bluuebunny/crossref_metadata_2025_split huggingface dataset:
3D Printed Models Improve Surgical Planning for Correction of Severe Postburn Ankle Contracture With External Fixator
Authors: Chen Youbai , Niu Zehao , Jiang Weiqian , Lei Yonghong , Guo Lingli , Xia Wensen , Song Baoqiang , Huang Luyu , Zhang Qixu , Han Yan 
Published: September 2020

Abstract
Background: Gradual distraction with external fixators such as Ilizarov frame has been widely used for the treatment of severe postburn ankle contracture (PAC). However, the application of external fixator is complex and conventional surgical planning based on 2D imaging is compromised due to a lack of spatial geometry and tactile feedback. The purpose of this study was to evaluate the surgical planning with patient-specific 3D-printed models (3DPM) for the treatment of PAC with external fixators. Methods: A two-centered retrospective cohort study, composed of consecutive patients who underwent external fixation for the treatment of severe PAC, was implemented. Patients were divided into two cohorts (3DPM group vs. Control group) according to whether 3DPM was used for preoperative surgical planning. The primary outcome variable was operation duration. Other outcome variables included improvement in metatarsal-tibial angle (MTA), range of motion (ROM), American Orthopedic Foot and Ankle Society (AOFAS) scores, and complications. Results: Between January 2008 and June 2018, ten patients with an average age of 23.8±14.1 yeas were treated for PAC at two centers. 3DPM were used for surgical planning in 5 patients. 3DPM group had significantly shorter operation duration than the control group (2±0.3 hours vs. 3.2±0.3 hours, p=0.0001). The comparison of preoperative, after removal of external fixator, and follow-up MTA, ROM, and AOFAS between the 3DPM and control group showed no significant differences. A plantigrade foot was achieved and gait was substantially improved in all patients at the final follow-up. Pin-tract infections occurred in 2 patients (one in each group) during distraction and were treated with wound care and oral antibiotics. Conclusion: The results of this study show that surgical planning using patient-specific 3DPM significantly reduced the operation duration while providing similar improvements in MTA, ROM, and AOFAS scores compared to traditional surgical planning for the correction of severe PAC with external fixators.
Effect of a Low-fodmap Diet for the Management of Functional Abdominal Pain Disorders in Children: A Study Protocol for a Randomized Controlled Trial
Authors: Stróżyk Agata , Horvath Andrea , Muir Jane , Szajewska Hania 
Published: September 2020

Abstract
Background Evidence from studies in adults documents that fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) may be triggers of symptoms in individuals with functional abdominal pain disorders (FAPDs). However, in children, the evidence is very limited. We aim to assess the effects of a low-FODMAP diet compared with a regular diet for the management of children with FAPDs. Methods We will perform a randomized, quadruple-blinded, controlled trial. Seventy-four children aged 8 to 18 years with a FAPD (Irritable Bowel Syndrome or Functional Abdominal Pain-Not Otherwise Specified), diagnosed according to the Rome IV criteria, will be randomly allocated to receive either a low-FODMAP diet or a regular diet for 4 weeks. The primary outcome will be the percentage of the responders, defined as the participants who have at least 30% improvement in abdominal pain intensity on a Visual Analogue Scale (VAS) during the last week of the trial compared with baseline, that is at least equal to the Reliable Change Index (≥ 25 mm change on VAS). Other outcomes will include changes in stool consistency, abdominal pain frequency, total scores on the Gastrointestinal Symptom Rating Scale, KIDSCREEN-10 Index and World Health Organization Five Well-Being Index, child’s school attendance and parents’ work absenteeism, and BMI-for-age z-score. Compliance, tolerability of the low-FODMAP diet, and adverse events also will be evaluated. Each FAPD subtype will be assessed separately.DiscussionThere is a need for high-quality evidence regarding the dietary management of children with FAPDs. This randomized controlled trial (RCT) of rigorous methodological design will help to establish the effectiveness, if any, of a low-FODMAP diet for the management of FAPDs in the pediatric population. The findings of this RCT will assist with the development of guidelines and influence the direction of further research. Trial registration: NCT04528914
Effects of Intravenous Immunoglobulin on the Course of Severe COVID-19: Results From a Retrospective Data Analysis of a Patient Cohort in Turkey Treated With or Without Octagam®
Authors: Esen Figen , Özcan Perihan E. , Orhun Günseli , Polat Özlem , Anaklı İlkay , Alay Gülçin , Tuna Verda , Çeliksoy Emre , Kılıç Mehmet , Mercan Mutlu , Tukek Tufan 
Published: September 2020

