bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hemoglobin structure at higher levels of hemoglobin A1C in type 2 diabetes and associated complications
Authors: Andleeb Farah , Hafeezullah  , Atiq Atia , Atiq Maria 
Published: April 2020

Abstract

Background:
Fourier transform infrared (FTIR) spectroscopy technique has not been used as a diagnostic tool for diabetes in clinical practice. This study was linked to structural changes in hemoglobin (Hb) in type 2 diabetes patients at higher levels of HbA1C using FTIR spectroscopy.

Methods:
Fifty-three diabetic patients from the Bahawal Victoria Hospital, Bahawalpur, Pakistan were categorized as group A (6% < HbA1C < 7%; n = 25) and group B (HbA1C ≥9%; n = 28). Another group (group N) of twenty blood samples was taken from healthy people from the Islamia University Bahawalpur, Pakistan. Data from all groups were collected from January 1, 2018 to March 31, 2019. The structure of Hb was studied by FTIR spectroscopy and impact of glucose on the fine structure of HbA1C was estimated.

Results:
Hb secondary structure erythrocyte parameters were altered by changing glucose concentrations. From FTIR spectra of all three groups it was found that Hb structure was slightly altered in group A, but significantly changed in group B (P < 0.05). There was an increase in β-sheet structure and a reduction in α-helix structure at elevated levels of HbA1C (group B) in type 2 diabetes.

Conclusion:
We suggest that higher level of glycation reflected by increased HbA1C might be a contributing factor to structural changes in Hb in type 2 diabetic patients. FTIR spectroscopy can be a novel technique to find pathogenesis in type 2 diabetes.
EARLY AND LATE MACULAR CHANGES AFTER THE INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR A FULL-THICKNESS MACULAR HOLE
Authors: Tsui Mei-Chi , Yang Chung-May 
Published: April 2020

Purpose:
To describe the anatomic evolution of full-thickness macular hole closure after the inverted internal limiting membrane (ILM) flap technique.

Methods:
A retrospective review of 39 eyes (38 patients) with a full-thickness macular hole treated with the inverted ILM flap technique was performed. Ophthalmic examinations and imaging were performed preoperatively and postoperatively.

Results:
Macular changes in the early postoperative period included flap closure (15.4%), U-shaped closure (17.9%), V-shaped closure (33.3%), W-shaped closure (28.2%), gap closure (2.6%), and gap open (2.6%). Flap closure was associated with low myopia and shorter axial length (P < 0.05). Two types of flap closure were observed. Type 1 was characterized by gap opening with an ILM cap, followed by a thickened ILM band drawing the edges of the macular hole closer with subsequent external limiting membrane formation; Type 2 was characterized by gap closure with an ILM cap, followed by gliotic proliferation filling the gap. Flap closure configuration disappeared within 4 months postoperatively. At the last follow-up, foveal contours were U-shaped closure (25.6%), V-shaped closure (35.9%), W-shaped closure (35.9%), and gap open (2.6%).

Conclusion:
Two types of flap closure were observed in the early postoperative period. Several patterns of the foveal contour were observed in the late period. The presence of the ILM flap predicts eventual hole closure. These findings require confirmation and further elucidation of their possible clinical significance.
Inhibiting MLL1-WDR5 interaction ameliorates neuropathic allodynia by attenuating histone H3 lysine 4 trimethylation-dependent spinal mGluR5 transcription
Authors: Lin Tzer-Bin , Lai Cheng-Yuan , Hsieh Ming-Chun , Ho Yu-Cheng , Wang Hsueh-Hsiao , Yang Po-Sheng , Cheng Jen-Kun , Chen Gin-Den , Ng Soo-Cheen , Peng Hsien-Yu 
Published: April 2020

