bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stress shielding of the proximal humerus in stemless anatomic total shoulder arthroplasty
Authors: Rankin Iain A , Goffin Joaquim , Khan L A Kash , Cairns David , Barker Scott L , Kumar Kapil 
Published: April 2023

Background This study aimed to assess the radiographic proximal humerus bony adaptations to stress shielding and associated clinical outcomes following stemless total shoulder arthroplasty. Methods A retrospective review of all patients who underwent stemless total shoulder arthroplasty surgery at our centre from 2010 to 2020 was performed. Results In total, 115 stemless total shoulder arthroplasty utilising a single implant design with a minimum one-year follow-up were identified over a 10-year period. The median follow-up was 3.5 years (range: 1–8.9 years). Evidence of stress shielding was observed in 20 cases (17%), (9 mild (8%), 0 moderate (0%), 11 severe (9%). No significant differences were seen between stress shielding and gender, body mass index, post-operative range-of-motion, patient satisfaction, or Oxford shoulder score. No significant differences were seen between the operative technique and stress shielding. No cases had evidence of humeral lucency. In total, 24 cases (21%) had evidence of glenoid lucency of Lazarus grade 0–3. No cases had Lazarus grades 4 or 5. There was no association between stress shielding and humeral lucency, glenoid lucency, or revision procedure. Discussion Stress shielding in this study occurred at lower rates than anticipated following stemless total shoulder arthroplasty and was not associated with radiographic evidence of lucency, revision procedures, or adverse effect on clinical outcome measures.
Application and performance of disease activity indices proposed for patients with systemic sclerosis in an international cohort of patients with juvenile systemic sclerosis
Authors: Klotsche Jens , Torok Kathryn S , Kasapcopur Ozgur , Adrovic Amra , Terreri Maria Teresa , Sakamoto Ana Paula , Katsicas Maria , Sztajnbok Flavio , Marrani Edoardo , Sifuentes-Giraldo Alberto , Stanevicha Valda , Anton Jordi , Feldmann Brian , Kostik Mikhail , Nemcova Dana , Santos Maria Jose , Appenzeller Simone , Avcin Tadej , Battagliotti Cristina , Berntson Lillemor , Bica Blanca , Brunner Jürgen , Eleftheriou Despina , Harel Liora , Horneff Gerd , Kallinich Tilmann , Minden Kirsten , Nielsen Susan , Patwardhan Anjali , Helmus Nicola , Foeldvari Ivan 
Published: April 2023

Objectives: Juvenile systemic sclerosis is a rare childhood disease. Three disease activity indices have been published for adult patients with systemic sclerosis: the European Scleroderma Study Group Index, a modified version of the European Scleroderma Study Group Index and the revised European Scleroderma Trials and Research index. The objective of this study was to determine the feasibility and performance of the three disease activity indices in a prospectively followed cohort of patients with juvenile systemic sclerosis. Methods: The analysis cohort was selected from the prospective international inception cohort enrolling juvenile systemic sclerosis patients. The correlation of the disease activity indices with the physicians’ and the patients’ global assessment of disease activity was determined. The disease activity indices were compared between patients with active and inactive disease. Sensitivity to change between 6- and 12-month follow-up was investigated by mixed models. Results: Eighty percent of the 70 patients had a diffuse cutaneous subtype. The revised European Scleroderma Trials and Research index was highly correlated with the physician-reported global disease activity/parents-reported global disease activity (r = 0.74/0.64), followed by the European Scleroderma Study Group activity index (r = 0.61/0.55) and the modified version of the European Scleroderma Study Group activity index (r = 0.51/0.43). The disease activity indices significantly differed between active and inactive patients. The disease activity indices showed sensitivity to change between 6- and 12-month follow-up among patients who improved or worsened according to the physician-reported global disease activity and the parents-reported global disease activity. Conclusion: Overall, no disease activity score is superior to the other, and all three scores have limitations in the application in juvenile systemic sclerosis patients. Furthermore, research on the concept of disease activity and suitable scores to measure disease activity in patients with juvenile systemic sclerosis is necessary in future.
European Headache Federation (EHF) critical re-appraisal and meta-analysis of oral drugs in migraine prevention—part 1: amitriptyline
Authors: Lampl Christian , Versijpt Jan , Amin Faisal Mohammad , Deligianni Christina I. , Gil-Gouveia Raquel , Jassal Tanvir , MaassenVanDenBrink Antoinette , Ornello Raffaele , Paungarttner Jakob , Sanchez-del-Rio Margarita , Reuter Uwe , Uluduz Derya , de Vries Tessa , Zeraatkar Dena , Sacco Simona 
Published: April 2023

