bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of tea root-derived proanthocyanidin fractions on protection of dentin collagen
Authors: Yang Honglin , Xie Bingqing , Wang Yue , Cui Yayun , Yang Hui , Wang Xiaoting , Yang Xi , Bao Guan-Hu 
Published: December 2019

Objectives Proanthocyanidins (PAs) have been widely used as effective agents for dentin collagen cross-linking to enhance the biomechanics and biostability of dentin in vitro. However, the effects and protective mechanisms of various tea root-derived PA components on dentin remain undefined. This study evaluated the effects of these tea root-derived PA components on dentin biomechanics and biostability. Methods In this study, ethyl acetate and n-butyl alcohol were used to extract PAs with different degrees of polymerization from tea roots; the effects of these PA extracts on dentin were evaluated. Results Dentin was treated with glutaraldehyde, ethyl acetate, n-butyl alcohol, or water. PAs with a high degree of polymerization, extracted using n-butyl alcohol, were able to more effectively improve dentin collagen cross-linking, increase resistance to bacterial collagenase digestion, and enhance dentin elasticity, relative to treatment with glutaraldehyde or PAs with a low degree of polymerization (extracted using ethyl acetate). Additionally, treatment with aqueous extract of tea roots was detrimental to dentin stability and function. Conclusions PAs with a high degree of polymerization were effective for dentin protection and restoration in vitro, suggesting clinical treatment potential for tea root-derived PAs.
Posterior Medial Meniscus Root Tears Potentiate the Effect of Increased Tibial Slope on Anterior Cruciate Ligament Graft Forces
Authors: Samuelsen Brian T. , Aman Zachary S. , Kennedy Mitchell Iung , Dornan Grant J. , Storaci Hunter W. , Brady Alex W. , Turnbull Travis Lee , LaPrade Robert F. 
Published: December 2019

Background: Increased posterior tibial slope and posterior medial meniscus root tears increase the force experienced by the anterior cruciate ligament (ACL) and predispose patients to higher rates of primary ACL injury or ACL graft failure after an ACL reconstruction (ACLR). However, the interplay among sagittal plane tibial slope, medial meniscus root tears, and ACLR graft force remains inadequately defined. Purpose/Hypothesis: The purpose was to quantify the effect of sagittal plane tibial slope on ACLR graft force at varying knee flexion angles with an intact medial meniscus, a posterior medial meniscus root tear, and a medial meniscus root repair. Our null hypothesis was that changes in slope and meniscal state would have no effect on the forces experienced by the ACLR graft. Study Design: Controlled laboratory study. Methods: Ten male fresh-frozen cadaveric human knees underwent a posteriorly based high tibial osteotomy. A spanning external fixator and wedges of varying sizes were used to stabilize the osteotomy and allow for accurate slope adjustment. After ACLR, specimens were compressed with a 1000-N axial load at flexion angles of 0° and 30° for each of the 3 meniscal states and at tibial slopes of 0° to 15° at 3° increments. Graft loads were recorded through a force transducer clamped to the graft. Results: Increasing tibial slope led to a linear increase in ACLR graft force at 0° and 30° of knee flexion. Posterior medial meniscus root tear led to significant increases in ACLR graft forces over the intact state, while root repair restored the function of the medial meniscus as a secondary stabilizer. At 30° of knee flexion, the tibial slope effect on ACLR graft force was potentiated in the root tear state as compared with the intact and root repair states—test of interaction effect: t(139) = 2.67 ( P = .009). Conclusion: Increases in tibial slope lead to a linear increase in ACLR graft forces, and this effect is magnified in the setting of a posterior medial meniscus root tear. At slopes >12°, a slope-changing osteotomy could be considered in the setting of a revision ACLR with a concomitant medial meniscus root tear. Clinical Relevance: Defining the relationship between tibial slope and varying states of meniscal insufficiency can help determine when it may be necessary to perform a slope-decreasing proximal tibial osteotomy before ACLR and meniscal repair.
Emergence of Alveolar Consolidations in Serial Lung Ultrasound and Diagnosis of Ventilator-Associated Pneumonia
Authors: Staub Leonardo Jönck , Biscaro Roberta Rodolfo Mazzali , Maurici Rosemeri 
Published: December 2019

