bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differences in fixation to young and elderly quadrilateral surfaces with anatomic quadrilateral surface plate (AQSP) based on cortical thickness morphological results
Authors: Guo Jialiang , Dong Weichong , Zhou Yali , Hu Jinglue , Ye Pengyu , Chen Wei , Zhang Yingze , Hou Zhiyong 
Published: March 2022

Abstract
Aims
With relatively thinner cortical thickness, the management of acetabulum osteoporotic fractures in elderly patients is difficult. The aim of the research was to compare and present the morphological characteristics of the quadrilateral plate in young and elderly age groups, such as the area, and position distribution of the thin cortical thickness region, fracture lines maps, and propose a revised design plate for elderly patients based on these anatomic information.

Methods
As a retrospective research, acetabular fracture with one normal hemipelvises, including 110 men and 39 women, were collected to present the morphological characteristics of the quadrilateral region. The subjects were divided into three different age groups: Group I = 18–40 years (31.3 ± 6.6 years), Group II = 41–60 years (49.9 ± 5.3 years), and Group III ≥ 61 years (68.7 ± 6.8 years). The area of the quadrilateral surface, the area and position distribution of the thin cortical thickness region, the ratio and fracture lines maps were calculated and compared with Mimics in different groups.

Results
The thin cortical thickness/width region area (TCWRA) was significantly increased in Group III compared with Group I and Group II. The ratio of TCWRA accounted for in the quadrilateral region was also significantly increased in Group III (≥ 61 years) compared with Group I (P = 0.01) and Group II (P = 0.011). None of the subjects had a component involving the “A” zone, thirty-three thin cortical thickness regions were located in the “B” zone, and one hundred and sixteen involved both zones of the quadrilateral plate (“A + B” zone). Furthermore, there were a significant differences in the fracture line distributions in three age groups. More fracture lines of elderly patients were located at anterior part (B zone) compared with Group I and Group II.

Conclusions
It was identified the area of thin cortical thickness region increased as age grown, and fracture lines were inclined to be more distributed in “B” zone in elderly patients. To meet the demands of acetabular fixation in different age groups, cortical thickness changes in young and elderly individuals should be given special attention when the quadrilateral surface plate is designed.
Level of evidence Level IV, observational study.
α-Mangostin inhibits LPS-induced bone resorption by restricting osteoclastogenesis via NF-κB and MAPK signaling
Authors: Zhang Wenkan , Jiang Guangyao , Zhou Xiaozhong , Huang Leyi , Meng Jiahong , He Bin , Qi Yiying 
Published: March 2022

Abstract
Background
Excessive osteoclast activation is an important cause of imbalanced bone remodeling that leads to pathological bone destruction. This is a clear feature of many osteolytic diseases such as rheumatoid arthritis, osteoporosis, and osteolysis around prostheses. Because many natural compounds have therapeutic potential for treating these diseases by suppressing osteoclast formation and function, we hypothesized that α-mangostin, a natural compound isolated from mangosteen, might be a promising treatment as it exhibits anti‐inflammatory, anticancer, and cardioprotective effects.

Methods
We evaluated the therapeutic effect of α-mangostin on the processes of osteoclast formation and bone resorption. The receptor activator of nuclear factor-κB (NF-κB) ligand (RANKL) induces osteoclast formation in vitro, and potential pathways of α-mangostin to inhibit osteoclast differentiation and function were explored. A mouse model of lipopolysaccharide‐induced calvarial osteolysis was established. Subsequently, micro-computed tomography and histological assays were used to evaluate the effect of α-mangostin in preventing inflammatory osteolysis.

Results
We found that α-mangostin could inhibit RANKL-induced osteoclastogenesis and reduced osteoclast‐related gene expression in vitro. F-actin ring immunofluorescence and resorption pit assays indicated that α-mangostin also inhibited osteoclast functions. It achieved these effects by disrupting the activation of NF-κB/mitogen-activated protein kinase signaling pathways. Our in vivo data revealed that α-mangostin could protect mouse calvarial bone from osteolysis.

