bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of a real-time automatic nosocomial infection surveillance system on hospital-acquired infection prevention and control
Authors: Wen Ruiling , Li Xinying , Liu Tingting , Lin Guihong 
Published: November 2022

Abstract
Background
The systematic collection of valid data related to hospital-acquired infections (HAIs) is considered effective for nosocomial infection prevention and control programs. New strategies to reduce HAIs have recently fueled the adoption of real-time automatic nosocomial infection surveillance systems (RT-NISSs). Although RT-NISSs have been implemented in some hospitals for several years, the effect of RT-NISS on HAI prevention and control needs to be further explored.

Methods
A retrospective, descriptive analysis of inpatients from January 2017 to December 2019 was performed. We collected hospital-acquired infection (HAI) cases and multidrug resistant organism (MDRO) infection cases by traditional surveillance in period 1 (from January 2017 to December 2017), and these cases were collected in period 2 (from January 2018 to December 2018) and period 3 (from January 2019 to December 2019) using a real-time nosocomial infection surveillance system (RT-NISS). The accuracy of MDRO infection surveillance results over the 3 periods was examined. The trends of antibiotic utilization rates and pathogen culture rates in periods 2 and 3 were also analysed.

Results
A total of 114,647 inpatients, including 2242 HAI cases, were analysed. The incidence of HAIs in period 2 was significantly greater than that in period 1 (2.28% vs. 1.48%, χ2 = 61.963, p < 0.001) and period 3 (2.28% vs. 2.05%, χ2 = 4.767, p = 0.029). The incidence of five HAI sites, including respiratory infection, urinary tract infection (UTI), surgical site infection (SSI), bloodstream infection (BSI) and skin and soft tissue infection, was significantly greater in period 2 compared with period 1 (both p < 0.05) but was not significantly different from that in period 3. The incidence of hospital-acquired MDRO infections in period 3 was lower than that in period 2. The identification of MDRO infection cases using the RT-NISS achieved a high level of sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV), especially in period 3 (Se = 100%, Sp = 100%, PPV = 100% and NPV = 100%).

Conclusion
The adoption of a RT-NISS to adequately and accurately collect HAI cases is useful to prevent and control HAIs. Furthermore, RT-NISSs improve accuracy in MDRO infection case reporting, which can timely and accurately guide and supervise clinicians in implementing MDRO infection prevention and control measures.
Protocol for the postoperative radiotherapy in N1 breast cancer patients (PORT-N1) trial, a prospective multicenter, randomized, controlled, non-inferiority trial of patients receiving breast-conserving surgery or mastectomy
Authors: Lee Tae Hoon , Chang Ji Hyun , Jang Bum-Sup , Kim Jae Sik , Kim Tae Hyun , Park Won , Kim Yong Bae , Kim Su Ssan , Han Wonshik , Lee Han-Byoel , Shin Kyung Hwan 
Published: November 2022

Abstract
Background
Postoperative radiotherapy (PORT) could be useful for pN1 breast cancer patients who have undergone breast-conserving surgery (BCS) or mastectomy. However, the value of regional nodal irradiation (RNI) for BCS patients, and the indications for post-mastectomy radiotherapy (PMRT) for pN1 breast cancer mastectomy patients, have recently been challenged due to the absence of relevant trials in the era of modern systemic therapy. “PORT de-escalation” should be assessed in patients with pN1 breast cancer.

Methods
The PORT-N1 trial is a multicenter, randomized, phase 3 clinical trial for patients with pN1 breast cancer that compares the outcomes of control [whole-breast irradiation (WBI) and RNI/PMRT] and experimental (WBI alone/no PMRT) groups. PORT-N1 aims to demonstrate non-inferiority of the experimental group by comparing 7-year disease-free survival rates with the control group. Female breast cancer patients with pT1-3 N1 status after BCS or mastectomy are eligible. Participants will be randomly assigned to the two groups in a 1:1 ratio. Randomization will be stratified by surgery type (BCS vs. mastectomy) and histologic subtype (triple-negative vs. non-triple-negative). In patients who receive mastectomy, dissection of ≥5 nodes is required when there is one positive node, and axillary lymph node dissection when there are two or three positive nodes. Patients receiving neoadjuvant chemotherapy are not eligible. RNI includes a “high-tangent” or wider irradiation field. This study will aim to recruit 1106 patients.

