bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk factors and protective factors for nonsuicidal self-injury in adolescents: A hospital- and school-based case–control study
Authors: Geng Shuo , Wang Lin , Sun Jinping , Xu Mingdong , Zhang Li , Yi Zhi , Ji Jun , Zhang Xu 
Published: April 2023

Objective Nonsuicidal Self-Injury (NSSI) in China has increasingly interested clinicians, although few studies have investigated its risk and protective factors. This study examined the risk factors of NSSI among Chinese adolescents. Methods The researchers recruited adolescent participants with NSSI from a hospital outpatient clinic to form a case group and recruited adolescents without NSSI who provided informed consent from the school to form a control group. Participants completed a questionnaire, and data were analyzed using logistic regression. Results A total of 138 cases and 276 controls participated in this study. Binary multivariate logistic regression analysis with adjusting for age and sex showed that domestic violence (OR = 8.615, 95%CI: 3.081–24.091), parental overconcern (OR = 6.995, 95%CI: 3.447–14.192), guilt (OR = 4.949, 95%CI: 2.227–10.996), and school bullying (OR = 21.676, 95%CI: 6.799–69.109) increased the risk of NSSI, while peer support (OR = 0.068, 95%CI: 0.030–0.150) and living in an urban environment (OR = 0.157, 95%CI: 0.056–0.437) decreased the risk of NSSI. Conclusion Some psychosocial factors were confirmed to be independent risk and protective factors for NSSI in this study. However, the clinical significance of the results needs to be interpreted with caution due to sample size limitations.
New Artificial Intelligence-Integrated Electromyography-Driven Robot Hand for Upper Extremity Rehabilitation of Patients With Stroke: A Randomized, Controlled Trial
Authors: Murakami Yuhei , Honaga Kaoru , Kono Hidemi , Haruyama Koshiro , Yamaguchi Tomofumi , Tani Mami , Isayama Reina , Takakura Tomokazu , Tanuma Akira , Hatori Kozo , Wada Futoshi , Fujiwara Toshiyuki 
Published: April 2023

Background An artificial intelligence (AI)-integrated electromyography (EMG)-driven robot hand was devised for upper extremity (UE) rehabilitation. This robot detects patients’ intentions to perform finger extension and flexion based on the EMG activities of 3 forearm muscles. Objective This study aimed to assess the effect of this robot in patients with chronic stroke. Methods This was a single-blinded, randomized, controlled trial with a 4-week follow-up period. Twenty patients were assigned to the active (n = 11) and control (n = 9) groups. Patients in the active group received 40 minutes of active finger training with this robot twice a week for 4 weeks. Patients in the control group received passive finger training with the same robot. The Fugl-Meyer assessment of UE motor function (FMA), motor activity log-14 amount of use score (MAL-14 AOU), modified Ashworth scale (MAS), H reflex, and reciprocal inhibition were assessed before, post, and post-4 weeks (post-4w) of intervention. Results FMA was significantly improved at both post ( P = .011) and post-4w ( P = .021) in the active group. The control group did not show significant improvement in FMA at the post. MAL-14 AOU was improved at the post in the active group ( P = .03). In the active group, there were significant improvements in wrist MAS at post ( P = .024) and post-4w ( P = .026). Conclusions The AI-integrated EMG-driven robot improved UE motor function and spasticity, which persisted for 4 weeks. This robot hand might be useful for UE rehabilitation of patients with stroke. Clinical Trial Registry Name: The effect of robotic rehabilitation using XMM-HR2 for the paretic upper extremity among hemiparetic patients with stroke. Clinical Trial Registration-URL: https://jrct.niph.go.jp/ Unique Identifier: jRCTs032200045.
Aortoiliac occlusive disease – a novel classification system based on anatomical segments and disease severity for management planning
Authors: Ogunsanya Ngozi Lola , Milner Ross , Delaney Chris L , Puckridge Phillip 
Published: April 2023

