bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patellar Tendon Rupture with Transosseous Tunnel Repair
Authors: Horner Nolan S. , Fenn Thomas W. , Ephron Chris , Nho Shane J. 
Published: April 2023

Background: Patellar tendon rupture is an injury most often occurring in adults and commonly caused by tensile overload to the extensor mechanism of the knee or direct trauma to the tendon. Early diagnosis and timely surgical repair lead to good functional outcomes and high rates of return to activity. Indications: In patients with impaired knee extensor mechanisms, inability to perform a straight leg raise, or evidence of complete tendon rupture on imaging, surgical tendon repair is indicated. Technical Description: The surgical technique demonstrated here presents a standard patellar tendon repair with transosseous tunnels of a 32-year-old man. Briefly, dissection was performed down to the retinacular layer, and the patellar tendon stump was identified. Any devitalized soft tissue was removed from the inferior pole of the patella and the proximal tendon stump by a rongeur. Two locking Krackow sutures were placed along the medial and lateral aspect of the patellar tendon. Then, a drill bit was used to create 3 transosseous tunnels in the patella and a nitinol basket was used to pass sutures through each tunnel. The retinacular layer was closed by figure-of-eight stiches, followed by layered closure of the subcutaneous layer, and finally, the skin. Results: Early surgical repair of the patellar tendon leads to good functional outcomes and return to sport rates. In a retrospective study of 38 knees, at average of 9.3 years follow-up, 96% of patients reported they were satisfied/very satisfied, with a 100% returning to work. High rates of return to sports have been reported from a retrospective study, with a 94.4% and 83.3% rate of return to sport and rate of return to sport at the same level, respectively. Discussion: In this surgical technique video, we review the common presentation, indications of surgical repair, key steps and technique pearls for a case of a ruptured patellar tendon. Furthermore, we review complications and postoperative rehabilitation guidelines, postoperative clinical outcomes, and return-to-sport rates existing in the literature. Finally, we assess key differences between 2 commonly used surgical techniques, knotless suture anchors versus transosseous tunnels, in patellar tendon repair. 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.
Commentary on the EU Commission's proposal for amending the Water Framework Directive, the Groundwater Directive, and the Directive on Environmental Quality Standards
Authors: Backhaus Thomas 
Published: April 2023

AbstractThe EU Commission published on the 26th of October 2022 its proposal for amending three central water management Directives, the Water Framework Directive, the Groundwater Directive, and the Directive on Environmental Quality Standards. The proposal introduces a series of amendments and changes to remedy shortcomings that were identified in the previous fitness check of the European water legislation and to align the legal framework with the scientific and technical progress of the last decades. This commentary briefly summarizes and evaluates the new elements that are most relevant from a toxicological and ecotoxicological perspective.The Commission proposal substantially extends the list of WFD priority substances and now includes 68 substances and substance groups. It also identifies five substances and substance groups as a priority for groundwater management. In several instances, generic sum-EQS values are suggested for selected substance groups, an approach that lacks scientific underpinning and might not always be sufficiently protective. EQS values for substances groups are certainly needed, but are better set using relative potency factors or other implementations of the Concentration Addition concept. The Commission proposal employs this approach for setting groupwise EQS values for PFAS chemicals and PAHs and it should be systematically applied also to other groups of priority substances.Effect-based methods (EBMs) are now included in the legal text of the WFD, which is highly welcome. However, the Commission proposal limits EBMs to explorative studies and does not include the setting of EQS values based on EBM-methods.Revising the major legislative frameworks offers opportunities to streamline water pollution management in the spirit of the “one substance, one assessment” idea. Further details on how substance evaluations performed in the context of water management can be harmonized with those performed by EFSA, ECHA and EMA during substance registration and authorization would have been welcome.
Assessment of cecal microbiota modulation from piglet dietary supplementation with copper
Authors: Paganin Ana Carolina Laureano , Monzani Paulo Sérgio , Carazzolle Marcelo Falsarella , Araujo Raquel Bighetti , Gonzalez-Esquerra Ricardo , Haese Douglas , Kill João L , Rezende Graziela Silva , de Lima César Gonçalves , Malavazi Iran , de Melo Freire Caio César , da Cunha Anderson Ferreira 
Published: April 2023