Abstract
Background: There is some evidence from case reports and a few studies in China that critically ill COVID-19 patients may benefit from treatment with intravenous immunoglobulins (IVIG). We compared clinical outcomes and biomarkers in a Turkish cohort of patients with severe COVID-19 who were treated with the institution's standard of care (SOC), either alone or in combination with IVIG.Methods: Data from COVID-19 patients treated in two intensive care units at the University hospital of Istanbul was analyzed retrospectively. Patients received preliminary SOC according to the institution's treatment algorithm, to which Octagam 5% at 30 g/day for 5 days was added in one of the two wards. Both groups were compared regarding baseline characteristics, survival, and changes in inflammation markers (C-reactive protein=CRP, ferritin, procalcitonin, interleukin-6, D‑dimer, leukocytes). Imbalance in baseline APACHE II scores was addressed by propensity-score-matching; otherwise Kaplan-Meier and multiple logistic regression models were used.Results: Data from 93 patients was analyzed, 51 had received IVIG and 42 had not. About 75% of patients were male and both groups had comparable body mass index (BMI) and blood group distribution. IVIG-treated patients were younger (means 65 vs. 71 years) and had slightly lower baseline disease scores (APACHE II: 20.6 vs. 22.4; SOFA: 5.0 vs. 7.0). Overall survival (OS) was 61% in the IVIG and 38% in the control group. After controlling for imbalances at baseline, there was still a trend for better OS (OR: 2.2, 95%CI: 0.9-5.4, p=0.091) and a significantly longer median survival time with IVIG (68 vs. 18 days, p=0.014). IVIG significantly reduced CRP levels, but had no relevant effect on other inflammation markers.Conclusion: Adjunct treatment with IVIG might add to the COVID-19 armamentarium, but results need to be confirmed in a randomized, controlled trial.
Right Ventricular-Arterial Uncoupling Independently Predicts Survival in COVID-19 ARDS
Authors: D'Alto Michele , Marra Alberto , Severino Sergio , Salzano Andrea , Romeo Emanuele , De Rosa Rosanna C , Stagnaro Francesca , Pagnano Gianpiero , Verde Raffaele , Murino Patrizia , Farro Andrea , Ciccarelli Giovanni , Vargas Maria , Fiorentino Giuseppe , Servillo Giuseppe , Gentile Ivan , Corcione Antonio , Cittadini Antonio , Naeije Robert , Golino Paolo 
Published: September 2020

Abstract
Aim. To investigate the prevalence and prognostic impact of right heart failure and right ventricular-arterial uncoupling in Corona Virus Infectious Disease 2019 (COVID-19) complicated by an acute respiratory distress syndrome (ARDS).Methods. Ninety-four consecutive patients (mean age 64 yrs) admitted for acute respiratory failure on COVID-19 were enrolled. Coupling of right ventricular function to the pulmonary circulation was evaluated by a comprehensive trans-thoracic echocardiography with focus on the tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (PASP) ratio Results. The majority of patients needed ventilatory support, which was non-invasive in 22 and invasive in 37. There were 25 deaths, all in the invasively ventilated patients. Survivors were younger (62±13 vs 68±12 years, p=0.033), less often overweight or usual smokers, had lower NT-proBNP and interleukin-6, and higher arterial partial pressure of oxygen (PaO2)/fraction of inspired O2 (FIO2) ratio (270±104 vs 117±57 mmHg, p<0.001). In the non-survivors, PASP was increased (42±12 vs 30±7 mmHg, p<0.001), while TAPSE was decreased (19±4 vs 25±4 mm, p<0.001). Accordingly the TAPSE/PASP ratio was lower than in the survivors (0.51±0.22 vs 0.89±0.29 mm/mmHg, p<0.001). At univariate/multivariable analysis, the TAPSE/PASP (HR:0.026; 95%CI:0.01-0.579; p:0.019) and PaO2/FIO2 (HR:0.988; 95%CI:0.988-0.998; p:0.018) ratios were the only independent predictors of mortality, with ROC-determined cut-off values of 159 mmHg and 0.635 mm/mmHg respectively.Conclusions. COVID-19 ARDS is associated with clinically relevant uncoupling of right ventricular function from the pulmonary circulation; bedside echocardiography of TAPSE/PASP adds to the prognostic relevance of PaO2/FIO2 in ARDS on COVID-19.
Unexpected central-memory CD8+ T cell reduction hampers the antitumor efficacy of mogamulizumab (anti-CC chemokine receptor 4 mAb) treatment
Authors: Maeda Yuka , Wada Hisashi , Saito Takuro , Sugiyama Daisuke , Irie Takuma , Minoura Kodai , Suzuki Susumu , Kojima Takashi , Kakimi Kazuhiro , Nakajima Jun , Funakoshi Takeru , Iida Shinsuke , Oka Mikio , Shimamura Teppei , Doi Toshihiko , Doki Yuichiro , Nakayama Eiichi , Ueda Ryuzo , Nishikawa Hiroyoshi 
Published: September 2020

