bluuebunny/crossref_metadata_2025_split huggingface dataset:
Brief Report: Programmatic Scale-up of Tuberculosis Preventive Treatment Among People Living With HIV Through Targeted Technical Assistance to High-Volume Antiretroviral Treatment Sites—Nigeria, 2018–2019
Authors: Boyd Andrew T. , Odume Bethrand , Sidibe Kassim , Onotu Dennis , Ogbanufe Obinna , Mgbakor Ifunanya , Swaminathan Mahesh 
Published: August 2020

Background:
Tuberculosis preventive treatment (TPT) is a critical intervention to reduce tuberculosis mortality among people living with HIV (PLHIV). To facilitate scale-up of TPT among PLHIV, the Nigeria Ministry of Health and the US Centers for Disease Control and Prevention (CDC) Nigeria, supported by US President's Emergency Plan for AIDS Relief implementing partners, launched a TPT-focused technical assistance strategy in high-volume antiretroviral treatment (ART) sites during 2018.

Setting:
Nigeria has an estimated 1.9 million PLHIV, representing the second largest national burden of PLHIV in the world, and an estimated 53% of PLHIV are on ART.

Methods:
In 50 high-volume ART sites, we assessed readiness for TPT scale-up through use of a standardized tool across the following 5 areas: clinical training, community education, patient management, commodities and logistics management, and recording and reporting. We deployed a site-level continuous quality improvement strategy to facilitate TPT scale-up. Implementing partners rapidly disseminated best practices from these sites to across all CDC-supported sites and reported aggregate data on monthly TPT initiations.

Results:
Through this targeted assistance and rapid dissemination of best practices to all other sites, the number of PLHIV who initiated TPT across all CDC-supported sites increased from 6622 in May 2018, when the approach was implemented, to 48,661 in September 2018. Gains in monthly TPT initiations were sustained through March 2019.

Conclusions:
Use of a standardized tool for assessing readiness for TPT scale-up provided a “checklist” of potential barriers to TPT scale-up to address at each site. The quality improvement approach allowed each site to design a specific plan to achieve desired TPT scale-up, and best practices were implemented concurrently at other, smaller sites. The approach could assist scale-up of TPT among PLHIV in other countries.
Use of Fractional CO2 Laser in Cleft Lip Scars
Authors: Shadad Mohamed , Ali Wagdi M. , Fayyaz Ghulam Qadir , El-Shazly Mohamed 
Published: August 2020

Background
Whatever the technique of the surgical repair, the scar remains and it is the most common cause for parent's and patient's dissatisfaction. We aimed in this work to evaluate the efficacy of the fractional CO2 (FCO2) laser on the later appearance of cleft lip scars in general and to compare between the early and late use of this tool to know its ideal application time in particular. To our knowledge, there are no published reports about this objective with regard to the number of patients and the concerned designated study.

Patients and Methods
One hundred twenty patients complaining of cleft lip scar were divided into 3 groups. Group 1 started FCO2 application 3 weeks postoperatively, group 2 started it 3 months postoperatively, and group 3 applied local creams only as a control group. Fractional CO2 laser had been applied for 5 to 7 sessions. Vancouver scar scale was used for scar evaluation determining vascularity, pigmentation, pliability, and height. Visual analog scale was also used depending on 5 independent physicians and nonmedical personnel to rate results on a graded scale from 0 to 10. Moreover, the scar width had been assessed through studying the final images by Photoshop CS5 Extended Version, in 2 fixed points of the scar width.

Results
Patients showed a great degree of improvement in their lip scar after FCO2 laser sessions. Vancouver Scar Scale score had insignificant differences between studied groups at the baseline before applying either FCO2 or local cream, whereas after their applications, it was significantly lower in group 1 (1.92 ± 0.88) in comparison with group 2 (3.70 ± 1.11) and group 3 (4.05 ± 1.29). Regarding scar width assessment, it was significantly lower in group 1 (2.51 ± 0.64) in comparison with groups 2 (3.17 ± 0.54) and 3 (3.27 ± 0.48). The visual analog scale by the participating medical personnel indicated that the FCO2-induced improvement in the lip scar appearance in group 1 more than groups 2 and 3 with a mean score of 44.17 ± 3.45, 36.53 ± 4.43, and 30.40 ± 5.22, respectively. The same assessment by the participating nonmedical personnel was significantly higher in group 1 (43.52 ± 4.20) in comparison with group 2 (37.52 ± 4.73) and group 3 (33.55 ± 4.85).

