UV-A light to stiffen the cornea. Recent ultra-structural examinations show that the disease is regional and does not affect the entire cornea. Treating only the affected zone with CXL could be as good as the standard CXL, that treats the entire cornea.

Methods
We set up a multicentre non-inferiority randomized controlled clinical trial comparing standard CXL (sCXL) and customized CXL (cCXL). Patients between 16 and 45 years old with progressive keratoconus were included. Progression is based on one or more of the following changes within 12 months: 1 dioptre (D) increase in keratometry (Kmax, K1, K2); or 10% decrease of corneal thickness; or 1 D increase in myopia or refractive astigmatism, requiring corneal crosslinking.

Discussion
The goal of this study is to evaluate whether the effectiveness of cCXL is non-inferior to sCXL in terms of flattening of the cornea and halting keratoconus progression. Treating only the affected zone could be beneficial for minimalizing the risk of damaging surrounding tissues and faster wound healing. Recent non-randomized studies suggest that a customized crosslinking protocol based on the tomography of the patient’s cornea may stop the progression of keratoconus and result in flattening of the cornea.

Trial registration
This study was prospectively registered at ClinicalTrials.gov on August 31st, 2020, the identifier of the study is NCT04532788.
Radial nerve palsy caused by a rapidly growing intramuscular hematoma in an infant with biliary atresia: a case report
Authors: Kawahara Kohei , Ota Koki , Numoto Shingo , Nakamura Nami , Miyamoto Ryosuke , Honma Hitoshi , Morishita Yusuke , Kawanami Katsuhisa , Matsushita Nozomi , Kato Shoko , Kaneko Kenitiro , Okumura Akihisa , Iwayama Hideyuki 
Published: May 2023

Abstract
Background
Biliary atresia (BA) is a rare cause of persistent jaundice in infants that can result in vitamin K malabsorption and vitamin K deficiency bleeding (VKDB). We present an infant with BA who developed a rapidly growing intramuscular hematoma in her upper arm after a vaccination which caused a radial nerve palsy.

Case presentation
An 82-day-old girl was referred to our hospital because of a rapidly growing left upper arm mass. She had received three doses of oral vitamin K before age 1 month. At age 66 days, she received a pneumococcal vaccination in her left upper arm. On presentation, she showed no left wrist or finger extension. Blood examination revealed direct hyperbilirubinemia, liver dysfunction, and coagulation abnormalities, indicating obstructive jaundice. Magnetic resonance imaging showed a hematoma in the left triceps brachii. Abdominal ultrasonography revealed an atrophic gallbladder and the triangular cord sign anterior to the portal vein bifurcation. BA was confirmed on cholangiography. VKDB resulting from BA in conjunction with vaccination in the left upper arm were considered the cause of the hematoma. The hematoma was considered the cause of her radial nerve palsy. Although she underwent Kasai hepatic portoenterostomy at age 82 days, the obstructive jaundice did not sufficiently improve. She then underwent living-related liver transplantation at age 8 months. The wrist drop was still present at age 1 year despite hematoma resolution.

Conclusions
Delayed detection of BA and inadequate prevention of VKDB can result in permanent peripheral neuropathy.
Multi-stakeholder perspectives regarding preferred modalities for mental health intervention delivered in the orthopedic clinic: a qualitative analysis
Authors: Cheng Abby L. , Leo Ashwin J. , Calfee Ryan P. , Dy Christopher J. , Armbrecht Melissa A. , Abraham Joanna 
Published: May 2023

AbstractBackgroundAlthough depressive and anxious symptoms negatively impact musculoskeletal health and orthopedic outcomes, a gap remains in identifying modalities through which mental health intervention can realistically be delivered during orthopedic care. The purpose of this study was to understand orthopedic stakeholders’ perceptions regarding the feasibility, acceptability, and usability of digital, printed, and in-person intervention modalities to address mental health as part of orthopedic care.MethodsThis single-center, qualitative study was conducted within a tertiary care orthopedic department. Semi-structured interviews were conducted between January and May 2022. Two stakeholder groups were interviewed using a purposive sampling approach until thematic saturation was reached. The first group included adult orthopedic patients who presented for management of ≥ 3 months of neck or back pain. The second group included early, mid, and late career orthopedic clinicians and support staff members. Stakeholders’ interview responses were analyzed using deductive and inductive coding approaches followed by thematic analysis. Patients also performed usability testing of one digital and one printed mental health intervention.ResultsPatients included 30 adults out of 85 approached (mean (SD) age 59 [14] years, 21 (70%) women, 12 (40%) non-White). Clinical team stakeholders included 22 orthopedic clinicians and support staff members out of 25 approached (11 (50%) women, 6 (27%) non-White). Clinical team members perceived a digital mental health intervention to be feasible and scalable to implement, and many patients appreciated that the digital modality offered privacy, immediate access to resources, and the ability to engage during non-business hours. However, stakeholders also expressed that a printed mental health resource is still necessary to meet the needs of patients who prefer and/or can only engage with tangible, rather than digital, mental health resources. Many clinical team members expressed skepticism regarding the current feasibility of scalably incorporating in-person support from a mental health specialist into orthopedic care.ConclusionsAlthough digital intervention offers implementation-related advantages over printed and in-person mental health interventions, a subset of often underserved patients will not currently be reached using exclusively digital intervention. Future research should work to identify combinations of effective mental health interventions that provide equitable access for orthopedic patients.Trial registrationNot applicable.
Electronic device and social network use and sleep outcomes among adolescents: the EHDLA study
Authors: Gaya Anelise Reis , Brum Rodolfo , Brites Keith , Gaya Adroaldo , de Borba Schneiders Letícia , Duarte Junior Miguel Angelo , López-Gil José Francisco 
Published: May 2023

