bluuebunny/crossref_metadata_2025_split huggingface dataset:
In vitro activation of ovarian cortex and autologous transplantation: A novel approach to primary ovarian insufficiency and diminished ovarian reserve
Authors: Devenutto L , Quintana R , Quintana T 
Published: August 2020

Abstract

BACKGROUND
Primary ovarian insufficiency (POI) and diminished ovarian reserve are two conditions that affect women’s fertility. Oocyte donation remains an option for these patients; however, the development of certain novel technologies, such as in vitro activation of ovarian cortex (IVA), enables the possibility of activating the pool of resting primordial follicles, increasing the chance of pregnancy.

OBJECTIVE AND RATIONALE
Here, we review the main pathways (PI3K and Hippo signaling) that govern the activation of primordial follicles and its application through the development of culture systems that support ovarian cortex for autologous transplantation. We also review the available data from case reports regarding outcomes of pregnancy and live birth rates with IVA.

SEARCH METHODS
A PubMed search was conducted using the PubMed-NCBI database to identify literature pertinent to the pathways involved in the activation of primordial follicles and the outcomes of IVA techniques from 2013 to the present.

OUTCOMES
Women with POI have around a 5% chance of spontaneous pregnancy. Recently, novel techniques involving the activation of primordial follicles through molecular pathways have been developed, thus increasing the odds of these patients. More recently, the introduction of a drug-free IVA technique has shown to increase the number of antral follicles with successful oocyte maturation after gonadotropin treatment, reaching pregnancy rates over 30%, either through spontaneous conception or by the implementation of assisted reproductive technology.

LIMITATIONS
The evidence of this review is based on a few small series, so data should be interpreted with caution, and only randomized controlled trials could estimate the real magnitude and success of the procedure.

REASONS FOR CAUTION
IVA technique remains an experimental strategy, with limited available data and the requirement of invasive procedures. Moreover, possible carcinogenic effects not yet determined after transplantation require special caution.

WIDER IMPLICATIONS
In view of the results achieved, IVA could provide a promising option for the preservation of fertility in some cancer patients and prepuberal girls where the only alternative is tissue cryopreservation.

STUDY FUNDING/COMPETING INTERESTS
The authors received no specific funding for this work and declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Yield of Random Biopsies During Colonoscopies in Inflammatory Bowel Disease Patients Undergoing Dysplasia Surveillance
Authors: Hu Anne B , Burke Kristin E , Kochar Bharati , Ananthakrishnan Ashwin N 
Published: August 2020

Abstract

Background
The development of chromoendoscopy (CE) and high definition endoscopy (HDE) has improved detection of subtle colonic dysplasia in patients with inflammatory bowel diseases (IBDs). The role of random biopsies for dysplasia surveillance is unclear.

Methods
We reviewed patients with IBD who underwent a CE or HDE colonoscopy and had colonic dysplasia detected. Detection of dysplasia was classified as either visible or random and graded as low grade dysplasia (LGD), high grade dysplasia (HGD), or indefinite for dysplasia. Multivariable regression adjusted for relevant confounders examined the predictors of dysplasia detectable on random biopsies alone.

Results
The study included 300 patients (203 ulcerative colitis, 97 Crohn’s disease with colonic involvement) contributing 442 colonoscopies; the mean disease duration was 24.5 years; 7.2% had primary sclerosing cholangitis (PSC). Three hundred sixty-two colonoscopies (82%) had only visible dysplasia, 52 (12%) had only random dysplasia, and 28 (6%) had both visible and random dysplasia. Longer disease duration (odds ratio, 1.04; 95% CI, 1.01–1.07), active inflammation (odds ratio, 2.89; 95% CI, 1.26–6.67), and concomitant PSC (odds ratio, 3.66; 95% CI, 1.21–11.08) were associated with detecting dysplasia on random biopsies compared with visible lesions. Patients with random dysplasia (21%) or both random and visible dysplasia (21%) were more likely to undergo surgical resection compared with those with only visible dysplasia (5%; P &lt; 0.001) and have subsequent development of colorectal cancer (15%, 7%, 1%, respectively; P &lt; 0.0001).