Conclusions
We proved that using FCO2 is significantly better than using local creams in the postoperative management of cleft lip scars. More in depth, the early application of this tool is also significantly better than its delayed use.

Clinical Trials Registration Name: Assessment of Fractional CO2 Laser in Treatment of Post-surgical Scarring of Cleft Lip

URL:
https://clinicaltrials.gov/ct2/show/NCT03277287?cond=Assessment+of+Fractional+CO2+Laser+in+Treatment+of+Post-surgical+Scarring+of+Cleft+Lip&draw=2&rank=1

Clinical Trials ID: NCT03277287

Registration Date: June 9, 2017, retrospectively registered
Trauma-Hemorrhage Stimulates Immune Defense, Mitochondrial Dysfunction, Autophagy, and Apoptosis in Pig Liver at 72 h
Authors: Shi Yulong , Greven Johannes , Guo Weijun , Luo Peng , Xu Ding , Wang Weikang , Relja Borna , Vollrath Jan T. , Buhl Eva Miriam , Horst Klemens , Bolierakis Eftychios , Bläsius Felix , Hildebrand Frank 
Published: August 2020

ABSTRACT
Hepatic dysfunction frequently occurs after trauma-hemorrhage, resulting in severe pathophysiological responses that include leukocyte shifting and self-mediated mechanisms of cells, such as autophagy and apoptosis. This in vivo study aimed to characterize mitochondrial morphology, leukocyte reaction, and the processes of autophagy and apoptosis after polytrauma hemorrhage (TH) in a long-term, large animal model.
Liver tissue was taken from a porcine TH model (hemorrhagic shock, blunt chest trauma, tibia fracture, and liver laceration) with an intensive care unit follow-up of 72 h. The ultrastructural changes of the liver tissue after TH were evaluated by transmission electron microscopy. The leukocyte phenotypes and autophagy and apoptosis pathways were elucidated by immunohistofluorescence, Western blot, and terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL).
In addition to post-traumatic changes in the mitochondrial morphology, the biomarkers of anti-inflammatory macrophages (CD163) and reparative monocytes (CD11R3 and CD16) were upregulated, while the inducible nitric oxide synthase was downregulated after TH. Furthermore, the autophagy-related protein expressions of LC3 and Beclin-1 were upregulated, whereas the protein expression of P62 was downregulated after TH. Costaining showed that the macrophages were LC3 (or Beclin-1) positive and that CD163 was copositive and upregulated. Apoptosis biomarkers (cleaved-caspase-3/caspase-3 and Bcl-2) increased after TH, which is in line with TUNEL results.
In conclusion, the observed findings indicate that mitochondrial dysfunction might be one trigger of hepatic autophagy and apoptosis after TH. These processes occur together with the activation of anti-inflammatory leukocytes in liver tissue. Further studies are needed to elucidate the potential therapeutic effects of inhibiting mitochondrial swelling during autophagy or apoptosis.
Early Sequential Microcirculation Assessment In Shocked Patients as a Predictor of Outcome: A Prospective Observational Cohort Study
Authors: Holley Anthony D. , Dulhunty Joel , Udy Andrew , Midwinter Mark , Lukin Bill , Stuart Janine , Boots Robert , Lassig-Smith Melissa , Holley Robert B. , Paratz Jenny , Lipman Jeffrey 
Published: August 2020

ABSTRACT

Objectives:
A dysfunctional microcirculation is universal in shock and is often dissociated from global hemodynamic parameters. Persistent microcirculatory derangements reflect ongoing tissue hypoperfusion and organ injury. The initial microcirculatory dysfunction and subsequent resolution could potentially guide therapy and predict outcomes. We evaluated the microcirculation early in a heterogenous shocked population. Microcirculatory resolution was correlated with measures of tissue perfusion and global hemodynamics. The relationship between the microcirculation over 24 h and outcome were evaluated.

Design:
We prospectively recruited patients with all forms of shock, based on global hemodynamics and evidence of organ hypoperfusion.

Setting:
A 30-bed adult intensive care unit (ICU).

Patients:
Eighty-two shocked patients.

Measurements and Main Results:
Following the diagnosis of shock, patients underwent a sublingual microcirculation examination using Sidestream Dark Field Imaging. The median age of patients was 66 years old (interquartile range [IQR] 54–71), with an Acute Physiology and Chronic Health Evaluation II of 27 (IQR 20–32). Microcirculatory parameters included Percentage Perfused Vessels (PPV), De Backer Score, and a heterogeneity index in patients with septic shock, according to the second consensus guidelines Additional parameters collected: temperature, heart rate and arterial pressure, cumulative fluid balance, and vasopressor use. Arterial blood samples were taken at the time of microcirculatory assessments, providing HCO3, lactate concentrations, PaO2, and PaCO2 measurements. A statistically significant improvement in PPV and the heterogeneity index was demonstrated. This improvement was mirrored by biomarkers of perfusion; however, the global hemodynamic parameter changes were not significantly different over the 24-h period. The early microcirculatory improvement was not predictive of an improvement in acute kidney injury, length of stay, ICU, or hospital mortality.

