bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pain and Fatigue in Patients With Ankylosing Spondylitis Treated With Tumor Necrosis Factor Inhibitors
Authors: Strand Vibeke , Deodhar Atul , Alten Rieke , Sullivan Emma , Blackburn Stuart , Tian Haijun , Gandhi Kunal K. , Jugl Steffen M. , Conaghan Philip G. 
Published: August 2020

Background/Objective
Patients with ankylosing spondylitis (AS) experience symptoms and comorbidities that impact their health-related quality of life (HRQoL) and ability to work. This real-world, global survey was conducted among AS patients receiving tumor necrosis factor inhibitors (TNFis) to evaluate both the frequency and severity of persistent symptoms, and the impact of pain and fatigue on HRQoL, employment status, and work activity.

Methods
Patients with AS and their treating physicians from 13 countries across 5 continents completed questionnaires capturing demographics, patient symptoms, current disease status, HRQoL, current therapy, employment status, and Work Productivity and Activity Impairment.

Results
Seven hundred five patients who had been receiving a TNFi for 3 months or more and completed both Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) pain and fatigue domains were included in the analysis; of these, 37.6% reported high BASDAI pain scores and 41.3% high BASDAI fatigue scores. Medical Outcomes Study–Short Form, 36-item version 2 domain, 5-dimensional EuroQoL Questionnaire, and 5-dimensional EuroQoL visual analog scale scores were significantly lower (p < 0.0001), and Work Productivity and Activity Impairment scores significantly higher (p < 0.0001), in patients with high levels of pain or fatigue than low levels.

Conclusions
Globally, levels of pain and fatigue remained high in AS patients receiving TNFi treatment, which were significantly associated with reduced HRQoL and work productivity. Such persistent symptoms in usual care suggest a substantial unmet need in AS pharmacologic and nonpharmacologic therapeutic pathways.
Ultradelayed Arterial Thrombosis
Authors: Smith Jesse R. , Teven Chad M. , Choudry Umar , Gottlieb Lawrence J. 
Published: August 2020

Background and Objectives
Delayed arterial thrombus causing loss of a cutaneous free flap at or beyond 6 months is a rare phenomenon. The purpose of this report is to describe 2 cases of arterial compromise requiring medical and surgical intervention at or beyond 6 months after radial forearm free flap (RFFF) phalloplasty and to define the phenomenon of ultradelayed arterial thrombosis.

Methods
Patient 1 is a 44-year-old transmale who presented with pulselessness, pallor, and hypersensitivity of his neophallus 10 years status post-RFFF phalloplasty using a saphenous vein interposition graft (SVIG) between the superficial femoral artery (SFA) and radial artery (RA). Patient 2 is a 35-year-old transmale who presented with similar complaints 6 months status post-RFFF phalloplasty with the same vascular connections as above.

Results
Patient 1 was found to have an arterial thrombus distal to the SFA-SVIG anastomosis requiring catheter-directed thrombolysis with tissue plasminogen activator, resulting in partial loss limited to the distal three fourths of the shaft. Patient 2 was also found to have an arterial thrombus distal to the SFA-SVIG anastomosis requiring catheter-directed thrombolysis with tissue plasminogen activator and common femoral artery CFA-RA bypass, resulting in partial loss limited to the neoglans.

Conclusions
Ultradelayed arterial thrombosis is a rare phenomenon requiring urgent intervention. The exact causes of this phenomenon, whether mechanical or physiological or both, have yet to be fully elucidated but it is hypothesized that the original anastomosis may continue to serve as the critical blood supply to its flap as far as 10 years after surgery.
Perforator-Based Pedicled Cross-Leg Flaps in Pediatric Patients
Authors: Abdelmegeed Ahmed Gaber , Abulezz Tarek Abdelhameed , Abo-Saeda Mohamed Abdel-al , Allam Karam Ahmed 
Published: August 2020

Background
Distal lower limb reconstruction is one of the most difficult and challenging tasks in plastic surgery. Despite the continuous advances in microsurgical techniques, pedicled cross-leg flaps still have a major role particularly in pediatric patients. Many techniques have been described to maximize the potential of the cross-leg flaps. The introduction of fasciocutaneous flaps has provided more potentials and made lower leg reconstruction easier and more successful. The description of perforator system in the leg has also made a revolution in the regional reconstruction. In this report, we present a new modification that increases the reach and facilitates the inset of the flaps.

