bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparing Rates of Fusion and Time to Fusion in Viable Cellular Allograft and Autograft
Authors: Frederick Robert M. , Sarfani Shumaila , Chiu Chi-Yang , Hayes Tristan , Bettin Clayton , Grear Benjamin , Richardson David , Murphy G. Andrew 
Published: August 2022

Background: Autograft or allograft frequently are used to enhance bone union in foot and ankle surgery. Viable cellular bone allograft uses viable cells and bone scaffolding in a gel base, but uncertainty remains around allograft’s greater efficacy than autograft regarding rates of fusion (ROF) and time to fusion (TTF). Methods: Autograft, viable cellular allograft, and viable cellular allograft with autograft were compared in 199 forefoot, midfoot, and hindfoot arthrodeses performed over a 6-year period. Data collected from electronic medical records and radiographs were analyzed to determine ROF and TTF as well as rates of revision surgery for delayed or nonunion and compared among groups. Results: Eighty-seven patients comprised the autograft group, 81 the allograft group, and 31 the combined group. No significant differences were noted in patient demographics among the groups. No statistically significant differences in ROF were noted among the 3 groups, with 86% (75 of 87) fusion in the autograft group, 93% (75 of 81) in the allograft group, and 84% (26 of 31) in the combined group ( P = .20). After conducting a multivariate analysis, we found no statistically significant difference for allograft or combined graft on TTF ( P = .1379 and .2311, respectively). No significant difference was found in rate of revision surgery for nonunion, which was 1.2% (1 of 81) in the allograft group, 3.4% (3 of 87) in the autograft group, and 6.5% (2 of 31) in the combined group ( P = .3). Conclusion: No significant difference was found in ROF, TTF, or rate of revision surgery when comparing viable cellular allograft to autograft or combined allograft-autograft. Viable cellular allograft may be a reasonable alternative to the gold standard of autograft and should be considered an option in patients undergoing arthrodesis in foot and ankle surgery. Level of Evidence: Level III, therapeutic.
Standing alone: experiences of vaccine-hesitant Danish healthcare professionals during COVID-19
Authors: Marså Kristoffer , Kristensen Tina Bøgelund , Konradsen Hanne 
Published: August 2022

Aim: The aim of the study was to explore the experiences of Danish healthcare professionals who were hesitant about the COVID-19 vaccine. Methods: Interviews were conducted over the telephone in January and February 2021. Results: Healthcare professionals experienced the need to avoid impossible conversations about vaccine hesitancy with their colleagues. They felt a lack of knowledge of long-term experience with the vaccine and a need to balance trust in themselves and the authorities. Conclusions: Healthcare professionals who were hesitant towards the COVID-19 vaccine felt they had to keep their concerns to themselves and felt isolated and pressured by their managers. This study is especially important for managers, who must ensure a trusting working environment in which employees can discuss their concerns without feeling pressured.
Impact of adherence to treatment with inhaled corticosteroids/long-acting β-agonists on asthma outcomes in the United States
Authors: Averell Carlyne M. , Laliberté François , Germain Guillaume , Duh Mei Sheng , Rousculp Matthew D. , MacKnight Sean D. , Slade David J. 
Published: August 2022

