bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sexualised drug use and chemsex in Italy: A questionnaire study based on a cohort of clients attending a STI outpatient service in Milan
Authors: Giacalone Serena , Barberi Francesco , Ramoni Stefano , Casazza Giovanni , Cusini Marco , Marzano Angelo Valerio 
Published: August 2023

Background Chemsex is a heterogeneous phenomenon with differences in distribution, setting, motivations and type of substances consumed between countries. The lack of data at national level of the Italian situation creates a perception of reduced need for intervention. Methods Anonymous paper questionnaires were distributed to patients who had registered themselves at the STI Department IRCCS Ca’ Granda Policlinico in Milan. Results A significant association was demonstrated between use of sexualised drugs, chemsex and the following variables: (1). Number of partners: in the group of clients with more than five partners, sexualised drug users were more than twice compared with those in the group with less than five partners (35.2% vs 16.2%) p<0.0001. (2). Use of dating apps: more than one out of two persons who used drugs during sex affirmed looking for partners on internet, p = 0.0059. (3). Low condom uses with occasional partners: percentage of individuals who declared not to use condoms or devices during their sexual encounters with occasional partners is more than twice as high in the sexualised drug users group with respect to controls (44.6% vs 21.4%); p = 0.0006). (4). Use of post exposure prophylaxis (PEP): among the PEP users, more than half participants belonged to the sexualised drug users’ group; p = 0.0021. Conclusions Sexualised drug use and chemsex are frequently practiced in Milan. This survey identified a specific population with higher-risk sexual behaviours and increased incidence of acute bacterial STIs.
Transmission of vertical vibration through a seat cushion at the seat pan: Effect of foam physical properties during different excitation magnitudes
Authors: Luo Qiao , He Yansong , Zhang Zhifei , Gao Kaizhan 
Published: August 2023

The vibration characteristics of car seats directly influence the ride comfort. Polyurethane foam is the key part of a seat, and its physical parameters have an important impact on the seat. In this study, the influence of the foam thickness and foam hardness on the vibration characteristics of seat cushion with different excitation magnitudes was investigated by using transmissibility and seat effective amplitude transmissibility (SEAT) value. First, vibration tests were carried out at a vertical vibration simulator with width-limited white noise vibration frequencies from 0.5 to 20 Hz with root-mean-square (r.m.s.) values of 0.4, 0.8, and 1.2 m/s2, the acceleration at the platform and the body-foam interfaces were measured to calculate the transmissibility, and the influence of the foam physical properties on the transmissibility was analyzed. Then, the SEAT value was introduced to assess the vibration isolation efficiency of the foam cushion, and the influence of the foam physical properties of the foam cushion on the vibration isolation efficiency was analyzed. With increasing thickness of the foam and decreasing hardness of the foam at the seat pan, the peak transmissibility increased and the resonance frequency decreased. The SEAT values show that increasing the foam thickness is beneficial to the improvement of the vibration isolation efficiency of the seat, but there is a diminishing return; the combination of physical parameters of low hardness and high thickness could make the vibration isolation performance of the seat better. In addition, the nonlinearity of human-seat system during different vibration magnitude was found.
A Modern Series of Secondary Aortoenteric Fistula – A 19-Year Experience
Authors: Sieber Sabine , Busch Albert , Sargut Mine , Knappich Christoph , Bohmann Bianca , Karlas Angelos , Friess Helmut , Eckstein Hans-Henning , Novotny Alexander 
Published: August 2023

