bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between Dietary Inflammatory Index and serum Klotho concentration among adults in the United States
Authors: Zhang Chichen , Zhang Zilong , Li Jiakun , Deng Linghui , Geng Jiwen , Jin Kun , Zheng Xiaonan , Qiu Shi , Dong BiRong 
Published: June 2022

Abstract
Background
Klotho is a hormone that emerges as an antiaging biomarker. However, the influence of the dietary pattern’s inflammatory potential on serum Klotho levels in human populations, especially in a general adult population, remains unknown. This study aimed to evaluate the relationship between the dietary inflammatory index (DII) and serum Klotho concentrations in individuals living in the United States.

Methods
From the 2007–2016 National Health and Nutrition Examination Survey database, data of participants who completed the full 24-h dietary history and underwent serum Klotho testing were analyzed. The association between DII and serum Klotho concentrations was estimated using multivariable linear regression models. We also conducted segmented regression model to examine the threshold effect of DII on serum Klotho concentrations.

Results
A total of 10,928 participants were included, with a median serum Klotho concentration of 805.20 pg/mL (IQR: 657.58 − 1001.12) and a median DII of 1.43 (IQR: − 0.16 − 2.82). Multivariable regression showed that participants with high DII scores were associated with low serum Klotho concentrations; when classifying DII into quartiles, after full adjustment, participants in DII quartiles 3 and 4 showed a decrease in Klotho levels (25.27 and 12.44 pg/ml, respectively) compared with those in the lowest quartile (quartile 1) (95% CI: − 41.80, − 8.73 and − 29.83, 4.95, respectively; P for trend = 0.036). The segmented regression showed that the turning point value of DII was − 1.82 (95% CI: − 2.32, − 0.80). A 1-unit increase in DII was significantly associated with lower Klotho levels by − 33.05 (95% CI: − 52.84, − 13.27; P = 0.001) when DII ranges from − 5.18 to − 1.82; however, the relationship was not significant when DII ranges from − 1.82 to 5.42 (P > 0.05). Furthermore, stratified analyses indicated that the observed associations between DII and serum Klotho concentration were stronger among those aged ≥ 56 years, those with normal weight, and those without chronic kidney disease (P for interaction = 0.003, 0.015, and 0.041, respectively).

Conclusions
In summary, we indicated that there was a dose–response relationship between DII and serum Klotho concentrations, suggesting that adhering to an anti-inflammatory diet has beneficial effects on aging and health by increasing the serum Klotho concentration.
Development of COVID-19 severity assessment score in adults presenting with COVID-19 to the emergency department
Authors: Subhani Faysal , Chhotani Abdul Ahad , Waheed Shahan , Zahid Rana Osama , Azizi Kiran , Buksh Ahmed Raheem 
Published: June 2022

Abstract
Background
Critically-ill Covid-19 patients require extensive resources which can overburden a healthcare system already under strain due to a pandemic. A good disease severity prediction score can help allocate resources to where they are needed most.

Objectives
We developed a Covid-19 Severity Assessment Score (CoSAS) to predict those patients likely to suffer from mortalities within 28 days of hospital admission. We also compared this score to Quick Sequential Organ Failure Assessment (qSOFA) in adults.

Methods
CoSAS includes the following 10 components: Age, gender, Clinical Frailty Score, number of comorbidities, Ferritin level, D-dimer level, neutrophil/lymphocyte ratio, C-reactive Protein levels, systolic blood pressure and oxygen saturation. Our study was a single center study with data collected via chart review and phone calls. 309 patients were included in the study.

Results
CoSAS proved to be a good score to predict Covid-19 mortality with an Area under the Curve (AUC) of 0.78. It also proved better than qSOFA (AUC of 0.70). More studies are needed to externally validate CoSAS.

Conclusion
CoSAS is an accurate score to predict Covid-19 mortality in the Pakistani population.
Syndromic surveillance of respiratory-tract infections and hand hygiene practice among pilgrims attended Hajj in 2021: a cohort study
Authors: Mahdi Hashim A. , Rashid Harunor , Qashqari Fadi S. , Hariri Sumyya H. , Marglani Osama A. , Barasheed Osamah , Albutti Aqel , Alwashmi Ameen S. , Shaban Ramon Z. , Booy Robert , Alfelali Mohammad 
Published: June 2022

Abstract
Background
The risk of transmission of viral respiratory tract infections (RTIs) is high in mass gatherings including Hajj. This cohort study estimated the incidence of symptomatic RTIs and hand hygiene compliance with its impact among Hajj pilgrims during the COVID-19 pandemic.