Background: Suboptimal adherence to maintenance medication has been associated with poor outcomes in asthma. This study examined single-inhaler inhaled corticosteroid (ICS)/long-acting β2 agonist (LABA) adherence and asthma-related outcomes. Methods: This retrospective observational study of patients with asthma initiating ICS/LABA used data from IQVIA PharMetrics Plus (1 January 2014–31 March 2019). Patients included were ⩾18 years old and had ⩾12 months continuous eligibility before, and ⩾180 days follow-up after, the index date. Adherence was measured as proportion of days covered ([PDC] adherent ⩾ 0.8; non-adherent <0.8) each quarter, with outcomes measured each subsequent quarter. Endpoints were asthma-related overall and severe (inpatient/emergency department [ED] visit) exacerbations, rescue medication use, and asthma-related healthcare resource utilization and costs. Regression models evaluated associations between adherence and outcomes, controlling for repeated measures and differences in baseline characteristics. Results: Overall, 50,037 patients were included (mean age 45.3 years; mean follow-up 23.3 months). Adherent patients were less likely to experience asthma-related overall (adjusted odds ratio [aOR] 95% confidence interval [CI]: 0.942 [0.890, 0.998]; p = 0.041), or severe exacerbations (aOR [95% CI]: 0.778 [0.691, 0.877]; p < 0.001) per quarter versus non-adherent patients. Adherent patients had lower severe exacerbation rates (adjusted rate ratio [aRR] [95% CI]: 0.792 [0.702, 0.893]; p < 0.001) but similar overall exacerbation rates (aRR [95% CI]: 0.993 [0.945, 1.044]; p = 0.783) versus non-adherent patients. The odds of rescue medication use were lower per 20% PDC increase (aOR [95% CI] short-acting β2 agonist: 0.991 [0.985, 0.996]; p = 0.001; oral corticosteroid: 0.988 [0.982, 0.995]; p < 0.001). Adherent patients were less likely to visit EDs per quarter (aOR [95% CI]: 0.775 [0.680, 0.883]; p < 0.001) and odds of hospitalization were lower per 20% PDC increase (aOR [95% CI]: 0.930 [0.881, 0.982]; p = 0.009). Across most measures, adherent patients incurred lower costs. Conclusion: This real-world study highlights the short-term clinical and economic benefits of ICS/LABA adherence in asthma, particularly in reducing severe exacerbations.
Diagnostic Value of Lateral Ankle Radiography in Achilles Tendon Rupture
Authors: Kokulu Kamil , Altunok İbrahim , Sert Ekrem Taha , Özdemir Serdar , Mutlu Hüseyin , Akça Hatice Şeyma 
Published: August 2022

Introduction: Achilles tendon rupture (ATR) is a common sports injury, but approximately 20% of acute ATR cases are misdiagnosed as ankle sprains at first presentation. This study aimed to investigate the diagnostic value of lateral ankle radiography in the diagnosis of acute ATR. Methods: This was a retrospective case-control study in which the lateral ankle radiographs of patients who presented to the emergency department between January 1, 2015 and December 31, 2019 were examined. The study included a total of 154 patients with acute ATR, who underwent lateral ankle radiography at the presentation and were surgically or magnetic resonance imaging (MRI) confirmed to have ATR in our hospital. The lateral ankle radiographs of the patients were examined by 2 clinicians blinded to clinical data for the following 3 findings: Kager’s fat pad sign, tibio-first metatarsal angle, and tibiocalcaneal angle. The same procedure was repeated for 308 controls who underwent lateral ankle radiography and were diagnosed with ankle sprain. Results: Kager’s fat pad sign was detected in 133 (86.4%) of the 154 patients with ATR and 26 (8.4%) of the 308 patients in the control group. The Kager’s fat pad sign, tibio-first metatarsal angle, and tibiocalcaneal angle sensitivity values for the diagnosis of ATR were 86.4%, 61.7%, and 65.6%, respectively, and their specificity values were 91.6%, 78.9%, and 56.2%, respectively. Interobserver reliability was determined to be good for all 3 radiographic findings. Conclusion: Clinicians should be particularly aware of Kager’s fat pad sign when examining lateral ankle radiographs for ankle injury. Levels of Evidence: Level IV: Case control study
Current Practice of Acute Spinal Cord Injury Management: A Global Survey of Members from the AO Spine
Authors: Hejrati Nader , Moghaddamjou Ali , Pedro Karlo , Alvi Mohammed Ali , Harrop James S. , Guest James D. , Kwon Brian K. , Fehlings Michael G. 
Published: August 2022

