bluuebunny/crossref_metadata_2025_split huggingface dataset:
Remission and relapses of myasthenia gravis on long-term tacrolimus: a retrospective cross-sectional study of a Chinese cohort
Authors: Bi Zhuajin , Cao Yayun , Liu Chenchen , Gui Mengcui , Lin Jing , Zhang Qing , Li Yue , Ji Suqiong , Bu Bitao 
Published: September 2022

Objective: To identify the factors that predict the remission and relapses in myasthenia gravis (MG) patients improved by prednisone and tacrolimus treatment. Methods: A retrospective, observational cohort analysis of MG patients who achieved remission after receiving prednisone and tacrolimus were performed at Tongji Hospital. The main outcome measures were the time to remission, prednisone discontinuation, tacrolimus reduction–associated relapse, and treatment outcome. Results: After adding tacrolimus, 256 patients were able to achieve remission with a mean time to remission of 2.1 ± 1.4 months. After a median follow-up of 2.9 years, 167 patients (65.2%) discontinued prednisone, and 20 patients (7.8%) achieved complete stable remission. Moreover, 53 of the 109 patients who were tapering tacrolimus experienced relapses. In multivariable analysis, female sex, low tacrolimus concentrations, and quantitative myasthenia gravis (QMG) scores have a positive correlation with the time to remission; concomitant additional autoimmune disease (AID) and high anti-acetylcholine receptor antibody (AChR-ab) levels were significantly associated with low probabilities of prednisone discontinuation [odds ratio (OR) = 0.312–0.912, respectively]; rapid tacrolimus decrement speed (⩾0.76 mg/year) was an independent predictor for the development of relapse during tapering tacrolimus (OR = 5.662). Conclusion: Sex, tacrolimus concentrations, and QMG scores can be used as potential predictors of the time to remission in MG patients treated with tacrolimus and prednisone. Prednisone should be tapered slowly, especially in patients with additional AID or high serum titers of AChR-ab. To avoid symptoms recurrence, the dose of tacrolimus should reduce slowly, not exceeding 0.76 mg/year.
Physician–patient communication in vascular surgery: Analysis of encounters in academic practice
Authors: Willging Abbygale M , Castro Elvis , Xu Jun 
Published: September 2022

Objective: To assess physician–patient communication in vascular consults with the aim of identifying areas for improvement. Introduction: Shared decision-making in clinical consults can enhance patient outcomes. Its potential benefits are significant in vascular surgery, where decisions are dependent on the patient’s definition of quality of life and outcomes are influenced by significant lifestyle changes. Methods: In this qualitative cross-sectional study, encounters between five vascular surgeons and their patients with two asymptomatic vascular diseases were audio recorded, transcribed, and analyzed for validated sociolinguistic statistics. The nine-item shared decision-making questionnaire was used to gauge subjective patient perspective. Results: Physicians spent an average of 19 min and 28 s (±8:55) per consult and an average of 12 min and 7 s talking to the patient (±6:33). Physicians used formalized language about 10.3 times an encounter (±8.39), checked for understanding 6.4 times (±4.84), and asked more close-ended than open-ended questions (10.5 ± 6.15 versus 4.6 ± 2.37). Physicians accounted for 46.34% of utterances (±6%) and averaged 5.8 interruptions per encounter (±4). Patients and company accounted for 53.66% of total utterances (±6%) and averaged 10.1 clarification questions (±9.78). The average nine-item shared decision-making questionnaire Likert-type score per patient was 2.82 on a range of −3 to +3 (±0.33), with positive numbers indicating agreement. On average, patients strongly (+2) or completely (+3) agreed that physicians covered the nine criteria. Conclusion: The 9-item shared decision-making questionnaire data showed that patients mostly felt their physician was adequate in exhibiting shared decision-making behaviors. However, physicians asked closed-ended questions that elicited “yes/no” or brief responses, continuously interrupted patient narratives, and rarely checked for understanding from their patients. These subliminal behaviors restrict patient participation in shared decision-making and may be corrected via longitudinal intervention.
Social workers coordination in primary healthcare for patients with complex needs: A scoping review
Authors: Couturier Yves , Lanoue Sèverine , Karam Marlène , Guillette Maxime , Hudon Catherine 
Published: September 2022