Abstract
Mixed lineage leukemia 1 (MLL1)-mediated histone H3 lysine 4 trimethylation (H3K4me3) of a subset of genes has been linked to the transcriptional activation critical for synaptic plasticity, but its potential contribution to neuropathic allodynia development remains poorly explored. Here, we show that MLL1, which is induced in dorsal horn neuron after spinal nerve ligation (SNL), is responsible for mechanical allodynia and increased H3K4me3 at metabotropic glutamate receptor subtype 5 (mGluR5) promoter. Moreover, SNL induced WD (Trp-Asp) repeat domain 5 subunit (WDR5) expression as well as the MLL1-WDR5 interaction accompany with H3K4me3 enrichment and transcription of mGluR5 gene in the dorsal horn in neuropathic allodynia progression. Conversely, WDR5-0103, a novel inhibitor of the MLL1-WDR5 interaction, reversed SNL-induced allodynia and inhibited SNL-enhanced mGluR5 transcription/expression as well as MLL1, WDR5, and H3K4me3 at the mGluR5 promoter in the dorsal horn. Furthermore, disrupting the expression of MLL1 or WDR5 using small interfering RNA attenuated mechanical allodynia and reversed protein transcription/expression and complex localizing at mGluR5 promoter in the dorsal horn induced by SNL. This finding revealed that MLL1-WDR5 complex integrity regulates MLL1 and WDR5 recruitment to H3K4me3 enrichment at mGluR5 promoter in the dorsal horn underlying neuropathic allodynia. Collectively, our findings indicated that SNL enhances the MLL1-WDR5 complex, which facilitates MLL1 and WDR5 recruitment to H3K4me3 enrichment at mGluR5 promoter in spinal plasticity contributing to neuropathic allodynia pathogenesis.
The Graphical Index of Pain: a new web-based method for high-throughput screening of pain
Authors: Steingrímsdóttir Ólöf Anna , Engdahl Bo , Hansson Per , Stubhaug Audun , Nielsen Christopher Sivert 
Published: April 2020

Abstract
This article is the first to present the Graphical Index of Pain (GRIP), a new user-friendly web-based method for high-throughput screening of pain. The long-term goal of the method is to improve global standardization of pain measurements. GRIP consists of a hierarchical body map with 10 first-tier body regions, and a second tier with multiple pain loci (167 among men, 168 among women), which provides detailed information about pain location and distribution. Follow-up questions for first-tier regions include the following pain characteristics: onset, episode frequency, episode duration (including constant pain), intensity, bothering, depth of pain, and effects on sleep and daily activities. The first implementation of GRIP was in the Tromsø Study (2015-2016), a population-based study of adults aged 40 to 99 years. In total, 21,083 individuals participated in the study, and 96% (n = 20,263; age 40-96 years) completed GRIP. Pain intensity at first-tier regions and pain location and distribution at second-tier regions are in this article presented by sex-stratified customized heat maps showing large sex difference. Mean time to mark the first- and second-tier regions was 74 seconds. In conclusion, GRIP allows for high-resolution assessment and presentation of pain location and distribution with minimal use of time.
Pediatric Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review*
Authors: Esangbedo Ivie D. , Brunetti Marissa A. , Campbell Frank M. , Lasa Javier J. 
Published: April 2020

Objectives:
This systematic review aims to summarize the body of available literature on pediatric extracorporeal cardiopulmonary resuscitation in order to delineate current utilization, practices, and outcomes, while highlighting gaps in current knowledge.

Data Sources:
PubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov databases.

Study Selection:
We searched for peer-reviewed original research publications on pediatric extracorporeal cardiopulmonary resuscitation (patients < 18 yr old) and were inclusive of all publication years.

Data Extraction:
Our systematic review used the structured Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. Our initial literature search was performed on February 11, 2019, with an updated search performed on August 28, 2019. Three physician reviewers independently assessed the retrieved studies to determine inclusion in the systematic review synthesis. Using selected search terms, a total of 4,095 publications were retrieved, of which 96 were included in the final synthesis. Risk of bias in included studies was assessed using the Risk of Bias in Non-Randomized Studies of Interventions-I tool.

Data Synthesis:
There were no randomized controlled trials of extracorporeal cardiopulmonary resuscitation use in pediatrics. A vast majority of pediatric extracorporeal cardiopulmonary resuscitation publications were single-center retrospective studies reporting outcomes after in-hospital cardiac arrest. Most pediatric extracorporeal cardiopulmonary resuscitation use in published literature is in cardiac patients. Survival to hospital discharge after extracorporeal cardiopulmonary resuscitation for pediatric in-hospital cardiac arrest ranged from 8% to 80% in included studies, and there was an association with improved outcomes in cardiac patients. Thirty-one studies reported neurologic outcomes after extracorporeal cardiopulmonary resuscitation, of which only six were prospective follow-up studies. We summarize the available literature on: determination of candidacy, timing of activation of extracorporeal cardiopulmonary resuscitation, staffing/logistics, cannulation strategies, outcomes, and the use of simulation for training.