Aims The aim of this classification system is to provide vascular surgeons with a simple tool that categorises disease severity by anatomical segment in aortoiliac occlusive disease and thus guide decision making and management strategies. Disease of the common femoral arteries is included as the distal extent of disease with respect to access for both open and endovascular intervention is essential to management planning. Methods The classification system designates diseased segment letters and numbers to guide treatment planning. The degree of disease other than stenotic or occluded is not required. In a similar manner to the TNM classification, anatomy and disease severity – based on angiography, CTA, and MRA – are categorised using a simple, user-friendly method. Two clinical cases are presented to exemplify the clinical application of this classification system. Results A simple and useful classification system is presented and ease of use exemplified by two clinical cases. Conclusions Management strategies for peripheral artery disease in general, aortoiliac occlusive disease specifically, have evolved rapidly in recent years. Existing classification systems, such as TASC II, steer the clinician towards specific treatment approaches. However, the first step in the management decision-making process is the accurate identification of the arterial segments that require treatment. None of the existing classification systems specifically address anatomy as an entity in itself. This classification system provides an intuitive framework, based on letters and numbers, that provides specific information on arterial segments and disease severity in aortoiliac occlusive disease on which clinicians can base management decisions. It has been developed to bolster this aspect of the vascular surgery armamentarium; to be used as a decision making and management planning tool, in partnership with, not instead of, existing classification systems.
Affiliate stigma and related factors among parents of autism spectrum condition: A pilot study from mainland China
Authors: Ma Yu , Lee Liz Yuanxi , Zhang Xuemin 
Published: April 2023

Background Autistic individuals show differences in social and behavioral performances. Autism-related stigma affects autistic children as well as their caregivers (e.g., parents). Research has shown that stigmatizing reactions from others toward caregivers of autistic children are common and that these caregivers suffer from affiliate stigma. Aims To examine the level of affiliate stigma among parents of autistic children and its predictive factors in mainland China. Methods This was a cross-sectional study involving parents of autistic children from mainland China. The sample consisted of 183 parents (mean age  =  36.5 years). The measures assessed included demographic characteristics, and parents completed two questionnaires. The Social Responsiveness Scale (SRS) was used to evaluate the characteristics of children by their parent's subjective assessments, and the Affiliate Stigma Scale (ASS) was used to investigate the affiliate stigma level of parents. Results The affiliate stigma levels of parents of autistic children were high, and the mean score of the affect subscale was higher than those of the other subscales. The mean ASS score differed significantly between employed and unemployed parents, those aged under 40 and over 40, and high- and low-income parents. The hierarchical regression analysis showed that parents’ age, monthly household income, and mean SRS score were significant predictors of the mean ASS score. The results indicated that parents of autistic children and their children need more social support and inclusion in mainland China. Conclusion The present study confirms the importance of studying primary caregivers (i.e., parents) in the context of traditional mainland Chinese culture. Although preliminarily, findings showed that the affiliate stigma levels of parents are high in mainland China, probably due to the influence of traditional cultural values. Moreover, considering the importance of autistic child characteristics, our results suggest that we should increase public knowledge of autism, enrich the general understanding of autism, and reduce the autism-related stigma of parents in mainland Chinese societies.
Distal Biceps Tendon Repair Using a Single Incision, Dual Anchor Technique
Authors: Jurgensmeier Kevin , Lamba Abhinav , Camp Christopher 
Published: April 2023

Background: Distal biceps tendon ruptures commonly present in the middle-aged population resulting in deficits of strength and endurance. Operative management has shown improved functional outcome; however, there is not a clear consensus on an ideal surgical method. Indications: Distal biceps tendon repair is indicated for patients with clinical evidence and supporting magnetic resonance imaging confirmation of complete or partial rupture of the biceps tendon. Ideally, surgery is performed within 1 to 2 weeks of the injury to minimize the amount of scar tissue that is formed and the severity of the tendon retraction. Technique Description: A single incision is created on the volar surface of the forearm approximately 15 mm distal to the main flexor crease. After dissection to and retrieval of the biceps tendon, a #2 FiberTag stitch is placed distally and secured in a standard looped, locking fashion. An anchor is then placed in the most proximal aspect of the radial tuberosity and preliminarily placed around the tendon. An all-suture intramedullary cortical button is then placed in the distal aspect of the radial tuberosity. The FiberTag sutures are then shuttled through the button and tightened to anatomically reduce the distal biceps. The sutures on the proximal anchor are then used as supplemental fixation. Results: An anterior, single incision technique provides exposure necessary for dual anchor fixation and anatomic restoration of the distal biceps tendon. Utilizing this approach, patients are found to have improved flexion and pronation at 1 year, lower rates of heterotopic ossification, and lower rates of reoperation. Conclusion: Distal biceps tendon repair through an anterior, single incision provides excellent exposure for surgical repair. Utilizing a dual anchor technique, the distal button allows for anatomic fixation while the proximal suture anchor provides secondary fixation and increases the bone-tendon interface. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Oxygen in interstitial lung diseases
Authors: Cordeiro Ricardo , Nunes André , Smith Oliver , Renzoni Elisabetta A. 
Published: April 2023