Introduction Care coordination has been part of social work for some time. It has been recognized as contributing to care coordination for long-term care for the elderly and mental health but less is known about their contribution in primary care with patients with complex health and social needs. As social workers are increasingly present in primary healthcare, this scoping review aims to provide a synthesis of social workers’ coordination activities for patients with complex needs in primary healthcare. Methods CINAHL, Medline, Scopus, SocioIndex, Social Work Abstracts, and ProQuest databases were searched, from 2004 to 2020 for peer-reviewed literature. A thematic analysis using deductive and inductive approaches was used to conduct this scoping review. Results Eighteen studies on 11 different care coordination interventions were included. The care coordination activities have been classified into four categories: 1) activities that target the patient, family, and caregivers; 2) activities that target health and social care professionals and services; 3) activities that link the patient and family with health and social professionals and services; and 4) cross-cutting activities that support and enhance other activity. Discussion A variety of care coordination interventions conducted by social workers were identified, all of which included related but different activities. Still, the common aim is to reduce fragmentation of care. Social workers, because of their disciplinary skills characterized by linkages to nonmedical services, can make a significant contribution to the coordination of care in primary health care, in collaboration with nurses.
Clinical and MRI Donor-Site Outcomes After Autograft Harvesting From the Medial Trochlea for Talar Osteochondral Lesions: Minimum 5-Year Clinical Follow-up
Authors: Guo Changjun , Li Xingchen , Zhu Yuan , Yang Chonglin , Xu Xiangyang 
Published: September 2022

Background: Autologous osteochondral transplantation (AOT) is a treatment option for large or cystic osteochondral lesions of the talus (OLTs), with promising clinical results. However, donor-site morbidity (DSM) has always been a concern with this procedure. Purpose: To investigate the clinical and radiological outcomes of autograft harvesting from the medial trochlea for OLTs. Study Design: Case series; Level of evidence, 4. Methods: A total of 46 consecutive patients were included after AOT procedures for OLTs, with donor autografts (single or double plugs) harvested from the medial trochlea of the ipsilateral knee. Lysholm scores were collected postoperatively at 12-month intervals to assess clinical outcomes. Postoperative magnetic resonance imaging (MRI) was used to assess the donor site using the MOCART (magnetic resonance observation of cartilage repair tissue) score. DSM was evaluated at 12-month intervals. Statistical analysis was performed to compare patients treated with single-plug and double-plug AOT procedures and establish whether there was any correlation between MOCART and Lysholm scores. Results: The mean follow-up period was 98.3 months (range, 67-144 months). The Lysholm scores for all patients were 92.5 ± 6.1 and 99.9 ± 0.2 at the 12-month and final follow-ups, respectively. MRI of the donor sites was taken at an average of 93.8 ± 20.5 (range, 61-141) months postoperatively, and the mean MOCART score was 76.2 ± 4.9. The overall incidence of DSM in this study was 4.3% at 12 months, postoperatively, which decreased to 0% at the 24-month follow-up. There was no significant difference in either the Lysholm score ( P = .16) or the MOCART score ( P = .83) between the single-plug and double-plug groups at the final follow-up. There were no significant correlations between MOCART and Lysholm scores and patient age, number of grafts, or body mass index. Conclusion: According to the study findings, the DSM of donor autografts harvested from the medial trochlea was low, and the number (single or double) of grafts did not affect the functional outcome.
Revision Anterior Cruciate Ligament Reconstruction and Increased Tibial Slope: When to Perform a Slope-Altering High Tibial Osteotomy
Authors: Lucidi Gian Andrea , Zsidai Bálint , Winkler Philipp W. , Godshaw Brian M. , Hughes Jonathan D. , Musahl Volker 
Published: September 2022