Conclusions:
This review highlights gaps in our understanding of best practices for pediatric extracorporeal cardiopulmonary resuscitation. We summarize current studies available and provide a framework for the development of future studies.
Three-Dimensionally–Printed Hand Surgical Simulator for Resident Training
Authors: Farrell Daniel A. , Miller Travis J. , Chambers Justin R. , Joseph Vinitha A. , McClellan W. Thomas 
Published: April 2020

Summary:
Reduced work hours and funding have fueled an increase in simulation-based training for plastic and orthopedic surgery residency programs. Unfortunately, certain simulation training can fail to enhance surgical skills because of availability, cost, or low fidelity. There is a growing interest among training programs for a cost-effective surgical simulator to improve basic skills and muscle memory of residents. The authors developed a three-dimensionally–printed, malleable, and anatomically accurate hand surgery simulator from a computed tomographic scan of an adult male subject. The bone matrix was specifically designed to provide proprioceptive feedback to hone drilling skills used in fracture repair and arthrodesis. The silicone soft-tissue covering provides excellent malleability to dissect and perform fracture-reducing maneuvers. Three-dimensional printing of “fracture bridges” allows the design of on-demand polyfracture models so the trainee can practice multiple types and locations of repairs as skills progress. To summarize, the authors’ hand simulator is an anatomical, low-cost, multiprocedure tool that can be used to improve the muscle memory and basic surgery skills of residents in training.
The Value of Ultrasonography in Assessing Fetal Lung Maturity
Authors: Tang Yan , Jin Xiao-dan , Xu Lin , Deng Ying , Chang Zhe , Li Qing , Peng Xiang-Lian 
Published: April 2020

Objective
To establish the normal parameters of fetal lung development at different gestational ages and to study their correlation with gestational age, thereby providing clinicians with a noninvasive method for assessing fetal lung maturity.

Methods
Two hundred eight cases with pregnancy of 22 to 39 weeks plus 6 days were divided into 18 groups according to gestational age. Ultrasound Doppler was used to measure the relevant parameters of fetal pulmonary development, including right pulmonary left and right diameter, right pulmonary upper and lower diameter, right pulmonary anterior and posterior diameter, right pulmonary area, thoracic area, inner diameter of fetal main pulmonary artery, and Doppler velocity curve parameters of main pulmonary artery: systolic acceleration time (AT), ejection time (ET), AT/ET.

Results
This study establishes normal parameters of lung development at different gestational weeks, draws scatter plots, correlation, and regression analysis of fetal main pulmonary artery AT, ET, AT/ET, and gestational weeks; selects the optimal equation; and analyzes the correlation among right pulmonary left and right diameter, right pulmonary upper and lower diameter, right pulmonary anterior and posterior diameter, right lung diameter, right lung area, thoracic area, and gestational weeks; and draw growth curve. The diameter of main pulmonary artery, AT, and AT/ET increased with the increase of gestational age and were positively correlated with gestational age (r = 0.948, 0.875, 0.810; P = 0.012). Ejection time had no correlation with gestational weeks. There were significant differences in the diameter of main pulmonary artery, AT, AT/ET between different gestational weeks (F = 240.67, 41.137, 23.067; P = 0.024); left and right diameter of right lung, anterior and posterior diameter of right lung, upper and lower diameter of right lung, chest area and right lung area were positively correlated with gestational weeks, and there were significant differences between different gestational weeks (F = 190.85, 105.74, 34.97, 172.33, 35.33, P = 0.018).

