bluuebunny/crossref_metadata_2025_split huggingface dataset:
No major difference in perceived quality of care in patients with hip or knee osteoarthritis assessed in a physical therapy-led triage compared with standard care: a randomized controlled trial
Authors: Gustavsson Linnea , Mohaddes Maziar , Samsson Karin , Beischer Susanne 
Published: June 2023

Abstract
Background
Physical therapy-led orthopedic triage is a care model used to optimize pathways for patients with hip or knee osteoarthritis. However, scientific evidence of the effectiveness of this model of care is still limited and only a few studies report patients’ perception of it. The aim of this study was to compare patients’ perceived quality of care after physical therapy-led triage with standard practice in a secondary care setting for patients with primary hip or knee osteoarthritis.

Methods
In this randomized study, patients with hip or knee osteoarthritis referred for an orthopedic consultation received either physical therapy-led triage (n = 344) or a standard care assessment by an orthopedic surgeon (n = 294). To evaluate the patients’ perceived quality of care, a short version of the Quality from the Patient’s Perspective (QPP) questionnaire was sent to the patients within a week after their assessment. The primary outcome was the statement “I received the best examination and treatment” on QPP.

Results
A total of 348 patients (70%, physical therapy-led triage: n = 249, standard care: n = 199) answered the questionnaire. No significant difference was found in the primary outcome between the groups (p = 0.6). Participants in the triage group perceived themselves to have received significantly better information about how to take care of their osteoarthritis (p = 0.017) compared with the standard care group. The standard care group reported that they participated in the decision-making process to a greater extent (p = 0.005), that their expectations were met to a greater degree (p = 0.013), and that their care depended more on their need for care rather than the caregivers’ routines (0.007).

Conclusion
Both groups report high perceived quality of care. Significant differences were found in four of 14 questions, one in favor of the physical therapist and three in favor of the standard care group. The findings of this study are in line with previous research and support the use of this care model for patients with hip or knee OA in secondary care. However, due to the dropout size, the results should be interpreted with caution.

Trial registration
Clinical Trials NCT04665908, registered 14/12/2020.
Preference of musculoskeletal pain treatment in middle-aged and elderly chinese people: a machine learning analysis of the China health and retirement longitudinal study
Authors: Mei Fengyao , Dong Shengjie , Li Jiaojiao , Xing Dan , Lin Jianhao 
Published: June 2023

Abstract
Background
Musculoskeletal pain is a major cause of physical disability, associated with huge socioeconomic burden. Patient preference for treatment is an important factor contributing to the choice of treatment strategies. However, effective measurements for evaluating the ongoing management of musculoskeletal pain are lacking. To help improve clinical decision making, it’s important to estimate the current state of musculoskeletal pain management and analyze the contribution of patient treatment preference.

Methods
A nationally representative sample for the Chinese population was derived from the China Health and Retirement Longitudinal Study (CHARLS). Information on the patients’ demographic characteristics, socioeconomic status, other health-related behavior, as well as history on musculoskeletal pain and treatment data were obtained. The data was used to estimate the status of musculoskeletal pain treatment in China in the year 2018. Univariate analysis and multivariate analysis were used to find the effect factors of treatment preference. XGBoost model and Shapley Additive exPlanations (SHAP) method were performed to analyze the contribution of each variable to different treatment preferences.

Results
Among 18,814 respondents, 10,346 respondents suffered from musculoskeletal pain. Approximately 50% of musculoskeletal pain patients preferred modern medicine, while about 20% chose traditional Chinese medicine and another 15% chose acupuncture or massage therapy. Differing preferences for musculoskeletal pain treatment was related to the respondents’ gender, age, place of residence, education level, insurance status, and health-related behavior such as smoking and drinking. Compared with upper or lower limb pain, neck pain and lower back pain were more likely to make respondents choose massage therapy (P < 0.05). A greater number of pain sites was associated with an increasing preference for respondents to seek medical care for musculoskeletal pain (P < 0.05), while different pain sites did not affect treatment preference.