Methods
The flap is taken from the posteromedial skin of the middle third of the leg. The design is determined by the location, size, and shape of the defect. The base of the flap should contain at least 2 perforators located by Doppler device. After elevation of the fasciocutaneous flap, 2 back cuts are performed in the upper and lower edge of the flap base preserving the 2 previously located perforators.

Results
Fifty patients, 32 males and 18 females, were reviewed and presented. Age of the patients ranged from 4 to 13 years and the defect size ranged from 20 to 130 cm. All flaps survived with 3 flaps had mild marginal ischemia, 2 flaps had mild infection, and 1 flap had partial dehiscence.

Conclusions
Back cuts made at the edges of the base of a cross-leg flap, preserving the feeding perforators, can increase the flap reach without jeopardizing its viability. It is also an easy to do technique and does not require any extra equipment or time.
ISAPS International Aesthetic Facial Plastic Surgery Fellowship in Rotterdam
Authors: Sanchez Balado Adrian 
Published: August 2020

Abstract
Facial plastic surgery and esthetic surgery are among the most challenging parts of the residency training. As a former fellow at Velthuis Kliniek Rotterdam with Dr. Van Der Meulen and Dr. Stevens, the author hereby present his unique 3-month experience offering actively participation in surgeries and consultation, academical education and research, and personal development for junior plastic surgeons who want to aspire to make facial and esthetic surgery their area of expertise.
Clinical Course of 195 Critically Ill COVID-19 Patients: A Retrospective Multicenter Study
Authors: Zhou Shuliang , Yang Yadong , Zhang Xingguo , Li Zhifeng , Liu Xing , Hu Chang , Chen Chunxi , Wang Dawei , Peng Zhiyong 
Published: August 2020

ABSTRACT

Introduction:
Coronavirus disease-2019 (COVID-19) outbreak has spread around the world. However, the dynamic course of critically ill COVID-19 has not been described thoroughly.

Patients and Methods:
We retrospectively analyzed 195 critically ill COVID-19 patients in Hubei province, China, between January 5, 2020 and April 3, 2020. Epidemiologic data, clinical features, treatments, and outcomes were collected and analyzed.

Results:
Most critically ill patients were older with higher Acute Physiology and Chronic Health Evaluation II scores. After critical illness onset, a total of 181 (92.8%) patients received ventilation support, of which 84 (43.1%) received noninvasive and 97 (49.7%) received invasive mechanic ventilation (IMV). Among the 97 patients with IMV, 28 (28.9%) received prone ventilation, 57 (58.8%) received neuromuscular blocked therapy, and 22 (11.3%) received tracheostomy due to prolonged ventilator use. Early hypoxemia, subsequent hypercapnia, pulmonary hypertension, and finally pulmonary fibrosis were notable in the clinical course of acute respiratory distress syndrome (ARDS). Eighty-nine (45.6%) patients presented with shock. Acute kidney injury (29.7%) and secondary infection (28.2%) were also notable. The overall mortality of critically ill patients at day 28 was 42.1%. Intensive care unit (ICU) mortality was around 33%, as 16 patients died prior to ICU admission. A low PaO2/FiO2 ratio was an independent risk factor for death. High viral load was observed in most non-survivors.

Conclusion:
ARDS and shock were notable in the critical illness of COVID-19. Ventilation support and hemodynamic support were the cornerstones for critical care. High viral load was associated with death of critically ill COVID-19 patients.
End-Tidal Carbon Dioxide Impacts Brain and Kidney Injury in Experimental Extracorporeal Cardiopulmonary Resuscitation (ECPR)
Authors: Ölander Carl-Henrik , Vikholm Per , Schiller Petter , Hellgren Laila 
Published: August 2020

ABSTRACT

Purpose:
Extracorporeal membrane oxygenation-assisted cardiopulmonary resuscitation (ECPR) is proposed for cardiac resuscitation in selected cases. End-tidal carbon dioxide (ETCO2) is easily obtained during conventional cardiopulmonary resuscitation (CPR). We hypothesized that the level of ETCO2 during CPR would reflect the degree of brain and kidney damage following ECPR in experimental refractory cardiac arrest.

Methods:
Ventricular fibrillation was induced in 10 pigs, followed by mechanical CPR for 45 min and thereafter ECPR for 180 min. Blood- and urine-samples, physiologic parameters, and histopathology of brain and kidney were analyzed. Animals were divided into Group High (GHigh) and Group Low (GLow) according to value of ETCO2 (10 mm Hg) at the end of CPR.