Domiciliary oxygen is essential in the care of hypoxaemic interstitial lung disease (ILD) patients. Guidelines concur in advising prescription of long-term oxygen therapy (LTOT) for ILD patients with severe hypoxaemia at rest, in view of its beneficial impact on breathlessness/disability and extrapolating potential survival benefits seen in COPD patients. A less severe hypoxaemia threshold for initiation of LTOT is recommended for patients with pulmonary hypertension (PH)/right heart failure, requiring careful evaluation in all ILD patients. In light of evidence suggesting a link between nocturnal hypoxaemia, development of PH and poor survival, studies assessing the impact of nocturnal oxygen are urgently needed.Severe exertional hypoxaemia is frequent in ILD patients, with impact on exercise tolerance, quality of life and mortality. Ambulatory oxygen therapy (AOT) has been associated with improvement in breathlessness and quality of life in ILD patients with exertional hypoxaemia. However, given the paucity of evidence, not all current AOT guidelines are in agreement. Ongoing clinical trials will provide further useful data. Despite its beneficial effects, supplemental oxygen imposes burdens and challenges to patients. A key unmet area of need is the development of less cumbersome and more efficient oxygen delivery systems to reduce the negative impact of AOT on patients' lives.
Experimental Investigation of Material Removal in Elliptical Vibration Cutting of Cortical Bone
Authors: Bai Wei , Zhai Yuhao , Zhao Jiaqi , Han Guangchao , Ye Linzheng , Zhu Xijing , Shu Liming , Wang Dong 
Published: April 2023

AbstractTo benefit tissue removal and postoperative rehabilitation, increased efficiency and accuracy and reduced operating force are strongly required in the osteotomy. A novel elliptical vibration cutting (EVC) has been introduced for bone cutting compared with conventional cutting (CC) in this paper. With the assistance of high-speed microscope imaging and the dynamometer, the material removals of cortical bone and their cutting forces from two cutting regimes were recorded and analysed comprehensively, which clearly demonstrated the chip morphology improvement and the average cutting force reduction in the EVC process. It also revealed that the elliptical vibration of the cutting tool could promote fracture propagation along the shear direction. These new findings will be of important theoretical and practical values to apply the innovative EVC process to the surgical procedures of the osteotomy.
Genetic diversity analysis in wheat cultivars using SCoT and ISSR markers, chloroplast DNA barcoding and grain SEM
Authors: Abouseada Heba H. , Mohamed Al-Safa H. , Teleb Samir S. , Badr Abdelfattah , Tantawy Mohamed E. , Ibrahim Shafik D. , Ellmouni Faten Y. , Ibrahim Mohamed 
Published: April 2023

Abstract
Background
Wheat is a major cereal that can narrow the gap between the increasing human population and food production. In this connection, assessing genetic diversity and conserving wheat genetic resources for future exploitation is very important for breeding new cultivars that may withstand the expected climate change. The current study evaluates the genetic diversity in selected wheat cultivars using ISSR and SCoT markers, the rbcL and matK chloroplast DNA barcoding, and grain surface sculpture characteristics. We anticipate that these objectives may prioritize using the selected cultivars to improve wheat production. The selected collection of cultivars may lead to the identification of cultivars adapted to a broad spectrum of climatic environments.