Conclusion
Factors including gender, age, socioeconomic status, and health-related behavior may have potential effects on people’ s choice of treatment for musculoskeletal pain. The information derived from this study may be useful for helping to inform clinical decisions for orthopedic surgeons when devising treatment strategies for musculoskeletal pain.
Construction and validation of a nomogram model for predicting the overall survival of colorectal cancer patients
Authors: Peiyuan Guo , xuhua Hu , Ganlin Guo , Xu Yin , Zining Liu , Jiachao Han , Bin Yu , Guiying Wang 
Published: June 2023

Abstract
Background
Colorectal cancer (CRC) is a frequent cancer worldwide with varied survival outcomes.

Objective
We aimed to develop a nomogram model to predict the overall survival (OS) of CRC patients after surgery.

Design
This is a retrospective study.

Setting
This study was conducted from 2015 to 2016 in a single tertiary center for CRC.

Patients
CRC patients who underwent surgery between 2015 and 2016 were enrolled and randomly assigned into the training (n = 480) and validation (n = 206) groups. The risk score of each subject was calculated based on the nomogram. All participants were categorized into two subgroups according to the median value of the score.

Main outcome measures
The clinical characteristics of all patients were collected, significant prognostic variables were determined by univariate analysis. Least absolute shrinkage and selection operator (LASSO) regression was applied for variable selection. The tuning parameter (λ) for LASSO regression was determined by cross-validation. Independent prognostic variables determined by multivariable analysis were used to establish the nomogram. The predictive capacity of the model was assessed by risk group stratification.

Results
Infiltration depth, macroscopic classification, BRAF, carbohydrate antigen 19 − 9 (CA-199) levels, N stage, M stage, TNM stage, carcinoembryonic antigen levels, number of positive lymph nodes, vascular tumor thrombus, and lymph node metastasis were independent prognostic factors. The nomogram established based on these factors exhibited good discriminatory capacity. The concordance indices for the training and validation groups were 0.796 and 0.786, respectively. The calibration curve suggested favorable agreement between predictions and observations. Moreover, the OS of different risk subgroups was significantly different.

Limitations
The limitations of this work included small sample size and single-center design. Also, some prognostic factors could not be included due to the retrospective design.

Conclusions
A prognostic nomogram for predicting the OS of CRC patients after surgery was developed, which might be helpful for evaluating the prognosis of CRC patients.
Assessing the cost-effectiveness of integrated case management of Neglected Tropical Diseases in Liberia
Authors: Godwin-Akpan Tiawanlyn G. , Diaconu Karin , Edmiston Melissa , Smith John Solunta , Sosu Fred , Weiland Stefanie , Kollie Karsor K. 
Published: June 2023

Abstract
Background
In 2017, Liberia became one of the first countries in the African region to develop and implement a national strategy for integrated case management of Neglected Tropical Diseases (CM-NTDs), specifically Buruli ulcer, leprosy, lymphatic filariasis morbidities, and yaws. Implementing this plan moves the NTD program from many countries' fragmented (vertical) disease management. This study explores to what extent an integrated approach offers a cost-effective investment for national health systems.

Methods
This study is a mixed-method economic evaluation that explores the cost-effectiveness of the integrated CM-NTDs approach compared to the fragmented (vertical) disease management. Primary data were collected from two integrated intervention counties and two non-intervention counties to determine the relative cost-effectiveness of the integrated program model vs. fragmented (vertical) care. Data was sourced from the NTDs program annual budgets and financial reports for integrated CM-NTDs and Mass Drug Administration (MDA) to determine cost drivers and effectiveness.

Results
The total cost incurred by the integrated CM-NTD approach from 2017 to 2019 was US$ 789,856.30, with the highest percentage of costs for program staffing and motivation (41.8%), followed by operating costs (24.8%). In the two counties implementing fragmented (vertical) disease management, approximately US$ 325,000 was spent on the diagnosis of 84 persons and the treatment of twenty-four persons suffering from NTDs. While 2.5 times as much was spent in integrated counties, 9–10 times more patients were diagnosed and treated.