Abstract
Objective
The aim of this paper is to critically re-appraise the published trials assessing amitriptyline for migraine prophylaxis.

Methods
We report our methods and results following the Preferred Reporting Items for Systematic Reviews (PRISMA), by searching MEDLINE, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov for randomized trials of pharmacologic treatments for migraine prophylaxis. We included randomized trials that compared amitriptyline with placebo for migraine prophylaxis in adults. Our outcomes of interest were informed by the Outcome Set for preventive intervention trials in chronic and episodic migraine (COSMIG) and include the proportion of patients who experience a 50% or more reduction in migraine days per month, migraine days per month, and adverse events leading to discontinuation.
We assessed risk of bias by using a modified Cochrane RoB 2.0 tool and the certainty of evidence by using the GRADE approach.

Results
Our search yielded 10.826 unique records, of which three trials (n = 622) were eligible for data synthesis and analysis. We found moderate certainty evidence that amitriptyline increases the proportion of patients who experience a 50% or more reduction in monthly migraine days, compared to placebo (relative risk: 1.60 (95% CI 1.17 to 2.19); absolute risk difference: 165 more per 1,000 (95% CI 47 more to 327 more). We found moderate certainty evidence that amitriptyline increases the proportion of patients who discontinue due to adverse events compared to placebo (risk difference: 0.05 (95% CI 0.01 to 0.10); absolute risk difference: 50 more per 1,000 (95% CI 10 more to 100 more).

Conclusions
Our meta-analysis showed that amitriptyline may have a prophylactic role in migraine patients, however these results are far from robust. This warrants further large-scale research to evaluate the role of amitriptyline in migraine prevention.
Maternal patterns of inheritance alter transcript expression in eggs
Authors: Harry Nathan D. , Zakas Christina 
Published: April 2023

Abstract
Background
Modifications to early development can lead to evolutionary diversification. The early stages of development are under maternal control, as mothers produce eggs loaded with nutrients, proteins and mRNAs that direct early embryogenesis. Maternally provided mRNAs are the only expressed genes in initial stages of development and are tightly regulated. Differences in maternal mRNA provisioning could lead to phenotypic changes in embryogenesis and ultimately evolutionary changes in development. However, the extent that maternal mRNA expression in eggs can vary is unknown for most developmental models. Here, we use a species with dimorphic development— where females make eggs and larvae of different sizes and life-history modes—to investigate the extent of variation in maternal mRNA provisioning to the egg.

Results
We find that there is significant variation in gene expression across eggs of different development modes, and that there are both qualitative and quantitative differences in mRNA expression. We separate parental effects from allelic effects, and find that both mechanisms contribute to mRNA expression differences. We also find that offspring of intraspecific crosses differentially provision their eggs based on the parental cross direction (a parental effect), which has not been previously demonstrated in reproductive traits like oogenesis.

Conclusion
We find that maternally controlled initiation of development is functionally distinct between eggs of different sizes and maternal genotypes. Both allele-specific effects and parent-of-origin effects contribute to gene expression differences in eggs. The latter indicates an intergenerational effect where a parent’s genotype can affect gene expression in an egg made by the next generation.
Application of Moringa leaves as soil amendment to tiger-nut for suppressing weeds in the Nigerian Savanna
Authors: Fadeyi Olasupo James , Fabunmi Thomas Oladeji , Soretire Adeniyi Adebowale , Olowe Victor Idowu Olugbenga , Raphael Adeyemi Olusegun 
Published: April 2023

Abstract
Background
The allelopathic effect of Moringa (Moringa oleifera Lam.) leaves applied as organic manure in tiger nut (Cyperus esculentus L.) production on associated weeds was investigated in the guinea savanna of South West Nigeria, during the 2014 (September - November) and 2015 (June - August) wet seasons.