Results
Multivariate clustering analyses of the ISSR and SCoT DNA fingerprinting polymorphism grouped three Egyptian cultivars with cultivar El-Nielain from Sudan, cultivar Aguilal from Morocco, and cultivar Attila from Mexico. In the other group, cultivar Cook from Australia and cultivar Chinese-166 were differentiated from four other cultivars: cultivar Cham-10 from Syria, cultivar Seri-82 from Mexico, cultivar Inqalab-91 from Pakistan, and cultivar Sonalika from India. In the PCA analysis, the Egyptian cultivars were distinct from the other studied cultivars. The rbcL and matK sequence variation analysis indicated similarities between Egyptian cultivars and cultivar Cham-10 from Syria and cultivar Inqalab-91 from Pakistan, whereas cultivar Attila from Mexico was distinguished from all other cultivars. Combining the data of ISSR and SCoT with the rbcL and matK results retained the close resemblance among the two Egyptian cultivars EGY1: Gemmeiza-9 and EGY3: Sakha-93, and the Moroccan cultivar Aguilal, and the Sudanese cultivar El-Nielain and between Seri-82, Inqalab-91, and Sonalika cultivars. The analysis of all data distinguished cultivar Cham-10 from Syria from all other cultivars, and the analysis of grain traits indicated a close resemblance between cv. Cham-10 from and the two Egyptian cultivars Gemmeiza-9 and Sakha-93.

Conclusions
The analysis of rbcL and matK chloroplast DNA barcoding agrees with the ISSR and the SCoT markers in supporting the close resemblance between the Egyptian cultivars, particularly Gemmeiza-9 and Sakha-93. The ISSR and SCoT data analyses significantly expressed high differentiation levels among the examined cultivars. Cultivars with closer resemblance may be recommended for breeding new wheat cultivars adapted to various climatic environments.
Impact of externally facilitated continuous quality improvement cohorts on Advanced Access to support primary healthcare teams: protocol for a quasi-randomized cluster trial
Authors: Breton Mylaine , Gaboury Isabelle , Martin Elisabeth , Green Michael E. , Kiran Tara , Laberge Maude , Kaczorowski Janusz , Ivers Noah , Deville-Stoetzel Nadia , Bordeleau Francois , Beaulieu Christine , Descoteaux Sarah 
Published: April 2023

Abstract
Background
Improving access to primary health care is among top priorities for many countries. Advanced Access (AA) is one of the most recommended models to improve timely access to care. Over the past 15 years, the AA model has been implemented in Canada, but the implementation of AA varies substantially among providers and clinics. Continuous quality improvement (CQI) approaches can be used to promote organizational change like AA implementation. While CQI fosters the adoption of evidence-based practices, knowledge gaps remain, about the mechanisms by which QI happens and the sustainability of the results. The general aim of the study is to analyse the implementation and effects of CQI cohorts on AA for primary care clinics. Specific objectives are: 1) Analyse the process of implementing CQI cohorts to support PHC clinics in their improvement of AA. 2) Document and compare structural organisational changes and processes of care with respect to AA within study groups (intervention and control). 3) Assess the effectiveness of CQI cohorts on AA outcomes. 4) Appreciate the sustainability of the intervention for AA processes, organisational changes and outcomes.

Methods
Cluster-controlled trial allowing for a comprehensive and rigorous evaluation of the proposed intervention 48 multidisciplinary primary care clinics will be recruited to participate. 24 Clinics from the intervention regions will receive the CQI intervention for 18 months including three activities carried out iteratively until the clinic’s improvement objectives are achieved: 1) reflective sessions and problem priorisation; 2) plan-do-study-act cycles; and 3) group mentoring. Clinics located in the control regions will receive an audit-feedback report on access. Complementary qualitative and quantitative data reflecting the quintuple aim will be collected over a period of 36 months.

Results
This research will contribute to filling the gap in the generalizability of CQI interventions and accelerate the spread of effective AA improvement strategies while strengthening local QI culture within clinics. This research will have a direct impact on patients’ experiences of care.

Conclusion
This mixed-method approach offers a unique opportunity to contribute to the scientific literature on large-scale CQI cohorts to improve AA in primary care teams and to better understand the processes of CQI.