Conclusions
The cost of a patient being diagnosed under the fragmented (vertical) implementation is five times higher than integrated CM-NTDs, and providing treatment is ten times as costly. Findings indicate that the integrated CM-NTDs strategy has achieved its primary objective of improved access to NTD services. The success of implementing an integrated CM-NTDs approach in Liberia, presented in this paper, demonstrates that NTD integration is a cost-minimizing solution.
Help-seeking challenges for female sexual concerns: a qualitative study from Iran
Authors: Maasoumi Raziyeh , Sabetghadam Shadi , Keramat Afsaneh , Aghayan Seyed Shahrokh 
Published: June 2023

Abstract
Background
To effectively manage sexual health, people must have access to sexual health services. A small percentage of women with sexual concerns seek professional help. Hence, the need to explain the help-seeking challenges is felt from the perspective of women and health care providers.

Methods
This study explored Iranian women’s challenges when seeking help for sexual concerns. Using a purposive sampling method, 26 in-depth interviews were conducted in Rasht in 2019–2020. The participants included sexually active women of reproductive age over 18 years old and 8 health care providers. The recorded interviews were transcribed and analyzed through content analysis.

Results
From the description of 17 subthemes provided by the participants, two main themes were achieved, “Unfavorable sexuality development context” and “Inefficient sexual health services.”

Conclusions
According to the results, it is suggested that policymakers pay more attention to the challenges women and health care providers face in help-seeking and promote sexuality education and sexual health services to achieve a higher level of help-seeking among women.
Cost-effectiveness of sacituzumab govitecan versus chemotherapy in patients with relapsed or refractory metastatic triple-negative breast cancer
Authors: Xie Jiao , Li SiNi , Li YaMin , Li JianHe 
Published: June 2023

AbstractBackgroundThe effectiveness of sacituzumab govitecan for metastatic triple-negative breast cancer (TNBC) has been reported in recent research, however, the value of the effectiveness and cost of sacituzumab govitecan is still unclear.MethodsA microsimulation model was developed using data from the ASCENT trial to assess the cost-effectiveness of sacituzumab govitecan for patients with relapsed or refractory metastatic TNBC over a lifetime. Model inputs, including clinical data, patient characteristics, and direct medical costs, were based on the ASCENT trial, public databases, and published literature. The primary outcomes of the model were the incremental cost-effectiveness ratio (ICER) and quality-adjusted life-years (QALYs). Univariate and probabilistic sensitivity analysis (PSA) and multiple scenario analyses were performed to address the uncertainty of the model.ResultsOur results revealed that sacituzumab govitecan versus chemotherapy costs $293,037 and yielded an additional 0.2340 of QALYs in the whole population with metastatic TNBC, leading to an ICER of $1,252,295 gained. And in the population with metastatic TNBC without brain metastasis, the sacituzumab govitecan versus chemotherapy costs $309,949 and obtained an extra 0.2633 of QALYs, which resulted in an ICER of $1,177,171/QALYs. Univariate analyses indicated that the model outcomes were most sensitive to the drug cost of sacituzumab govitecan, the utility of progression-free disease, and the utility of progressed disease.ConclusionFrom the US payer perspective, sacituzumab govitecan is unlikely to be a cost-effective option for patients with relapsed or refractory metastatic TNBC compared with chemotherapy. Based on the value standpoint, a price decrease of sacituzumab govitecan is expected to increase the cost-effectiveness of sacituzumab govitecan in patients with metastatic TNBC.
Associations between polygenic risk score and covid-19 susceptibility and severity across ethnic groups: UK Biobank analysis
Authors: Farooqi Raabia , Kooner Jaspal S. , Zhang Weihua 
Published: June 2023

Abstract
Background
COVID-19 manifests with huge heterogeneity in susceptibility and severity outcomes. UK Black Asian and Minority Ethnic (BAME) groups have demonstrated disproportionate burdens. Some variability remains unexplained, suggesting potential genetic contribution. Polygenic Risk Scores (PRS) can determine genetic predisposition to disease based on Single Nucleotide Polymorphisms (SNPs) within the genome. COVID-19 PRS analyses within non-European samples are extremely limited. We applied a multi-ethnic PRS to a UK-based cohort to understand genetic contribution to COVID-19 variability.

Methods
We constructed two PRS for susceptibility and severity outcomes based on leading risk-variants from the COVID-19 Host Genetics Initiative. Scores were applied to 447,382 participants from the UK-Biobank. Associations with COVID-19 outcomes were assessed using binary logistic regression and discriminative power was validated using incremental area under receiver operating curve (ΔAUC). Variance explained was compared between ethnic groups via incremental pseudo-R2 (ΔR2).