Objectives Secondary aortoenteric fistula is a rare and life-threatening condition. Clear evidence on the ideal therapeutic approach is largely missing. This study aims to analyze symptoms, etiology, risk factors, and outcomes based on procedural details. Patients and Methods All patients with secondary aortoenteric fistula admitted between 2003 and 2021 were included. Patient characteristics, surgical procedure details, and postoperative outcomes were analyzed. Outcomes were stratified and compared according to the urgency of operation and the procedure performed. Descriptive statistics were used. The primary endpoint was in-hospital mortality. Results A total of twentytwo patients (68% male, median age 70 years) were identified. Main symptoms were gastrointestinal bleeding, pain, and fever. From the twentytwo patients ten patients required emergency surgery and ten urgent surgery. Emergency patients were older on average (74 vs 63 years, P = .015) and had a higher risk of postoperative respiratory complications (80% vs 10%, P = .005). Primary open surgery with direct replacement of the aorta or an extra-anatomic bypass with an additional direct suture or resection of the involved bowel was performed in sixteen patients. In four patients underwent endovascular bridging treatment with the definitive approach as a second step. Other two patients died without operation (1x refusal; 1x palliative cancer history). In-hospital mortality was 27%, respectively. Compared to patients undergoing urgent surgery, those treated emergently showed significantly higher in-hospital (50% vs 0%, P = .0033) mortalities. Conclusion Despite rapid diagnosis and treatment, secondary aortoenteric fistula remains a life-threatening condition with 27% in-hospital mortality, significantly increased upon emergency presentation.
Intramedullary Nail Fixation for the Treatment of Symptomatic Fibular Nonunion: A Case Series
Authors: Kavanagh Amber M. , Schumann Jaclyn , Burgess Brian J. 
Published: August 2023

Ankle fractures are a relatively common injury in the lower extremity. They can be treated with conservative management if they are nondisplaced and only involve the fibula. Nonunions at the fracture site, however, are a potential complicating factor during treatment. There is growing literature supporting the use of intramedullary fixation for fracture care. Not only does it have the advantages of using smaller incisions to preserve periosteum while providing improved biomechanical outcomes, but intramedullary reaming can help stimulate cells to promote bone healing. Few articles discuss the use and success of intramedullary reaming in revision surgery of the distal fibula. We present 3 cases of computed tomography–confirmed fibular nonunion following conservative fracture care, which underwent revision surgery with fibular nail fixation technique. These cases illustrate clinical and image findings as well as highlight the surgical technique used for each patient. At follow-up, all patients were asymptomatic and radiographs confirmed healing of the previous nonunion site. These cases are examples of successful revision for fibular fracture nonunion using intramedullary nail fixation. Level of Evidence: Level IV: Case series
A Cluster Analysis of Oral and Cognitive Health Indicators in the CLSA: An Exploratory Study on Cholinergic Activity as the Link
Authors: Rohani K. , Nicolau B. , Madathil S. , Booij L. , Jafarpour D. , Haricharan P.B. , Feine J. , Alchini R. , Tamimi F. , de Souza R. 
Published: August 2023

Introduction: Poor oral health has been suggested as a risk factor for cognitive decline. Yet, biologically plausible mechanisms explaining this relationship remain unknown. Objectives: We aimed (1) to identify oral and cognitive health clustering patterns among middle-aged to elderly Canadians and (2) to investigate the extent to which these patterns could be explained by bone mineral density (BMD), a proxy measure of the cholinergic neurons’ activity. Methods: This cross-sectional study used baseline data from the Comprehensive cohort of the Canadian Longitudinal Study of Aging (CLSA). Oral health was assessed by a self-report questionnaire, and 7 task-based instruments measured cognitive health. We identified oral and cognitive health clusters, our outcome variables, using latent class analysis. Two sets of multivariate logistic regression and 95% confidence intervals were used to investigate whether BMD explains the odds of membership in a certain oral and cognitive health group. The final models were adjusted for socioeconomic, health, and lifestyle factors. Results: Our study sample (N = 25,444: 13,035 males, 12,409 females) was grouped into 5 and 4 clusters based on the oral health status and performance on the cognitive tasks, respectively. After adjusting for all potential covariates, increase in BMD was not associated with higher odds of membership in classes with better oral health (odds ratio [OR] = 1.58 [95% confidence interval {CI}: 0.85–2.92]) and cognitive health (OR = 1.61 [95% CI: 1–2.6]) compared with the groups with the least favorable oral and cognitive health status, respectively. Conclusion: Middle-aged and elderly Canadians show different oral and cognitive health profiles, based on their denture-wearing status and performance on cognitive tests. No evidence could be found to support BMD in place of cholinergic neurons’ activity as the common explanatory factor behind the association between oral health and cognitive health. Knowledge Transfer Statement: This study is probably the first of its kind to shed light on the cholinergic system as a potential pathway influencing oral and cognitive health. Our findings may support the notion that any potential association between poor oral health and cognitive health might be explained by common contributors, helping clinicians to find the common risk factors for both conditions.
Assessing Trustworthiness of Internet Pharmacies with an Internet Browser Extension
Authors: Patel Vraj , Lovett Mason , Rybarczyk Ryan , Hertig John 
Published: August 2023