Background: Lung ultrasound (LUS) has been reported as a promising diagnostic tool for ventilator-associated pneumonia (VAP), but patients with previous lung parenchyma commitment have been not studied. Purpose: To evaluate whether the emergence of sonographic consolidations, rather than their presence, can improve the VAP diagnosis in a sample including patients with previous lung parenchyma diseases. Methods: Patients who completed 48 hours of mechanical ventilation were prospectively studied with daily LUS examinations. We checked the emergence of different consolidation types on the eve and on the day of a clinical suspicion of VAP. We elaborated an algorithm considering, sequentially, the emergence of (1) subpleural consolidations in anterior lung regions on the eve of suspicion; (2) lobar/sublobar consolidation in anterior lung regions on the day of suspicion; (3) lobar/sublobar consolidation with dynamic air bronchograms on the day of suspicion; and (4) any other lobar/sublobar consolidation on the day of suspicion in association with a positive Gram smear of endotracheal aspirate. Results: Of the 188 included patients, 60 were suspected and 33 confirmed VAP. The presence of sonographic consolidations at the clinical suspicion had no diagnostic value for VAP. The emergence of subpleural consolidations in anterior lung regions on the eve of suspicion had specificity of 95% (95% confidence interval [CI], 79%-99%). The emergence of lobar/sublobar consolidations in anterior lung regions on the day of suspicion had specificity of 100% (95% CI, 87%-100%). The emergence of lobar/sublobar consolidations with dynamic air bronchograms on the day of suspicion had specificity of 96% (95% CI, 81%-99%). Finally, the proposed algorithm had sensitivity of 63% (95% CI, 46%-77%) and specificity of 85% (95% CI, 67%-94%) for VAP. Conclusions: The presence of sonographic consolidations was not accurate for VAP when patients with previous lung parenchyma commitment were included. However, serial LUS examinations detected the emergence of specific signs of VAP.
Effects of Road Infrastructure on Employment, Productivity and Growth: An Empirical Analysis at Country Level
Authors: Laborda Leopoldo , Sotelsek Daniel 
Published: December 2019

This article estimates the effect of transport infrastructure at country level, on employment, productivity (total factor productivity (TFP), and their components technical efficiency–pure and the scale—and technological change) and economic growth, using a dynamic panel approach. We focus on two broad categories of transport infrastructure: (1) road density and (2) road paved. Using dynamic panel GMM system estimation, we find positive effects of road density and road paved on total factor productivity (TFP) in countries with middle low and low income (using parametric and non-parametric estimations). On the other hand, and taking into account the Deng’s hypothesis of a nonlinearity relationship between transport infrastructure and economic growth (Deng, 2013, Transport Reviews 33(6): 686–99), we found empirical evidence about a Kuznets curve when we consider the percentage of roads paved. In countries with middle low and low income, we also found a Kuznets curve between road density and unemployment. JEL Classification: H54, R42, O47, O4, C23
Impact of International Nosocomial Infection Control Consortium’s multidimensional approach on central line–associated bloodstream infection rates in Bahrain
Authors: Alkhawaja Safaa , Saeed Nermeen Kamal , Rosenthal Victor Daniel , Abdul-Aziz Sana , Alsayegh Ameena , Humood Zainab Mahdi , Ali Khadija Mohamed , Swar Saleh , Magray Tahira Anwar Saeed 
Published: December 2019