Conclusion
Nearly one fifth of dysplasia detected in patients with IBD was found on random biopsies. Patients with high risk characteristics may benefit from continuing the practice of random biopsies during surveillance examinations.
Reductions of Some Two-Dimensional Crystalline Representations via Kisin Modules
Authors: Bergdall John , Levin Brandon 
Published: August 2020

AbstractWe determine rational Kisin modules associated with 2-dimensional, irreducible, crystalline representations of $\textrm{Gal}(\overline{{\mathbb{Q}}}_p/{\mathbb{Q}}_p)$ of Hodge–Tate weights $0, k-1$. If the slope is larger than $\lfloor \frac{k-1}{p} \rfloor $, we further identify an integral Kisin module, which we use to calculate the semisimple reduction of the Galois representation. In that range, we find that the reduction is constant, thereby improving on a theorem of Berger, Li, and Zhu.
Emergent Flexibility in Institutional Development: How International Rules Really Change
Authors: Búzás Zoltán I , Graham Erin R 
Published: August 2020

AbstractHow do formal international institutions change and adjust to new circumstances? The conventional wisdom in international relations, outlined by rational design, is that the answer lies in designed flexibility, which allows states to adjust agreements. Drawing on rich but disparate literatures across subfields of political science—especially constructivism and historical institutionalism—we propose an alternative, which we call “emergent flexibility.” Emergent flexibility is a property of international institutions that is not intentionally crafted by rule-makers when a rule is formally established, but is subsequently discovered, activated, and accessed by creative rule-users in ways unintended by designers. Rich case studies trace how rule-users have accessed emergent flexibility through the legal interpretive strategy of subsequent practice to change rigid rules of the UN Charter and the European Convention on Human Rights. A key implication of emergent flexibility is that, contrary to rational design expectations, international institutions designed to be rigid can adjust to unforeseen circumstances even in the absence of formal redesign, allowing cooperation to continue. The broadening of flexibility from designed to emergent reveals the politics of flexibility between formal design moments, provides a more nuanced notion of intentionality, and equips us to better address fundamental positive and normative questions of institutional development.
Toxicological Investigations in a Death Involving 2,5-Dimethoxy-4-Chloamphetamine (DOC) Performed on an Exhumed Body
Authors: Aknouche Frédéric , Ameline Alice , Kernalleguen Angeline , Arbouche Nadia , Maruejouls Christophe , Kintz Pascal 
Published: August 2020

Abstract
During a party in another country, several adults sniffed a powder presented as being lysergic acid diethylamide (LSD). The next morning, two subjects, including a French citizen, were found dead. After a body examination that concluded that the death was due to respiratory and cardiac collapses, the French citizen’s corpse was returned to France and buried. Four years later, the body was exhumed, and an autopsy that did not reveal traumatic injury was performed. During the autopsy, biological specimens were collected. A comprehensive toxicological screening, followed by confirmation using ultra high performance liquid chromatography tandem mass spectrometry (UHPLC-MS-MS) revealed the presence of 2,5-dimethoxy-4-chloamphetamine (DOC) in all specimens: liver (99 ng/g), spleen (28 ng/g), bone (14 ng/g), lung (15 ng/g) and pubic hair (32 pg/mg). No other drug, including pharmaceuticals and drugs of abuse were identified, but the circumstances of specimen collection can influence drug stability. Literature survey about DOC stability in biological material did not contribute in interpretation as there is no data dealing with storage for about 4 years before quantitative analysis. A stability study was performed at the laboratory. Blank blood was spiked with DOC at 1 mg/L, stored at + 4°C and −20°C and regularly tested over 6 months. The percentages of concentration remaining from the initial concentration of DOC stored for 6 months at + 4°C and −20°C were 53% and 59%, respectively. To characterize the metabolite(s) of DOC, the drug was incubated with a pool of human hepatic microsomes and the cofactors required to ensure the functioning of the main phase I enzymes. The incubation media were analyzed by liquid chromatography (LC) coupled to high-resolution mass spectrometry (MS), and the results showed hydroxy-DOC. However, the hydroxy-metabolite was not identified in the liver or spleen of the subject. Although the French pathologist considered that it was more likely than not a toxic death, it is difficult to attribute the death to DOC alone, as it was impossible to test for ethanol and other chemically instable drugs. This case presents original data, which can be useful to increase the knowledge in designer drug toxicity.
Crowdsourced Photographs as an Effective Method for Large-Scale Passive Tick Surveillance
Authors: Kopsco Heather L , Xu Guang , Luo Chu-Yuan , Rich Stephen M , Mather Thomas N 
Published: August 2020