Background: Many people are turning to online pharmacies for medication purchases leading to a growing number of legal and illegal online pharmacies (IOPs). With a growing number of IOPs, consumers are more likely to receive substandard or falsified medications when purchasing medications online. Objectives: This study aims to identify the number of verified, not recommended, and not verified pharmacy websites consumers see using different keywords and medications on an Internet browser based off the National Association Boards of Pharmacy’s (NABP) list of verified and not recommended websites. It also aims to compare which keywords result in more not recommended pharmacy websites compared with verified pharmacy websites for consumers over time. Design and Methods: We created an Internet browser extension compatible with different Internet browsers to quickly identify which search results are verified, not recommended, and not verified based on NABP lists. We then utilized an application programming interface to automatically search different key terms and classify the search results as verified, not recommended, and not verified over a 4-week data collection period for analysis. Results: A total of 131 key terms were used for the search. There was an average signal determining the number of verified and not recommended search results compared with not verified results of 4.3% over the 4-week data collection period. There was about a 3:1 ratio of not recommended to verified search results noted. Top signal and not recommended search result producing keywords contained words such as “shipped” and “cheap.” Conclusion: The Internet browser extension will aid in making it easier to identify which search results are safe and which are not safe when searching to purchase medications online. This study has set the premise on expanding how to use an Internet pharmacy extension to combat IOPs, improve patient safety, and increase safe access to medications.
Zinc Oxide Nanoparticles Foliar Application Effectively Enhanced Zinc and Aroma Content in Rice (Oryza sativa L.) Grains
Authors: Wang Rui , Mi Kailiang , Yuan Xijun , Chen Jie , Pu Jialing , Shi Xinyan , Yang Yanju , Zhang Hongcheng , Zhang Haipeng 
Published: August 2023

AbstractThe search for an effective zinc fertilizer and its application method to effectively increase zinc content and enhance aroma in rice grains is a crucial objective. In this study, a 2-year field plot experiment was conducted to investigate the influence of ZnO NPs foliar spraying on rice quality, grain zinc and aroma content, along with exploring the physiological mechanisms underlying these effects. Our results demonstrated that the rice breakdown value and taste value of foliar spraying zinc oxide nanoparticles were improved by 31.0–41.7% and 8.2–13.0% compared with CK (control treatment involved spraying water), improving the tasting and steaming quality of rice. While Fe and Cu content in grains decreased for the application of zinc oxide nanoparticles, zinc oxide nanoparticles foliar spraying significantly increased the zinc content and accumulation of grains by 33.6–65.1% and 37.8–74.7%, respectively. Further analysis showed that the sprayed zinc oxide nanoparticles achieved effective enrichment of zinc in edible parts and increased the final bioavailability of Zn. In addition, foliar spraying of zinc oxide nanoparticles significantly increased activities of nitrate reductase and glutamine synthetase in leaves, which elevated nitrogen content in leaves and grains, and ultimately enhanced 2-acetyl-1-pyrroline (2-AP) content in grains at maturity by 6.1–21.4% compared to CK. Our findings indicated that zinc oxide nanoparticles can be practically applied as a foliar fertilizer at the gestation for quality improvement, zinc enrichment and aroma enhancement of rice grains.
The effect of luteinizing hormone changes in GnRH antagonist protocol on the outcome of controlled ovarian hyperstimulation and embryo transfer
Authors: Zhou Jing-Shuang , Chen Jian-Hong , Tang Fei-Fei , Ou Jian-Ping , Tao Xin , Cai Liu-Hong 
Published: August 2023

Abstract
Backgroud
To investigate the effect of Luteinizing hormone (LH) level changes on the outcomes of controlled ovarian hyperstimulation (COH) and embryo transfer (ET) in gonadotropin-releasing hormone antagonist (GnRH-ant) protocol.

Methods
A total of 721 patients undergoing GnRH-ant protocol COH for the first IVF/ICSI cycles were retrospectively analyzed. COH process were divided into 2 stages, before (stage 1) and after (stage 2) the GnRH-ant initiation, and each with 5 groups basing on LH levels: LH decreased more than 50% (groups A1, A2), decreased 25-50% (groups B1, B2), change less than 25% (groups C1, C2), increased 25-50% (groups D1, D2), and increased more than 50% (groups E1, E2).

