bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performance of timed function tests as outcome measures in idiopathic inflammatory myopathy—results from a single-centre cohort
Authors: Dunga Saikumar , Kavadichanda Chengappa , Bairwa Devender , Thabah Molly Mary , Negi Vir Singh 
Published: April 2022

Abstract

Objective
To evaluate performance of timed function tests (TFTs) in assessing muscle strength and endurance as determined by Manual Muscle Testing 8 (MMT-8) and Functional Index 2 (FI-2), respectively, in idiopathic inflammatory myopathies (IIM).

Methods
This cohort study included 42 IIM patients satisfying 2017 EULAR/ACR criteria. Patients were classified as active (n = 18) or inactive disease (n = 24) based on clinical status at baseline. MMT-8, FI-2, 30 s rise from chair test, 30 s 1 kg arm rise test and 2-min walking distance (2MWD) were administered at baseline, 3 months and 6 months. Pearson rank correlation analysis and receiver operating curves were performed to assess the performance of timed function tests.

Results
All patients were followed up at 3 months and 39 completed 6 months’ follow-up. All the three TFTs had excellent convergent (r &gt; 0.7, P &lt; 0.05) and divergent validity (P &lt; 0.05). Only 2MWD had moderate to strong correlation with ΔMMT-8 at 3 and 6 months among those with active disease (P = 0.001). All the TFTs correlated with ΔFI-2 in active disease but only Δ2MWD correlated with ΔFI-2 in inactive disease at 6 months (r = 0.506, P = 0.036). At a cut-off of 5% improvement in MMT-8, 2MWD had an area under the curve (AUC) of 0.868 with 95% sensitivity with 2% improvement at 3 months. To detect a 10% ΔMMT-8, Δ2MWD at a cut of 8% and 7% had an AUC of 0.909 and 0.893 with a sensitivity of 92% at 3 and 6 months, respectively (P &lt; 0.05).

Conclusion
2MWD is a reliable indicator of muscle strength, endurance and treatment response. The 2MWD can be self-administered by patients, making it a potential patient-reported outcome measure.
Pedigree-based analyses of changes in genetic variability in three major swine breeds in Taiwan after a disease outbreak
Authors: Wu Ruei-Syuan , Wang Hsu-Chang , Su Chan Liang , Wang Pei-Hwa , Lin En-Chung 
Published: April 2022

AbstractPedigree analysis was performed in three major Taiwanese swine breeds to evaluate the genetic variability in the current population and determine the main reason for genetic diversity (GD) loss after the occurrence of foot-and-mouth disease (FMD) in Taiwan. The pedigree files of the Duroc, Landrace, and Yorkshire breeds, containing 60,237, 87,177, and 34,373 records, respectively, were analyzed. We divided the population into two subpopulations (pre-1998 and post-1998) to determine the role of FMD in GD loss. Pedigree completeness and related indicators were analyzed to evaluate the pedigree quality, and several parameters were used to measure the levels of GD and further used to determine the major cause of GD loss. The pedigree completeness indexes for the different breeds were higher than 0.60, and the trend was enhanced after the FMD outbreak. The estimated proportion of random genetic drift in GD loss increased in all breeds over time (from 62.64% to 78.44% in Duroc; from 26.26% to 57.99% in Landrace; and from 47.97% to 55.00% in Yorkshire, respectively). The effective population size of Duroc and Landrace were increased by the time (Duroc: from 61.73 to 84.75; Landrace: from 108.70 to 113.64); however, it shows opposite trend in Yorkshire population (decline from 86.21 to 50.00). In summary, the occurrence of FMD led to the major loss of GD loss by random genetic drift. Therefore, for the recovery of GD, breeders in Taiwan should increase the effective population size with newly imported genetic materials and adjust the breeding strategy to reduce the inbreeding rate.
Regional Water Availability and WASH Indicators as Predictors of Malnutrition in Under-5 Children: Analysis of the National Family Health Survey, India (2015–16)
Authors: Das Milan , Verma Madhur , Sahoo Soumya Swaroop , Gupta Madhu 
Published: April 2022

Abstract

Background
Water, sanitation and hygiene (WASH) practices determine child nutrition in resource-constrained countries and are influenced by regional water availability. We assessed any relationship between malnutrition and WASH practices among under-5 children in India’s areas as per water availability.