Conclusions:
Early sequential evaluation of the microcirculation in shocked patients, demonstrated statistically significant improvement in the PPV and microvascular heterogeneity with standard care. These improvements were mirrored by biomarkers of organ perfusion; however, the changes in global hemodynamics were not as pronounced in this early phase. Early improvement in the microcirculation did not predict clinical outcome.
Thrombin Generation Kinetics are Predictive of Rapid Transfusion in Trauma Patients Meeting Critical Administration Threshold
Authors: MacArthur Taleen A. , Spears Grant M. , Kozar Rosemary A. , Dong Jing-fei , Auton Matthew , Jenkins Donald H. , Bailey Kent R. , Ashrani Aneel A. , Ferrara Mike J. , Immermann Joseph M. , Halling Timothy M. , Park Myung S. 
Published: August 2020

ABSTRACT

Introduction:
We hypothesize that a patient (pt) with accelerated thrombin generation, time to peak height (ttPeak), will have a greater odds of meeting critical administration threshold (CAT) criteria (> 3 packed red blood cell [pRBC] transfusions [Tx] per 60 min interval), within the first 24 h after injury, independent of international normalized ratio (INR).

Methods:
In a prospective cohort study, trauma patients were enrolled over a 4.5-year period and serial blood samples collected at various time points. We retrospectively stratified pts into three categories: CAT+, CAT− but receiving some pRBC Tx, receiving no Tx within the first 24 h. Blood collected prior to Tx was analyzed for thrombin generation parameters and prothrombin time (PT)/INR.

Results:
A total of 484 trauma pts were analyzed: injury severity score = 13 [7,22], age = 48 [28, 64] years, and 73% male. Fifty pts met criteria for CAT+, 64 pts CAT−, and 370 received no Tx. Risk factors for meeting CAT+: decreased arrival systolic blood pressure (OR 2.82 [2.17, 3.67]), increased INR (OR 2.09, [1.66, 2.62]) and decreased time to peak OR 2.27 [1.74, 2.95]). These variables remained independently associated with increased risk of requiring Tx in a multivariable logistic model, after adjusting for sex and trauma type.

Conclusions:
Pts in hemorrhagic shock, who meet CAT+ criteria, are characterized by accelerated thrombin generation. In our multivariable analysis, both ttPeak and PT/INR have a complementary role in predicting those injured patients who will require a high rate of Tx.
Resolved External Ophthalmoplegia and Hearing Loss in Wernicke's Encephalopathy With Thiamine Replacement
Authors: Nyce Maxwell Q. , Chisholm Joshua S. , Szmanda Julia A. , Boyce A. Katharina , Boczar Caroline M. , Kattah Jorge C. 
Published: August 2020

Background:
Wernicke encephalopathy (WE) is classically described by a clinical triad consisting of confusion, ataxia, and ophthalmoplegia, but recent reports emphasize a history of malnutrition along with 2 elements of the WE triad (Caine's criteria) to enhance diagnostic sensitivity. The ophthalmoplegia, vestibular, and auditory expeditious improvement with intravenous thiamine usually confirms the diagnosis; serum levels generally provide additional diagnostic certainty.

Methods:
Here, we discuss the case of a woman with a distant history of gastric sleeve, poor nutrition and protracted vomiting, who developed acute confusion, imbalance, near-total external ophthalmoplegia (EO), and hearing loss. The baseline thiamine level was 28 πmol/L (Normal: 70–180 πmol/L). We performed serial neurological, vestibular, and audiological examination to document over 5 days, the effect of intravenous (IV) thiamine, and again at 3 months with continued oral supplementation. We provide serial documentation with photographs and video recording of oculomotor abnormalities, audiometric testing, and a video of horizontal head impulse testing, and imaging findings.