Abstract
As tick vector ranges expand and the number of tickborne disease cases rise, physicians, veterinarians, and the public are faced with diagnostic, treatment, and prevention challenges. Traditional methods of active surveillance (e.g., flagging) can be time-consuming, spatially limited, and costly, while passive surveillance can broadly monitor tick distributions and infection rates. However, laboratory testing can require service fees in addition to mailing and processing time, which can put a tick-bite victim outside the window of potential prophylactic options or under unnecessary antibiotic administration. We performed a retrospective analysis of a national photograph-based crowdsourced tick surveillance system to determine the accuracy of identifying ticks by photograph when compared to those same ticks identified by microscopy and molecular methods at a tick testing laboratory. Ticks identified by photograph were correct to species with an overall accuracy of 96.7% (CI: 0.9522, 0.9781; P &lt; 0.001), while identification accuracy for Ixodes scapularis Say (Ixodida: Ixodidae), Amblyomma americanum Linnaeus (Ixodida: Ixodidae), and Dermacentor variabilis Say (Ixodida: Ixodidae), three ticks of medical importance, was 98.2% (Cohen’s kappa [κ] = 0.9575; 95% CI: 0.9698, 0.9897), 98.8% (κ = 0.9466, 95% CI: 0.9776, 0.9941), and 98.8% (κ = 0.9515, 95% CI: 0.9776, 0.9941), respectively. Fitted generalized linear models revealed that tick species and stage were the most significant predictive factors that contributed to correct photograph-based tick identifications. Neither engorgement, season, nor location of submission affected identification ability. These results provide strong support for the utility of photograph-based tick surveillance as a tool for risk assessment and monitoring among commonly encountered ticks of medical concern.
A Liquid Biopsy to Assess Brain Tumor Recurrence: Presence of Circulating Mo-MDSC and CD14+ VNN2+ Myeloid Cells as Biomarkers That Distinguish Brain Metastasis From Radiation Necrosis Following Stereotactic Radiosurgery
Authors: Soler David C , Kerstetter-Fogle Amber , Elder Theresa , Raghavan Alankrita , Barnholtz-Sloan Jill S , Cooper Kevin D , McCormick Thomas S , Sloan Andrew E 
Published: August 2020

Abstract

BACKGROUND
Brain metastases (BM) are the most common type of brain tumor malignancy in the US. They are also the most common indication for stereotactic radiosurgery (SRS). However, the incidence of both local recurrence and radiation necrosis (RN) is increasing as treatments improve. MRI imagery often fails to differentiate BM from RN; thus, patients must often undergo surgical biopsy or resection to obtain a definitive diagnosis.

OBJECTIVE
To hypothesize that a marker of immunosuppression might serve as a surrogate marker to differentiate patients with active vs inactive cancer—including RN.

METHODS
We thus purified and quantified Monocytic Myeloid-Derived Suppressor Cells (Mo-MDSC) by flow cytometry in patients proven by biopsy to represent BM or RN.

RESULTS
We report the utility of the previously reported HLA-Dr-Vnn2 Index or DVI to discriminate recurrent BM from RN using peripheral blood. The presence of CD14+ HLA-DRneg/low Mo-MDSC is significantly increased in the peripheral blood of patients with brain metastasis recurrence compared to RN (Average 61.5% vs 7%, n = 10 and n = 12, respectively, P < .0001). In contrast, expression of VNN2 on circulating CD14+ monocytes is decreased in BM patients compared to patients with RN (5.5% vs 26.5%, n = 10 and n = 12, respectively, P = .0008). In patients with biopsy confirmed recurrence of brain metastasis, the average DVI was 11.65, whereas the average DVI for RN patients was consistently <1 (Avg. of 0.17).

CONCLUSION
These results suggest that DVI could be a useful diagnostic tool to differentiate recurrent BM from RN using a minimally invasive blood sample.
Dietetic intervention for adult outpatients with an eating disorder: a systematic review and assessment of evidence quality
Authors: McMaster Caitlin M , Fong Mackenzie , Franklin Janet , Hart Susan 
Published: August 2020

Abstract

Context
Eating disorders (EDs) are complex mental illnesses that require medical, psychological, and dietetic intervention to assist patients achieve recovery.