Results:
Carotid blood pressure and blood flow declined over time in both groups during CPR but was higher in GHigh. Coefficient of determination for ETCO2 and carotid blood flow was substantial (r2 = 0.62). The oxygen delivery index was higher for GHigh 444 (396–485) L/min/m2 as compared with GLow
at 343 (327–384) L/min/m2 (P = 0.02) at the end of ECPR. Also, P-S100B were lower in GHigh, (P < 0.05) and GLow demonstrated worse histopathological injury in central parts of the brain (P < 0.01). During ECPR, urinary output was higher in GHigh (P < 0.05). Kidney injury marker Plasma Neutrophil Gelatinae-associated Lipocalin increased in both groups during ECPR but was more pronounced in GLow (P = 0.03). Renal histopathology revealed no difference between groups.

Conclusions:
ETCO2 at the end of mechanical CPR is inversely associated with extent of brainstem and renal injury following ECPR.
Initial Report From a Swedish High-volume Transplant Center After the First Wave of the COVID-19 Pandemic
Authors: Felldin Marie , Søfteland John Mackay , Magnusson Jesper , Ekberg Jana , Karason Kristjan , Schult Andreas , Larsson Hillevi , Oltean Mihai , Friman Vanda 
Published: August 2020

Background.
Solid organ transplant (SOT) recipients may be more vulnerable to coronavirus disease 2019 (COVID-19). Data on the clinical course of COVID-19 in immunosuppressed patients are limited, and the optimal management strategy for these patients is yet unclear.

Methods.
We present 53 SOT recipients (31 kidney transplant recipients, 8 liver transplant recipients, 5 heart transplant recipients, 5 lung transplant recipients, 3 liver-kidney transplant recipients, and 1 kidney-after-heart transplant recipient), transplanted at a Swedish high-volume transplant center and each diagnosed with COVID-19 between February 21, 2020 and June 22, 2020. Demographic, clinical, and treatment data were extracted from the electronic patient files.

Results.
Patients reported fever (61%), cough (43%), diarrhea (31%), and upper respiratory symptoms (29%). The median age was 56 years, and 57% were male. According to severity, 55% had mild, 13% had moderate, 19% had severe, and 13% had critical disease. Thirty-seven patients (70%) were hospitalized, with 8 requiring intensive care. Thirteen of the 37 patients were initially managed as outpatients but later hospitalized. One patient received hydroxychloroquine, and no patients received antivirals. Antimetabolites and calcineurin inhibitors were held or reduced in two-thirds. Twenty-seven of 37 hospitalized patients (73%) received low-molecular-weight heparin. Five (13.5%) hospitalized patients died. Overall survival for the entire cohort was 90.5%. No rejection episodes were noted.

Conclusions.
Hospitalization, lowering of immunosuppression, and prophylactic anticoagulation were the most common therapeutic interventions for SOT recipients with COVID-19. A significant proportion of patients could be managed on an outpatient basis, while keeping a low threshold for admission. Mild and moderate disease forms seem to have a good outcome.
Total Charge Required to Induce a Seizure in a Retrospective Cohort of Patients Undergoing Dose Titration of Right Unilateral Ultrabrief Pulse Electroconvulsive Therapy
Authors: Luccarelli James , McCoy Thomas H. , Seiner Stephen J. , Henry Michael E. 
Published: August 2020

Objectives
The use of ultrabrief pulse (UBP) stimuli and individual seizure threshold determination have been proposed as ways of minimizing the cognitive side effects of electroconvulsive therapy (ECT), but large samples of patients receiving UBP ECT are lacking. This study reports a retrospective cohort of patients receiving an index course of right unilateral UBP ECT and characterizes the amount of charge required to induce a seizure.

Methods
A single-center retrospective chart review was conducted of adult patients receiving a first lifetime course of ECT using an UBP titration from 2005 to 2017.

Results
There were 2328 patients that received a dose titration during the study period, with a mean dose of 21.82 ± 21.61 mC applied to induce a seizure. During the early part of the study period, a mean dose of 18.73 ± 8.99 mC was used, with 28% of patients seizing at a dose of less than 19.2 mC. In the later period, the initial step of dose titration was standardized at 19.2 mC, yielding a mean initial dose to induce a seizure of 22.72 ± 24.00 mC.