Conclusions
Our findings demonstrate that α-mangostin can inhibit osteoclastogenesis both in vitro and in vivo and may be a potential option for treating osteoclast-related diseases.
Physicians’ knowledge on specific rare diseases and its associated factors: a national cross-sectional study from China
Authors: Zhang Huanyu , Xiao Ying , Zhao Xinyue , Tian Zhuang , Zhang Shu-yang , Dong Dong 
Published: March 2022

Abstract
Background
Rare disease patients often experience diagnosis delays or misdiagnosis, which may be due to lack of knowledge on rare diseases among physicians.

Objective
To assess Chinese physicians’ knowledge on specific rare diseases and identify its associated factors.

Methods
Thirty-four patient organizations with a unique disease of interest were invited to develop 3 knowledge questions for each rare disease to assess physicians’ knowledge on the disease that they felt most experienced in. The total knowledge score for each participant ranged from a score of 0 to 3. A national cross-sectional study conducted in a cohort of 3197 physicians from 6 provinces across western, central and eastern China. The demographic information of the participants was collected including gender, age, birthplace, income, education, hospital class, working title, working years, and specialty. A multiple linear regression analysis was performed to assess the independent associations between the physician variables and the total knowledge score.

Results
Two thousand, one hundred and fifteen (66.16%) of the involved physicians obtained a total knowledge score of 2 or 3. The median knowledge scores of 10 (29.4%) rare diseases were a score of 1.5 or below. Physicians with female gender (β = 0.08, p < 0.05 for females vs. males), and a monthly income of 5000–10,000 RMB (β = 0.11, p < 0.01 for 5000–10,000 vs. < 5000) and 10,000–30,000 RMB (β = 0.14, p < 0.05) were associated with a higher score. Specialties of physicians who received a relatively higher score included internal medicine, obstetrics and gynecology, radiology, intensive care unit, and surgery.

Conclusions
Almost two thirds of the participants had an average or good level of knowledge on the specific rare disease that they felt most experienced in. Physicians with female gender, a monthly income of 5000–10,000 RMB and 10,000–30000 RMB, and specialties of internal medicine, obstetrics and gynecology, radiology, intensive care unit, and surgery, were associated with a relatively higher knowledge score.
Utilizing the “teach-back” method to improve surgical informed consent and shared decision-making: a review
Authors: Seely Kevin D. , Higgs Jordan A. , Nigh Andrew 
Published: March 2022

AbstractThe teach-back method is a valuable communication tool that can be employed to improve patient safety and shared decision-making. Its utility in patient care has been studied extensively in many areas of clinical medicine. However, the literature on the use of teach-back in surgical patient education and informed consent is limited. Additionally, there is some ambiguity about the functional definition and performance of the teach-back method in the literature, consequently rendering this valuable tool an enigma. This review examines the current standards and ethics of preoperative informed consent and provides a concise, actionable definition of teach-back. The manner in which teach-back has been implemented in medicine and surgery is then examined in detail. Studies analyzing the use of teach-back in medicine have demonstrated its effectiveness and benefit to patient care. Further study on the use of teach-back to improve preoperative informed consent is supported by the few preliminary trials showing a positive effect after implementing the teach-back method in critical patient interactions.
Characterization of a rare mosaic unbalanced translocation of t(3;12) in a patient with neurodevelopmental disorders
Authors: Hu Xiaolin , Baker Elizabeth K. , Johnson Jodie , Balow Stephanie , Pena Loren D. M. , Conlin Laura K. , Guan Qiaoning , Smolarek Teresa A. 
Published: March 2022

Abstract
Background
Unbalanced translocations may be de novo or inherited from one parent carrying the balanced form and are usually present in all cells. Mosaic unbalanced translocations are extremely rare with a highly variable phenotype depending on the tissue distribution and level of mosaicism. Mosaicism for structural chromosomal abnormalities is clinically challenging for diagnosis and counseling due to the limitation of technical platforms and complex mechanisms, respectively. Here we report a case with a tremendously rare maternally-derived mosaic unbalanced translocation of t(3;12), and we illustrate the unreported complicated mechanism using single nucleotide polymorphism (SNP) array, fluorescence in situ hybridization (FISH), and chromosome analyses.