Objective
Available evidence was reviewed regarding dietetic intervention for adult outpatients with an ED and the quality of this evidence was assessed.

Data sources
Systematic literature searches were conducted using 5 databases (MEDLINE, PreMEDLINE, EMBASE, CINAHL, PsycINFO) for studies comparing adults with an ED receiving a dietetic intervention with those receiving a psychological intervention alone, those receiving a combined dietetic and psychological intervention, or a control group.

Data extraction
Literature searches returned 3078 results, with 10 articles reporting on 9 randomized controlled trials meeting the inclusion criteria. The quality of evidence was assessed using the Cochrane Risk-of-Bias tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

Data analysis
GRADE assessments for studies involving individuals with anorexia nervosa indicated very low quality of evidence for outcomes including weight, ED psychopathology and ED behaviors , and no studies measured nutritional changes. For studies conducted with participants with bulimia nervosa or binge eating disorder, only 1 study included a group receiving combined evidence-based psychological and dietetic intervention. A combined intervention produced moderate-quality evidence for lower attrition, greater abstinence from ED behaviors, and more meals eaten per week in comparison with a stand-alone psychological or dietetic intervention.

Conclusions
There is currently limited evidence to sufficiently assess the impact of incorporating dietetic interventions into outpatient treatment for adults with an ED; however, available evidence supports clinical practice guidelines that dietetic intervention should not be delivered as a stand-alone treatment. Additional methodologically sound studies in larger samples are required to fully inform dietetic treatment in EDs and incorporation of such interventions as part of a multidisciplinary treatment approach.
Diagnostic Infectious Diseases Testing Outside Clinics: A Global Systematic Review and Meta-analysis
Authors: Kpokiri Eneyi E , Marley Gifty , Tang Weiming , Fongwen Noah , Wu Dan , Berendes Sima , Ambil Bhavana , Loveday Sarah-Jane , Sampath Ranga , Walker Jennifer S , Matovu Joseph K B , Boehme Catharina , Pai Nitika Pant , Tucker Joseph D 
Published: August 2020

Abstract

Background
Most people around the world do not have access to facility-based diagnostic testing, and the gap in availability of diagnostic tests is a major public health challenge. Self-testing, self-sampling, and institutional testing outside conventional clinical settings are transforming infectious disease diagnostic testing in a wide range of low- and middle-income countries (LMICs). We examined the delivery models of infectious disease diagnostic testing outside clinics to assess the impact on test uptake and linkage to care.

Methods
We conducted a systematic review and meta-analysis, searching 6 databases and including original research manuscripts comparing testing outside clinics with conventional testing. The main outcomes were test uptake and linkage to care, delivery models, and adverse outcomes. Data from studies with similar interventions and outcomes within thematic areas of interest were pooled, and the quality of evidence was assessed using GRADE. This study was registered in PROSPERO (CRD42019140828).
We identified 10 386 de-duplicated citations, and 76 studies were included. Data from 18 studies were pooled in meta-analyses. Studies focused on HIV (48 studies), chlamydia (8 studies), and multiple diseases (20 studies). HIV self-testing increased test uptake compared with facility-based testing (9 studies: pooled odds ratio [OR], 2.59; 95% CI, 1.06–6.29; moderate quality). Self-sampling for sexually transmitted infections increased test uptake compared with facility-based testing (7 studies: pooled OR, 1.74; 95% CI, 0.97–3.12; moderate quality).
Conclusions.  Testing outside of clinics increased test uptake without significant adverse outcomes. These testing approaches provide an opportunity to expand access and empower patients. Further implementation research, scale-up of effective service delivery models, and policies in LMIC settings are needed.
Imaging of Lyme Neuroborreliosis: A Pictorial Review
Authors: Garkowski Adam , Łebkowska Urszula , Kubas Bożena , Garkowska Ewa , Rutka Katarzyna , Gawarecka Elwira , Zajkowska Joanna 
Published: August 2020

AbstractLyme neuroborreliosis is a common feature of Borrelia burgdorferi infection (as a neurological manifestation occurring in 10%–15% of all Lyme disease cases) and may involve any part of the nervous system, and its coverings, but usually manifests as lymphocytic meningitis, cranial neuritis, and/or radiculoneuritis. This review describes the imaging findings in Lyme neuroborreliosis: the focal point is on the manifestations of involvement visible on brain and spine imaging.
2 Systemic glucocorticoids and bradycardia in critically ill children: a retrospective study
Authors: Maltais-Bilodeau Camille , Frenette Maryse , Morissette Geneviève , Bailey Dennis , Cloutier Karine , Laberge Camille , Simonyan David 
Published: August 2020

Abstract

Background
Glucocorticoids are widely used in the pediatric population. They are associated with numerous side effects including repercussions on the cardiovascular system. The impact on heart rate is not well known, but bradycardia has been reported, mostly with high doses.