Trial registration
Clinical Trials: NCT05715151.
Impact of a postpartum care rehabilitation program to prevent postpartum depression at a secondary municipal hospital in Qingdao China: a cross-sectional study
Authors: Zhang Xiaoqian , Zuo Xiaoli , Matheï Catharina , Aertgeerts Bert , Afnan Masoud , Li Tang , Buntinx Frank , Vermandere Mieke 
Published: April 2023

AbstractBackgroundThe emerging postpartum rehabilitation (PPR) program in Chinese hospitals characterized by applying ongoing medical care through traditional cultural practices shows a protective effect in early puerperium in China. This study explores the benefit of PPR program practices to postpartum depression (PPD) and the influencing factors for PPD among Chinese women during the first postnatal six weeks.MethodsThe cross-sectional study included 403 participants and was conducted in a Secondary Municipal Hospital in Qingdao, China, from 01 to 2018 to 31 December 2021. Information on this PPR program was collected during the six-weeks postpartum consultation, including the Edinburgh postnatal depression scale (EPDS) scores, the measurement results for diastasis recti abdominis, and the international physical activity questionnaire (long form) (IPAQ-L) scores. Logistic regression models were used to examine the effect of the PPR program on PPD among the local population. The secondary aim of this study was to investigate possible influencing factors for PPD, such as coronavirus disease 2019 (COVID-19), physical exercises, etc.ResultsPPR program has shown a positive effect in preventing PPD (p < 0.001) and diastasis recti prevalence (p < 0.001) during the six-weeks postnatal control in Qingdao, China. Better post-pregnancy weight reduction (p = 0.04) and higher metabolic equivalent of task (MET) value (p < 0.001) were noticed in the non-PPR group. Furthermore, lower PPD risk was associated with factors such as longer relationship duration years (2–5 years) (p = 0.04) and exercising one to three times a week (p = 0.01). A higher PPD risk was related to factors such as urinary incontinence during the postpartum period (p = 0.04) and subjective insomnia (p < 0.001). No significant effect was shown between COVID-19 and the EPDS score in this study (p = 0.50).ConclusionOur results suggested that the PPR program provided protection against PPD and diastasis recti during the first six weeks after delivery. Urinary incontinence and subjective insomnia were the main risk factors for PPD, while longer relationship duration years and exercising one to three times a week gave protective effects to PPD. This study emphasized that a comprehensive ongoing medical care program, such as the PPR program, effectively improves women’s mental and physical health in the early postpartum in China.
Analysis of choroidal thickness in juvenile systemic lupus erythematosus and its correlation with laboratory tests
Authors: Ru Li , Xu Jinping , Lin Zhongjing , Cao Lanfang , Zhang Lin 
Published: April 2023

Abstract
Background
The aim of this study is to investigate the alterations of choroidal thickness (CT) in juvenile systemic lupus erythematosus (JSLE) using enhanced depth imaging optical coherence tomography (EDI-OCT). We also aimed to assess whether CT parameters correlated with systemic health status in JSLE patients.

Methods
JSLE patients and age- and sex-matched healthy subjects were recruited. A detailed ophthalmological examination was applied to all participants. CT measurements were acquired in the macular region using EDI-OCT. Moreover, a spectrum of laboratory tests was examined to evaluate the systemic conditions, and the Th1/Th2/Th17/Treg cytokine profiles in the peripheral blood were also analyzed in JSLE group.

Results
A total of 45 JSLE patients with no visual impairment and 50 healthy individuals were enrolled in the study. CT values in the macular region were decreased in JSLE patients when compared with healthy controls, even adjusting for age, axial length and refraction. There were no significant correlations between CT and cumulative dose of hydroxychloroquine or duration of hydroxychloroquine use (all P > 0.05). The average macular, temporal and subfoveal CT in JSLE group was negatively correlated with IL-6 and IL-10 (all P < 0.05), but had no significant correlations with other laboratory results (all P > 0.05).

Conclusions
JSLE patients without ocular involvement may have significant variations in choroidal thickness at the macular area. Choroidal alterations might be associated with the systemic cytokine profiles in JSLE.