Case presentation
An 18-year-old female with a history of microcephaly, pervasive developmental disorder, intellectual disability, sensory integration disorder, gastroparesis, and hypotonia presented to our genetics clinic. She had negative karyotype by parental report but no other genetic testing performed previously. SNP microarray analysis revealed a complex genotype including 8.4 Mb terminal mosaic duplication on chromosome 3 (3p26.3->3p26.1) with the distal 5.7 Mb involving two parental haplotypes and the proximal 2.7 Mb involving three parental haplotypes, and a 6.1 Mb terminal mosaic deletion on chromosome 12 (12p13.33->12p13.31) with no evidence for a second haplotype. Adjacent to the mosaic deletion is an interstitial mosaic copy-neutral region of homozygosity (1.9 Mb, 12p13.31). The mother of this individual was confirmed by chromosome analysis and FISH that she carries a balanced translocation, t(3;12)(p26.1;p13.31).

Conclusion
Taken together, the proband, when at the stage of a zygote, likely carried the derivative chromosome 12 from this translocation, and a postzygotic mitotic recombination event occurred between the normal paternal chromosome 12 and maternal derivative chromosome 12 to “correct” the partial 3p trisomy and partial deletion of 12p. To the best of our knowledge, it is the first time to report the mechanism utilizing a combined cytogenetic and cytogenomic approach, and we believe it expands our knowledge of mosaic structural chromosomal disorders and provides new insight into clinical management and genetic counseling.
Growth retardation and congenital heart disease in a boy with a ring chromosome 6 of maternal origin
Authors: Dong Yanling , Li Jian , Zeng Ziye , Zhang Xue , Liang Mingxin , Yi Hong , Luo Jianyun , Li Junnan 
Published: March 2022

Abstract
Background
Rare chromosomal structural abnormalities, including ring chromosomes, often pose challenges to clinical genetic counselling.

Results
Here, we report a newborn with congenital heart disease and developmental delay who inherited ring chromosome 6 [46,XY,r(6)(p25q27)mat] from a phenotypically normal mother. Genotypes and phenotypes were analysed by molecular cytogenetic analysis, whole-exome sequencing and literature review.

Conclusions
Our study showed that the pathogenicity of the ring chromosome abnormality [r(6)(p25q27)] was mainly affected by chromosome imbalance, deletions of genes with haploinsufficiency, duplications of genes with triple sensitivity, parental inheritance of the imbalance and the imprinting status of the affected genes.
Preparedness for mass gatherings: rescue and emergency medical services’ workloads during mass gathering events
Authors: Koski Anssi , Pappinen Jukka , Kouvonen Anne , Nordquist Hilla 
Published: March 2022

Abstract
Background
Mass gathering (MG) events may cause delayed emergency responses via various mechanisms and strain the resources of local emergency services. Therefore, preparedness, including adequate pre-planning and sufficient resourcing during MG events, is vital. The aim of this retrospective register study was to investigate the impact of MG events on the workload of rescue and emergency medical service (EMS) personnel during events to enable more precise and sufficient deployment of these authorities’ operative resources.

Methods
The data from Finland covered of 25,124 EMS and rescue service missions during a three-year period (2015–2017), including data from nine MG events and reference material for the same weekdays two weeks before and after the event. The data were analysed through statistical and geospatial analyses.

Results
Our findings showed that missions increased in most events included in this study. Analysis of the missions’ reasons showed that the categories of violence, traffic accidents and other accidents and injuries increased during events, with violence-related missions showing the highest relative risk (RR 1.87, 95% CI 1.43–2.44). In the four-grade (A–D) urgency grading, the analysis showed an increase in category C missions and a decrease in non-urgent category D missions. The analysis indicated an increase in missions during the evening and night-time. The geospatial analysis revealed dense hotspots of missions in the vicinity of the event area.

Conclusion
The workload for EMS and rescue service personnel increases during MG events. Most of the increase is allocated to EMS staff, peaking in evening and night hours. The geospatial analysis showed hotspots of missions on the outskirts of the actual event area during events; thus, the workload can also increase for those authority resources that are not directly allocated to the event. Detailed information regarding workloads is valuable for the authorities that are responsible for resource planning and preparedness for MG events. Replicating the study internationally would improve the methodology for the future.
Cellular mechanisms underlying response and resistance to CDK4/6 inhibitors in the treatment of hormone receptor-positive breast cancer
Authors: Watt April C. , Goel Shom 
Published: March 2022