Study Design Cross-sectional, international survey. Objectives To examine current international practices as well as knowledge, adoption, and barriers to guideline implementation for acute spinal cord injury (SCI) management. Methods A survey was distributed to members of AO Spine. The questionnaire was structured to obtain demographic data and preferred acute SCI practices surrounding steroid use, hemodynamic management, and timing of surgical decompression. Results 593 members completed the survey including orthopaedic surgeons (54.3%), neurosurgeons (35.6%), and traumatologists (8.4%). Most (61.2%) respondents were from low and middle-income countries (LMICs). 53.6% of physicians used steroids for the treatment of acute SCIs. Respondents from LMICs were more likely to administer steroids than HICs (178 vs. 78; P < .001). 331 respondents (81.5%) answered that patients would receive mean arterial pressure (MAP) targeted treatment. In LMICs, SCI patients were less likely to be provided with MAP-targeted treatment (76.9%) as compared to HICs (89%; P < .05). The majority of respondents (87.8%) reported that patients would benefit from early decompression. Despite overwhelming evidence and surgeons’ responses that would offer early surgery, 62.4% of respondents stated they encounter logistical barriers in their institutions. This was particularly evident in LMICs, where 57.9% of respondents indicated that early intervention was unlikely to be accomplished, while only 21.1% of respondents from HICs stated the same ( P < .001). Conclusion This survey highlights challenges in the implementation of standardized global practices in the management of acute SCI. Future research efforts will need to refine SCI guidelines and address barriers to guideline implementation.
New Indication for an Established Procedure: Cervical Cerclage for Prevention of Umbilical Cord Prolapse
Authors: Petrikovsky B. M. , Terrani M. , Dillon A. 
Published: August 2022

Objective: Funic presentation is a risk factor for umbilical cord prolapse. In the majority of cases, umbilical cord prolapse is an obstetric emergency. Currently there is no strategy to prevent umbilical cord prolapse in patients with funic presentation. Placing a third trimester cervical cerclage was proposed, as a mechanical barrier of prolapse, in women with funic presentation. Materials and Methods: Twelve patients with funic presentation, detected between 23 and 34 weeks of gestation, were included in the study. Patients were informed that although cervical cerclage have been widely used in obstetrics, it had not been offered in patients with funic presentation. Gestational age at delivery, mode of delivery, location of umbilical cord at birth, presence or absence of umbilical cord prolapsed, and neonatal condition at birth were recorded in all cases. Results: Patients’ age varied from 21 to 40 years, mean of 28 ± 6.2 years, and gestational age at the time of diagnosis of funic presentation varied from 26 to 34 weeks of pregnancy. All patients were seen weekly after the cervical cerclage placement to assess the umbilical cord location. Seven patients had vertex presentation, four had breech presentation, and one had transverse lie presentation. A follow-up sonogram of the umbilical cord revealed the following: funic presentation was persistent throughout the entire pregnancy in five patients, disappeared in four, and became intermittent in three. The delivery mode was as follows: cesarean section was performed in eight patients (five with persistent funic presentation, two with intermittent, and one with resolved funic presentation because of failure to progress in labor). There were five patients who delivered vaginally. Funic presentation was confirmed in all patients who underwent cesarean sections. None of the patients had had an umbilical cord prolapse. Conclusion: In view of high perinatal mortality of umbilical cord prolapses, placement of cervical cerclage could be added to obstetric armamentarium in patients with funic presentation, after proper counseling.
Large mammal telomere length variation across ecoregions
Authors: Fohringer Christian , Hoelzl Franz , Allen Andrew M. , Cayol Claire , Ericsson Göran , Spong Göran , Smith Steven , Singh Navinder J. 
Published: August 2022

AbstractBackgroundTelomere length provides a physiological proxy for accumulated stress in animals. While there is a growing consensus over how telomere dynamics and their patterns are linked to life history variation and individual experience, knowledge on the impact of exposure to different stressors at a large spatial scale on telomere length is still lacking. How exposure to different stressors at a regional scale interacts with individual differences in life history is also poorly understood. To better understand large-scale regional influences, we investigated telomere length variation in moose (Alces alces) distributed across three ecoregions. We analyzed 153 samples of 106 moose representing moose of both sexes and range of ages to measure relative telomere lengths (RTL) in white blood cells.ResultsWe found that average RTL was significantly shorter in a northern (montane) and southern (sarmatic) ecoregion where moose experience chronic stress related to severe summer and winter temperatures as well as high anthropogenic land-use compared to the boreal region. Our study suggests that animals in the northern boreal forests, with relatively homogenous land use, are less disturbed by environmental and anthropogenic stressors. In contrast, animals in areas experiencing a higher rate of anthropogenic and environmental change experience increased stress.ConclusionAlthough animals can often adapt to predictable stressors, our data suggest that some environmental conditions, even though predictable and ubiquitous, can generate population level differences of long-term stress. By measuring RTL in moose for the first time, we provide valuable insights towards our current understanding of telomere biology in free-ranging wildlife in human-modified ecosystems.
Serum anti-SPP1 autoantibody as a potential novel biomarker in detection of esophageal squamous cell carcinoma
Authors: Wang Chen , Sun Guiying , Wang Huimin , Dai Liping , Zhang Jianying , Du Renle 
Published: August 2022