Background: Central line–associated bloodstream infections are serious life-threatening infections in the intensive care unit setting. Methods: To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and INICC Surveillance Online System (ISOS) on central line–associated bloodstream infection rates in Bahrain from January 2013 to December 2016, we conducted a prospective, before-after surveillance, cohort, observational study in one intensive care unit in Bahrain. During baseline, we performed outcome and process surveillance of central line–associated bloodstream infection on 2320 intensive care unit patients, applying Centers for Disease Control and Prevention’s National Healthcare Safety Network definitions. During intervention, we implemented IMA through ISOS, including (1) a bundle of infection prevention interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on central line–associated bloodstream infection rates and consequences, and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention on the central line–associated bloodstream infection rate. Results: During baseline, 672 central line days and 7 central line–associated bloodstream infections were recorded, accounting for 10.4 central line–associated bloodstream infections per 1000 central line days. During intervention, 13,020 central line days and 48 central line–associated bloodstream infections were recorded. After the second year, there was a sustained 89% cumulative central line–associated bloodstream infection rate reduction to 1.2 central line–associated bloodstream infections per 1000 central line days (incidence density rate, 0.11; 95% confidence interval 0.1–0.3; p, 0.001). The average extra length of stay of patients with central line–associated bloodstream infection was 23.3 days, and due to the reduction of central line–associated bloodstream infections, 367 days of hospitalization were saved, amounting to a reduction in hospitalization costs of US$1,100,553. Conclusion: Implementing IMA was associated with a significant reduction in the central line–associated bloodstream infection rate in Bahrain.
Pediatric Anterior Cruciate Ligament Reruptures Are Related to Lower Functional Scores at the Time of Return to Activity: A Prospective, Midterm Follow-up Study
Authors: Astur Diego Costa , Novaretti João Victor , Cavalcante Elton Luiz Borges , Goes Adilson , Kaleka Camila Cohen , Debieux Pedro , Krob Joseph J. , Freitas Eduardo Vasconcelos de , Cohen Moises 
Published: December 2019

Background: Skeletally immature patients show a higher rate of anterior cruciate ligament (ACL) reruptures. A better understanding of the risk factors for an ACL rerupture in this population is critical. Purpose/Hypothesis: The objective of this study was to analyze preoperative, intraoperative, and postoperative characteristics of pediatric patients undergoing ACL reconstruction and determine the relationship of these factors with an ACL rerupture. It was hypothesized that patients with worse activity scores and knee function at the time of return to activity would have a higher rate of ACL reruptures at midterm follow-up. Additionally, it was hypothesized that most ACL reruptures would occur before age 20 years in the study population. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 65 skeletally immature patients (age <16 years) with ACL ruptures underwent reconstruction with a quadruple hamstring tendon graft between 2002 and 2016. Of these patients, 52 were available for the study. Patient characteristics, surgical details, Tegner and Lysholm scores, and ACL reconstruction outcomes were recorded. Patients were analyzed and compared according to ACL rerupture occurrence. Results: Of the 52 patients, 18 (34.6%) experienced an ACL rerupture after reconstruction. The majority of reruptures (77.8%) occurred before age 20 years. There were 2 patients who sustained ACL reruptures during the rehabilitation period before they returned to activity. The majority of reruptures occurred after 12 months (83.2%), with 66.6% occurring after 24 months. Upon returning to activity between 6 and 9 months postoperatively, patients who ended up with intact ACL grafts reported 69% higher mean Tegner scores ( P = .006) and 64% higher mean Lysholm scores than patients who sustained ACL reruptures ( P < .001). Within the limits of this study, we could identify no statistical relationship between the rate of ACL reruptures and different sport types, surgical techniques, or associated injuries ( P > .05). Conclusion: Skeletally immature patients who underwent ACL reconstruction and sustained ACL reruptures had lower Tegner and Lysholm scores upon returning to activity than patients without ACL reruptures. In addition, most ACL reruptures occurred in patients younger than 20 years (77.8%) and after 24 months postoperatively (66.6%).
Drawing and Dialogue: Youth’s Experiences With the “Face” of Diabetes
Authors: Liesch Shari K , Elertson Kathleen M 
Published: December 2019