Methods
Five Moringa leaves rates (0, 2.5, 5.0, 7.5 and 10 t/ha) and three tuber sizes (0.28 g, 0.49 g and 0.88 g dry weight) were laid out in the main plot and sub-plot, respectively in a split-plot arrangement fitted into randomized complete block design and replicated three times.

Results
Parameters measured, which include, weed cover score (WCS), weed density (WD) and weed dry matter production (WDMP) were significantly (p<0.05) influenced in both years by Moringa leaf. In 2015, WCS, WD and WDMP significantly (p<0.05) reduced by 25–73%, 35–78% and 26–70% on Moringa leaves-treated plots respectively. There were significant (p<0.05) interactions between quantity of Moringa leaves incorporated and tuber size. The bigger the tuber and the higher the quantity of Moringa leaves incorporated the lower the WCS, WD and WDMP.

Conclusions
Consequently, application of 10 t.ha− 1 Moringa leaves and planting of large or medium-sized tubers were recommended for optimum weed suppression in tiger nut production in South West Nigeria.
The climate changes promoted the chloroplast genomic evolution of Dendrobium orchids among multiple photosynthetic pathways
Authors: Xue Qiqian , Yang Jiapeng , Yu Wenhui , Wang Hongman , Hou Zhenyu , Li Chao , Xue Qingyun , Liu Wei , Ding Xiaoyu , Niu Zhitao 
Published: April 2023

AbstractDendrobium orchids have multiple photosynthetic pathways, which can be used as a model system for studying the evolution of crassulacean acid metabolism (CAM). In this study, based on the results of the net photosynthetic rates (Pn), we classified Dendrobium species into three photosynthetic pathways, then employed and compared their chloroplast genomes. The Dendrobium chloroplast genomes have typical quartile structures, ranging from 150,841–153,038 bp. The apparent differences in GC content, sequence variability, and IR junctions of SSC/IRB junctions (JSBs) were measured within chloroplast genomes among different photosynthetic pathways. The phylogenetic analysis has revealed multiple independent CAM origins among the selected Dendrobium species. After counting insertions and deletions (InDels), we found that the occurrence rates and distribution densities among different photosynthetic pathways were inconsistent. Moreover, the evolution patterns of chloroplast genes in Dendrobium among three photosynthetic pathways were also diversified. Considering the diversified genome structure variations and the evolution patterns of protein-coding genes among Dendrobium species, we proposed that the evolution of the chloroplast genomes was disproportional among different photosynthetic pathways. Furthermore, climatic correlation revealed that temperature and precipitation have influenced the distribution among different photosynthetic pathways and promoted the foundation of CAM pathway in Dendrobium orchids. Based on our study, we provided not only new insights into the CAM evolution of Dendrobium but also provided beneficial genetic data resources for the further systematical study of Dendrobium.
The establishment of transient expression systems and their application for gene function analysis of flavonoid biosynthesis in Carthamus tinctorius L
Authors: Xian Bin , Xi Ziqing , Ren Chaoxiang , Yan Jie , Chen Jiang , Pei Jin 
Published: April 2023

Abstract
Background
Safflower (Carthamus tinctorius L.) is an important economic crop and a traditional medicinal material rich in flavonoids, which can alleviate cardiovascular and cerebrovascular pathologies. Thus, many candidate genes involved in safflower flavonoid biosynthesis have been cloned. However, owing to the lack of a homologous gene expression system, research on gene function is limited to model plants. Therefore, a gene function identification protocol for safflower must be established.