Conclusions
Ultrasound Doppler can be used as a noninvasive detecting equipment to evaluate the growth of fetal lung, thus providing a basis for the evaluation of fetal lung maturity.
Guns, scalpels, and sutures: The cost of gunshot wounds in children and adolescents
Authors: Phillips Ryan , Shahi Niti , Bensard Denis , Meier Maxene , Shirek Gabrielle , Goldsmith Adam , Recicar John , Haasz Maya , Schroeppel Thomas , Moulton Steven 
Published: April 2020

BACKGROUND
Firearm injuries are the second leading cause of death among US children. While injury prevention has been shown to be effective for blunt mechanisms of injury, the rising incidence of accidental gunshot wounds, school shootings, and interpersonal gun violence suggests otherwise for firearm-related injuries. The purpose of the study is to describe the incidence, injury severity, and institutional costs of pediatric gun-related injuries in Colorado.

METHODS
Pediatric patients (≤18 years), who sustained firearm injuries between 2008 and 2018, were identified from the trauma registries of three pediatric trauma centers in Colorado. Patients were stratified based on age: those younger than 14 years were defined as children and those 15 years to 18 years as adolescents.

RESULTS
Our cohort (n = 308) was predominantly male (87%), with a median age of 14 years. The overall mortality rate was 11% (34/308), with significantly fewer children (5%) dying from their injuries when compared with adolescents (14%; p = 0.04). Sixty-five (21%) patients required blood product transfusions, with 23 (7.4%) patients receiving a massive transfusion. Overall, 52% (161/308) required a major operation, with 15% undergoing an exploratory laparotomy. One third (4/13) of the patients who had a thoracotomy in the emergency department survived to hospital discharge. Overall, 14.0% of patients had psychiatric follow-up at both 30 days and 1 year. The readmission rate for complications was 11.6% at 30 days and 14% at 1 year. The total cost of care for all pediatric firearm-related injuries was approximately US $26 million.

CONCLUSION
The survivors of pediatric firearm injuries experience high operative and readmission rates, sustain long-term morbidities, and suffer from mental health sequelae. Combining these factors with the economic impact of these injuries highlights the immense burden of disease. This burden may be palliated by a multipronged approach, which includes the development and dissemination of injury prevention strategies and better follow-up care for these patients.

LEVEL OF EVIDENCE
Epidemiological, Level III.
A Retrospective Analysis for Risk Factors and Early Prognosis of Delayed Withdrawal Extracorporeal Membrane Oxygenation After Lung Transplantation
Authors: Minqiang Liu , Xiaoshan Li , Bo Xu , Guilong Wang , Zhengfeng Gu , Dong Wei , Jingyu Chen , Qiang Wu , Chunxiao Hu 
Published: April 2020

Background.
Extracorporeal membrane oxygenation (ECMO) is widely used for cardiopulmonary assistance during lung transplantation (LTx). However, the optimal timing for ECMO removal remains controversial. This study aimed to evaluate the risk factors and early prognosis of delayed withdrawal ECMO after LTx.

Methods.
Two hundred sixty-seven patients who underwent LTx supported by ECMO were included in this study. Based on whether or not ECMO was completely stopped in the operating room, patients were divided into early ECMO withdrawal group (group E, 107 cases) and delayed withdrawal group (group D, 160 cases). Perioperative data of the donors and recipients, including the suspected risk factors for delayed removal of ECMO, postoperative complications, and hospital survival rate, were retrospectively analyzed.

Results.
Preoperative New York Heart Association cardiac function for recipients and mechanical ventilation time for donors were independent risk factors for delayed weaning of ECMO in veno-arterial ECMO patients. Compared with group E, the odds of postoperative pulmonary infection, primary graft dysfunction, renal dysfunction, blood transfusion volume, and mechanical ventilation time were significantly higher in group D (all P < 0.05). Delayed withdrawal ECMO was decisive factor for early postoperative death, as the risk of early postoperative death in group D was 1.99 (95% confidence interval, 1.13-3.54) times as that in the group E.