Abstract
Developing Treg cell-targeted therapies is an important aspect in cancer immunotherapy. Here, we investigate anti-CCR4 mAb (mogamulizumab) with solid cancer patients in phase 1b clinical trial based on the predominant detection of CCR4-expressing eTreg cells in tumors. While eTreg cells in peripheral blood were significantly decreased after mogamulizumab administration in all patients, clinical responses were hardly detected. Comprehensive immune-monitoring revealed that concomitant reduction of central-memory CD8+ T cells with CCR4 expression, that reportedly play an important role in antitumor activity. This reduction was subsided in long survivors in whom central-memory CD8+ T cells possessed lower CCR4 expression and/or NK cells exhibited an exhausted phenotype. Thus, excess doses of mogamulizumab harboring enhanced antibody-dependent cellular cytotoxicity could unexpectedly deplete central-memory CD8+ T cells with CCR4 expression. We therefore need to carefully determine the optimal dose of mogamulizumab for successful clinical application as cancer immunotherapy to avoid unexpected depletion of effector components.
Mesenchymal Stem Cells Regulate IL8 and TGFA Expression in a Novel Leucocytes Depleted Platelet-Rich Plasma-Skin Equivalent in a Preliminary in vitro Study of Chronic Wound Healing
Authors: Seria Elisa , Galea George , Grech Gabriella , Tagliaferro Sarah Samut , Felice Alexander 
Published: September 2020

Abstract
Background: Chronic leg ulcerations are associated with Haemoglobin disorders, Type 2 Diabetes Mellitus, and long-term venous insufficiency. Mesenchymal stem cells (MSCs) ability to modulate the inflammatory response represents the fundamental requisite for their applicability as a treatment of chronic wounds.Methods: This study aimed to develop a novel bioactive platelet-rich plasma (PRP)-leukocytes-depleted scaffold to reproduce typical clinical wound of patients with poor chronic skin perfusion and low leucocytes infiltration. After scratching the wound model to mimic injury three conditions were compared; an untreated condition, a condition treated with recombinant TNF to mimic an inflammatory state and a condition treated with TNF and also with MSCs to evaluate how the latter’s immunomodulatory properties affect the therapeutic outcomes in an inflammatory state. Gene expression of IL8 and TGFA were analysed in biological triplicates of the three conditions. Statistical analysis was done through a paired student t-test and a p <0.05 was considered significant.Results: We set up a skin model that consisted of a leukocyte-depleted, platelet-rich plasma scaffold, with embedded fibroblasts as dermal equivalent and seeded keratinocytes on it as multi-layered epidermidis. IL8 expression increased upon scratching (p=0.014) and continued to increase up to day 1 (p=0.048). IL8 expression decreased upon administration of TNF (p=0.005) but then increased again. IL8 expression decreased in the untreated condition after day 1 as the natural healing process took place and was lower than in treated conditions in day 8 (p=0.048). TGFA expression decreased upon scratching (p=0.006) and increased again in day 1, more so in the untreated than in the treated conditions (p=0.02). TGFA expression decreased again in day 4 in the study group before increasing sharply (p=0.027) in day 8 to reach pre-scratch levels. Conclusion: This study found that a leukocyte-depleted PRP-based skin equivalent can be useful in the study of treatments of chronic wounds. This study also indicates that MSCs appear to modulate the expression of IL8 by switching from an immunosuppressive phenotype to a pro-inflammatory phenotype. These results indicate that the administration of MSCs could offer a potential therapeutic approach for the treatment of leg ulcers in patients with poor skin perfusion.
Association of Serum Antibodies Against the Mycobacterium Avium Complex and Hemoptysis: A Cross-Sectional Study
Authors: Ogata Hiroaki , Moriwaki Atsushi , Nakagawa Taisuke , Sakoda Soichiro , Ishimatsu Akiko , Taguchi Kazuhito , Aso Hiroshi , Nogami Hiroko , Kadowaki Masako , Tateshi Yuko , Yoshida Makoto 
Published: September 2020