Methods
We did a secondary data analysis of the National Family Health Survey-IV. Stunting, wasting and being underweight were the significant outcomes. Regional water availability, households’ source of water, sanitation and disposal of the child stool were the major independent variables. We report the prevalence estimates, bivariate associations and adjusted odds ratio to predict the child’s malnutrition per regional water availability after using appropriate sampling weight.

Results
Of the 186 875 children, 41%, 20% and 36% were stunted, wasted and underweight. Only 26% of children had access to improved drinking water sources, whereas 50.0% were defecating in open. Around 65% of children’s stools were disposed of in unhygienic ways. Undernutrition depicted a significant association with independent variables. There were higher chances of stunting with a decrease in regional water availability, unimproved sanitation and unhygienic ways of stool disposal. Wasting was intensified by all these factors, except the safe disposal of stools.

Conclusions
WASH indicators exert a protective effect on undernutrition.
Highly pathogenic avian influenza virus incursions of subtype H5N8, H5N5, H5N1, H5N4, and H5N3 in Germany during 2020-21
Authors: King Jacqueline , Harder Timm , Globig Anja , Stacker Lina , Günther Anne , Grund Christian , Beer Martin , Pohlmann Anne 
Published: April 2022

Abstract
From October 2020 to July 2021, five different subtypes (H5N8, H5N5, H5N1, H5N4, and H5N3) and seven genotypes of highly pathogenic avian influenza viruses (HPAIV) belonging to clade 2.3.4.4b were detected in a broad array of avian hosts in Germany. Initial incursion by wild birds with an unprecedented involvement of charadriiforme species at the Wadden Sea coast only carrying subtype H5N3, lateral spread between poultry with detection of novel reassortants and mixed infections in poultry holdings, suspected spillback of HPAIV from poultry to wild birds, and detection of HPAIV-infected wild birds during the following summer in 2021 were hallmarks of this epizootic. Local reassortment events with low pathogenic AIV strains were detected by phylogenetic analyses, with a dominating HP H5N8 and later HP H5N1 strain responsible for most cases. In addition, the first-ever described HPAIV strain of subtype H5N4 could be genetically characterized.
An Arts-Based Workshop Using Scalp Tattoos to Connect Students with Cancer Patients’ Experiences of Chemotherapy and Hair Loss
Authors: Clements Meredith L. , Wimbish Preston W. , Wall Rachel E. 
Published: April 2022

Problem
Students eager to enter the medical field must develop perspective-taking skills that enhance their ability to connect with patients. Toward this goal, the authors developed a pilot workshop for undergraduate students that included an art activity during which they collaborated to design scalp tattoos to symbolize cancer patients’ experiences with chemotherapy and hair loss.

Approach
A 90-minute, arts-based workshop was held in April 2019. One author selected anonymous excerpts from previously conducted interviews with patients experiencing ovarian and uterine cancer. These excerpts were shared with students to humanize patients’ perspectives and give context to the difficulty of coping with chemotherapy-induced alopecia. Students discussed these excerpts and images of scalp tattoos from the internet. Together, they then designed scalp tattoos representing their perspective on the experience of coping with chemotherapy and hair loss and drew them onto mannequin heads.

Outcomes
Twenty members of the university community participated in this workshop, including 3 faculty members and 17 undergraduate students. Participants worked together to create 2 sets of scalp tattoos. Of the 20 participants, 75% (n = 15) responded to the postworkshop survey. All respondents were undergraduate students, and 73% (n = 11) reported an increase in empathy toward patients and 87% (n = 13) an increased connection with the patient experience. All respondents agreed that the art activity demonstrated the importance of taking the patient’s perspective.

