bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Posterior and Lateral Surface Plating for Type B Weber Lateral Malleoli Fractures
Authors: Hegde Atmananda , Shetty Chethan , Joseph Nitin , Mane Prajwal 
Published: February 2022

Purpose The purpose of this study is to compare the functional outcomes, radiological outcomes, complication rates, and hardware removal between lateral and posterior surface plating in isolated type B Weber lateral malleolus fractures. Methods It was a retrospective study that compared the outcomes of type B Weber lateral malleoli fractures treated by either lateral surface or posterior surface plating. Radiological and functional outcomes were assessed at regular intervals. The follow-up details and the complications and need for implant removal were collected from the hospital records. Results Our study included 60 patients (male-35 and female-25). The mean age was 41.7 ± 10.5 years. In all, 28 (46.7%) patients received lateral surface plating and 32 (53.3%) patients received posterior surface plating. The mean time gap between the injury and the surgery was significantly more among patients who underwent lateral plate insertion ( P < .001). The mean operative time required for both the procedures was comparable, hence nonsignificant (P = .576). The mean American Orthopaedic Foot and Ankle Society score (AOFAS) after 2 years of operation was significantly higher for posterior plate insertion ( P = .014). The complication rates as well as the implant removal rates were higher in patients with lateral plating ( P < .05). Conclusion Posterior surface plating can be considered as the procedure of choice for isolated type B Weber lateral malleolus fractures with respect to better functional outcome, lesser complications rates, and need for implant removal. Level of Evidence: Level III: Economic/decision
‘Using humanity to change systems’ – understanding the work of online feedback moderation: A case study of Care Opinion Scotland
Authors: Berry Emma , Skea Zoë C , Campbell Marion K , Locock Louise 
Published: February 2022

Objective To gain a deeper understanding of online patient feedback moderation through the organisation of Care Opinion in Scotland. Methods An ethnographic study, initially using in-person participant observations, switching to remote methods due to the pandemic. This involved the use of remote observations and interviews. Interviews were carried out with the whole Scottish team ( n = 7). Results Our results identify three major themes of work found in online patient feedback moderation. The first is process work, where moderators make decisions on how to edit and publish stories. The second is emotional labour from working with healthcare experiences and with NHS staff. The third is the brokering/mediation role of Care Opinion, where they must manage the relationships between authors, subscribing healthcare providers and Scottish Government. Our results also capture that these different themes are not independent and can at times influence the others. Conclusion Our results build on previous literature on Care Opinion and provide novel insights into the emotional and brokering/mediation work they undertake. Care Opinion holds a unique position, where they must balance the interests of the key stakeholders. Care Opinion holds the power to amplify authors’ voices but the power to make changes to services lies with NHS staff and services. Online moderation work is complex, and moderators require support to carry out their work especially given the emotional impact. Further research is planned to understand how patient stories are used by NHS Scotland, and the emotional labour involved with stories, from both the author and NHS staff perspective.
Anatomical and Technical Considerations of Robot-Assisted Cervical Pedicle Screw Placement: A Cadaveric Study
Authors: Mao Jennifer Z. , Soliman Mohamed A.R. , Karamian Brian A. , Khan Asham , Fritz Alexander G. , Avasthi Naval , DiMaria Stephen , Levy Bennett R. , O’Connor Timothy E. , Schroeder Gregory , Pollina John , Vaccaro Alexander R. , Mullin Jeffrey P. 
Published: February 2022