Background: Slope-correcting high tibial osteotomy (HTO) is gaining popularity for mitigating the impact of posterior tibial slope (PTS) on graft failure in patients requiring revision anterior cruciate ligament (ACL) reconstruction surgery. Biomechanical and clinical studies have demonstrated that PTS reduction results in decreased graft forces and satisfactory patient outcomes, making it an important technique in the setting of complex revision ACL reconstruction (ACL-R). Indications: Slope-correcting HTO can be performed for the management of recurrent knee instability after ACL-R due to a high PTS of 12° or greater. Technique Description: A 3- to 4-inch incision is made along the tibia using an anteromedial approach, and the exposed patellar tendon is protected using a retractor. The anterior compartment is exposed by an incision in the tibialis anterior fascia, followed by elevation of the tibialis anterior and placement of a Hohmann retractor. Subperiosteal elevation of the medial collateral ligament (MCL) is performed on the medial side of the tibial tubercle. The position of eventual screw fixation is marked, and a straight tubercle osteotomy is performed without anteriorization, leaving a freely exposed proximal tibia. Two K-wires are used to mark the location of the osteotomy. Soft tissue structures are protected with Hohmann retractors on both sides while using an oscillating saw to perform the osteotomy. A few degrees (1°-3°) of overcorrection are preferred. The osteotomy is completed, retaining 1cm of posterior hinge. The wedge is removed and reduced by hyperextending the knee under gentle manual traction. Pre-contoured, low-profile plates with locking screws are placed, with 3 screws proximally and another 3 distally. During concurrent ACL-R, the screws should leave room for drilling of the ACL tibial tunnel. Results: Studies investigating the effects of slope-correcting HTO concurrent to revision ACL-R have reported reduced anterior tibial translation and rotatory knee instability, improved patient-reported outcomes, and a reduction in graft failure risk. Description/Conclusion: Slope-reducing HTO is an essential technique in the arsenal of complex ACL surgeons aiming to correct the detrimental effect of an increased PTS on ACL graft integrity in the setting of revision ACL-R.
Validity of the Early Functional Ability scale (EFA) among critically ill patients undergoing early neurological rehabilitation
Authors: Boltzmann Melanie , Schmidt Simone B. , Gutenbrunner Christoph , Krauss Joachim K. , Höglinger Günter U. , Weimar Christian , Rollnik Jens D. 
Published: September 2022

Abstract
Background
A reliable assessment of the functional abilities of patients after severe brain damage is crucial for valid prognostication and treatment decisions, but most clinical scales are of limited use among this specific group of patients.

Aim
The present study investigates the usefulness of the Early Functional Ability (EFA) scale, which determines the functional abilities of severely impaired patients.

Methods
Critically ill patients consecutively admitted to early neurological rehabilitation were screened for eligibility. We assessed the correlation between the EFA scale and (i) the Early Rehabilitation Barthel Index (ERBI), and (ii) the Coma Recovery Scale-Revised (CRS-R). The 1-year outcome on the Glasgow Outcome Scale-extended (GOSE) was used to examine the predictive validity. Demographical and medical variables were entered into univariate and multivariate binary regression models to identify independent predictors of 1-year outcome.

Results
Two hundred fifty-seven patients (168 men) with a median age of 62 years (IQR = 51–75) were enrolled. The correlation of the EFA scale with the CRS-R was high but low with the ERBI upon admission. Multivariate regression analysis yielded the vegetative subscale of the EFA scale as the only independent predictor for the 1-year outcome of patients admitted to early neurological rehabilitation.

Conclusions
This study shows a high correlation of the EFA scale with the CRS-R but a weak correlation with the ERBI in patients with low functional abilities. With improving patient abilities, these correlations were partly reversed. Thus, the EFA scale is a useful tool to assess the functional abilities and the prognosis of critically ill patients adequately and may be more feasible than other scales.
A qualitative study of the impact of peer support on women’s mental health treatment experiences during the perinatal period
Authors: Rice Chloe , Ingram Emma , O’Mahen Heather 
Published: September 2022

Abstract
Background
Perinatal mental health problems are prevalent, affecting up to 20% of women However, only 17–25% receive formal support during the perinatal period. In this qualitative study, we sought to examine women’s experiences with peer support for mental health problems during the perinatal period.

Methods
Semi-structured interviews and focus groups were conducted with twenty-five mothers from the UK who had utilised peer support for a perinatal mental health problem. Data was analysed using thematic analysis.

Results
Seven major themes were identified in women’s help seeking process and experience of peer support. These included; perinatal specific precipitating factors that contributed to their mental health problems, barriers in the form of unhelpful professional responses, feelings of isolation, acceptance of the problem and need to actively re-seek support, finding support either through luck or peer assistance.