Abstract
Background: Hemoptysis is very common and can be life threatening in clinical practice for nontuberculous mycobacteria. The serum antibody against the Mycobacterium avium complex (MAC-Ab), the majority of nontuberculous mycobacteria species, is well known to reflect the activity of MAC lung disease; however, there is no study investigating the association between the MAC-Ab and hemoptysis in MAC patients. Therefore, we assessed whether the MAC-Ab is a good biomarker for hemoptysis among subjects with MAC lung disease. Methods: This study was conducted as a five-year retrospective survey at the National Hospital Organization Fukuoka National Hospital. A total of 155 patients aged ≥ 20 years with MAC lung disease were enrolled and separated into seropositive and seronegative groups using the cutoff for MAC-Ab levels of 0.7 U/ml. The prevalence of hemoptysis and odds ratios for the presence of hemoptysis were estimated and compared between the groups. Results: The prevalence of hemoptysis was twice as high in the seropositive group than in the seronegative group (42.2% and 21.7%, respectively, P = 0.02). The multivariable-adjusted risk of hemoptysis was elevated in the seropositive group as compared with the seronegative group (odds ratio = 2.79 (95% confidence interval 1.15–7.44)). Conclusions: A positive MAC-Ab level was a significant risk factor for hemoptysis among patients with MAC lung disease. MAC patients who tested positive for the MAC-Ab should be carefully followed up for the potential development of hemoptysis.
“This is My Boy’s Health! Talk Straight to Me!” Perspectives on Accessible and Culturally Safe Care Among Aboriginal and Torres Strait Islander Patients of Clinical Genetics Services
Authors: Dalach Philippa , Savarirayan Ravi , Baynam Gareth , McGaughran Julie , Kowal Emma , Massey Libby , Jenkins Misty , Paradies Yin , Kelaher Margaret 
Published: September 2020

Abstract
BackgroundAboriginal and Torres Strait Islander people do not enjoy equal access to specialist health services that adequately meet their needs. Clinical genetics services are at the vanguard of realising the health benefits of genomic medicine. As the field continues to expand in clinical utility and implementation it is critical that Aboriginal and Torres Strait Islander people are able to participate and benefit equally to avoid further widening of the existing health gap. This is the first study to explore barriers to accessing clinical genetics services among Aboriginal and Torres Strait Islander people, which has been acknowledged as a key strategic priority in Australian genomic health policy.MethodsA participatory design process engaged a majority-Aboriginal Project Reference Group and Aboriginal End-User Group. 63 semi-structured interviews were conducted with Aboriginal and/or Torres Strait Islander people who had accessed the government-funded clinical genetics service in Western Australia, Queensland or the Northern Territory between 2014-2018. The sample included patients, parents and carers. Participants were asked to recount their ‘patient journey’, from referral through to post-appointment and reflect on their perceptions of genetics and its implications for the health of themselves and their families. Analysis tracked chronological service engagement, followed by an inductive thematic approach. ResultsBarriers to access and engagement were present at each stage of the patient journey. These included challenges in obtaining a referral, long waiting periods, limited genetic literacy, absence of Aboriginal support services, communication challenges and lack of adequate psychosocial support and follow-up after attendance. Participants’ overall experiences of attending a genetic health service were varied, with positive perceptions tied closely to a diagnosis being achieved. The experience of (and expectation for) recognition of cultural identity and provision of culturally safe care was low among participants. Unaddressed concerns continued to cause significant distress in some people years after their appointment took place.ConclusionsThere is significant scope for improving the care provided to Aboriginal and Torres Strait Islander people at clinical genetics services. Immediate attention to minimising logistical barriers, developing relationships with Aboriginal Community Controlled Health Services and providing practical and specific cultural safety training for practitioners is required at the service-level. Our findings strongly support the development of guidelines or policies recognising the collective cultural needs of Aboriginal and Torres Strait Islander people in relation to genomic health care.
Pattern of Thyroid Cancer and Its Associated Factors Among Thyroid Patients Underwent Thyroidectomy at Jimma Medical Center, Southwest Ethiopia; A Four Years Retrospective Review
Authors: Mulatu Bilisuma , Michael Yadene , Alemu Seifu , Demissie Wondu Reta 
Published: September 2020