Results
In the present study, using safflower callus as the experimental material, Agrobacterium and biolistic transient expression systems were established. In the Agrobacterium transient expression system, the highest transformation rate was obtained at the original Agrobacterium concentration of OD600 0.4, infiltration concentration of OD600 0.6, infection for 20 min, co-culture for 3 days, and acetosyringone concentration of 100 μmol·L−1. In the biolistic transient expression system, the highest transformation efficiency was observed at helium pressure of 1,350 psi, vacuum degree of -0.8 bar, flight distance of 6.5 cm, one round of bombardment, plasmid concentration of 3 μg·shot−1, and gold particle concentration of 100 μg·shot−1. Further, these two transient expression systems were used for the functional analysis of CtCHS1 as an example. After overexpression, relative CtCHS1 expression increased, particularly in Agrobacterium-transformed calli. Additionally, the contents of some flavonoids were altered; for instance, naringenin and genistein levels were significantly increased in Agrobacterium-transformed calli, whereas luteolin, luteolin-7-O-rutinoside, and apigenin derivative levels were significantly decreased in biolistic-transformed calli.

Conclusion
Using safflower callus as the experimental material, highly efficient Agrobacterium and biolistic transient expression systems were successfully established, and the utility of both systems for investigating gene function was demonstrated. The proposed safflower callus transient expression systems will be useful for further functional analyses of flavonoid biosynthetic genes in safflower.
Successful treatment of a severe Takotsubo syndrome case complicated by liver abscess
Authors: Zhang Zhi-Yue , Sun Jin-Jin , Wang Jun-Hua , Wang Peng , Liu Bai-Mei , Xing Jun-Hua , Liu Jun , Zhang Da-Peng , Kong Zhen-Zhen , Zhang Hai-Tao , Yu Xin-Ya 
Published: April 2023

AbstractThe main manifestations of Takotsubo syndrome (TTS) are a spherical expansion of the left ventricle or near the apex and decreased systolic function. TTS is mostly thought to be induced by emotional stress, and the induction of TTS by severe infection is not often reported. A 72-year-old female patient with liver abscess reported herein was admitted due to repeated fever with a history of hypertension and impaired glucose tolerance. Her severe infection caused TTS, and her blood pressure dropped to 80/40 mmHg. IABP treatment was performed immediately and continued for 10 days, and comprehensive medication was administered. Based on her disease course and her smooth recovery, general insights and learnings may be: Adding to mental and other pathological stress reaction, serious infections from pathogenic microorganism could be of great important causation of stress reaction leading to TTS, while basic diseases such as coronary heart disease, hypertension, and diabetes were be of promoting factors; In addition to effective drug therapies for TTS, the importance of the timely using of IABP should be emphasized.
Exploring different research questions via complex multi-state models when using registry-based repeated prescriptions of antidepressants in women with breast cancer and a matched population comparison group
Authors: Skourlis Nikolaos , Crowther Michael J. , Andersson Therese M‑L. , Lu Donghao , Lambe Mats , Lambert Paul C. 
Published: April 2023

Abstract
Background
Multi-state models are used to study several clinically meaningful research questions. Depending on the research question of interest and the information contained in the data, different multi-state structures and modelling choices can be applied. We aim to explore different research questions using a series of multi-state models of increasing complexity when studying repeated prescriptions data, while also evaluating different modelling choices.

Methods
We develop a series of research questions regarding the probability of being under antidepressant medication across time using multi-state models, among Swedish women diagnosed with breast cancer (n = 18,313) and an age-matched population comparison group of cancer-free women (n = 92,454) using a register-based database (Breast Cancer Data Base Sweden 2.0). Research questions were formulated ranging from simple to more composite ones. Depending on the research question, multi-state models were built with structures ranging from simpler ones, like single-event survival analysis and competing risks, up to complex bidirectional and recurrent multi-state structures that take into account the recurring start and stop of medication. We also investigate modelling choices, such as choosing a time-scale for the transition rates and borrowing information across transitions.

Results
Each structure has its own utility and answers a specific research question. However, the more complex structures (bidirectional, recurrent) enable accounting for the intermittent nature of prescribed medication data. These structures deliver estimates of the probability of being under medication and total time spent under medication over the follow-up period. Sensitivity analyses over different definitions of the medication cycle and different choices of timescale when modelling the transition intensity rates show that the estimates of total probabilities of being in a medication cycle over follow-up derived from the complex structures are quite stable.