Results
There were no significant differences among groups of stage1 regarding COH and ET outcomes. For stage 2, the more obvious the decrease of LH level, the more the number of oocytes retrieved, mature oocytes, fertilized oocytes, embryos cleavaged and the numbers of embryo available (P < 0.05), but without significant differences regarding ET outcomes. We also found the freeze-all rate in Group A2 was higher (P < 0.001).

Conclusion
LH level changes before GnRH-ant addition were not related to COH and ET outcomes. LH level changes after the addition of GnRH-ant were related to the outcome of COH, and no significant differences were found relating to ET outcomes.
Deep learning-based postoperative visual acuity prediction in idiopathic epiretinal membrane
Authors: Wen Dejia , Yu Zihao , Yang Zhengwei , Zheng Chuanzhen , Ren Xinjun , Shao Yan , Li Xiaorong 
Published: August 2023

Abstract
Background
To develop a deep learning (DL) model based on preoperative optical coherence tomography (OCT) training to automatically predict the 6-month postoperative visual outcomes in patients with idiopathic epiretinal membrane (iERM).

Methods
In this retrospective cohort study, a total of 442 eyes (5304 images in total) were enrolled for the development of the DL and multimodal deep fusion network (MDFN) models. All eyes were randomized into a training dataset with 265 eyes (60.0%), a validation dataset with 89 eyes (20.1%), and an internal testing dataset with the remaining 88 eyes (19.9%). The input variables for prediction consisted of macular OCT images and diverse clinical data. Inception-Resnet-v2 network was utilized to estimate the 6-month postoperative best-corrected visual acuity (BCVA). Concurrently, a regression model was developed using the clinical data and OCT parameters in the training data set for predicting postoperative BCVA. The reliability of the models was subsequently evaluated using the testing dataset.

Results
The prediction DL algorithm exhibited a mean absolute error (MAE) of 0.070 logMAR and root mean square error (RMSE) of 0.11 logMAR in the testing dataset. The DL model demonstrated a robust promising performance with R2 = 0.80, notably superior to R2 = 0.49 of the regression model. The percentages of BCVA prediction errors within ± 0.20 logMAR amounted to 94.32% in the testing dataset.

Conclusions
The OCT-based DL model demonstrated sensitivity and accuracy in predicting postoperative BCVA in iERM patients. This innovative DL model exhibits substantial potential for integration into surgical planning protocols.
Implementing shared decision-making interventions in breast cancer clinical practice: a scoping review
Authors: Oprea Natalia , Ardito Vittoria , Ciani Oriana 
Published: August 2023

Abstract
Background
Shared decision-making (SDM) is a collaborative process whereby patients and clinicians jointly deliberate on the best treatment option that takes into account patients’ preferences and values. In breast cancer care, different treatment options have become available to patients in the last decade. Various interventions, including patient decision aids (PtDAs), have been designed to promote SDM in this disease area. This study aimed at investigating the factors that influence the successful adoption and implementation of SDM interventions in real-world healthcare delivery settings.

Methods
A scoping review of scientific and grey literature was conducted for the period 2006–2021 to analyse the support for SDM interventions and their adoption in breast cancer clinical practice. The interpretation of findings was based on the Practical, Robust Implementation and Sustainability Model (PRISM) for integrating research findings into practice.

Results
Overall, 19 studies were included for data synthesis, with more than 70% published since 2017. The availability of SDM tools does not automatically translate into their actual use in clinical settings. Factors related to users’ co-creation, the clinical team’s attitude and knowledge, organisational support and regulatory provisions facilitate the adoption of SDM interventions. However, overlooking aspects such as the re-organisation of care pathways, patient characteristics, and assigning of resources (human, financial, and facilities) can hinder implementation efforts.