Next Steps
This arts-based workshop is effective and can be replicated for other audiences, including undergraduate students, medical students, and practicing clinicians, to encourage perspective-taking and compassion for patients. Further analysis of students’ skill development using pre- and postworkshop data is needed.
The Utility of the Modified Fels Knee Skeletal Maturity System in Limb Length Prediction
Authors: Furdock Ryan J. , Cho Elizabeth , Benedick Alexander J. , Yu Jiao , Sattar Abdus , Liu Raymond W. 
Published: April 2022

Background:
Predicting ultimate lower extremity length is important in the treatment of lower limb length discrepancy (LLD), congenital limb deficiency, and other etiologies. Utilizing skeletal age over chronological age improves the prediction of ultimate lower extremity length. The recently described modified Fels knee skeletal maturity system allows for skeletal age estimation via imaging always available in LLD patients. We sought to compare the accuracy of the modified Fels knee skeletal maturity system versus chronological age in ultimate limb length prediction of a modern adolescent clinical population.

Methods:
The medical records of all patients treated at our institution over a 20-year period with unilateral lower extremity pathology and available lower extremity imaging before and after reaching skeletal maturity were reviewed. Skeletal maturity was defined radiographically by closed distal femoral, proximal tibial, and proximal fibular physes. The femoral, tibial, and lower extremity length was measured in all radiographs. The modified Fels knee skeletal maturity system was applied to all radiographs obtained before maturity to estimate skeletal age. The accuracy of 3 widely utilized lower extremity length prediction systems was compared when utilizing estimated Fels skeletal age versus chronological age inputs.

Results:
A total of 245 radiographs (109 before maturity) from 43 patients were eligible for inclusion. On cross-sectional analysis, linear modeling using Fels skeletal ages was uniformly associated with higher (improved) R
2 values than chronological age-based models. On longitudinal analysis, skeletal age mixed-effects models had significantly lower (improved) Akaike information criterion and Bayesian information criterion values than chronological age models in all cases. Cohen d values were also significantly different (P<0.05) for the skeletal age models compared with chronological age models in all cases.

Conclusions:
In the treatment of LLD, the modified Fels knee skeletal maturity system can be readily applied to available imaging to improve the prediction of ultimate femoral, tibial, and lower extremity length. This skeletal maturity system may have significant utility in the estimation of ultimate LLD and determination of appropriate timing of epiphysiodesis.

Level of Evidence:
Level III.
Outcomes Evaluating Quality of Life and Their Measurement Properties in Early-onset Scoliosis: A Systematic Review
Authors: Baird Charles , Archer James , Gardner Adrian , Rushton Alison , Heneghan Nicola R. 
Published: April 2022

Introduction:
Early-onset scoliosis (EOS) is a spinal deformity affecting children under the age of 10. Understanding the impact of EOS on quality of life can be achieved through appropriate patient/carer-reported outcome measures (PROMs). The aim of this systematic review was to identify, evaluate and summarize the evidence for the measurement properties of health-related quality of life (HR-QoL) outcome measures in the EOS population.

Methods:
A 2-stage search methodology was conducted across the PubMed, MEDLINE, EMBASE, EMCARE, PsychINFO, and CINAHL databases. Search 1 identified PROMs used to evaluate the quality of life in EOS, and search 2 identified studies of the measurement properties of these PROMs. Two reviewers performed searching, study screening and selection and assessed studies for risk of bias using the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist. One reviewer performed data extraction. Evidence for each measurement property per PROM was summarized and evaluated using a modified GRADE approach.

Results:
Search 1 identified 19 (10 disease-specific, 9 generic) PROMs that have been used to assess HR-QoL or a relevant domain in the EOS population. Search 2 identified only one PROM (the 24-item Early-Onset Scoliosis Questionnaire, EOSQ) with eligible studies (n=4) evaluating measurement properties. There is low-quality evidence for sufficient content validity, very low-quality evidence for sufficient reliability and low-quality evidence for sufficient criterion validity, specifically regarding the pulmonary function domain) of the EOSQ. Construct validity and responsiveness were rated as indeterminate. There were no studies on measurement error.

Conclusions:
Our search strategy found that measurement properties have only been evaluated for one PROM, the EOSQ. There is low-quality evidence for sufficient measurement properties for the EOSQ in patients under the age of 10 with EOS. Further research is needed to improve the quality of evidence for EOSQ measurement properties and investigate other PROMs in this population.