Conclusions.
During the period of LTx, New York Heart Association grade III/IV for recipients and mechanical ventilation time ≥5 days for donors are suggestive of delayed veno-arterial ECMO removal, and clinicians should minimize the postoperative bypass time of ECMO when conditions permit.
Displacement ventilation: a viable ventilation strategy for makeshift hospitals and public buildings to contain Covid-19 and other airborne diseases
Authors: Bhagat Rajesh K. , Linden P. F. 
Published: April 2020

AbstractThe SARS-CoV-2 virus has so far infected more than 2.4 million people around the world, and its impact is being felt by all. Patients with airborne diseases such as Covid-19 should ideally be treated in negative pressure isolation rooms. However, due to the overwhelming demand for hospital beds, patients are being treated in general wards, hospital corridors, and makeshift hospitals. Adequate building ventilation in hospitals and public spaces is a crucial factor to contain the disease1,2, to exit the current lockdown situation, and reduce the chance of subsequent waves of outbreaks. Lu et al. 3 reported an air-conditioner induced Covid-19 outbreak, by an asymptomatic patient, in a restaurant in Guangzhou, China, which exposes our vulnerability to future outbreaks linked to ventilation in public spaces. We demonstrate that displacement ventilation (either mechanical or natural ventilation), where air intakes are at low level and extracts are at high level, is a viable alternative to negative pressure isolation rooms, which are often not available on site in hospital wards and makeshift hospitals. Displacement ventilation produces negative pressure at the occupant level, which draws fresh air from outdoor, and positive pressure near the ceiling, which expels the hot and contaminated air out. We acknowledge that, in both developed and developing countries, many modern large structures lack the openings required for natural ventilation. This lack of openings can be supplemented by installing extract fans. We provide guidelines for such mechanically assisted-naturally ventilated makeshift hospitals, and public spaces such as supermarkets and essential public buildings.
Development and testing of a game-based digital intervention for working memory training in autism spectrum disorder
Authors: Wagle Surbhit , Ghosh Arka , Karthic P , Ghosh Akriti , Pervaiz Tarana , Kapoor Rashmi , Patil Koumudi , Gupta Nitin 
Published: April 2020

AbstractAutism spectrum disorder (ASD) is prevalent globally, yet it lacks cost-effective treatment approaches. Deficits in executive functions occur frequently in autism spectrum disorder and present a target for intervention. Here we report the design and development of five smartphone-based games for training working memory in autistic children. These open-source games, available free of cost to the community, were designed to match the behavioral preferences and sensorimotor abilities of autistic kids. We then conducted a preliminary trial to test the effectiveness of a month-long intervention using these games. Although we did not see a significant change in the working memory of all children with a month-long training, children who performed better on the games also showed more improvement in their working memory, suggesting that a longer intervention with the games might be useful in improving working memory. Using a Hindi translation of the Autism Treatment Evaluation Checklist (ATEC), we also tested the far transfer of the training in reducing autistic symptoms. We found no significant change in the autistic symptoms after the intervention. Further, there was no correlation between the change in the working memory and the change in the autistic symptoms.
Comparison of SARS-CoV-2 Exit Strategies Building Blocks
Authors: Barkan Elad , Shilo Smadar , Talmor-Barkan Yeela 
Published: April 2020

AbstractWe consider and compare various exit strategy building blocks and key measures to mitigate the current SARS-CoV-2 pandemic, some already proposed as well as improvements we suggest. Our comparison is based on a computerized simulation integrating accumulated SARS-CoV-2 epidemiological knowledge. Our results stress the importance of immediate on-symptom isolation of suspected cases and household members, and the beneficial effects of prompt testing capacity. Our findings expose significant epidemic-suppression differences among strategies with seemingly similar economic cost stressing the importance of not just the portion of population and business that is released, but also the pattern. The most effective building blocks are the ones that integrate several base strategies - they allow to release large portions of the population while still achieving diminishing viral spread. However, it may come with a price on somewhat more complex schemes. For example, our simulations indicate that a personal isolation of 4 days once every two weeks, for example a long weekend (Fri-Mon) self-isolation once every two weeks, while protecting the 5% most sensitive population would reduce R well below 1 even if ten percent of the population do not follow it. This kind of integrated strategy can be either voluntary or mandatory and enforced. We further simulate the contrasting approach of a stratified population release in a hope to achieve herd immunity, which for the time being seems inferior to other suggested building blocks. Knowing the tradeoff between building blocks could help optimize exit strategies to be more effective and suitable for a particular area or country, while maximizing human life as well as economic value. Given our results, we believe that pandemic can be controlled within a reasonable amount of time and at a reasonable socio-economic burden.