Conclusion
Peer support showed promise as an effective means to reduce perinatal mental health difficulties; either as a form of formal support or as an adjunct to formal support. The results highlight ways to improve perinatal women’s access to mental health support through peer-based mechanisms.
Effects of a fixed nurse team in the orthopaedic surgery operating room on work efficiency and patient outcomes: a propensity score-matched historically controlled study
Authors: Zhong Huaying , Zhou Limin , Liao Shaoling , Tang Jing , Yue Liqun , Mo Meizhen , Zhong Yiyue 
Published: September 2022

Abstract
Background
The work value of operating room (OR) nurses is directly reflected in nursing quality. However, evaluating the work value of these nurses has not been sufficiently investigated. This study evaluated the effects of a fixed nurse team (FNT) in an orthopaedic surgery OR on work efficiency and patient outcomes.

Methods
A propensity score-matched historically controlled study conducted from 1 July 2015 to 30 June 2018 was used to investigate the difference in nursing quality between an FNT period and a non-FNT period in the orthopaedic surgery OR at a tertiary care hospital in China. The primary outcome was surgical site infections (SSIs) during in-hospital visits, and as a secondary outcome, other nursing-sensitive quality indicators were assessed with historically controlled data. A multifactor logistic regression model was constructed to examine the primary outcome differences between the FNT and non-FNT periods before and after propensity score matching.

Results
In total, 5365 patients and 33 nurses were included in the final analysis. The overall SSI rate was 2.1% (110/5365; the non-FNT period 2.6% [64/2474], the FNT period 1.6% [46/2891]). A lower incidence of SSIs in patients (odds ratio 0.57, 95% CI 0.36 to 0.88, P=0.013), a lower turnover time of the surgical procedure (odds ratio 0.653, 95% CI 0.505 to 0.844, P<0.001), and improvement in surgeon satisfaction (odds ratio 1.543, 95% CI 1.039 to 2.292, P=0.031), were associated with the FNT period compared with the non-FNT period. However, we did not find significant differences between the FNT period and the non-FNT period in terms of the other indicators.

Conclusions
The presence of an FNT in an OR reduces the incidence of SSIs in surgical patients and the turnover time of surgical procedures and improves surgeon satisfaction. Further implementation of an advanced-practice nurse model with nurse specialists is encouraged.
Investigation of Toxoplasma infection in zoo animals using multispecies ELISA and GRA7 nested PCR
Authors: Liu Ru-Min , Huang Wei-Hsiang , Wang Shang-Lin , Wang Sin-Ling , Huang Pei-Yun , Lien Chen-Yeh , Lai Yen-Hsueh , Wang Pao-Jung , Wu Li-Hsin , Liao Albert Taiching 
Published: September 2022

Abstract
Background
Toxoplasma is an obligate intracellular protozoan that causes an important zoonotic disease with a worldwide distribution. Felids are the definitive hosts of this parasite, while virtually all warm-blooded animals, including birds, serve as intermediate hosts. Four ring-tailed lemurs (Lemur catta) in the Taipei Zoo died of acute Toxoplasma infection in June 2019. Since then, Toxoplasma has occasionally been identified in this Zoo during necropsy of dead animals and PCR of animal blood samples. Therefore, a general survey of Toxoplasma infection in animals in the Zoo seems to be needed.

Methods and results
An indirect multispecies ELISA was used for the first time to screen for Toxoplasma infection in 326 serum samples collected from 75 species of animals. The infection rate of Toxoplasma was 27% (88/326). A commercial latex agglutination (LAT) assay was used to re-examine the samples with doubtful and uncertain ELISA results (151 samples from 42 species). The infection rate increased to 36.2% (118/326), and the indirect multispecies ELISA appeared to be applicable to 31 of 75 species animals included in this study. Nested PCR assays targeting the dense granule protein 7 (GRA7) gene and B1 gene were also used to detect Toxoplasma in DNA samples extracted from 10 liver or blood specimens from 8 animals. GRA7 gene fragments were amplified from 8 samples from 7 animals, while B1 gene fragments were amplified from only 4 samples from 4 animals. From the B1 nested PCR and the sequence data of GRA7 fragments amplified from infectious specimens, the animals in the Zoo were speculated to have been infected by at least three different Toxoplasma variants.