Study Design Cadaver study. Objectives Assess the feasibility of robot-assisted cervical pedicle screw (RA-CPS) placement and understand the anatomical considerations of this technique. Methods Four cadaver specimens free from bony pathology were acquired. Anatomical considerations, such as pedicle width (PW) and height (PH), transverse pedicle angle (TPA), and maximal screw length (MSL), were recorded from preoperative computational tomography (CT) scans. Intraoperative cone-beam CT was acquired and registered to the robotic system. After cervical levels were segmented, screw sizes and trajectories were planned, and RA-CPS were placed. Accuracy was assessed using Gertzbein and Robbin’s classification on postoperative CT scans. Results Thirty-five RA-CPS were placed. Major breaches (≥Grade C) occurred in 28.57% screws. Grade A or B accuracy was found in 71.43% of screws, with the most common direction of breach being medial (81.3%). The greatest proportion of breach per level occurred in the upper subaxial levels, (C3:71.4%, C4 66.6%, C5:50%) which had the smallest PW (C3: 4.34 ± .96 mm, C4: 4.48 ± .60, C5: 5.76 ± 1.11). PH was greatest at C2 (8.14 ± 1.89 mm) and ranged subaxial from 6.36 mm (C3) to 7.48 mm (C7). The mean PW was 5.37 mm and increased caudally from 4.34 mm (C3) to 6.31 mm (C7). The mean TPA was 39.9° and decreased moving caudally 46.9°) to C7 (34.4°). The MSL was 37.1 mm and increased from C2 (26.3 mm) to C7 (41.0 mm). Conclusion RA-CPS has the potential to be feasible, but technological and instrument modifications are necessary to increase the accuracy in the cervical region.
Undergraduate Medical Students’ Perceptions of an Online Audio-Visual-Based Module for Teaching Musculoskeletal Physical Examination Skills
Authors: Alomar Abdulaziz Z 
Published: February 2022

Introduction Video-based learning has gained prominence in medical education and, more recently, in musculoskeletal teaching. This study investigated medical students’ perceptions of the effectiveness of online video-based learning for musculoskeletal physical examination skills. Methods For one academic year, undergraduate medical students were instructed online through video-based learning before bedside teaching about the physical examination of knee and shoulder joints. At the end of the course, the students participated in a survey to assess their perceptions of the online video-based learning module using a pre-validated questionnaire. The questionnaire consisted of closed-ended and open-ended questions. The closed-ended question responses were assessed using a Likert scale; the open-ended responses were analyzed qualitatively. Results In total, 242 out of 310 students who participated in the online video-based learning responded to the survey. Most students found the teaching approach to be satisfactory and preferable to traditional teaching methods. However, they also felt that these modules could not replace hands-on practice. The most helpful aspects of the training modules were a better understanding of the specific tests, technique, and sequence of administering the physical examination. Perceived limitations included the inadequately addressed theoretical basis of the physical examination and the special tests, the need for more time to explain clinical anatomy, and the practical implications of the positive special tests. Conclusion Undergraduate medical students perceive VBL as helpful for MPES learning. The positive aspects of the VBL approach in teaching MPES are that it is comprehensive, easily accessible, offers standardized teaching, save times, and it includes demonstrations of special tests, examination techniques, and the sequence and organization of the clinical examination. The main perceived limitations were lack of content regarding clinical reasoning and the anatomical basis of the clinical tests.
Seminal fluid gene expression and reproductive fitness in Drosophila melanogaster
Authors: Patlar Bahar , Civetta Alberto 
Published: February 2022

Abstract
Background
The rapid evolution of seminal fluid proteins (SFPs) has been suggested to be driven by adaptations to postcopulatory sexual selection (e.g. sperm competition). However, we have recently shown that most SFPs evolve rapidly under relaxed selective pressures. Given the role of SFPs in competition for fertilization phenotypes, like the ability to transfer and store sperm and the modulation of female receptivity and ovulation, the prevalence of selectively relaxed SFPs appears as a conundrum. One possible explanation is that selection on SFPs might be relaxed in terms of protein amino acid content, but adjustments of expression are essential for post-mating function. Interestingly, there is a general lack of systematic implementation of gene expression perturbation assays to monitor their effect on phenotypes related to sperm competition.

Results
We successfully manipulated the expression of 16 SFP encoding genes using tissue-specific knockdowns (KDs) and determined the effect of these genes’ perturbation on three important post-mating phenotypes: female refractoriness to remating, defensive (P1), and offensive (P2) sperm competitive abilities in Drosophila melanogaster. Our analyses show that KDs of tested SFP genes do not affect female refractoriness to remating and P2, however, most gene KDs significantly decreased P1. Moreover, KDs of SFP genes that are selectively constrained in terms of protein-coding sequence evolution have lower P1 than KDs of genes evolving under relaxed selection.