Conclusions
Mean seizure thresholds may be lower than reported in previous studies, and a significant proportion of patients may have a seizure threshold lower than the first step of many existing dose titration protocols.
Real-time spatial health surveillance: mapping the UK COVID-19 epidemic
Authors: Fry Richard , Hollinghurst Joe , R Stagg Helen , A Thompson Daniel , Fronterre Claudio , Orton Chris , A Lyons Ronan , V Ford David , Sheikh Aziz , J Diggle Peter 
Published: August 2020

AbstractThe COVID-19 pandemic has highlighted the need for robust data linkage systems and methods for identifying outbreaks of disease in near real-time. Using self-reported app data and the Secure Anonymised Information Linkage (SAIL) Databank, we demonstrate the use of sophisticated spatial modelling for near-real-time prediction of COVID-19 prevalence at small-area resolution to inform strategic government policy areas. A pre-requisite to an effective control strategy is that predictions need to be accompanied by estimates of their precision, to guard against over-reaction to potentially spurious features of ‘best guess’ predictions. In the UK, important emerging risk-factors such as social deprivation or ethnicity vary over small distances, hence risk needs to be modelled at fine spatial resolution to avoid aggregation bias. We demonstrate that existing geospatial statistical methods originally developed for global health applications are well-suited to this task and can be used in an anonymised databank environment, thus preserving the privacy of the individuals who contribute their data.
On COVID-19-safety ranking of seats in intercontinental commercial aircrafts: A preliminary multiphysics computational perspective
Authors: Desai Prathamesh S. , Sawant Nihar , Keene Andrew 
Published: August 2020

AbstractThe evolution of coronavirus disease (COVID-19) into a pandemic has severely hampered the usage of public transit systems. In a post-COVID-19 world, we may see an increased reliance on autonomous cars and personal rapid transit (PRT) systems, with inherent physical distancing, over buses, trains and aircraft for intracity, intercity, and interstate travel. However, air travel would continue to be the dominant mode of intercontinental transportation for humans. In this study, we perform a comprehensive computational analysis of typical intercontinental aircraft ventilation systems to determine the seat where environmental factors are most conducive to human comfort with regards to air quality, protection from orally or nasally released pollutants such as CO2 and coronavirus, and thermal comfort levels. Air velocity, temperature, and air pollutant concentration emitted from the nose/mouth of fellow travelers are considered for both Boeing and Airbus planes. In each plane, first class, business class, and economy class sections were analyzed. We present conclusions as to which is the optimum seat in each section of each plane and provide the data of the environmental conditions to support our inferences. The findings may be used by the general public to decide which seat to occupy for their next intercontinental flight. Alternatively, the commercial airliners can use such a model to plan the occupancy of the aircraft on long-duration intercontinental flights (viz., Airbus A380 and Boeing B747).
The Mental Health of Healthcare Staff during the COVID-19 Pandemic: It Depends on How Much They Work and Their Age
Authors: Xu Xingzi , Zhang Stephen X. , Jahanshahi Asghar Afshar , Li Jizhen , Bagheri Afsaneh , Nawaser Khaled 
Published: August 2020

ABSTRACTBackgroundHealthcare staff are the forefront of fight against COVID-19 and they are under enormous pressure due to the fast growth in the number and severity of infected cases. This creates their mental issues such as distress, depression and anxiety. Exploring healthcare staff’s mental health during the pandemic contributes to improving their persistence in the growing challenges created by COVID-19 and enabling effective management of their mental health.MethodsAn online survey of 280 healthcare staff in all the 31 provinces of Iran was conducted during April 5–20, 2020. The survey assessed staff’s distress, depression and anxiety in the COVID-19 pandemic.ResultsNearly a third of healthcare staff suffered from distress, depression and anxiety. Females and more educated healthcare staff were more likely to experience distress. Compared to personnel who did not have COVID-19, those who were unsure whether they had COVID-19 were more likely to experience distress and depression. The number of COVID-19 cases among the staff’s colleagues or friends positively predicted their anxiety. Compared to radio technologists, doctors were less likely to experience distress and anxiety. Technicians and obstetrics experienced less anxiety. Analysis the interaction between weekly working days and age of the staff indicated the chance of experiencing distress and depression varied greatly by working days among younger but not older healthcare staff.ConclusionThe predictors of mental health issues assists healthcare organizations to identify healthcare staff with mental health issues in sever crises such as the COVID-19 pandemic. Our research highlight the need to identify more working characteristics as predictors for healthcare staff at different ages.FundingThis work was supported by Tsinghua University-INDITEX Sustainable Development Fund (No. TISD201904).
Cancer in HIV-positive and HIV-negative adolescents and young adults in South Africa: a cross-sectional study
Authors: Dhokotera Tafadzwa , Bohlius Julia , Egger Matthias , Spoerri Adrian , Ncayiyana Jabulani , Naidu Gita , Olago Victor , Zwahlen Marcel , Singh Elvira , Muchengeti Mazvita 
Published: August 2020