Discussion
The PORT-N1 trial aims to verify that PORT de-escalation after BCS or mastectomy is safe for pN1 breast cancer patients in terms of oncologic outcomes and capable of reducing toxicity rates. This trial will provide information crucial for designing PORT de-escalation strategies for patients with pN1 breast cancer.

Trial registration
This trial was registered at ClinicalTrials.gov (NCT05440149) on June 30, 2022.
An update on explaining the rural-urban gap in under-five mortality in India
Authors: Kumar Chandan , Piyasa  , Saikia Nandita 
Published: November 2022

Abstract
Background
Rural Indians have higher mortality rates than urban Indians. However, the rural-urban gap in under-five mortality has changed is less researched. This paper aims to assess 1) whether the rural-urban gap in under-five mortality has reduced over time 2) Whether rural children are still experiencing a higher likelihood of death after eliminating the role of other socioeconomic factors 3) What factors are responsible for India’s rural-urban gap in under-five mortality.

Methods
We used all rounds for National Family Health Survey data for understanding the trend of rural-urban gap in under-five mortality. Using NFHS-2019-21 data, we carried out a binary logistic regression analysis to examine the factors associated with under-five mortality. Fairlie’s decomposition technique was applied to understand the relative contribution of different covariates to the rural–urban gap in under-five mortality.

Results
India has witnessed a more than 50% reduction in under-five mortality rate between 1992 and 93 and 2019–21. From 1992 to 93 to 2019–21, the annual decrease in rural and urban under-five mortality is 1.6% and 2.7%, respectively. Yet, rural population still contributes a higher proportion of the under-five deaths. The rural-urban gap in under-five mortality has reduced from 44 per thousand live births in 1992–1993 to 30 per thousand in 2004–2005 which further decreased to 14 per thousand in 2019–2021. There is no disadvantage for the rural children due to their place of residence if they belong to economically well-off household or their mothers are educated. It is wealth index rather than place of residence which determines the under-five mortality. Economic (50.82% contribution) and educational differential (28.57% contribution) are the main reasons for rural-urban under-five mortality gaps.

Conclusion
The existing rural-urban gap in under-five mortality suggests that the social and health policies need to be need to reach rural children from poor families and uneducated mothers. This call for attention to ensure that the future programme must emphasize mothers from economically and educationally disadvantaged sections. While there should be more emphasis on equal access to health care facilities by the rural population, there should also be an effort to strengthen the rural economy and quality of education.
Existential aspects documented in older people’s patient records in the context of specialized palliative care: a retrospective review
Authors: Sjöberg Marina , Rasmussen Birgit H. , Edberg Anna-Karin , Beck Ingela 
Published: November 2022

Abstract
Background
Documentation of older people’s end-of-life care should cover the care given and provide an overview of their entire situation. Older people approaching the end of life often have complex symptoms, live with bodily losses, and face an unknown future in which existential aspects come to the forefront. Knowledge of the existential aspects recorded in palliative care documentation is sparse and merits improvement. This knowledge is relevant to the development of more holistic documentation and is necessary in order to promote reflection on and discussion of documentation of the sensitive existential considerations arising in palliative care. The aim of this study was to describe the documentation of existential aspects in the patient records of older people receiving specialized palliative care.

Methods
Data were obtained from a retrospective review of the free-text notes in 84 records of randomly selected patients aged ≥75 years enrolled in specialized palliative care units who died in 2017. The notes were analysed using an inductive qualitative content analysis.

Results
The notes documented existential aspects in terms of connotations of well-being and ill-being. Documented existential aspects were related to the patients’ autonomy concerning loss of freedom and self-determination, social connectedness concerning loneliness and communion, emotional state concerning anxiety and inner peace, and state of being concerning despair and hope. The notes on existential aspects were, however, not recorded in a structured way and no care plans related to existential aspects were found.

Conclusions
Existential aspects concerning both ill-being and well-being were sparsely and unsystematically documented in older people’s patient records, but when notes were extracted from these records and analysed, patterns became evident. Existential aspects form an important basis for delivering person-centred palliative care. There is a need to develop structured documentation concerning existential aspects; otherwise, patients’ thoughts and concerns may remain unknown to healthcare professionals.
A community based study on haemoglobinopathies and G6PD deficiency among particularly vulnerable tribal groups in hard-to-reach malaria endemic areas of Odisha, India: implications on malaria control
Authors: Dixit Sujata , Das Arundhuti , Rana Ramakanta , Khuntia Hemant K. , Ota Akhil B. , Pati Sanghamitra , Bal Madhusmita , Ranjit Manoranjan 
Published: November 2022

Abstract
Background
Haemoglobinopathies and G6PD deficiency are inherited disorders found mostly in malaria-endemic areas among different tribal groups of India. However, epidemiological data specific to Particularly Vulnerable Tribal Groups (PVTGs), important for planning and implementing malaria programmes, is limited. Therefore, the present community-based study aimed to assess the prevalence of haemoglobinopathies and G6PD deficiency among the 13 PVTGs found in the state of Odisha, reporting the maximum malaria cases in the country.