AbstractPharmacological inhibitors of cyclin-dependent kinases 4 and 6 (CDK4/6) are now an established standard of care for patients with advanced hormone receptor-positive breast cancer. The canonical mechanism underlying CDK4/6 inhibitor activity is the suppression of phosphorylation of the retinoblastoma tumor suppressor protein, which serves to prevent cancer cell proliferation. Recent data suggest that these agents induce other diverse effects within both tumor and stromal compartments, which serve to explain aspects of their clinical activity. Here, we review these phenomena and discuss how they might be leveraged in the development of novel CDK4/6 inhibitor-containing combination treatments. We also briefly review the various known mechanisms of acquired resistance in the clinical setting.
Hybrid high-definition microvessel imaging/shear wave elastography improves breast lesion characterization
Authors: Gu Juanjuan , Ternifi Redouane , Larson Nicholas B. , Carter Jodi M. , Boughey Judy C. , Stan Daniela L. , Fazzio Robert T. , Fatemi Mostafa , Alizad Azra 
Published: March 2022

Abstract
Background
Low specificity in current breast imaging modalities leads to increased unnecessary follow-ups and biopsies. The purpose of this study is to evaluate the efficacy of combining the quantitative parameters of high-definition microvasculature imaging (HDMI) and 2D shear wave elastography (SWE) with clinical factors (lesion depth and age) for improving breast lesion differentiation.

Methods
In this prospective study, from June 2016 through April 2021, patients with breast lesions identified on diagnostic ultrasound and recommended for core needle biopsy were recruited. HDMI and SWE were conducted prior to biopsies. Two new HDMI parameters, Murray’s deviation and bifurcation angle, and a new SWE parameter, mass characteristic frequency, were included for quantitative analysis. Lesion malignancy prediction models based on HDMI only, SWE only, the combination of HDMI and SWE, and the combination of HDMI, SWE and clinical factors were trained via elastic net logistic regression with 70% (360/514) randomly selected data and validated with the remaining 30% (154/514) data. Prediction performances in the validation test set were compared across models with respect to area under the ROC curve as well as sensitivity and specificity based on optimized threshold selection.

Results
A total of 508 participants (mean age, 54 years ± 15), including 507 female participants and 1 male participant, with 514 suspicious breast lesions (range, 4–72 mm, median size, 13 mm) were included. Of the lesions, 204 were malignant. The SWE-HDMI prediction model, combining quantitative parameters from SWE and HDMI, with AUC of 0.973 (95% CI 0.95–0.99), was significantly higher than the result predicted with the SWE model or HDMI model alone. With an optimal cutoff of 0.25 for the malignancy probability, the sensitivity and specificity were 95.5% and 89.7%, respectively. The specificity was further improved with the addition of clinical factors. The corresponding model defined as the SWE-HDMI-C prediction model had an AUC of 0.981 (95% CI 0.96–1.00).

Conclusions
The SWE-HDMI-C detection model, a combination of SWE estimates, HDMI quantitative biomarkers and clinical factors, greatly improved the accuracy in breast lesion characterization.
INHBA is a mediator of aggressive tumor behavior in HER2+ basal breast cancer
Authors: Liu Moqing , Smith Rebecca , Liby Tiera , Chiotti Kami , López Claudia S. , Korkola James E. 
Published: March 2022

Abstract
Background
Resistance to HER2-targeted therapeutics remains a significant clinical problem in HER2+ breast cancer patients with advanced disease. This may be particularly true for HER2+ patients with basal subtype disease, as recent evidence suggests they receive limited benefit from standard of care HER2-targeted therapies. Identification of drivers of resistance and aggressive disease that can be targeted clinically has the potential to impact patient outcomes.

Methods
We performed siRNA knockdown screens of genes differentially expressed between lapatinib-responsive and -resistant HER2+ breast cancer cells, which corresponded largely to luminal versus basal subtypes. We then validated hits in 2-d and 3-d cell culture systems.

Results
Knockdown of one of the genes, INHBA, significantly slowed growth and increased sensitivity to lapatinib in multiple basal HER2+ cell lines in both 2-d and 3-d cultures, but had no effect in luminal HER2+ cells. Loss of INHBA altered metabolism, eliciting a shift from glycolytic to oxidative phosphorylative metabolism, which was also associated with a decrease in tumor invasiveness. Analysis of breast cancer datasets showed that patients with HER2+ breast cancer and high levels of INHBA expression had worse outcomes than patients with low levels of INHBA expression.