Conclusions
According to the serological investigation, we speculated that over one-third (36.2%) of animals in Taipei Zoo presented the infection of Toxoplasma, and the indirect multispecies ELISA we used can be applied to detect Toxoplasma infection in 31 animal species included in this study. Sequence analysis revealed that at least three Toxoplasma variants were infecting the animals of Taipei Zoo.
Increased circulating myeloid-derived suppressor cells in vivax malaria and severe falciparum malaria
Authors: Leonardo Leo , Kenangalem Enny , Poespoprodjo Jeanne R. , Noviyanti Rintis , Price Ric N. , Anstey Nicholas M. , Minigo Gabriela , Kho Steven 
Published: September 2022

Abstract
Background
Circulating myeloid-derived-suppressor-cells (MDSC) with immunosuppressive function are increased in human experimental Plasmodium falciparum infection, but have not been studied in clinical malaria.

Methods
Using flow-cytometry, circulating polymorphonuclear-MDSC were evaluated in cryopreserved samples from patients with uncomplicated Plasmodium vivax (n = 8) and uncomplicated (n = 4) and severe (n = 16) falciparum malaria from Papua, Indonesia.

Results
The absolute number of circulating polymorphonuclear-MDSC were significantly elevated in severe falciparum malaria patients compared to controls (n = 10). Polymorphonuclear-MDSC levels in uncomplicated vivax malaria were also elevated to levels comparable to that seen in severe falciparum malaria.

Conclusion
Control of expansion of immunosuppressive MDSC may be important for development of effective immune responses in falciparum and vivax malaria.
Attention-optimized DeepLab V3 + for automatic estimation of cucumber disease severity
Authors: Li Kaiyu , Zhang Lingxian , Li Bo , Li Shufei , Ma Juncheng 
Published: September 2022

Abstract
Background
Automatic and accurate estimation of disease severity is critical for disease management and yield loss prediction. Conventional disease severity estimation is performed using images with simple backgrounds, which is limited in practical applications. Thus, there is an urgent need to develop a method for estimating the disease severity of plants based on leaf images captured in field conditions, which is very challenging since the intensity of sunlight is constantly changing, and the image background is complicated.

Results
This study developed a simple and accurate image-based disease severity estimation method using an optimized neural network. A hybrid attention and transfer learning optimized semantic segmentation model was proposed to obtain the disease segmentation map. The severity was calculated by the ratio of lesion pixels to leaf pixels. The proposed method was validated using cucumber downy mildew, and powdery mildew leaves collected under natural conditions. The results showed that hybrid attention with the interaction of spatial attention and channel attention can extract fine lesion and leaf features, and transfer learning can further improve the segmentation accuracy of the model. The proposed method can accurately segment healthy leaves and lesions (MIoU = 81.23%, FWIoU = 91.89%). In addition, the severity of cucumber leaf disease was accurately estimated (R2 = 0.9578, RMSE = 1.1385). Moreover, the proposed model was compared with six different backbones and four semantic segmentation models. The results show that the proposed model outperforms the compared models under complex conditions, and can refine lesion segmentation and accurately estimate the disease severity.

Conclusions
The proposed method was an efficient tool for disease severity estimation in field conditions. This study can facilitate the implementation of artificial intelligence for rapid disease severity estimation and control in agriculture.
The histone modification reader ZCWPW1 promotes double-strand break repair by regulating cross-talk of histone modifications and chromatin accessibility at meiotic hotspots
Authors: Yuan Shenli , Huang Tao , Bao Ziyou , Wang Shiyu , Wu Xinyue , Liu Jiang , Liu Hongbin , Chen Zi-Jiang 
Published: September 2022

Abstract
Background
The PRDM9-dependent histone methylation H3K4me3 and H3K36me3 function in assuring accurate homologous recombination at recombination hotspots in mammals. Beyond histone methylation, H3 lysine 9 acetylation (H3K9ac) is also greatly enriched at recombination hotspots. Previous work has indicated the potential cross-talk between H3K4me3 and H3K9ac at recombination hotspots, but it is still unknown what molecular mechanisms mediate the cross-talk between the two histone modifications at hotspots or how the cross-talk regulates homologous recombination in meiosis.

Results
Here, we find that the histone methylation reader ZCWPW1 is essential for maintaining H3K9ac by antagonizing HDAC proteins’ deacetylation activity and further promotes chromatin openness at recombination hotspots thus preparing the way for homologous recombination during meiotic double-strand break repair. Interestingly, ectopic expression of the germ-cell-specific protein ZCWPW1 in human somatic cells enhances double-strand break repair via homologous recombination.

Conclusions
Taken together, our findings provide new insights into how histone modifications and their associated regulatory proteins collectively regulate meiotic homologous recombination.