Results
Compared to those at low genetic risk, those at high risk had a significantly greater risk of severe COVID-19 for White (odds ratio [OR] 1.57, 95% confidence interval [CI] 1.42–1.74), Asian (OR 2.88, 95% CI 1.63–5.09) and Black (OR 1.98, 95% CI 1.11–3.53) ethnic groups. Severity PRS performed best within Asian (ΔAUC 0.9%, ΔR2 0.98%) and Black (ΔAUC 0.6%, ΔR2 0.61%) cohorts. For susceptibility, higher genetic risk was significantly associated with COVID-19 infection risk for the White cohort (OR 1.31, 95% CI 1.26–1.36), but not for Black or Asian groups.

Conclusions
Significant associations between PRS and COVID-19 outcomes were elicited, establishing a genetic basis for variability in COVID-19. PRS showed utility in identifying high-risk individuals. The multi-ethnic approach allowed applicability of PRS to diverse populations, with the severity model performing well within Black and Asian cohorts. Further studies with larger sample sizes of non-White samples are required to increase statistical power and better assess impacts within BAME populations.
Decreased level of serum NT-proCNP associates with disease severity in COVID-19
Authors: Bojti Istvan , Przewosnik Anne-Sophie , Luxenburger Hendrik , Hofmann Maike , Neumann-Haefelin Christoph , Esser Jennifer S. , Siegel Patrick M. , Maier Alexander , Kovacs Sarolta Bojtine , Kardos Laszlo , Csanádi Zoltan , Rieder Marina , Duerschmied Daniel , Lother Achim , Bode Christoph , Szabó Gabor Tamas , Czuriga Daniel 
Published: June 2023

Abstract
Background
C-type natriuretic peptide (CNP) is an endothelium-derived paracrine molecule with an important role in vascular homeostasis. In septic patients, the serum level of the amino-terminal propeptide of CNP (NT-proCNP) shows a strong positive correlation with inflammatory biomarkers and, if elevated, correlates with disease severity and indicates a poor outcome. It is not yet known whether NT-proCNP also correlates with the clinical outcome of patients suffering from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In the current study, we aimed to determine possible changes in the NT-proCNP levels of patients with coronavirus disease 2019 (COVID-19), with special regard to disease severity and outcome.

Methods
In this retrospective analysis, we determined the serum level of NT-proCNP in hospitalized patients with symptoms of upper respiratory tract infection, using their blood samples taken on admission, stored in a biobank. The NT-proCNP levels of 32 SARS-CoV-2 positive and 35 SARS-CoV-2 negative patients were measured to investigate possible correlation with disease outcome. SARS-CoV-2 positive patients were then divided into two groups based on their need for intensive care unit treatment (severe and mild COVID-19).

Results
The NT-proCNP was significantly different in the study groups (e.g. severe and mild COVID-19 and non-COVID-19 patients), but showed inverse changes compared to previous observations in septic patients: lowest levels were detected in critically ill COVID-19 patients, while highest levels in the non-COVID-19 group. A low level of NT-proCNP on admission was significantly associated with severe disease outcome.

Conclusions
Low-level NT-proCNP on hospital admission is associated with a severe COVID-19 disease course. The pathomechanism underlying this observation remains to be elucidated, while future studies in larger patient cohorts are necessary to confirm these observations and reveal therapeutic importance.
Trial registration DRKS00026655 Registered 26. November 2021
Non-linear association of atherogenic index of plasma with insulin resistance and type 2 diabetes: a cross-sectional study
Authors: Yin Bei , Wu Zihong , Xia Yaqing , Xiao Shunqiang , Chen Lingling , Li Yousheng 
Published: June 2023

Abstract
Background
Although there is numerous evidence on the epidemiological risk factors for insulin resistance (IR)-related metabolic diseases, there is still insufficient evidence to explore the non-linear association of Atherogenic Index of Plasma (AIP) with IR. Therefore, we aimed to elucidate the non-linear relationship between AIP and IR and type 2 diabetes (T2D).