Methods
This cross-sectional study was conducted from July 2018 to February 2019 in 12 districts, home to all 13 PVTGs, in an estimated sample size of 1461, selected two-stage sampling method. Detection of haemoglobinopathies was done by the variant analyser. Screening of G6PD deficiency was carried out using DPIP method followed by quantification using spectrophotometry. The PCR–RFLP technology was used to determine variant of G6PD deficiency and haplotype analysis of sickle cell, while ARMS-PCR and GAP-PCR was used for detecting the mutation pattern in β-thalassaemia and α-thalassaemia respectively. The diagnosis of malaria was done by Pf-PAN RDT as point of care, followed by nPCR for confirmation and Plasmodium species identification.

Results
The prevalence of sickle cell heterozygotes (AS) was 3.4%, sickle cell homozygous (SS) 0.1%, β-thalassaemia heterozygotes 0.3%, HbS/β-thalassaemia compound heterozygote 0.07%, HbS-α-thalassaemia 2.1%, G6PD deficiency 3.2% and malaria 8.1%. Molecular characterization of βS revealed the presence of Arab-Indian haplotype in all HbS cases and IVS 1–5 G → C mutation in all β-thalassaemia cases. In case of α-thal, αα/α-3.7 gene deletion was most frequent (38%), followed by αα/α-4.2 (18%) and α-3.7/α-3.7 (4%). The frequency of G6PD Orissa (131C → G) mutation was found to be 97.9% and G6PD Mediterranean (563C → T) 2.1%. Around 57.4% of G6PD deficient individuals and 16% of the AS were found to be malaria positive.

Conclusion
The present study reveals wide spread prevalence of sickle cell anaemia, α-thalassaemia, G6PD deficiency and malaria in the studied population. Moderate to high prevalence of G6PD deficiency and malaria warrants G6PD testing before treating with primaquine (PQ) for radical cure of Plasmodium vivax. Screening and counselling for HbS is required for the PVTGs of Odisha.
Intravoxel incoherent motion (IVIM) MRI in pediatric patients with synovitis of the knee joint: a prospective pilot study
Authors: Huch Britta , Stumpf Kilian , Bracher Anna-Katinka , Rasche Volker , Vogele Daniel , Schütz Catharina , Janda Aleš , Beer Meinrad , Neubauer Henning 
Published: November 2022

Abstract
Background
Diagnosing synovial inflammation by administration of gadolinium-based contrast agents is limited by invasiveness and possible side effects, especially in children and adolescents.

Purpose
We investigated diagnostic accuracy of diffusion-weighted (DWI) MRI with intravoxel incoherent motion (IVIM) imaging compared to contrast-enhanced MRI for detecting synovitis of the knee in a population of pediatrics and young adults. In addition we compared quantitative measures of synovial diffusion and perfusion to a group of healthy volunteers.

Methods
In this prospective study, 8 pediatric patients with 10 symptomatic knees (6 girls and 2 boys, mean age 13 years) with known or suspected synovitis underwent pre- and post-contrast 3.0 T MRI of the knee joint and additional DWI sequences between October 2016 and July 2019. For comparison we enrolled 5 healthy young adults (2 women and 3 men, median age 27 years) with contrast-free MRI of both knees. Post-contrast T1w images and DWI images at b = 1000s/mm2 with apparent diffusion coefficient (ADC) maps of patients were separately rated by two independent and blinded readers with different levels of experience for the presence or absence and degree of synovitis along with the level of confidence. We measured signal intensity on DWI of synovium, joint effusion and muscle with regions of interests and calculated the IVIM-parameters tissue diffusion coefficient (D) and perfusion fraction (f) for patients and volunteers.