Conclusions
Each research question requires the definition of an appropriate multi-state structure, with more composite ones requiring such an increase in the complexity of the multi-state structure. When a research question is related with an outcome of interest that repeatedly changes over time, such as the medication status based on prescribed medication, the use of novel multi-state models of adequate complexity coupled with sensible modelling choices can successfully address composite, more realistic research questions.
Family doctors’ roles and perceptions on antibiotic consumption and antibiotic resistance in Romania: a qualitative study
Authors: Ghiga Ioana , Pitchforth Emma , Stålsby Lundborg Cecilia , Machowska Anna 
Published: April 2023

AbstractBackgroundAntimicrobial resistance (AMR) is a major global health issue, bringing significant health burden and costs to societies. Increased antibiotic consumption (ABC) is linked to AMR emergence. Some of the known drivers of ABC are antibiotics over-prescription by physicians and their misuse by patients. Family doctors are recognised as important stakeholders in the control of ABC as they prescribe antibiotics and are considered a reliable source of medical information by patients. Therefore, it is important to explore their perceptions, especially in Romania, which has the highest ABC among European Union Member States. Furthermore, there is no published research exploring Romanian family doctors’ perceptions regarding this phenomenon.MethodsThis was a qualitative study with data collection via semi-structured interviews among 12 family doctors. Manifest and latent content analysis was used to gain an in-depth understanding of their perceptions. Findings were mapped onto the domains of the Behaviour Change Wheel to facilitate a theory driven systematization and analysis.ResultsTwo main subthemes emerged: i) factors affecting ABC and prescribing and ii) potential interventions to tackle ABC and antibiotic resistance. The factors were further grouped in those that related to the perceived behaviour of family doctors or patients as well as those that had to do with the various systems, local contexts and the COVID-19 pandemic. An overarching theme: ‘family doctors in Romania see their role differently when it comes to antibiotic resistance and perceive the lack of patient education or awareness as one of the major drivers of ABC’ was articulated. The main findings suggested that the perceived factors span across the capability, opportunity and motivational domains of the behaviour change wheel and could be addressed through a variety of interventions – some identified by the participants. Findings can also be viewed through cultural lenses which shed further light on the family doctor- patient dynamic when it comes to antibiotics use.ConclusionPotential interventions to tackle identified factors emerged, revolving mostly on efforts to educate patients or the public. This exploratory research provides key perspectives and facilitates further research on potential interventions to successfully address AMR in Romania or similar settings.
Risk factors of pneumonia in persons with and without Alzheimer’s disease: a matched cohort study
Authors: Järvinen Heli , Tolppanen Anna-Maija , Hartikainen Sirpa 
Published: April 2023

Abstract
Background
Pneumonia is a very common infection in the cognitively impaired adult population, often leading to long-term deterioration, in physical and cognitive performance. Evidence is lacking on whether chronic comorbidities and drug use are risk factors for pneumonia in persons with Alzheimer’s disease (AD). The objective of this study was to investigate the risk factors of pneumonia in community dwellers with and without AD.

Methods
We performed a retrospective register-based study utilizing the Medication Use and Alzheimer’s disease (MEDALZ) cohort, which is based on Finnish nationwide healthcare registers and includes all community dwellers who received a verified clinical diagnosis of AD between 2005 to 2011. This study comprised 69,350 persons with AD and 69,350 persons without AD matched by age, gender, and region of residence. Association between comorbidities, drug use, and hospitalization due to pneumonia were assessed using Cox Regression.

Results
During the follow-up, 25.0% (n = 17,105) of the AD cohort and 15.8% (n = 10,966) of the non-AD cohort were hospitalized due to pneumonia. Persons with AD had a higher risk of pneumonia also after adjusting for comorbidities (HR 1.76, 95% CI 1.71–1.80). Previous pneumonia was the strongest risk factor for pneumonia in both cohorts. All comorbidities and drug use excluding biological product use were associated with a higher risk of pneumonia, but stronger associations were observed in the non-AD cohort. The risk of hospitalization following psychotropic drug use was proportional to the number of psychotropics utilized.

Conclusions
Pneumonia is a serious, potentially life-threatening illness, and risk factors for pneumonia include several potentially avoidable drugs. In addition, good care of existing comorbidities might prevent pneumonia and related hospitalization.