Methods
During the week of Hajj rituals in 2021, domestic pilgrims were recruited by phone and asked to complete a baseline questionnaire. Pilgrims were followed up after seven days using a questionnaire about the development of symptoms, and practices of hand hygiene. Syndromic definitions were used to clinically diagnose ‘possible’ influenza-like illnesses (ILI) and COVID-19 infection.

Results
A total of 510 pilgrims aged between 18 and 69 (median of 50) years completed the questionnaire, 280 (54.9%) of whom were female, and all of them (except for one) were vaccinated against COVID-19 with at least one dose. The mean (± SD) of pilgrims’ hand hygiene knowledge score (on a scale of 0 to 6) was 4.15 (± 1.22), and a higher level of knowledge was correlated with a higher frequency of handwashing using soap and water. Among those 445 pilgrims who completed the follow-up form, 21 (4.7%) developed one or more respiratory symptoms, of which sore throat and cough were the commonest (respectively 76.2% and 42.8%); ‘possible ILI’ and ‘possible COVID-19’ were present in 1.1% and 0.9% of pilgrims. Obesity was found to be a significant factor associated with the risk of developing RTIs (odds ratio = 4.45, 95% confidence interval 1.15–17.13).

Conclusions
Hajj pilgrims are still at risk of respiratory infections. Further larger and controlled investigations are needed to assess the efficacy of hand hygiene during Hajj.
Impact of an intradialysis virtual-reality-based exercise program on healthcare resources expenditure: a micro-costing analysis
Authors: García-Testal Alicia , Martínez-Olmos Francisco José , Gil-Gómez Jose Antonio , Villalón-Coca Javier , Ortiz-Ramón Rafael , Cana-Poyatos Alicia , García-Maset Rafael , Segura-Ortí Eva 
Published: June 2022

Abstract
Background
Engagement in exercise by haemodialysis (HD) patients has been shown to generate benefits both in terms of improved functional capacity and in the health-related quality of life. The use of non-immersive virtual reality (VR) games represents a new format for the implementation of intradialysis exercise. Some studies have shown that engaging in exercise for 6 months reduces the consumption of antihypertensive drugs and decreases the time spent admitted to hospital among individuals receiving HD treatments. The objective of this study was to evaluate changes in the consumption of healthcare resources and micro-costing for patients on HD who completed a VR exercise program.

Materials and methods
Design: This study is a secondary analysis of a clinical trial. The participants performed an intradialysis exercise program with non-immersive virtual reality for 3 months. The variables were recorded in two periods: 12 months before and 12 months after the start of the exercise program.

Results
The micro-costing analysis showed a significant decrease in the mean cost, in euros, for the consumption of laboratory tests − 330 (95% CI:[− 533, − 126];p = 0.003), outpatient visits − 351 ([− 566, − 135];p = 0.003), and radiology tests − 111 ([− 209, − 10];p = 0.03) in the 12 months after the implementation of the exercise program relative to the 12 months prior to its start.

Conclusion
The implementation of intradialysis exercise programs decreased the expenditure of some healthcare resources. Future studies could help clarify if longer interventions would have a stronger impact on these cost reductions.
Parathyroid hormone-related peptide and parathyroid hormone-related peptide receptor type 1 in locally advanced laryngeal cancer as prognostic indicators of relapse and survival
Authors: Almadori Giovanni , Coli Antonella , De Corso Eugenio , Mele Dario Antonio , Settimi Stefano , Di Cintio Giovanni , Brigato Francesca , Scannone Domenico , Lauriola Libero , Ranelletti Franco Oreste 
Published: June 2022

Abstract
Background
Parathyroid hormone-related peptide (PTHrP) overexpression and poor patient outcome have been reported for many human tumors, but no studies are available in laryngeal cancer. Therefore, we studied the expression of PTHrP and its receptor, parathyroid hormone-related peptide receptor type 1 (PTH1R), in primary locally advanced laryngeal squamous cell carcinomas (LALSCC) also in relation to the clinical outcome of patients.