Conclusions
Our results suggest a more predominant role, than previously acknowledged, of variation in gene expression than coding sequence changes on sperm competitive ability in D. melanogaster.
Models to predict the short-term survival of acute-on-chronic liver failure patients following liver transplantation
Authors: Yang Min , Peng Bo , Zhuang Quan , Li Junhui , Liu Hong , Cheng Ke , Ming Yingzi 
Published: February 2022

Abstract
Background
Acute-on-chronic liver failure (ACLF) is featured with rapid deterioration of chronic liver disease and poor short-term prognosis. Liver transplantation (LT) is recognized as the curative option for ACLF. However, there is no standard in the prediction of the short-term survival among ACLF patients following LT.

Method
Preoperative data of 132 ACLF patients receiving LT at our center were investigated retrospectively. Cox regression was performed to determine the risk factors for short-term survival among ACLF patients following LT. Five conventional score systems (the MELD score, ABIC, CLIF-C OFs, CLIF-SOFAs and CLIF-C ACLFs) in forecasting short-term survival were estimated through the receiver operating characteristic (ROC). Four machine-learning (ML) models, including support vector machine (SVM), logistic regression (LR), multi-layer perceptron (MLP) and random forest (RF), were also established for short-term survival prediction.

Results
Cox regression analysis demonstrated that creatinine (Cr) and international normalized ratio (INR) were the two independent predictors for short-term survival among ACLF patients following LT. The ROC curves showed that the area under the curve (AUC) ML models was much larger than that of conventional models in predicting short-term survival. Among conventional models the model for end stage liver disease (MELD) score had the highest AUC (0.704), while among ML models the RF model yielded the largest AUC (0.940).

Conclusion
Compared with the traditional methods, the ML models showed good performance in the prediction of short-term prognosis among ACLF patients following LT and the RF model perform the best. It is promising to optimize organ allocation and promote transplant survival based on the prediction of ML models.
Bloodstream infection and pneumonia caused by Chlamydia abortus infection in China: a case report
Authors: Zhu Changjun , Lv Minjie , Huang Jianling , Zhang Changwen , Xie Lixu , Gao Tianming , Han Bo , Wang Wenjing , Feng Ganzhu 
Published: February 2022

Abstract
Background
Chlamydia abortus is generally considered to cause abortion, stillbirth, and gestational sepsis in pregnant women, but it’s rare in bloodstream infection and pneumonia.

Case presentation
We present details of a patient with bloodstream infection and pneumonia caused by Chlamydia abortus. Both blood next-generation sequencing (NGS) and sputum NGS indicate Chlamydia abortus infection. The patient received intravenous infusion of piperacillin sodium and tazobactam sodium (4.5 g/8 h) and moxifloxacin (0.4 g/d) and oral oseltamivir (75 mg/day). Within one month of follow-up, the patient's clinical symptoms were significantly improved, and all laboratory parameters showed no marked abnormality. However, chest computer tomography (CT) showed the inflammation wasn’t completely absorbed. And we are still following up.

Conclusions
Chlamydia abortus can cause pneumonia in humans. NGS has the particular advantage of quickly and accurately identifying the infection of such rare pathogens. Pneumonia is generally not life-threatening, and has a good prognosis with appropriate treatment. However, Chlamydia infection can lead to serious visceral complications which clinicians should pay attention to.
Epidemiological and clinical risk factors related to severe COVID-19 in Iran: a multi-center study
Authors: Hashemi-Shahri Seyed Mohammad , Tabatabaei Seyed Mohammad Nasiraldin , Ansari-Moghaddam Alireza , Mohammadi Mahdi , Okati-Aliabad Hassan , Tabatabaei Seyed Mehdi , Ansari Hossein , Abbasi Mohammadhadi , Sheikhzadeh Khodadad , Baygi Mehdi Zanganeh , Sartipi Majid , Sanei-Sistani Sharareh , Khorashad Ali Reza Salimi , Ansari-Moghadam Fatemeh , Torab Neda , Khalili Tahereh , Miri-Aliabad Ghasem 
Published: February 2022

Abstract
Background
Iran was one of the first countries to be affected by COVID-19. Identifying factors associated with the severity of COVID-19 is effective in disease management. This study investigated the epidemiological and clinical features and factors related to the severity of COVID-19 in one of the less privileged areas in Iran.