Abstract
Background
Swine production expanded in the last decades. Efforts have been made to improve meat production and to understand its relationship to pig gut microbiota. Copper (Cu) is a usual supplement to growth performance in animal production. Here, two performance studies were conducted to investigate the effects of three different sources of Cu on the microbiota of piglets. A total of 256 weaned piglets were randomly allocated into 4 treatments (10 replicates per treatment of 4 piglets per pen in Trial 1 and 8 replicates of 3 piglets per pen in Trial 2). Treatments included a control group (fed 10 mg/kg of Cu from CuSO4), a group fed at 160 mg/kg of Copper (II) sulfate (CuSO4) or tri-basic copper chloride (TBCC), and a group fed with Cu methionine hydroxy analogue chelated (Cu-MHAC) at 150, 80, and 50 mg/kg in Phases 1 (24–35 d), 2 (36–49 d), and 3 (50–70 d), respectively. At 70 d, the cecum luminal contents from one pig per pen were collected and polled for 16 S rRNA sequencing (V3/V4 regions). Parameters were analyzed in a completely randomized block design, in which each experiment was considered as a block.

Results
A total of 1337 Operational Taxonomic Units (OTUs) were identified. Dominance and Simpson ecological metrics were statistically different between control and treated groups (P < 0.10) showing that different Cu sources altered the gut microbiota composition with the proliferation of some bacteria that improve gut health. A high abundance of Prevotella was observed in all treatments while other genera were enriched and differentially modulated, according to the Cu source and dosage. The supplementation with Cu-MHAC can modify a group of bacteria involved in feed efficiency (FE) and short chain fatty acids (SCFA) production (Clostridium XIVa, Desulfovibrio, and Megasphera). These bacteria are also important players in the activation of ghrelin and growth hormones that were previously reported to correlate with Cu-MHAC supplementation.

Conclusions
These results indicated that some genera seem to be directly affected by the Cu source offered to the animals. TBCC and Cu-MHAC (even in low doses) can promote healthy modifications in the gut bacterial composition, being a promising source of supplementation for piglets.
Uncovering early transcriptional regulation during adventitious root formation in Medicago sativa
Authors: Ai Ye , Qian Xu , Wang Xiaoqian , Chen Yinglong , Zhang Tiejun , Chao Yuehui , Zhao Yan 
Published: April 2023

Abstract
Background
Alfalfa (Medicago sativa L.) as an important legume plant can quickly produce adventitious roots (ARs) to form new plants by cutting. But the regulatory mechanism of AR formation in alfalfa remains unclear.

Results
To better understand the rooting process of alfalfa cuttings, plant materials from four stages, including initial separation stage (C stage), induction stage (Y stage), AR primordium formation stage (P stage) and AR maturation stage (S stage) were collected and used for RNA-Seq. Meanwhile, three candidate genes (SAUR, VAN3 and EGLC) were selected to explore their roles in AR formation. The numbers of differentially expressed genes (DEGs) of Y-vs-C (9,724) and P-vs-Y groups (6,836) were larger than that of S-vs-P group (150), indicating highly active in the early AR formation during the complicated development process. Pathways related to cell wall and sugar metabolism, root development, cell cycle, stem cell, and protease were identified, indicating that these genes were involved in AR production. A large number of hormone-related genes associated with the formation of alfalfa ARs have also been identified, in which auxin, ABA and brassinosteroids are thought to play key regulatory roles. Comparing with TF database, it was found that AP2/ERF-ERF, bHLH, WRKY, NAC, MYB, C2H2, bZIP, GRAS played a major regulatory role in the production of ARs of alfalfa. Furthermore, three identified genes showed significant promotion effect on AR formation.