Conclusions
Our data suggest that INHBA is associated with aggressiveness of the basal subtype of HER2+ tumors, resulting in poor response to HER2-targeted therapy and an invasive phenotype. We hypothesize that targeting this pathway could be an effective therapeutic strategy to reduce invasiveness of tumor cells and to improve therapeutic response.
The effect of tourniquet application on the morphology and function of quadriceps in patients undergoing total knee arthroplasty: study protocol for a single-blind randomized controlled trial
Authors: Dong Ziyang , Li Yang , Tao Liyuan , Tian Hua 
Published: March 2022

Abstract
Background
Tourniquet is currently widely used in total knee arthroplasty to reduce intraoperative blood loss. The academic view of tourniquet application in TKA is now in dispute. Some scholars argue that tourniquet may cause quadriceps injury and bring extra side effects, so they oppose the application of tourniquet. Others find that tourniquet application has no significant adverse impact on TKA patients. Regarding its advantages in reducing intraoperative blood loss, they advocate the regular application of tourniquet in TKA. Quadriceps injury is considered the main cause of tourniquet side effects. There are now many high-quality trials about tourniquet application in TKA but few of them concentrate on quadriceps morphology and function.

Methods
A prospective, single-blind, randomized controlled trial will be adopted. The target sample is 130. Patients who meet the eligibility criteria will be randomly allocated to the tourniquet group and non-tourniquet group. The primary outcome is quadriceps thickness evaluated by ultrasound test. Secondary outcomes include quadriceps stiffness, rehabilitation outcomes, operation time, intraoperative and postoperative blood loss, blood transfusion rate, thigh circumference, VAS score, opioid consumption, d-dimer and C-reactive protein level in the serum, knee function score, postoperative satisfaction score, and complications.

Discussion
This proposed study will contribute to improve evidence of tourniquet application in total knee arthroplasty. This will be a high-quality single-blind randomized controlled trial with a sufficient sample size and strict study design. It will investigate the effects of tourniquet application especially on the morphology and function of quadriceps in patients undergoing total knee arthroplasty and offer advice for tourniquet application in clinical practice.

Trial registration
Chinese Clinical Trial Registry ChiCTR2000035097. Registered on 31 July 2020
A randomized non-inferiority study of low-dose and standard-dose ticagrelor after intervention for acute coronary syndrome: study protocol for the TIGER STUDY
Authors: Pang Yanan , Ma Minglu , Xia Jiachun , Wang Dong , YanChen  , Ye Jianfei , Jia Zhongwei , Wu Sicheng , Yang Jian , Hou Lei 
Published: March 2022

Abstract
Background
Current guidelines recommend that patients with acute coronary syndrome (ACS) who have successfully undergone percutaneous coronary intervention (PCI) should continue to use dual antiplatelet therapy (DAPT) for 12 months. The long-term use of standard-dose dual antiplatelet therapy will increase the risk of bleeding. An optimized antiplatelet strategy that can prevent ischemic events and reduce the risk of bleeding remains to be explored.

Methods
The study is a prospective, multicenter, randomized, open-label, controlled study involving 2090 patients from six clinical centers in China. Through the interactive web response system (IWRS), ACS patients undergoing successful PCI will be randomly divided into the low-dose ticagrelor group or the normal-dose ticagrelor group, after taking 100 mg aspirin and 90 mg ticagrelor bid for 1 week. The primary endpoint is a composite of cardiovascular death, non-fatal myocardial infarction, stent thrombosis, repeat revascularization, and stroke. The secondary endpoints are bleeding events of grade 2 or higher according to Bleeding Academic Research Consortium [BARC] criteria, cardiovascular death, acute myocardium infarction, and coronary revascularization at 1 year.

Discussion
Recent studies have confirmed that 90 mg ticagrelor alone can safely and effectively reduce bleeding without increasing ischemic events of patients with ACS after PCI. Compared with standard-dose DAPT, whether low-dose ticagrelor combined with aspirin can ensure the anti-ischemic effect while reducing the bleeding risk remains unclear in Chinese patients.
The TIGER study will be the first large-scale, multicenter study to compare the efficacy and safety of low-dose and standard-dose ticagrelor combined with aspirin in ACS patients 1 week after successful PCI.

Trial registration
Clinicaltrials.gov NCT04255602. Registered on 5 February 2020.