AbstractObjectiveTo determine the spectrum of cancers in AYAs living with HIV in South Africa compared to their HIV negative peers.DesignCross sectional study with cancer data provided by the National Cancer Registry and HIV data from the National Health Laboratory Service.Setting and participantsThe NHLS is the largest provider of pathology services in the South African public sector with an estimated coverage of 80%. The NCR is a division of the NHLS. We included AYAs (aged 10-24 years) diagnosed with cancer by public health sector laboratories between 2004 and 2014 (n=8 479). We included 3 672 in the complete case analysis.Primary and secondary outcomesWe used linked NCR and NHLS data to determine the spectrum of cancers by HIV status in AYAs. We also used multivariable logistic regression to describe the association of cancer in AYAs with HIV, adjusting for age, sex (as appropriate), ethnicity, and calendar period. Due to the large proportion of unknown HIV status we also imputed (post-hoc) the missing HIV status.ResultsFrom 2004-2014, 8 479 AYAs were diagnosed with cancer, HIV status was known for only 45% (n=3812); of those whose status was known, about half were HIV positive (n=1853). AYAs living with HIV were more likely to have Kaposi’s sarcoma (adjusted odds ratio (aOR) 218, 95% CI 89.9-530), cervical cancer (aOR 2.18, 95% CI 1.23-3.89), non-Hodgkin’s lymphoma (aOR 2.12, 95% CI 1.69-2.66), and anogenital cancers other than cervix (aOR 2.73, 95% CI 1.27-5.86). About 44% (n=1 062) of AYAs with HIV related cancers had not been tested for HIV, though they were very likely to have the disease.ConclusionsCancer burden in AYAs living with HIV in South Africa could be reduced by screening young women for cervical cancer and vaccinating them against human papilloma virus (HPV) infection.Strength and limitationsThis is the first nationwide study in South Africa to compare the distribution of cancers in adolescents and young adults (AYAs) by HIV status.The record linkage and the additional results determined from the text mining process ensured that we extracted the maximum available HIV results.We assumed a CD4 count test indicates being HIV positive but CD4 testing maybe performed for other reasonsSince this was a population of only AYAs diagnosed with cancer, the odds ratios could be overestimated or underestimated depending on the frequency of the cancer
A Human-Immune-System (HIS) humanized mouse model (DRAGA: HLA-A2. HLA-DR4. Rag1 KO.IL-2Rγc KO. NOD) for COVID-19
Authors: Brumeanu Teodor-D. , Vir Pooja , Karim Ahmad Faisal , Kar Swagata , Benetiene Dalia , Lok Megan , Greenhouse Jack , Putmon-Taylor Tammy , Kitajewski Christopher , Chung Kevin K. , Pratt Kathleen P. , Casares Sofia A. 
Published: August 2020

AbstractWe report the first Human Immune System (HIS)-humanized mouse model (“DRAGA”: HLA-A2.HLA-DR4.Rag1KO.IL-2RγcKO.NOD) for COVID-19 research. This mouse is reconstituted with human cord blood-derived, HLA-matched hematopoietic stem cells. It engrafts human epi/endothelial cells expressing the human ACE2 receptor for SARS-CoV-2 and TMPRSS2 serine protease co-localized on lung epithelia. HIS-DRAGA mice sustained SARS-CoV-2 infection, showing deteriorated clinical condition, replicating virus in the lungs, and human-like lung immunopathology including T-cell infiltrates, microthrombi and pulmonary sequelae. Among T-cell infiltrates, lung-resident (CD103+) CD8+T cells were sequestered in epithelial (CD326+) lung niches and secreted granzyme B and perforin, indicating cytotoxic potential. Infected mice also developed antibodies against the SARS-CoV-2 viral proteins. Hence, HIS-DRAGA mice showed unique advantages as a surrogatein vivohuman model for studying SARS-CoV-2 immunopathology and for testing the safety and efficacy of candidate vaccines and therapeutics.