Methods
In a multi-center study, all patients admitted to Zahedan University of Medical Sciences hospitals in southeastern Iran were investigated from February 29 to April 31, 2020. Demographic, epidemiological, and clinical data of patients were extracted from medical records. Bivariate and multivariate logistic regression models were used to explore the risk factors associated with the severity of COVID-19.

Results
Among the 413 patients, 55.5% were male, and 145 (35.10%) were in a severe condition at admission time. Multivariate analysis showed that the adjusted odds of the disease severity increased in patients with older age (OR 2.27; 95% CI 1.41–3.65), substance abuse (OR 2.49; 95% CI 1.14–5.43), having one underlying disease (OR 1.52; 95% CI 0.90–2.55), having two underlying disease (OR 2.31; 95% CI 1.19–4.50), and having three or more underlying disease (OR 2.60; 95% CI 1.19–5.66).

Conclusions
COVID-19 was more severe in older patients, patients with a history of substance abuse, and patients with the underlying disease. Understanding the factors affecting the disease severity can help the clinical management of COVID-19, especially in less privileged areas where fewer resources are available.
Mental health and life satisfaction among 10–11-year-olds in Wales, before and one year after onset of the COVID-19 pandemic
Authors: Moore Graham , Anthony Rebecca , Angel Lianna , Hawkins Jemma , Morgan Kelly , Copeland Lauren , Murphy Simon , Van Godwin Jordan , Shenderovich Yulia 
Published: February 2022

Abstract
Background
In many countries, including in the United Kingdom (UK), COVID-19 social distancing measures placed substantial restrictions on children’s lives in 2020 and 2021, including closure of schools and limitations on play. Many children faced milestones such as transition to secondary school having missed several months of face-to-face schooling in the previous academic years.

Methods
This paper examines change in mental health difficulties, life satisfaction, school connectedness, and feelings about transition to secondary school among 10–11-year-olds in Wales, UK, using data from repeat cross-sectional surveys before and after the onset of the COVID-19 pandemic. Participants were 4032 10–11-year-old schoolchildren. The first cohort completed a school-based survey in 2019 (prior to introduction of social distancing measures), and the second in 2021 (following full return to school after two rounds of school closure).

Results
The percentage of children reporting elevated emotional difficulties rose from 17% in 2019 to 27% in 2021 (Odds Ratio = 1.65; 95%CI = 1.23 to 2.20). There was no evidence of increased behavioural difficulties (OR = 1.04; 95%CI = 0.73 to 1.46). There was a tendency toward declines in life satisfaction in all analyses, but this intersected the null (OR = 0.86; 95%CI = 0.70 to 1.07). Children reported a high degree of school connectedness before and after the pandemic, with no evidence of change in ratings of teacher relationships, pupil relationships or pupil involvement in school life. There was no evidence of impacts of the pandemic on children’s feelings about the transition to secondary school, with feelings becoming more positive as transition neared. Most findings were robust to a range of sensitivity analyses.

Conclusions
Supporting children’s emotional recovery from the COVID-19 pandemic is a public health priority requiring urgent and effective action at multiple levels of society. Maintaining connectedness to school through the pandemic may have played a role in preventing a steeper increase in child mental health difficulties.
Association between physical activity, sedentary time, participation in organized activities, social support, sleep problems and mental distress among adults in Southern Norway: a cross-sectional study among 28,047 adults from the general population
Authors: Stea Tonje Holte , Solaas Susanne Aune , Kleppang Annette Løvheim 
Published: February 2022

Abstract

Background
Identification of modifiable factors associated with poor mental health is crucial to develop targeted and effective intervention strategies for prevention of mental distress and illness in the general population. Thus, the aim of the present study was to examine the association between low level of leisure-time physical activity, high sedentary time, low participation in organized activities, low social support, sleep problems, and mental distress in a large sample of Norwegian adults.

Methods
A cross-sectional study was completed by 28,047 adults (≥18 years old) in southern Norway by filling out an online self-report questionnaire. Multivariable binary logistic regression models, stratified according to gender and adjusted for age and perceived financial situation, were used to examine possible associations between unhealthy lifestyle behaviors, participation in organized activities, social support, and mental distress.