Results
All patients showed at least some synovial contrast enhancement, 8 (80%) children knees were diagnosed with synovitis on contrast-enhanced (= ce)-T1w, the diagnostic standard. Ratings by the first and second reader on ce-T1w and DWI showed full agreement (kappa = 1) in diagnosing synovitis and substantial agreement (k = 0,655) for the degree of synovial enhancement. Interobserver agreement on DWI showed fair agreement (k = 0,220) between both readers. Diagnostic confidence was lower on DWI. Mean D- and f-values of muscle was comparable between patients and volunteers. Effusion mean D was higher, mean f was lower, synovial mean D was lower, mean f higher in patients than in volunteers. All differences were statistically significant (p < 0.001).

Conclusions
Diffusion-weighted MRI with IVIM imaging remains a promising, though reader-dependent alternative to i.v. contrast-enhanced imaging in pediatric patients to reliably diagnose, or rule out, synovitis of the knee joint. We detected significantly restricted synovial diffusion and increased perfusion in patients compared to healthy volunteers.

Trial registration
Ethical Comitee University Hospital Ulm, Nr. 320/16.
Long-acting reversible contraceptives use among adolescent girls and young women in high fertility countries in sub-Saharan Africa
Authors: Sambah Francis , Aboagye Richard Gyan , Seidu Abdul-Aziz , Tengan Charles Lwanga , Salihu Tarif , Ahinkorah Bright Opoku 
Published: November 2022

Abstract
Background
Given the instrumental role long-acting reversible contraceptives (LARCs) play in reducing unintended pregnancies, there is a need to understand the factors that predict their use among adolescent girls and young women in high fertility countries. Our study examined the prevalence and predictors of LARCs use among adolescent girls and young women in high fertility countries in sub-Saharan Africa.

Materials and methods
We pooled data from the women’s files of the most recent Demographic and Health Surveys (DHS) from 2010 to 2020 of the top ten high fertility countries in sub-Saharan Africa, which are part of the DHS programme. The total sample was 5854 sexually active adolescent girls and young women aged 15–24 who were using modern contraceptives at the time of the survey. Descriptive and multilevel logistic regression models were used in the analyses. The results were presented using percentages and adjusted odds ratio (AOR) with their respective 95% confidence intervals (CIs).

Results
At the descriptive level, the overall prevalence of LARCs utilisation was 17.6% in the ten countries, with the lowest of 1.7% in Angola and the highest of 55.8% in Mali. Adolescent girls and young women who were married had a lower likelihood of LARCs utilisation than those who were never married [AOR = 0.63, 95% CI = 0.45, 0.88]. Adolescent girls and young women who wanted no more children had higher odds of LARCs use compared to those who wanted more children [AOR = 1.56, 95% CI = 1.09, 2.26]. Adolescent girls and young women with one to three births [AOR = 6.42, 95% CI = 4.27, 9.67], and those with four or more births [AOR = 7.02, 95% CI = 3.88, 12.67] were more likely to use LARCs compared to those who had no children. Countries in sub-Saharan Africa with lower probability of utilizing LARCs were Angola, Niger and Mozambique, whereas adolescent girls and young women in Mali had higher probability of utilizing LARCs.

Conclusion
Our findings suggest that LARCs utilisation among adolescent girls and young women is low in high fertility countries in sub-Saharan Africa. To reduce the rates of unplanned pregnancies and induced abortions, it is imperative that adolescent girls and young women in sub-Saharan Africa are educated on the advantages of utilising LARCs. Additionally, governments, policymakers, and stakeholders in sub-Saharan Africa should raise awareness by executing health promotion measures to enhance the demand for LARCs among adolescent girls and young women. Achieving these would not only prevent unplanned pregnancies and induced abortions, but also help meet the United Nation’s health and well being for all as enshrined in Sustainable Development Goals 3 and 5.
Daphnoretin relieves IL-1β-mediated chondrocytes apoptosis via repressing endoplasmic reticulum stress and NLRP3 inflammasome
Authors: Zhou Jianbo , Wang Qinzhi 
Published: November 2022

Abstract
Background
Osteoarthritis (OA), mainly caused by severe joint degeneration, is often accompanied by joint pain and dysfunction syndrome. Inflammatory mediators and apoptosis play key roles in the evolution of OA. It is reported that daphnoretin has significant antiviral and anti-tumor values. The present study aims at investigating the role of daphnoretin in OA.