Objective: The purpose of this qualitative pilot study was to evaluate drawing, narration, color use, and meaning through discussion to increase insight surrounding youth’s lived experience with type 1 diabetes. Methods: This qualitative study reflects a convenience sample of 20 (female = 12, male = 8) youth aged 8 to 15 years with an established diagnosis of type 1 diabetes. During a nonclinic session, 3 drawings—self-portrait, face of diabetes, and future self-portrait—were created. Interviews were completed with an art therapist or clinic nurse practitioner using a standardized script. Results: All “face” of diabetes drawings depicted images separate from self. The most frequent color noted was gray, due to pencil use. No significant difference in disclosures or dialogue were observed between interviews conducted by the art therapist or nurse practitioner. Emerging themes noted: diabetes is unpredictable and stigmatizing, causes fears, and impacts daily life, yet discussions evidenced overall coping and resilience. Conclusions: Drawing during clinic visits enhances communication and understanding of youth’s lived experience. Findings offer clinical benefit when managing care and support for chronic health conditions.
Finding Dental Harm to Patients through Electronic Health Record–Based Triggers
Authors: Walji M.F. , Yansane A. , Hebballi N.B. , Ibarra-Noriega A.M. , Kookal K.K. , Tungare S. , Kent K. , McPharlin R. , Delattre V. , Obadan-Udoh E. , Tokede O. , White J. , Kalenderian E. 
Published: December 2019

Background: Patients may be inadvertently harmed while undergoing dental treatments. To improve care, we must first determine the types and frequency of harms that patients experience, but identifying cases of harm is not always straightforward for dental practices. Mining data from electronic health records is a promising means of efficiently detecting possible adverse events (AEs). Methods: We developed 7 electronic triggers (electronic health record based) to flag patient charts that contain distinct events common to AEs. These electronic charts were then manually reviewed to identify AEs. Results: Of the 1,885 charts reviewed, 16.2% contained an AE. The positive predictive value of the triggers ranged from a high of 0.23 for the 2 best-performing triggers (failed implants and postsurgical complications) to 0.09 for the lowest-performing triggers. The most common types of AEs found were pain (27.5%), hard tissue (14.8%), soft tissue (14.8%), and nerve injuries (13.3%). Most AEs were classified as temporary harm (89.2%). Permanent harm was present in 9.6% of the AEs, and 1.2% required transfer to an emergency room. Conclusion: By developing these triggers and a process to identify harm, we can now start measuring AEs, which is the first step to mitigating harm in the future. Knowledge Transfer Statement: A retrospective review of patients’ health records is a useful approach for systematically identifying and measuring harm. Rather than random chart reviews, electronic health record–based dental trigger tools are an effective approach for practices to identify patient harm. Measurement is one of the first steps in improving the safety and quality of care delivered.
IKZF1 deletions in pediatric acute lymphoblastic leukemia: still a poor prognostic marker?
Authors: Stanulla Martin , Cavé Hélène , Moorman Anthony V. 
Published: December 2019

AbstractImproved personalized adjustment of primary therapy to the perceived risk of relapse by using new prognostic markers for treatment stratification may be beneficial to patients with acute lymphoblastic leukemia (ALL). Here, we review the advances that have shed light on the role of IKZF1 aberration as prognostic factor in pediatric ALL and summarize emerging concepts in this field. Continued research on the interplay of disease biology with exposure and response to treatment will be key to further improve treatment strategies.
Laparoscopic lateral suspension: a single-site and single-surgeon experience
Authors: Mang Claudia , Huemer Hansjörg , Birkenmaier Ariane , Humburg Jörg 
Published: December 2019

Abstract
Background
In the reconstructive surgery for pelvic organ prolapse (POP), different newer mesh fixation techniques as an alternative to sacrocolpopexy has been developed. In order to gain more data about the different techniques, it is important to analyze success and recurrence rates of surgical procedures.

Methods
Collection and analysis of data from patients treated with laparoscopic lateral suspension (LLS). Patients were followed up for 6 weeks after surgery. Consultations were continued, if needed, up to 2.5 years. Main outcome measures were anatomic results, POP recurrence, mesh exposure and reoperation rate, and potential risk factors for relapse.