Abstract
Background: Thyroid cancer is the most common malignant disease of endocrine system and its incidence is rapidly increasing globally (about three to four times higher among females and accounts the sixth most common malignancy diagnosed in women). Among the four major types of thyroid cancer, papillary thyroid cancer (PTC) accounts 85-90% from all thyroid cases, followed by follicular thyroid cancer (FTC) which accounts for 5-10% of cases.Materials and Methods: A retrospective data of 260 patients who underwent thyroid surgery from 2015 to 2019 were included in the study and the status of the disease (clinical manifestations, laboratory/pathology findings (thyroid function tests (TFTs) and biopsy) were reviewed from patient cards. The pattern of thyroid cancer was discriminated based on histo-pathological biopsy result. Descriptive and analytical statistics were applied to express the finding and reported by tables, figures and narration. Cross tabulation and logistic regression was applied to determine the association between thyroid CA and predictors. A p-value of <0.05 was declared as statistically significant. Results: From the total sample of 260 patients underwent thyroid surgery, majority of them were females 219(84.2%), belong to age interval of 31-40 years (34.6%), dwellers of Oromia region (91.2%) and Jimma zone (83.8%). Colloid goiter was the most prevalent (74.6%) pattern of thyroid disease followed by follicular CA (4.2%), papillary CA (1.9%) and medullary CA (0.77%) while biopsy results of 48(18.46%) patients were not known. In general, about the 194(91.5%) of the thyroid lesion was identified as benign type and malignancy accounts for 18(8.5%) from the total conducted biopsy results of 212 patients. About six variables (duration of the disease, marital status, family history of the disease, nodularity, surface and border of the thyroid mass) were the candidate variables in binary logistic regression (p-value <0.25) and finally, three variables (duration of the disease (>10 years), surface (rough) and border (irregular) of the thyroid mass) were identified as the predictors of thyroid malignancy with AOR 0.05(0.004-0.60, P-v=0.016; 1.9(1.17-5.8), P-v=0.012 and 2.5(1.13-16.16), P-v<0.001 respectively.Conclusion and recommendation: The burden of malignancy was higher and alarming among thyroid diseases and warrants early screening and management.
Clinical Characteristics and Risk Factors of Disseminated Intravascular Coagulation in Patients with COVID-19
Authors: Jin Meng , Yue Xinying , Zhang Shanshan , Wang Yanan , Lu Zequn , Yao Zhi , Wang Jing , Xiao Jun , Li Qinglin , Liu Cai , Cui Hongyuan , Hu Ke , Wu Xiaofan , Tian Jianbo , Xiao Yi 
Published: September 2020

Abstract
Background: Coronavirus disease 2019 (COVID-19) has spread globally. However, the association between COVID-19 and disseminated intravascular coagulation (DIC) has been scarcely addressed. We aimed to systematically characterize the clinical features and examine risk factors for DIC development in COVID-19 patients.Methods: In this single-centered, retrospective, and observational study, all patients with DIC (N=59) and 270 patients without DIC were matched by propensity score matching based on age, sex, and comorbidities. Demographic data, symptoms, radiological, laboratory examinations, and clinical outcomes were compared between patients with and without DIC. Furthermore, univariable and multivariable logistic regression were used to explore the risk factors associated with DIC development in COVID-19 patients.Results: Higher proportion of patients with DIC and COVID-19 (54 of 59 [91·53%]) developed into death than non DIC patients (58 of 270 [21·48%]). Patients with DIC presented aggravated inflammation responses, liver damage, and especially coagulation dysfunction. Moreover, in addition to previously reported coagulation-related markers, such as FDP, D-dimer, and platelet, we also identified several novel risk factors associated with DIC development, including decreased fibrinogen (OR=0·476, 95%CI=0·380-0·596, P<0·0001) and ALB (0·901, 0·845- 0·961, P=0·0015), and elevated IL-6 (1·010, 1·005-1·015, P=0·00017) and TNF-α (1·053, 1·016-1·091, P=0·0045).Conclusions: Patients with DIC and COVID-19 were predisposed to poor clinical outcomes. These risk factors identified may be helpful for early surveillance of disease progression and making standardized treatment strategies.