Conclusions
Compared to the mounting evidence on the efficacy of SDM interventions, knowledge to support their sustained implementation in daily care is still limited, albeit results show an increasing interest in strategies that facilitate their uptake in breast cancer care over time. These findings highlight different strategies that can be used to embed SDM interventions in clinical practice. Future work should investigate which approaches are more effective in light of organisational conditions and external factors, including an evaluation of costs and healthcare system settings.
Altered insulin secretion dynamics relate to oxidative stress and inflammasome activation in children with obesity and insulin resistance
Authors: González-Domínguez Álvaro , Belmonte Thalía , Domínguez-Riscart Jesús , Ruiz-Ocaña Pablo , Muela-Zarzuela Inés , Saez-Benito Ana , Montañez-Martínez Raúl , Mateos Rosa M. , Lechuga-Sancho Alfonso M. 
Published: August 2023

Abstract
Background
Insulin resistance (IR) is considered the main driver of obesity related metabolic complications, and is related to oxidative stress and inflammation, which in turn promote each other. There is currently no specific definition of IR in children, rather, that for adult population is used by pediatric endocrinologists instead. Altered insulin secretion dynamics are associated with worse metabolic profiles and type 2 diabetes mellitus development, thus we aimed to test whether insulin response relates to oxidative stress and inflammation in children.

Methods
We conducted a case–control study, including 132 children classified as follows: 33 children without obesity (Lean); 42 with obesity but no IR according to the American Diabetes Association criteria for adults (OBIR-); 25 with obesity and IR and an early insulin response to an oral glucose tolerance test (OGTT) (EP-OBIR +); 32 with obesity, IR, and a late insulin peak (LP-OBIR +); and studied variables associated with lipid and carbohydrate metabolism, oxidative stress, inflammation and inflammasome activation.

Results
The measured parameters of children with obesity, IR, and an early insulin response were similar to those of children with obesity but without IR. It was late responders who presented an impaired antioxidant system and elevated oxidative damage in erythrocytes and plasma, and inflammasome activation at their white blood cells, despite lower classical inflammation markers. Increased uric acid levels seems to be one of the underlying mechanisms for inflammasome activation.

Conclusions
It is insulin response to an OGTT that identifies children with obesity suffering oxidative stress and inflammasome activation more specifically. Uric acid could be mediating this pathological inflammatory response by activating NLRP3 in peripheral blood mononuclear cells.

Graphical Abstract
Dual-screw versus single-screw cephalomedullary nails for intertrochanteric femoral fractures: a systematic review and meta-analysis
Authors: Yang Fan , Li Xiafei , Zhao Lei , Yang Qi 
Published: August 2023

Abstract
Background
Internal fixation with cephalomedullary nails has been widely used in the treatment of intertrochanteric femoral fractures (IFF). Yet, the difference in efficacy and safety between the commonly used integrated dual-screw cephalomedullary nail (InterTAN) and single-screw cephalomedullary nail remains inconclusive. Thus we performed the present systematic review and meta-analysis.

Methods
Randomized controlled trials (RCTs) or observational studies comparing InterTAN with proximal femoral nail anti-rotation (PFNA), the Asian PFNA (PFNA-II), or the Gamma3 nail in treating IFF were searched on PubMed, EMBASE, Web of Science and Cochrane Library from inception to April 30, 2023. The differences in perioperative parameters and clinical and radiological outcomes were evaluated by mean difference (MD) with 95% confidence interval (95%CI). The risks of various complications and mortality were assessed by risk ratio (RR) with 95%CI.

Results
Twenty-three studies comprising 3566 patients were included. Compared with single-screw cephalomedullary nails (PFNA/PFNA-II, Gamma3), InterTAN conferred significantly reduced risk of implant failures (RR = 0.37, 95%CI 0.26 to 0.51, P < 0.001), hip and thigh pain (RR = 0.70, 95%CI 0.55 to 0.90, P = 0.006) and all-cause revision/reoperation (RR = 0.38, 95%CI 0.26 to 0.57, P < 0.001). Moreover, patients treated with InterTAN had significantly higher 1-year Harris Hip Score (MD = 0.82, 95%CI 0.20–1.44, P = 0.010) and shorter time to union/healing (MD = − 0.66 days, 95%CI  − 1.16 to  − 0.16, P = 0.009). Femoral neck shortening, time to full bearing, and incidences of non-union, infection, deep venous thrombosis, and mortality were comparable between both groups.

Conclusions
The integrated dual-screw InterTAN construct has superior performance in reducing risks of complications and improving clinical and functional outcomes in the treatment of IFF. More well-designed, high-quality RCTs are warranted to confirm these findings.