Results:
Over the course of 5 days of IV thiamine supplementation, we demonstrate our patient's resolution of near complete EO. We assessed vestibular paresis with horizontal head impulse testing, after complete resolution of the EO. The initially positive bilateral h-HIT showed decreased gain and overt corrective saccades, it clinically resolved by day 5, but video h-HIT testing demonstrated persistent decreased horizontal vestibulo-ocular reflex (VOR) gain and covert horizontal saccades, which persisted at the 3-month examination. By contrast, the vertical VOR gain was normal without corrective saccades. Bedside audiometry completed during the acute phase demonstrated severely restricted auditory speech comprehension, which normalized 3 months later. Severe truncal ataxia improved as well.

Conclusions:
This case is an example of how awareness of the variations in the clinical presentation of WE can be crucial in achieving an early diagnosis and obtaining better outcomes. A history of the poor nutritional status can be an important clue to aid in this early diagnosis.
Comprehensive evaluation of cardiovascular efficacy and safety outcomes of SGLT2 inhibitors in high risk patients of cardiovascular disease: systematic review and meta-analysis
Authors: Bhattarai Mukul , Salih Mohsin , Regmi Manjari , Al-akchar Mohammad , Koester Cameron , Ibrahim Abdisamad , Parajuli Priyanka , Garcia Odalys Lara , Bhandari Bishal , Rehman Anis , Siddique Momin 
Published: August 2020

Objectives
To demonstrate a magnitude of the cardiovascular benefits, concomitantly analyzing the safety outcomes of sodium-glucose cotransporter 2 inhibitor (SGLT2-I) comprehensively, as a class effect in a larger sample size combined from recent randomized control trials.

Methods
We searched electronic databases using specific terms and evaluated 6 efficacy and 10 safety outcomes. Odds ratios (ORs) and 95% confidence interval (CI) were used to compare two interventions.

Results
Five studies (n = 41 267) were included, among which 23 539 received SGLT2-I. The SGLT2-I group favored reduction in major adverse cardiovascular events (OR, 0.78; 95% CI, 0.62–0.98; P = 0.03), cardiovascular death (CVD) or heart failure hospitalization (OR, 0.60; 95% CI, 0.46–0.80; P = 0.0004), rate of hospitalization for heart failure (OR, 0.56; 95% CI, 0.44–0.72; P < 0.00001), CVD (OR, 0.68; 95% CI, 0.50–0.93; P = 0.01), all-cause mortality (OR, 0.67; 95% CI, 0.48–0.93; P = 0.02) and myocardial infarction (OR, 0.79; 95% CI, 0.64–0.99; P = 0.04) when compared to the placebo group. Safety analysis showed higher diabetic ketoacidosis (DKA) rate in SGLT2-I group (OR, 2.33; 95% CI, 1.40–3.90; P = 0.001); in contrast, major hypoglycemic events were significantly lower (OR, 0.79; 95% CI, 0.73–0.87; P < 0.00001). AKI was significantly higher in the placebo group (OR, 0.76; 95% CI, 0.65–0.88; P = 0.0004). There were no statistically significant effects on other outcomes.

Conclusion
In selected high-risk patients of cardiovascular disease, the SGLT2-I is a potential effective class of drugs for improving cardiovascular outcomes and all-cause mortality without an increased risk of all other major complications except DKA on this meta-analysis.
ELISA detection of SARS-CoV-2 antibodies in saliva
Authors: MacMullan Melanie A. , Ibrayeva Albina , Trettner Kylie , Deming Laura , Das Sudipta , Tran Frances , Moreno Jose Ricardo , Casian Joseph G. , Chellamuthu Prithivi , Kraft Jeffrey , Kozak Kenneth , Turner Fred E. , Slepnev Vladimir I. , Le Page Lydia M. 
Published: August 2020

AbstractTo facilitate containment of the COVID-19 pandemic currently active in the United States and across the world, options for easy, non-invasive antibody testing are required. Here we have adapted a commercially available, serum-based ELISA for use with saliva samples, which will enable widespread, affordable testing for patients who experienced this disease.
Estimating Cumulative COVID-19 Infections by a Novel “Pandemic Rate Equation”
Authors: Hamilton David H. 
Published: August 2020