Results
Thirty-nine patients were treated between July 2015 and November 2017. In the first visit, one patient was diagnosed with an early relapse (success rate: 95%). Another six women relapsed during follow-up (mean, 13.5 months; success rate, 82%). Patients with recurrence were younger (62 vs. 68 years) and had initially a higher degree of prolapse, a higher parity (3.8 vs. 1.9), more previous surgeries, and longer operating times.
Early exposures were seen in 5.3% patients and raised up to 13% during follow-up; all but one were treated successful with local estrogen therapy. Risk factors for exposure were higher age and longer operating time.
The whole reoperation rate was 13%.

Conclusions
LLS might be a valid alternative to the laparoscopic sacrocolpopexy in women with prolapse in the anterior compartment and apical descent. Younger women with higher parity and higher degree of prolapse in the middle compartment had a higher recurrence rate after LLS.
Selection of microbial biomarkers with genetic algorithm and principal component analysis
Authors: Zhang Ping , West Nicholas P. , Chen Pin-Yen , Thang Mike W. C. , Price Gareth , Cripps Allan W. , Cox Amanda J. 
Published: December 2019

Abstract
Background
Principal components analysis (PCA) is often used to find characteristic patterns associated with certain diseases by reducing variable numbers before a predictive model is built, particularly when some variables are correlated. Usually, the first two or three components from PCA are used to determine whether individuals can be clustered into two classification groups based on pre-determined criteria: control and disease group. However, a combination of other components may exist which better distinguish diseased individuals from healthy controls. Genetic algorithms (GAs) can be useful and efficient for searching the best combination of variables to build a prediction model. This study aimed to develop a prediction model that combines PCA and a genetic algorithm (GA) for identifying sets of bacterial species associated with obesity and metabolic syndrome (Mets).

Results
The prediction models built using the combination of principal components (PCs) selected by GA were compared to the models built using the top PCs that explained the most variance in the sample and to models built with selected original variables. The advantages of combining PCA with GA were demonstrated.

Conclusions
The proposed algorithm overcomes the limitation of PCA for data analysis. It offers a new way to build prediction models that may improve the prediction accuracy. The variables included in the PCs that were selected by GA can be combined with flexibility for potential clinical applications. The algorithm can be useful for many biological studies where high dimensional data are collected with highly correlated variables.
Computational assembly of a human Cytomegalovirus vaccine upon experimental epitope legacy
Authors: Quinzo Monica J. , Lafuente Esther M. , Zuluaga Pilar , Flower Darren R. , Reche Pedro A. 
Published: December 2019

Abstract
Background
Human Cytomegalovirus (HCMV) is a ubiquitous herpesvirus affecting approximately 90% of the world population. HCMV causes disease in immunologically naive and immunosuppressed patients. The prevention, diagnosis and therapy of HCMV infection are thus crucial to public health. The availability of effective prophylactic and therapeutic treatments remain a significant challenge and no vaccine is currently available. Here, we sought to define an epitope-based vaccine against HCMV, eliciting B and T cell responses, from experimentally defined HCMV-specific epitopes.

Results
We selected 398 and 790 experimentally validated HCMV-specific B and T cell epitopes, respectively, from available epitope resources and apply a knowledge-based approach in combination with immunoinformatic predictions to ensemble a universal vaccine against HCMV. The T cell component consists of 6 CD8 and 6 CD4 T cell epitopes that are conserved among HCMV strains. All CD8 T cell epitopes were reported to induce cytotoxic activity, are derived from early expressed genes and are predicted to provide population protection coverage over 97%. The CD4 T cell epitopes are derived from HCMV structural proteins and provide a population protection coverage over 92%. The B cell component consists of just 3 B cell epitopes from the ectodomain of glycoproteins L and H that are highly flexible and exposed to the solvent.

Conclusions
We have defined a multiantigenic epitope vaccine ensemble against the HCMV that should elicit T and B cell responses in the entire population. Importantly, although we arrived to this epitope ensemble with the help of computational predictions, the actual epitopes are not predicted but are known to be immunogenic.