Results
Our results showed an increased odds of having mental distress among men reporting low leisure-time physical activity (OR: 1.18; 95%CI: 1.03–1.37), high sedentary time (1.32; 1.16–1.51), low involvement in organized activities (1.43; 1.25–1.64), low social support (2.55; 2.18–2.99), and sleep problems (7.29; 6.35–8.37) compared to the rest of the male population. For women, the results showed increased odds of mental distress among those reporting high sedentary time (1.25; 1.11–1.39), low involvement in organized activities (1.60; 1.42–1.80), low social support (2.71; 2.39–3.06), and sleep problems (5.78; 5.15–6.50) compared to the rest of the female population. For both men and women, results also indicated that mental distress was increased among younger adults and among those reporting financial difficulties compared to the rest of the population.

Conclusion
Our results showed an association between unhealthy lifestyle behaviors, low participation in organized activities, low social support and mental distress, and that the strength of the association varied substantially. These findings provide increased knowledge about the relationship between modifiable lifestyle factors and mental health which should have implications for future public health efforts.
Multiple vas deferens with polyorchidism and many congenital malformations in a symptomatic 11-year-old male patient: a rare case report
Authors: Mansour Marah , Ismail Mohammad Adel , Dashan Mohammad Ali , Kheat Ahmad , Alsuliman Tamim , Alrebdawi Khaled 
Published: February 2022

Abstract
Background
Ductus deferens may manifest in a variety of anomalies such as its absence, duplication, ectopy, or diverticulum. Ectopic seminal tract opening has two main types, ectopic ejaculatory duct opening, and ectopic vas deferens opening. Generally, ductus deferens anomalies affect approximately 0.05% of the population. Patients may be asymptomatic or complaining of urinary tract infections and/or epididymitis. Most of these cases are associated with renal dysplasia. To confirm the diagnosis Cystourethroscopy catheterization and retrograde urethrogram should be performed, but the definitive diagnosis is done by vasography. The definitive treatment is complete surgical resection of the pathological urogenital connection. This case is commonly discovered while exploring other findings such as testicular torsion and inguinal hernia.

Case presentation
We report a rare case of an 11-year-old male who presented with gross hematuria and numerous congenital malformations including a left polydactyly clubfoot, polyorchidism, with several surgical procedures, and left kidney dysgenesis. Surgery was performed for a left inguinal hernia, during which a third undescended testicle was discovered incidentally and was eradicated. A retrograde urethrogram was performed to establish the diagnosis. A fistula- that is connected with the left ureter- was resected. The histopathologic findings confirmed the diagnosis of true duplication of the Vas deferens, with communication between the ureter and the vas deferens. By follow-up, the kidney function tests were within normal limits.

Conclusions
This case report aims to highlight the early diagnosis and management of the duplicated vas deferens and the associated congenital malformations to improve the prognosis and kidney function and to avoid long-term complications.
A rare case of male Fournier’s gangrene with mixed Actinomyces turicensis infection
Authors: Mao Tong-chun , Zhou Xuan , Tian Meng-nan , Zhang Yi-ming , Wang Shao-liang 
Published: February 2022

Abstract
Background
Fournier's gangrene (FG), a urological emergency with high mortality, is an infectious necrotizing fasciitis of the perineal and genital regions. The majority of FG is caused by polymicrobial organisms involving mixed aerobes and anaerobes but rarely reveals Actinomyces species.

Case presentation
We report a healthy 67-year-old Asian male who presented with rapidly progressive painful swelling of the scrotum. Clinically diagnosed with FG, the patient underwent an emergency radical debridement, followed by broad-spectrum antibiotics and negative pressure wound therapy. The identification of the causative microorganisms showed Actinomyces turicensis and the antibiotic treatment was adjusted accordingly. After wound bed preparation, we took split-thickness skin grafts to cover the scrotal wound. Active management to minimize faecal contamination was applied throughout the whole course of treatment and repair. The patient was satisfied with the outcome. This was an extremely rare case of A. turicensis as the main causative pathogen of FG.

Conclusions
FG due to Actinomyces species is rarely reported, but we should still consider this pathogenic microorganism that has long been neglected.