Abstract
Background
Considering the evident risk in the literature between the use of screen devices and sleep, there are still few studies on the relationship between each electronic screen device, media programs and sleep duration and sleep-related problems among adolescents and which variables interfere in these relationships. Therefore, this study has the following objectives: (1) to determine which are the most common electronic display devices related to sleep time and outcomes and (2) to determine which are the most common social network applications, such as Instagram and WhatsApp, associated with sleep outcomes.

Methods
This was a cross-sectional study with 1101 Spanish adolescents between 12 and 17 years old. Age, sex, sleep, psychosocial health, adherence to the Mediterranean diet (MD), sport practice, and time spent on screen devices were assessed by an ad hoc questionnaire. Linear regression analyses were applied, adjusting for several covariables. Poisson regression was applied between the sexes. A p value < 0.05 was considered statistically significant.

Results
Cell phone use was more associated with sleep time (13%). In boys, time spent on cell phones (prevalence ratio [PR] = 1.09; p < 0.001) and videogames (PR = 1.08; p = 0.005) had a higher prevalence ratio. When psychosocial health was included in the models, we found the greatest association (Model 2: PR = 1.15; p = 0.007). For girls, time spent on the cell phone was significantly associated with sleep-related problems (PR = 1.12; p < 0.001), and adherence to the MD became the second most important in the model (PR = 1.35; p < 0.001), followed by psychosocial health and cell phone use (PR = 1.24; p = 0.007). Time spent on WhatsApp was associated with sleep-related problems only among girls (PR = 1.31; p = 0.001) and was the most important variable in the model along with MD (PR = 1.26; p = 0.005) and psychosocial health (PR = 1.41; p < 0.001).

Conclusions
Our results suggest a relationship between cell phones, video games, and social networks with sleep-related problems and time.
SARS-CoV-2 incidence among teaching staff in primary and secondary schools—Wales, 2020–2021
Authors: Thomas Ffion , Fedeli André , Steggall Emily , Gonzalez Gonzalez Jose Maria , Salmon Jane , Williams Christopher , Craine Noel 
Published: May 2023

Abstract

Background
During the COVID-19 pandemic, face-to-face delivery of education in schools across Wales was disrupted with repeated school closures to limit risk of infection. Evidence describing the incidence of infection amongst school staff during times when schools were open is limited. A previous research study found infection rates were higher in English primary school settings when compared with secondary. An Italian study suggested teachers weren’t at greater risk of infection in comparison to the general population. The aim of this study was to identify whether educational staff had higher incidence rates than their counterparts in the general population in Wales, and secondly whether incidence rates amongst staff differed between primary and secondary school settings and by teacher age.

Methods
We performed a retrospective observational cohort study using the national case detection and contact tracing system implemented during the COVID pandemic. Age stratified person-day COVID-19 incidence rates amongst teaching staff linked to primary or secondary schools in Wales were calculated for the autumn and summer terms during 2020–2021.

Results
The observed pooled COVID-19 incidence rates for staff across both terms was 23.30 per 100,000 person days (95% CI: 22.31–24.33). By comparison, the rate in the general population aged 19–65, was 21.68 per 100,000 person days (95%: CI 21.53–21.84). Incidence among teaching staff was highest in the two youngest age groups (< 25 years and 25–29 years). When compared to the age matched general population, incidence was higher in the autumn term amongst primary school teachers aged ≤ 39 years, and in the summer term higher only in the primary school teachers aged < 25 years.

Conclusion
The data were consistent with an elevated risk of COVID-19 amongst younger teaching staff in primary schools when compared to the general population, however differences in case ascertainment couldn’t be excluded as a possible reason for this. Rate differences by age group in teaching staff mirrored those in the general population. The risk in older teachers (≥ 50 years) in both settings was the same or lower than in the general population. Amongst all age groups of teachers maintaining the key risk mitigations within periods of COVID transmission remain important.
Social determinants of health in rural Indian women & effects on intervention participation
Authors: Arun Aarthi , Prabhu Manohar Prasad 
Published: May 2023

AbstractThe social determinants of health have become an increasingly crucial public health topic in recent years and refer to the non-medical factors that affect an individual’s health outcomes. Our study focuses on understanding the various social and personal determinants of health that most affect women’s wellbeing. We surveyed 229 rural Indian women through the deployment of trained community healthcare workers to understand their reasons for not participating in a public health intervention aimed to improve their maternal outcomes. We found that the most frequent reasons cited by the women were: lack of husband support (53.2%), lack of family support (27.9%), not having enough time (17.0%), and having a migratory lifestyle (14.8%). We also found association between the determinants: women who had lower education levels, were primigravida, younger, or lived in joint families were more likely to cite a lack of husband or family support. We determined through these results that a lack of social (both spousal and familial) support, time, and stable housing were the most pressing determinants of health preventing the women from maximizing their health outcomes. Future research should focus on possible programs to equalize the negative effects of these social determinants to improve the healthcare access of rural women.