Methods
This cross-sectional study was conducted in the National Health and Nutrition Survey (NHANES) from 2009 to 2018. A total of 9,245 participants were included in the study. The AIP was calculated as log10 (triglycerides/high-density lipoprotein cholesterol). The outcome variables included IR and T2D defined by the 2013 American Diabetes Association guidelines. The weighted multivariate linear regression, weighted multivariate logistic regression, subgroup analysis, generalized additive model, smooth fitting curve and two-part logistic regression were adopted to reveal the relationship of AIP with IR and T2D.

Results
After adjustment for age, gender, race, education level, smoking status, alcohol consumption, vigorous/moderate physical activity, body mass index, waist circumference and hypertension, we found that AIP was positively associated with fasting blood glucose (β = 0.08, 95% CI: 0.06, 0.10), glycosylated hemoglobin (β = 0.04, 95% CI: 0.39, 0.58), fasting serum insulin (β = 4.26, 95% CI: 3.73, 4.79), and homeostasis model assessment of insulin resistance (β = 0.22, 95% CI: 0.18, 0.25). Further studies found that AIP was associated with increased risk of IR (OR = 1.29, 95% CI: 1.26–1.32) and T2D (OR = 1.18, 95% CI: 1.15–1.22). However, the positive association between AIP and IR or T2D was more significant in female than in male (IR: P for interaction = 0.0135; T2D: P for interaction = 0.0024). A non-linear and inverse L-shaped association was found between AIP and IR, while a J-shaped association was found between AIP and T2D. In patients with − 0.47 < AIP < 0.45, increased AIP was significantly associated with increased risk of IR and T2D.

Conclusions
AIP showed an inverse L-shaped association with IR and a J-shaped association with T2D, indicating that AIP should be reduced to a certain level to prevent IR and T2D.
Enhanced extracellular production of raw starch-degrading α-amylase in Bacillus subtilis through expression regulatory element modification and fermentation optimization
Authors: Yao Dongbang , Han Xudong , Gao Huanhuan , Wang Bin , Fang Zemin , Li He , Fang Wei , Xiao Yazhong 
Published: June 2023

Abstract
Background
Raw starch-degrading α-amylase (RSDA) can hydrolyze raw starch at moderate temperatures, thus contributing to savings in starch processing costs. However, the low production level of RSDA limits its industrial application. Therefore, improving the extracellular expression of RSDA in Bacillus subtilis, a commonly used industrial expression host, has great value.

Results
In this study, the extracellular production level of Pontibacillus sp. ZY raw starch-degrading α-amylase (AmyZ1) in B. subtilis was enhanced by expression regulatory element modification and fermentation optimization. As an important regulatory element of gene expression, the promoter, signal peptide, and ribosome binding site (RBS) sequences upstream of the amyZ1 gene were sequentially optimized. Initially, based on five single promoters, the dual-promoter Pveg-PylB was constructed by tandem promoter engineering. Afterward, the optimal signal peptide SPNucB was obtained by screening 173 B. subtilis signal peptides. Then, the RBS sequence was optimized using the RBS Calculator to obtain the optimal RBS1. The resulting recombinant strain WBZ-VY-B-R1 showed an extracellular AmyZ1 activity of 4824.2 and 41251.3 U/mL during shake-flask cultivation and 3-L fermenter fermentation, which were 2.6- and 2.5-fold greater than those of the original strain WBZ-Y, respectively. Finally, the extracellular AmyZ1 activity of WBZ-VY-B-R1 was increased to 5733.5 U/mL in shake flask by optimizing the type and concentration of carbon source, nitrogen source, and metal ions in the fermentation medium. On this basis, its extracellular AmyZ1 activity was increased to 49082.1 U/mL in 3-L fermenter by optimizing the basic medium components as well as the ratio of carbon and nitrogen sources in the feed solution. This is the highest production level reported to date for recombinant RSDA production.

Conclusions
This study represents a report on the extracellular production of AmyZ1 using B. subtilis as a host strain, and achieved the current highest expression level. The results of this study will lay a foundation for the industrial application of RSDA. In addition, the strategies employed here also provide a promising way for improving other protein production in B. subtilis.