Conclusions
Stimulation of stem basal cells in alfalfa by cutting induced AR production through the regulation of various hormones, transcription factors and kinases. This study provides new insights of AR formation in alfalfa and enriches gene resources in crop planting and cultivation.
Non-thyroidal Illness Syndrome (NTIS) is no independent predictor for mortality in ICU patients
Authors: Krug Natalie , Bercker Sven , Busch Thilo , Friese Steffen , Jahn Nora , Voelker Maria Theresa 
Published: April 2023

Abstract
Background
Low T3-(/T4-) syndrome, also known as non-thyroidal Illness Syndrome (NTIS) describes a decrease in free serum thyroid hormones without a concomitant increase in TSH, frequently observed in critically ill patients. However, whether NTIS is only a metabolic adaption to stress in critically ill or plays a crucial role as an independent risk factor for ICU mortality, remains unknown. Our study aimed to evaluate NTIS as an independent risk factor for increased ICU mortality.

Methods
All patients admitted to the interdisciplinary intensive care unit (ICU) at the University Hospital of Leipzig between 2008 and 2014 were retrospectively analyzed for thyroidal function. Baseline data, information on additional thyroid function tests, disease progression, hospital and ICU length of stay (LOS) and patient outcome were retrospectively analyzed from the hospitals digital information system. For statistical evaluation, univariate analysis, matched pairs analysis and multivariate logistic regression were conducted.

Results
One thousand, seven hundred ninety patients were enrolled in the study, of which 665 showed NTIS. Univariate analysis revealed a positive association of NTIS with ICU- and hospital-LOS, need for mechanical ventilation, incidence of sepsis, acute respiratory distress syndrome, acute liver failure and increased ICU mortality. Results of matched pair analysis confirmed these findings. In multivariate logistic regression, NTIS was associated with an increased ICU-LOS, increased duration of mechanical ventilation, acute kidney injury and liver failure, but showed no independent association with increased ICU-mortality.

Conclusion
Duration of mechanical ventilation as well as incidence of acute kidney injury, sepsis and acute liver failure were detected as independent predictors of mortality in patients with NTIS. NTIS itself was no independent predictor of increased ICU-mortality.
Low blood carotenoid status in dementia and mild cognitive impairment: A systematic review and meta-analysis
Authors: Wang Lin , Zhao Tie , Zhu Xu , Jiang Qinghua 
Published: April 2023

Abstract
Background
Given their potent antioxidation properties, carotenoids play a role in delaying and preventing dementia and mild cognitive impairment (MCI). However, observational studies have found inconsistent results regarding the associations between blood carotenoid levels and the risk of dementia and MCI. We conducted this systematic review and meta-analysis to investigate the relationship between blood carotenoid levels and the risk of dementia and MCI.

Methods
A systematic search was performed in the Web of Science, PubMed, Embase, and Cochrane Library electronic databases to retrieve relevant English articles published from their inception until February 23, 2023. Study quality was assessed by the Newcastle-Ottawa scale. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were pooled using random-effect meta-analyses. Ultimately, 23 studies (n = 6610) involving 1422 patients with dementia, 435 patients with MCI, and 4753 controls were included.

Results
Our meta-analysis showed that patients with dementia had lower blood lycopene (SMD: -0.521; 95%CI: -0.741, -0.301), α-carotene (SMD: -0.489; 95%CI: -0.697, -0.281), β-carotene (SMD: -0.476; 95%CI: -0.784, -0.168), lutein (SMD: -0.516; 95%CI: -0.753, -0.279), zeaxanthin (SMD: -0.571; 95%CI: -0.910, -0.232) and β-cryptoxanthin (SMD: -0.617; 95%CI: -0.953, -0.281) than the controls. Our results indicated that blood carotenoid levels were significantly lower in patients with dementia than in controls, despite high heterogeneity across the studies. Owing to insufficient data, we did not observe a similar and stable relationship between blood carotenoid levels and MCI.

Conclusions
Our meta-analysis indicated that lower blood carotenoid levels may be a risk factor for dementia and MCI.
Prevalence and the affecting factors on depression, anxiety and stress (DASS) among elders in Qazvin City, in the Northwest of Iran
Authors: Raeisvandi Abouzar , Amerzadeh Mohammad , Hajiabadi Fatemeh , Hosseinkhani Zahra 
Published: April 2023

Abstract
Background
Depression, anxiety, and stress are among the most common mental health disorders of the elderly that affect the health of individuals and society. Considering the growing trend of the elderly population in Iran, this study aimed to determine the prevalence of these disorders and to identify the factors affecting them in the elderly.