Objectives
We described the occurrence of bradycardias and the variation of heart rate in critically ill children receiving glucocorticoids.

Design/Methods
We conducted a retrospective study including 1 month old to 18 year old children admitted to the Pediatric Intensive Care Unit between 2014 and 2017, who received a glucocorticoid dose equivalent to 1 to 15 mg/kg/day of prednisone. We collected data on exposition to glucocorticoids, heart rate before, during and after the exposition, and interventions from the medical staff in response to bradycardia. The primary outcome was the occurrence of bradycardia and the secondary outcomes were the magnitude of heart rate variation and the clinical management of bradycardias.

Results
We included 92 admissions (85 patients). The median dose of glucocorticoid used was 2.80 mg/kg/day of prednisone (2.08—3.80). We found 70 cases (76%) with at least one bradycardia. Before treatment, all patients had a mean heart rate higher than the 5th percentile for age. During exposition to glucocorticoids, 8 patients (10%, n = 83) had a median heart rate ≤ 5th percentile. We noted 46 cases of bradycardia (50%) that led to an intervention from the medical staff, but no patient had a major event associated to bradycardia. We found a significant association between bradycardia and age (estimate -0.136, 95% CI -0.207—-0.065, p &lt; 0.001), glucocorticoid dose (estimate 4.820, 95% CI 2.048—7.592, p &lt; 0.001) and intravenous administration (estimate 8.709, 95% CI 1.893—15.524, p = 0.012).

Conclusion
In our study, most children hospitalized at the intensive care unit receiving standard doses of glucocorticoid experienced bradycardia. The majority of episodes led to an intervention from the medical staff. Presence of bradycardia was associated with younger age, higher dose and IV administration of glucocorticoids.
8 Positive Distraction Entertainment System (PDES) in Paediatric Population Undergoing Day Surgery
Authors: Chang Michael , Fernandes Alicia , Frankel Alexandra 
Published: August 2020

Abstract

Background
Patients undergoing procedures at hospitals may experience anxiety and such anxiety can be heightened in pediatric populations. Anxiety can invoke a physical and mental stress response leading to poorer health outcomes and in children these outcomes include: resistance to treatment, nightmares, longer recovery periods, lowered pain thresholds and separation anxiety (Biddis, 2014; Manyande 2015; Aydın 2017).

Objectives
This study aimed to test whether a virtual reality intervention is feasible, beneficial and effective in reducing anxiety prior to surgery in the pediatric population of Scarborough Health Network.

Design/Methods
Virtual Reality (VR) is a computer technology that simulates a user’s physical presence in a virtual or imaginary environment. ‘Bubble Bloom’, an underwater fishing game where participants launch bubbles to catch colourful fish, is the VR game that the children are administered in a two phased research design to explore whether the VR intervention was a beneficial tool in reducing anxiety in our pediatric population. Phase 1 was a trial phase in which participants (n=20) were administered the condensed version of the State Trait Anxiety Scale before and after the intervention to determine if anxiety levels had been reduced. Participants were also administered an experience survey to explore patient satisfaction, headset comfort, and virtual reality satisfaction.
Phase 2, randomized control trial, is currently ongoing with the same measures and VR intervention being administered. In Phase 2, participants are randomized to the control group (regular play activities) or intervention (virtual reality game).

Results
In Phase 1, all participants indicated they enjoyed the experience of the virtual reality intervention. Sixteen of the 20 participants had pre scores that were in the mild to moderate anxiety range (80%). Of these 16 participants, 10 participants’ post scores decreased to the normal or no anxiety range (63%). Additionally, 80% of participants demonstrated a reduction in anxiety post-virtual reality intervention.

Conclusion
Phase 1 results were encouraging with 80% of participants experiencing a reduction in anxiety and all participants enjoying the virtual reality experience.