Level of Evidence:
Level II.
Total Gynecomastia Removal with Layered Closure: A Study of 567 Cases
Authors: Caridi Robert C. 
Published: April 2022

Background:
Conventional teaching dictates subtotal removal of gynecomastia tissue to ensure a cosmetically acceptable result. Modern-day concerns regarding gynecomastia treatment include continued “puffy nipples,” possible recurrence, and compromised aesthetic results resulting from incomplete tissue removal. The author practiced complete tissue removal with a layered closure technique to optimize the cosmetic result while addressing treatment complications.

Methods:
A single surgeon treated 567 patients using a standard four-step approach with complete tissue removal. A retrospective chart review was performed to assess complications and reason for surgical revision.

Results:
All revision procedures were for postoperative scar tissue accumulation. No revisions for complaints of contour depression, recurrence, or continued puffy nipples were noted. No necrosis of the nipple-areola complex or skin was noted.

Conclusions:
Complete removal of gynecomastia tissue was not only possible but also essential to achieve optimal cosmetic results. The layered closure technique is a useful adjunctive treatment after gynecomastia total tissue removal.
A Case of Orthognathic Surgery for Jaw Deformity in a Patient with Spinocerebellar Ataxia
Authors: Sato Marika , Kawase-Koga Yoko , Hamada Hayato , Chikazu Daichi 
Published: April 2022

Summary:
Spinocerebellar ataxia (SCA) is a progressive neurodegenerative disease that can cause various ataxia symptoms. Here we report a patient with spinocerebellar ataxia who underwent orthognathic surgery to correct a mandibular protrusion with facial asymmetry. A 33-year-old woman was admitted to our hospital for orthognathic surgery. She started preoperative orthodontic treatment after a diagnosis of mandibular protrusion with facial asymmetry. Two and a half years later, after completing preoperative orthodontic treatment, she returned to our hospital after being diagnosed with spinocerebellar ataxia. After discussing the risk of surgery with the anesthesiologist and neurologist, we elected to perform orthognathic surgery after the patient provided informed consent. Sagittal split ramus osteotomy and intraoral vertical ramus osteotomy were performed under general anesthesia, but no remarkable perioperative complications occurred. After a 3-year follow-up, the occlusion has remained stable, and no postoperative relapse occurred. Whether we should provide surgical treatment for SCA patients is controversial. However, when long-term predictions were considered, altering an occlusion could improve a patient’s quality of life in the present case.
Prepectoral Breast Reconstruction in Morbidly Obese Patients
Authors: Gabriel Allen , Storm-Dickerson Toni L. , Chan Vivian , Lord Rob , O’Rorke Erin , Maxwell G. Patrick 
Published: April 2022

Background:
Prosthetic breast reconstruction via the subpectoral approach in morbidly obese patients (body mass index: ≥40 kg/m2) has been reported to be associated with an increased risk of perioperative complications and poor outcomes. Further, immediate reconstruction appears to carry a higher risk of poor outcomes than delayed reconstruction in this population. The impact of morbid obesity on outcomes after prepectoral breast reconstruction has not yet been evaluated, and such was the purpose of this study.

Methods:
This retrospective study included all consecutive patients with morbid obesity who underwent prepectoral expander/implant reconstruction between July 2009 and April 2020 in the first author’s practice. Patient records were reviewed, and data on demographics, comorbidities, radiotherapy use, type of mastectomy, mastectomy specimen weight, and postoperative complications following reconstruction were retrieved. Complications were stratified and compared by timing of reconstruction (immediate versus delayed).

Results:
Eighty-five breasts in 45 morbidly obese patients were reconstructed. Postoperative complications occurred in 11 breasts (12.9%) and included major skin necrosis (3.5%), seroma (4.7%), wound dehiscence (5.9%), and reconstructive failure (1.2%). Timing of reconstruction had little impact on postoperative complications other than major skin necrosis, which was significantly higher in the delayed group (11.1% versus 1.5%).