Methods
We conducted a retrospective exploratory study, using immunohistochemistry, on PTHrP, PTH1R and HER1 expressions in LALSCC of 66 patients treated with bio-radiotherapy with cetuximab.

Results
The expressions of PTHrP and PTH1R in LALSCC were associated with the degree of tumor differentiation (p = 0.01 and 0.04, respectively). Poorly differentiated tumors, with worse prognosis, expressed PTHrP at nuclear level and were PTH1R negative. PTHrP and PTH1R were expressed at cytoplasmic level in normal larynx epithelium and more differentiated laryngeal cancer cells, suggesting an autocrine/paracrine role of PTHrP in squamous cell differentiation of well differentiated tumors with good prognosis. Eighty-one percent HER1 positive tumors expressed PTHrP (p < 0.0001), mainly at nuclear level, consistent with the known up-regulation of PTHrP gene by HER1 signaling. In multivariable analyses, patients with PTHrP positive tumors had a higher relative risk of relapse (HR = 5.49; CI 95% = 1.62–22.24; p = 0.006) and survival (HR = 8.21; CI 95% = 1.19–105.00; p = 0.031) while those with PTH1R positive tumors showed a lower relative risk of relapse (HR = 0.18; CI 95% = 0.04–0.62; p = 0.002) and survival (HR = 0.18; CI 95% = 0.04–0.91; p = 0.029).

Conclusions
In LALSCC nuclear PTHrP and absence of PTH1R expressions could be useful in predicting response and/or resistance to cetuximab in combined therapies, contributing to an aggressive behavior of tumor cells downstream to HER1.
Patient-centered research: how do women tolerate nipple fluid aspiration as a potential screening tool for breast cancer?
Authors: Patuleia Susana I. S. , Moelans Cathy B. , Koopman Jasmijn , van Steenhoven Julia E. C. , van Dalen Thijs , van der Pol Carmen C. , Jager Agnes , Ausems Margreet G. E. M. , van Diest Paul J. , van der Wall Elsken , Suijkerbuijk Karijn P. M. 
Published: June 2022

Abstract
Background
Nipple fluid aspiration (NFA) is a technique to acquire nipple aspirate fluid (NAF), which is considered a rich source of breast-specific biomarkers. Originating directly from the mammary ducts, this liquid biopsy can offer insight into the process of carcinogenesis at its earliest stage and therefore could be of added value to the current imaging-based breast cancer screening tools. With that in mind, it is necessary to know how well NFA is tolerated.

Aim
To evaluate the participants’ tolerability of NFA compared to breast imaging screening methods and blood draws.

Materials and methods
Three cohorts of women underwent NFA: healthy women (n = 190), women diagnosed with breast cancer (n = 137) and women at high risk of developing breast cancer (n = 48). A 0–10 discomfort score of NFA, mammography, breast MRI and blood draws, was filled in at the study visits, which took place once or annually.

Results
The median discomfort rate of NFA was 1, which was significantly lower than the median discomfort of mammography and breast MRI (5 and 3, respectively, p < 0.001), but significantly higher than median discomfort for blood draws (0, p < 0.001). The great majority of women would undergo the procedure again (98%) and recommend it to others (97%).

Conclusion
This study shows that NFA was well tolerated by healthy women, women diagnosed with breast cancer and high-risk women. This makes NFA a feasible method to pursue as a potential future breast cancer early detection tool, based on resident biomarkers.

Trial registration
NL41845.041.12, NL57343.041.16 and NL11690.041.06 in trialregister.nl.
A machine-learning model to predict postoperative delirium following knee arthroplasty using electronic health records
Authors: Jung Jong Wook , Hwang Sunghyun , Ko Sunho , Jo Changwung , Park Hye Youn , Han Hyuk-Soo , Lee Myung Chul , Park Jee Eun , Ro Du Hyun 
Published: June 2022

Abstract
Background
Postoperative delirium is a challenging complication due to its adverse outcome such as long hospital stay. The aims of this study were: 1) to identify preoperative risk factors of postoperative delirium following knee arthroplasty, and 2) to develop a machine-learning prediction model.

Method
A total of 3,980 patients from two hospitals were included in this study. The model was developed and trained with 1,931 patients from one hospital and externally validated with 2,049 patients from another hospital. Twenty preoperative variables were collected using electronic hospital records. Feature selection was conducted using the sequential feature selection (SFS). Extreme Gradient Boosting algorithm (XGBoost) model as a machine-learning classifier was applied to predict delirium. A tenfold-stratified area under the curve (AUC) served as the metric for variable selection and internal validation.