Methods
The OA mouse model was constructed by performing the destabilization of the medial meniscus through surgery, and the OA cell model was induced in ATDC5 chondrocytes with IL-1β (10 ng/mL) in vitro. Chondrocyte viability and apoptosis were measured by 3-(4,5)-dimethylthiahiazo (-z-y1)-3,5-di-phenytetrazoliumromide (MTT), Caspase-3 activity, and flow cytometry. The levels of COX-2, iNOS, TNF-α, IL-6, Bax, Bcl2, cleaved-Caspase3, endoplasmic reticulum stress (ERS) proteins (GRP78, CHOP, ATF6, and Caspase-12), and NLRP3-ASC-Caspase1 inflammasome were determined by quantitative real-time PCR or western blot. The concentrations of TNF-α, IL-6, and PGE2 were tested by enzyme-linked immunosorbent assay. The content of nitrates was detected by the Griess method. In vivo, morphologic differences in knee joint sections and the thickness of the subchondral bone density plate in mice were observed by hematoxylin–eosin (H&E) staining and safranin O-fast green staining.

Results
Daphnoretin effectively choked IL-1β-induced chondrocyte apoptosis and facilitated cell viability. Daphnoretin dose-dependently abated ERS, inflammatory mediators, and the activation of NLRP3 inflammasomes in IL-1β-induced chondrocytes. What’s more, in vivo experiments confirmed that daphnoretin alleviated OA progression in a murine OA model by mitigating inflammation and ERS.

Conclusion
Daphnoretin alleviated IL-1β-induced chondrocyte apoptosis by hindering ERS and NLRP3 inflammasome.

Graphical abstract
Association between serum ferritin and bone mineral density in US adults
Authors: Peng Peng , Xiao Fangjun , Gao Shihua , Fang Weihua , Lin Tianye , He Wei , Wei Qiushi 
Published: November 2022

Abstract
Background
The association between serum ferritin and bone mineral density (BMD) is still controversial. This study aims to investigate the association of serum ferritin level with BMD in US adults.

Methods
We conducted a cross-sectional study consisting of 8445 participants from National Health and Nutrition Examination Survey. Serum ferritin and lumbar spine BMD were used as independent variables and dependent variables, respectively. We evaluated the association between serum ferritin and lumbar spine BMD through a weighted multivariable linear regression model. Subgroup and interaction analysis was also performed in this study.

Results
After adjusting for other confounding factors, serum ferritin was negatively correlated with lumbar spine BMD [β =  − 0.090, 95% CI (− 0.135, − 0.045)]. Further subgroup analysis found that the strongest negative association mainly exists in females aged over 45 years [β =  − 0.169, 95% CI (− 0.259, − 0.079)], and this association is not significant in other groups.

Conclusions
The results found that the association between serum ferritin and lumber spine BMD differed by gender and age. Increased level of serum ferritin may indicate a higher risk of osteoporosis or osteopenia in females aged over 45 years.
An alternative posterior ascending pulmonary artery treatment in lobectomy with inflammatory lymph node infiltration
Authors: Iijima Yoshihito , Ishikawa Masahito , Iwai Shun , Yamagata Aika , Motono Nozomu , Yamada Sohsuke , Uramoto Hidetaka 
Published: November 2022

Abstract
Background
Lobectomy may be a challenging treatment option in lung cancer with inflammatory lymph node infiltration. Moreover, the en-masse lobectomy technique, which involves the simultaneous ligation or stapling of pulmonary vessels and bronchi at the hilar area, is controversial.

Case presentation
We report the case of a 75-year-old woman who presented with lung cancer and lymph node infiltration from the posterior ascending pulmonary artery (A2) to the superior pulmonary artery (A6). A nodule was observed in her right upper lobe on chest computed tomography while treating her for a myocardial infarction 3 months prior; hence, a radical lobectomy was planned. Her main pulmonary artery could be constricted using surgical tape, but this was not possible in the peripheral pulmonary artery of the ascending A2 due to widespread lymph node infiltration. Intraoperative frozen sections confirmed the absence of metastases in the hilar lymph nodes. Pulmonary angioplasty was aborted because the cardiac function had not fully recovered from the previous procedure. The ascending A2 and upper lobe bronchus were collectively treated using an auto-stapler. Two months postoperatively, computed tomography showed no pulmonary artery aneurysm.

Conclusions
This report highlights that the en-masse technique may be recommended as an alternative for A2 treatment during lobectomy in cases with inflammatory lymph node infiltration. Surgeons should consider switching to thoracotomy, in such cases, to avoid fatal intraoperative complications.