Methods
We conducted this cross-sectional study using cluster random sampling on 301 elderly people referred to Qazvin health centers. Data was collected using the Depression, Anxiety, Stress Scale 21 (DASS-21) questionnaire and analyzed through univariate and multivariate linear regression tests with the interaction between variables in STATA Version 14 software. A P-value of less than 0.05 was significant.

Results
The prevalence of depression was 45.5%, anxiety 35.5%, and stress 40.2%. Our findings showed that 22.9%, 7.9%, and 14.3% of people had severe and very severe levels of depression, anxiety, and stress. The variables of age, comorbidity, living status and job status had a significant relationship with the DASS score (p < 0.05). There was an interaction between the variables of comorbidity and income status influencing the DASS score (β = 0.68, 95% CI 0.15, 1.22).

Conclusion
The prevalence of depression, anxiety and stress in the elderly was high, indicating the inappropriate status of their mental health. Therefore, it is necessary to take operational steps to reduce some problems in the elderly, prioritize the elderly suffering from concurrent diseases, the unemployed elderly, those who do not have a certain income, and the elderly who live alone.
The role of medication adherence in the association between depressive symptoms and quality of life in older adults with type 2 diabetes mellitus
Authors: Yang Hao , Wu Fangtuan , Gui Mingdong , Cheng Yuwei , Zhang Li 
Published: April 2023

Abstract
Background
At present, the role of medication adherence in the association between depressive symptoms and quality of life (QOL) in older adults with type 2 diabetes mellitus (T2DM) was unclear. The purpose of this study was to explore the associations among depressive symptoms, medication adherence and QOL in older adults with T2DM.

Methods
In this cross-sectional study, 300 older adults with T2DM from the First Affiliated Hospital of Anhui Medical University were enrolled. Among them, 115 patients had depressive symptoms and 185 had no depressive symptoms. Univariate linear regression analysis was conducted to identify possible covariates. Univariate and multivariable linear regression analyses were performed to explore the associations between depressive symptoms and medication adherence or QOL in older adults with T2DM. Multiplicative interaction analysis was evaluated whether there was interaction effect between medication adherence and depressive symptoms on QOL of patients. Mediating effect analysis was used to analyze the medication effect of medication adherence on depressive symptoms and QOL in older adults with T2DM.

Results
Decreased medication adherence was observed in patients with depressive symptoms (β = -0.67, 95%CI: -1.10, -0.24) after adjusting for covariates. Depressive symptoms were associated with decreased QOL in older adults with T2DM (β = -5.99, 95%CI: -7.56, -4.42). The mediating analysis revealed that depressive symptoms were associated with decreased medication adherence (β = -0.67, 95%CI: -1.09, -0.25). Medication adherence was linked with increased QOL of older adults with T2DM (β = 0.65, 95%CI: 0.24, 1.06). Depressive symptoms were correlated with decreased QOL of older adults with T2DM (β = -5.56, 95%CI: -7.10, -4.01). The percentage mediated by medication adherence on depressive symptoms and QOL in older adults with T2DM was 10.61%.

Conclusion
Medication adherence might mediate depressive symptoms and QOL of older adults with T2DM, which might provide a reference for the improvement of QOL of these patients.
Education program promoting report of elder abuse by nursing students: a pilot study
Authors: Park Dahye , Ha Jeongmin 
Published: April 2023

Abstract
Background
Elder abuse is an important public health concern that requires urgent attention. One main barrier to active responses to elder abuse in clinical settings is a low level of relevant knowledge among nurses. This study aims to develop an educational program to promote an intent to report elder abuse among nursing students and assess its effectiveness, with a focus on the rights of older adults.

Methods
A mixed method design was used with the Analyze, Design, Develop, Implement, and Evaluate model. Twenty-five nursing students from Chungbuk Province participated in the study. Attitude toward older adults and knowledge of, awareness of, attitude towards, and intent to report elder abuse were assessed quantitatively and analyzed using paired t-test. The feasibility of the program and feedback were collected qualitatively through group interviews and analyzed using content analysis.