Results
The incidence rate of delirium was 4.9% (n = 196). The following seven key predictors of postoperative delirium were selected: age, serum albumin, number of hypnotics and sedatives drugs taken preoperatively, total number of drugs (any kinds of oral medication) taken preoperatively, neurologic disorders, depression, and fall-down risk (all p < 0.05). The predictive performance of our model was good for the developmental cohort (AUC: 0.80, 95% CI: 0.77–0.84). It was also good for the external validation cohort (AUC: 0.82, 95% CI: 0.80–0.83). Our model can be accessed at https://safetka.connecteve.com.

Conclusions
A web-based predictive model for delirium after knee arthroplasty was developed using a machine-learning algorithm featuring seven preoperative variables. This model can be used only with information that can be obtained from pre-operative electronic hospital records. Thus, this model could be used to predict delirium before surgery and may assist physician’s effort on delirium prevention.
T2 mapping and fat quantification of lumbar paraspinal muscle in ankylosing spondylitis: a case control study
Authors: Huang Ruibin , Yang Hongwu , Chen Liujiang , Su Shuyan , Wu Xiaojia , Zhuang Ruyao , Liu Yuan 
Published: June 2022

Abstract
Background
To compare changes in the composition of paraspinal muscles of patients with ankylosing spondylitis (AS) and matched healthy controls using T2 mapping and T2 IDEAL and correlate the quantitative magnetic resonance imaging (qMRI) results with clinical assessments of AS patients.

Method
In total, 37 AS patients and 37 healthy controls were enrolled in the case control study. T2 mapping with and without fat saturation and IDEAL imaging were used to assess the multifidus (MF) and erector spinae (ES) at the levels of L3/L4 and L4/L5 for all subjects. Mean T2non-fatsat, T2fat, T2fatsat, cross-sectional area (CSA), and fat fraction (FF) were compared between AS and healthy controls. Correlations of qMRI results with clinical assessments were analyzed in AS.

Results
Significantly elevated mean T2non-fatsat values and the FF of the MF and ES at both levels were observed in AS and compared to the controls (p < 0.05). The mean T2fatsat values of ES and MF were significantly higher only at the level of L3/L4 in AS compared to healthy controls (p < 0.05). A loss of muscle CSA compatible with atrophy was present in MF and ES at both levels in AS compared to the controls (p < 0.05). Weak to moderate positive correlations were found between FF and age and disease duration in AS (r = 0.318–0.415, p < 0.05). However, such positive correlation was not observed between FF and disease duration after adjusting for age (p > 0.05).

Conclusions
Our findings indicate that using a combination of IDEAL and T2 mapping may provide deeper insights into the pathophysiological degeneration of paraspinal muscles in AS.
Hemorrhagic shock caused by preoperative computed tomography-guided microcoil localization of lung nodules: a case report
Authors: Yang Fan , Min Jie 
Published: June 2022

Abstract
Background
Video-assisted thoracoscopic surgery (VATS) is an emerging technology in minimally invasive surgery, which has become recognized as standard treatments for early-stage lung cancer. Microcoil localization is considered to be a safe and effective way of preoperative localization, and is essential to facilitate VATS wedge-resection for lung nodules.

Case presentation
Here we report a rare case of a 28-year-old female who developed hemorrhagic shock caused by delayed pneumothorax after preoperative computed tomography (CT)-guided microcoil localization. The thoracic CT revealed hydropneumothorax in the right thoracic cavity at 10 h after microcoil localization, and the patient later had significant decreased hemoglobin level (87 g/L). Emergency thoracoscopic exploration demonstrated that the hemorrhagic shock was induced by delayed pneumothorax, which led to the fracture of an adhesive pleura cord and an aberrant vessel. Electrocoagulation hemostasis was then performed for the fractured vessel and the patient gradually recovered from the hypovolemic shock.