Conclusions:
Prosthetic breast reconstruction via the prepectoral approach can be successfully performed in morbidly obese patients, with outcomes approaching those seen in nonobese patients when performed by experienced surgeons. Patients with morbid obesity should not be denied this reconstructive approach because of their body mass index.
Functional connectivity and neurotransmitter impairments of the salience brain network in chronic low back pain patients: a combined resting-state functional magnetic resonance imaging and 1H-MRS study
Authors: Baumbach Philipp , Meißner Winfried , Reichenbach Jürgen R. , Gussew Alexander 
Published: April 2022

Abstract
Functional reorganisation of the salience network (SN) has been proposed as one of the key pathomechanisms associated with central nociceptive processing in the chronic pain state. Being associated with an altered functional connectivity within the SN, these processes have been hypothesized to result from a loss of inhibitory function leading to node hyperexcitability and spontaneous pain. Combined resting-state BOLD functional magnetic resonance imaging (MRI) and 1H-MR spectroscopy was applied to chronic back pain patients and healthy subjects to assess deviations from functional integrity (weighted closeness centrality [wCC], derived from resting-state functional MRI), oscillatory BOLD characteristics (spectral power), and neurotransmitter levels (GABA+, glutamate+glutamine) in 2 key SN nodes, anterior insular (aInsR) and anterior mid-cingulate cortices. In addition, examinations were repeated in chronic back pain patients after a 4-week interdisciplinary multimodal pain treatment and in healthy subjects after 4 weeks to explore longitudinal, treatment-mediated changes in target variables. The aInsR and, to a lesser extent, the anterior mid-cingulate of patients exhibited significantly reduced wCC accompanied by a spectral power shift from a lower to a higher frequency band, indicating a desynchronization of their neuronal activity within the SN, possibly because of increased spontaneous activations. Without revealing neurotransmitter differences, patients alone showed significant positive associations between local GABA+ levels and wCC in aInsR, suggesting a stronger dependence of node synchronization on the inhibitory tone in the chronic pain state. However, this needs to be explored in the future using magnetic resonance spectroscopy techniques that are more sensitive to detecting subtle neurotransmitter changes and also allow multifocal characterization of neurotransmitter tone.
Bone scan with technetium 99m-methyl diphosphonate, the missing link in the initial staging of muscle-invasive bladder carcinoma
Authors: Ghorbani Hamidreza , Soltani Salman , Zakavi Seyed Rasoul , Masoudifard Alireza , Aryan Reihaneh , Mottaghi Mahdi , Aryana Kamran , Aghaee Atena 
Published: April 2022

Background
Accurate staging is crucial to determine the type of treatment for patients with bladder cancer (BCa), especially in high-risk cases. We aimed to assess the role of bone scan in the initial staging of muscle-invasive bladder carcinoma (MIBC).

Material and methods
Forty-five patients with MIBC were referred to our tertiary clinic to perform a technetium 99m-methyl diphosphonate (Tc99m-MDP) bone scan from January 2019 to March 2020. The patients underwent bone scintigraphy with pelvic SPECT/CT before radical cystectomy. Whole-body scanning was performed 4 hours after Tc99m-MDP injection in both anterior and posterior views. Since the most common bone involvement site in these patients is the pelvic bones and the spine, pelvic SPECT/CT was performed in all patients.

Results
Frequency of skeletal metastasis was 26.7%. Only 19% of the metastases were detected by previous pelvic CT/MRI images performed for routine staging. All the reported skeletal metastases by previous anatomical imaging methods were detected in the bone scan. There was no statistically significant correlation between bone metastasis and the patient’s age, lymph nodes metastasis (LNM), hydronephrosis, and muscle-invasive type. The mean serum calcium level was 8.7 ± 0.57 in patients with bone metastasis and 8.87 ± 0.99 in patients without bone metastasis, which was not statistically significant.

Conclusion
Bone scan has higher diagnostic performance than conventional imaging methods for detecting bone metastases. It changed the management plan in 8.8% of our patients, so we conclude that performing a whole-body bone scan in the initial staging of MIBC would be helpful.