AbstractA fundamental problem dealing with the Covid-19 pandemic has been to estimate the rate of infection, since so many cases are asymptomatic and contagious just for a few weeks. For example, in the US, estimate the proportion P(t) = N/330 where N is the US total who have ever been infected (in millions)at time t (months, t = 0 being March 20). This is important for decisions on social restrictions, and allocation of medical resources, etc. However, the demand for extensive testing has not produced good estimates. In the US, the CDC has used the blood supply to sample for anti-bodies. Anti-bodies do not tell the whole picture, according to the Karolinska Instituet [2], many post infection cases show T-cell immunity, but no anti-bodies. We introduce a method based on a difference-differential equation (dde) for P(t). We emphasize that this is just for the present, with no prediction on how the pandemic will evolve. The dde uses only x = x (s), which is the number/million testing positive, and y = y (s), the number/million who have been tested for all time 0 ≤ s ≤ t (months), with no assumptions on the dynamics of the pandemic. However, we need two parameters. First, ρ, the ratio of asymptomatic to symptomatic infected cases. Second, τ, the period of active infection when the virus can be detected. Both are random variables with distribution which can be estimated. For fixed ρ, we prove uniform bounds

are best possible, with range depending on τ. One advantage of our theory is being able to estimate P for many regions and countries where x and y is the only information available.
Generalizability of Polygenic Risk Scores for Breast Cancer in the Multiethnic eMERGE Study
Authors: Liu Cong , Zeinomar Nur , Chung Wendy K. , Kiryluk Krzysztof , Ghravi Ali G. , Hripcsak George , Crew Katherine D. , Shang Ning , Khan Atlas , Fasel David , Manolio Teri A. , Jarvik Gail P. , Rowley Robb , Justice Ann E. , Rahm Alanna K. , Fullerton Stephanie M. , Smoller Jordan W. , Larson Eric B. , Crane Paul K. , Dikilitas Ozan , Terry Mary Beth , Weng Chunhua 
Published: August 2020

AbstractBackgroundThe majority of polygenic risk scores (PRS) for breast cancer have been developed and validated using cohorts of European ancestry (EA). Less is known about the generalizability of these PRS in other ancestral groups.MethodsThe Electronic Medical Records and Genomics (eMERGE) network cohort dataset was used to evaluate the performance of seven previously developed PRS (three EA-based PRSs, and four non-EA based PRSs) in three major ancestral groups. Each PRS was separately evaluated in EA (cases: 3939; controls: 28840), African ancestry (AA) (cases: 121; controls: 1173) and self-reported LatinX ancestry (LA) (cases: 92; controls: 1363) women. We assessed the association between breast cancer risk and each PRS, adjusting forage, study site, breast cancer family history, and first three ancestry informative principal components.ResultsEA-based PRSs were significantly associated with breast cancer risk in EA women per one SD increase (odds ratio [OR] = 1.45, 95% confidence interval [CI] = 1.40–1.51), and LA women (OR = 1.41, 95% CI = 1.13–1.77), but not AA women (OR = 1.13, 95% CI = 0.92–1.40). There was no statistically significant association for the non-EA PRSs in all ancestry groups, LA including an LA-based PRS and an AA-based PRS.ConclusionWe evaluated EA-derived PRS for estimating breast cancer risk using the eMERGE dataset and found they generalized well in LA women but not in AA women. For non-EA based PRSs, we did not replicate previously reported associations for the respective ancestries in the eMERGE cohort. Our results highlight the need to improve representation of diverse population groups, particularly AA women, in research cohorts.
A Deep Learning Model to Predict the Need for Mechanical Ventilation Using Chest X-Ray Images in Hospitalized COVID-19 Patients
Authors: Kulkarni Anoop , Athavale Ambarish M. , Sahni Ashima , Sukhal Shashvat , Sahni Abhimanyu , Itteera Mathew , Zhukovsky Sara , Vernik Jane , Abraham Mohan , Joshi Amit , Amarah Amatur , Ruiz Juan , Hart Peter D. , Kulkarni Hemant 
Published: August 2020

ABSTRACTPurposeEarly identification of a potentially deteriorating clinical course in hospitalized COVID-19 patients is critical since there exists a resource-demand gap for the ventilators.MaterialsWe aimed to develop and validate a deep learning-based approach to predict the need for mechanical ventilation as early as at the time of initial radiographic evaluation. We exploited the well-established DenseNet121 deep learning architecture for this purpose on 663 X-ray images derived from 528 hospitalized COVID-19 patients. Two Pulmonary and Critical Care experts blindly and independently evaluated the same X-ray images for purpose of validation.ResultsWe found that our deep learning model predicted the need for ventilation with a high accuracy, sensitivity and specificity (90.06%, 86.34% and 84.38%, respectively). This prediction was done approximately three days ahead of the actual intubation event. Our model also outperformed two Pulmonary and Critical Care experts who evaluated the same X-ray images and provided an incremental accuracy of 7.24–13.25%.ConclusionOur deep learning model accurately predicted the need for mechanical ventilation early during hospitalization of COVID-19 patients. Until effective preventive or treatment measures become widely available for COVID-19 patients, prognostic stratification as provided by our model is likely to be highly valuable.