Conclusions
Microcoil localization is a relatively safe and effective way of preoperative localization of lung nodules, however, hemorrhagic shock could be induced by rupture of pleural aberrant vessels subsequent to puncture related pneumothorax. Shorten the time interval between localization and thoracoscopic surgery, extend the monitoring time after localization might help to reduce the risk of these complications.
Family caregivers’ concerns about advance care planning for home-dwelling people with dementia: a cross-sectional observational study in Japan
Authors: Nakanishi Miharu , Nakashima Taeko , Miyamoto Yuki , Yamasaki Syudo , Nishida Atsushi 
Published: June 2022

Abstract
Background
The importance of advance care planning for people with dementia has increased during the Coronavirus Disease 2019 Pandemic. However, family caregivers may have concerns about having conversations regarding advance care planning with their loved ones, which may hinder the initiation of such planning. This study investigated family caregivers’ concerns regarding conducting advance care planning for home-dwelling individuals with dementia.

Methods
A prospective cross-sectional study compared the level of family-caregiver concern between those who had initiated advance care planning and those who did not. In June 2021, an internet-based questionnaire survey was administered to Japan-based family caregivers of persons with dementia. Registered members of a Japan-based survey company were recruited; inclusion criteria were being aged 40 years or older and having been a primary, non-professional caregiver of a family member with dementia. Respondents rated their level of agreement with six statements regarding advance-care-planning-related concerns. Respondents also reported their psychological well-being using the WHO-5 Well-Being Index.

Results
Overall, 379 family caregivers participated in this survey. Of these, 155 (40.9%) reported that their loved ones had initiated advance care planning, of whom 88 (56.8%) stated that care professionals were involved in the advance-care-planning conversations. The level of family-caregiver concern was significantly lower when the loved one initiated the conversation concerning advance care planning. After adjusting for the characteristics of persons with dementia and their caregivers, family caregivers with lower psychological well-being showed significantly higher levels of concern.

Conclusions
Family caregivers reported concerns regarding conducting advance care planning. There is a need for educational and clinical strategies that encourage professionals to address the psychological needs of family caregivers.
Preparing tomorrow’s medical specialists for participating in oncological multidisciplinary team meetings: perceived barriers, facilitators and training needs
Authors: Walraven Janneke E. W. , van der Meulen Renske , van der Hoeven Jacobus J. M. , Lemmens Valery E. P. P. , Verhoeven Rob H. A. , Hesselink Gijs , Desar Ingrid M. E. 
Published: June 2022

Abstract
Introduction
The optimal treatment plan for patients with cancer is discussed in multidisciplinary team meetings (MDTMs). Effective meetings require all participants to have collaboration and communication competences. Participating residents (defined as qualified doctors in training to become a specialist) are expected to develop these competences by observing their supervisors. However, the current generation of medical specialists is not trained to work in multidisciplinary teams; currently, training mainly focuses on medical competences. This study aims to identify barriers and facilitators among residents with respect to learning how to participate competently in MDTMs, and to identify additional training needs regarding their future role in MDTMs, as perceived by residents and specialists.

Methods
Semi-structured interviews were conducted with Dutch residents and medical specialists participating in oncological MDTMs. Purposive sampling was used to maximise variation in participants’ demographic and professional characteristics (e.g. sex, specialty, training duration, type and location of affiliated hospital). Interview data were systematically analysed according to the principles of thematic content analysis.

Results
Nineteen residents and 16 specialists were interviewed. Three themes emerged: 1) awareness of the educational function of MDTMs among specialists and residents; 2) characteristics of MDTMs (e.g. time constraints, MDTM regulations) and 3) team dynamics and behaviour. Learning to participate in MDTMs is facilitated by: specialists and residents acknowledging the educational function of MDTMs beyond their medical content, and supervisors fulfilling their teaching role and setting conditions that enable residents to take a participative role (e.g. being well prepared, sitting in the inner circle, having assigned responsibilities). Barriers to residents’ MDTM participation were insufficient guidance by their supervisors, time constraints, regulations hindering their active participation, a hierarchical structure of relations, unfamiliarity with the team and personal characteristics of residents (e.g. lack of confidence and shyness). Interviewees indicated a need for additional training (e.g. simulations) for residents, especially to enhance behavioural and communication skills.

Conclusion
Current practice with regard to preparing residents for their future role in MDTMs is hampered by a variety of factors. Most importantly, more awareness of the educational purposes of MDTMs among both residents and medical specialists would allow residents to participate in and learn from oncological MDTMs. Future studies should focus on collaboration competences.