Abstract
Background
Esophageal squamous cell carcinoma (ESCC) has poor prognosis mainly due to lacking of effective diagnostic biomarkers. Aberrant expression of secreted phosphoprotein 1 (SPP1) protein has been observed in several cancers. The purpose of this study is to assess the feasibility of serum autoantibody to SPP1 in detection of ESCC.

Methods
The SPP1 protein levels in 108 ESCC tissues and 72 adjacent normal tissues were analyzed by immunohistochemistry. Discovery group containing 62 serum samples from ESCC patients and 62 serum samples from normal controls (NC) were used to detect the levels of anti-SPP1 autoantibody by enzyme-linked immunosorbent assay (ELISA). Validation group containing another 100 ESCC and 100 NC serum samples were tested to confirm the levels of autoantibody to SPP1. Western blotting was performed to further confirm the results of ELISA.

Results
SPP1 protein was significantly overexpressed in ESCC tissues compared to adjacent normal tissues. ELISA results showed that serum autoantibody to SPP1 was significantly increased in ESCC compared to NC in both discovery and validation groups. Autoantibody to SPP1 could discriminate patients with ESCC from NC with the area under curve (AUC) values of 0.653 and 0.739 in discovery and validation group, respectively. The results of ELISA and the occurrence of immunoreactivity to SPP1 in ESCC sera were confirmed by western blotting.

Conclusion
Our study indicated the potential significance of anti-SPP1 autoantibody as a novel biomarker for detection of ESCC.
The relationships of shift work, hair cortisol concentration and dyslipidaemia: a cohort study in China
Authors: Zhu Lejia , Zhang Yu , Song Lin , Zhou Ziqi , Wang Jin , Wang Yangmei , Sang Lingli , Xiao Jing , Lian Yulong 
Published: August 2022

Abstract
Background
Currently, cardiovascular disease is the leading cause of death, and dyslipidaemia is an independent and modifiable major risk factor. Previous studies on shift work with dyslipidaemia and hair cortisol concentration (HCC) have yielded conflicting results. The aim of this study was to clarify the association between shift work, dyslipidaemia, and HCC. We further explored the mediating effect of HCC.

Methods
In this cohort study, baseline data were collected from participants in May 2013. The cohort included 2170 participants- 1348 shift workers and 822 non-shift workers- who were followed up for 6 years with four questionnaire surveys from July 2014, October 2015, and May to December 2019. Hair samples were collected from 340 participants during the baseline period for HCC testing with an automated radioimmunoassay. Dyslipidaemia was defined using the National Cholesterol Education Program Adult Treatment Panel III diagnostic criteria.

Results
Shift workers had a higher risk of dyslipidaemia than workers on the fixed day shift (two-shift RR = 1.408, 95% CI: 1.102–1.798; three-shift RR = 1.478, 95% CI: 1.134–1.926; four-shift RR = 1.589, 95% CI: 1.253–2.015). Additionally, shift workers had higher HCC levels than fixed day shift workers, with geometric mean concentration (GMC) ± geometric standard difference (GSD) = 2.625 ± 2.012 ng/g, two-shift GMC ± GSD = 3.487 ± 1.930 ng/g, three-shift GMC ± GSD = 2.994 ± 1.813 ng/g, and four-shift GMC ± GSD = 3.143 ± 1.720 ng/g. High HCC was associated with a high incidence of dyslipidaemia. After controlling for confounding factors, this study showed that HCC played a role in mediating dyslipidaemia in shift workers and accounted for 16.24% of the effect.