Results
After the education program, attitude toward older adults (Cohen’s d = 1.08), knowledge of (Cohen’s d = 2.15), awareness of (Cohen’s d = 1.56), attitude towards (Cohen’s d = 1.85), and intent to report elder abuse (Cohen’s d = 2.78) increased, confirming the positive effects of this program. Overall, all participants were satisfied with the contents and method of the program.

Conclusions
The method of program delivery should be improved and tailored strategies to boost program engagement among nursing students should be explored to implement and disseminate the program.
Impact of race-independent equations on estimating glomerular filtration rate for the assessment of kidney dysfunction in liver disease
Authors: Stämmler Frank , Derain-Dubourg Laurence , Lemoine Sandrine , Meeusen Jeffrey W. , Dasari Surendra , Lieske John C. , Robertson Andrew , Schiffer Eric 
Published: April 2023

AbstractBackgroundAltered hemodynamics in liver disease often results in overestimation of glomerular filtration rate (GFR) by creatinine-based GFR estimating (eGFR) equations. Recently, we have validated a novel eGFR equation based on serum myo-inositol, valine, and creatinine quantified by nuclear magnetic resonance spectroscopy in combination with cystatin C, age and sex (GFRNMR). We hypothesized that GFRNMRcould improve chronic kidney disease (CKD) classification in the setting of liver disease.ResultsWe conducted a retrospective multicenter study in 205 patients with chronic liver disease (CLD), comparing the performance of GFRNMRto that of validated CKD-EPI eGFR equations, including eGFRcr (based on creatinine) and eGFRcr-cys (based on both creatinine and cystatin C), using measured GFR as reference standard. GFRNMRoutperformed all other equations with a low overall median bias (-1 vs. -6 to 4 ml/min/1.73 m2for the other equations;p < 0.05) and the lowest difference in bias between reduced and preserved liver function (-3 vs. -16 to -8 ml/min/1.73 m2for other equations). Concordant classification by CKD stage was highest for GFRNMR(59% vs. 48% to 53%) and less biased in estimating CKD severity compared to the other equations. GFRNMRP30 accuracy (83%) was higher than that of eGFRcr (75%;p = 0.019) and comparable to that of eGFRcr-cys (86%;p = 0.578).ConclusionsAddition of myo-inositol and valine to creatinine and cystatin C in GFRNMRfurther improved GFR estimation in CLD patients and accurately stratified liver disease patients into CKD stages.
Functional connectivity of the language area in migraine: a preliminary classification model
Authors: Gou Chen , Yang Shuangfeng , Hou Qianmei , Rudder Peter , Tanglay Onur , Young Isabella , Peng Tingting , He Weiwei , Yang Liuyi , Osipowicz Karol , Doyen Stephane , Mansouri Negar , Sughrue Michael E. , Wang Xiaoming 
Published: April 2023

AbstractBackgroundMigraine is a complex disorder characterized by debilitating headaches. Despite its prevalence, its pathophysiology remains unknown, with subsequent gaps in diagnosis and treatment. We combined machine learning with connectivity analysis and applied a whole-brain network approach to identify potential targets for migraine diagnosis and treatment.MethodsBaseline anatomical T1 magnetic resonance imaging (MRI), resting-state functional MRI(rfMRI), and diffusion weighted scans were obtained from 31 patients with migraine, and 17 controls. A recently developed machine learning technique, Hollow Tree Super (HoTS) was used to classify subjects into diagnostic groups based on functional connectivity (FC) and derive networks and parcels contributing to the model. PageRank centrality analysis was also performed on the structural connectome to identify changes in hubness.ResultsOur model attained an area under the receiver operating characteristic curve (AUC-ROC) of 0.68, which rose to 0.86 following hyperparameter tuning. FC of the language network was most predictive of the model’s classification, though patients with migraine also demonstrated differences in the accessory language, visual and medial temporal regions. Several analogous regions in the right hemisphere demonstrated changes in PageRank centrality, suggesting possible compensation.ConclusionsAlthough our small sample size demands caution, our preliminary findings demonstrate the utility of our method in providing a network-based perspective to diagnosis and treatment of migraine.