Conclusions
Shift work was linked to increased risk of dyslipidaemia compared with fixed day shift work. Higher HCC was associated with a higher prevalence of dyslipidaemia. HCC had a significant mediating effect on dyslipidaemia in shift workers.
Prevalence and clinical characteristics of malignant lung nodules in tuberculosis endemic area in a single tertiary centre
Authors: Zaharudin Norsyuhada , Jailaini Mas Fazlin Mohamad , Abeed Nik Nuratiqah Nik , Ng Boon Hau , Ban Andrea Yu-Lin , Imree Mohd , Zakaria Rozman , Zakaria Syed Zulkifli Syed , Hamid Mohamed Faisal Abdul 
Published: August 2022

Abstract
Background
Lung nodule management remains a challenge to clinicians, especially in endemic tuberculosis areas. Different guidelines are available with various recommendations; however, the suitability of these guidelines for the Asian population is still unclear. Our study described the prevalence of malignant lung nodules among nodules measuring 2–30 mm, the demographic and characteristics of lung nodules between benign and malignant groups, and the clinician's clinical practice in managing lung nodules.

Method
Retrospective review of lung nodules from the computed tomography archiving and communication system (PACS) database and clinical data from January 2019 to January 2022. The data was analysed by using chi square, mann whitney test and simple logistic regression.

Results
There were 288 nodules measuring 2–30 mm identified; 49 nodules underwent biopsy. Twenty-seven (55%) biopsied nodules were malignant, (prevalence of 9.4%). Among the malignant lung nodules, 74% were adenocarcinoma (n = 20). The commonest benign nodules were granuloma n = 12 (55%). In nodules > 8 mm, the median age of malignant and benign was 72 ± 12 years and 66 ± 16 years, respectively (p = 0.024). There was a significant association of benign nodules (> 8 mm) in subjects with previous or concurrent tuberculosis (p = 0.008). Benign nodules are also associated with nodule size ≤ 8 mm, without spiculation (p < 0.001) and absence of emphysema (p = 0.007). The nodule size and the presence of spiculation are factors to make the clinicians proceed with tissue biopsy. Spiculated nodules and increased nodule size had 11 and 13 times higher chances of undergoing biopsy respectively (p < 0.001).) Previous history of tuberculosis had a 0.874 reduced risk of progression to malignant lung nodules (p = 0.013). These findings implied that these three factors are important risk factors for malignant lung nodules. There was no mortality association between benign and malignant. Using Brock's probability of malignancy, nodules ≤ 8 mm had a low probability of malignancy.

Conclusion
The prevalence of malignant lung nodules in our centre was comparatively lower than non-Asian countries. Older age, the presence of emphysema, and spiculation are associated with malignancy. Clinical judgment is of utmost importance in managing these patients. Fleishner guideline is still being used as a reference by our clinician.
Effects of the ketogenic diet in mice with hind limb ischemia
Authors: Shalamu Adilan , Dong Zhen , Liu Bowen , Pan Lihong , Cai Yun , Liu Liwei , Ma Xiurui , Hu Kai , Sun Aijun , Ge Junbo 
Published: August 2022

Abstract
Background
The ketogenic diet (KD) has anti-tumor and anti-diabetic effects in addition to its anti-epileptic role. It could also improve cardiac function and attenuate neurological insult. However, the effect of KD on blood perfusion or tissue recovery after ischemia remains largely unknown. Thus, we observed blood flow and ischemic tissue recovery following hind limb ischemia (HLI) in mice.

Methods
C57 mice were fed with either a KD or normal diet (ND) for 2 weeks, before inducing hind limb ischemia, blood perfusion of ischemic limb tissue was observed at 0, 7, and 21 days post operation.

Results
KD not only decreased blood perfusion of ischemic limb tissue but also delayed muscle recovery after ischemia, induced muscle atrophy of non-ischemic tissue compared to mice fed with ND. Furthermore, KD delayed wound healing at the surgical site and aggravated inflammation of the ischemic tissue. At the cellular level, KD altered the metabolic status of limb tissue by decreasing glucose and ketone body utilization while increasing fatty acid oxidation. Following ischemia, glycolysis, ketolysis, and fatty acid utilization in limb tissue were all further reduced by KD, while ketogenesis was mildly increased post KD in this mice model.

Conclusion
The KD may cause impaired tissue recovery after ischemia and possible muscle atrophy under a prolonged diet. Our results hint that patients with limb ischemia should avoid ketogenic diet.