bluuebunny/crossref_metadata_2025_split huggingface dataset:
Routine Venous Thromboembolism Prophylaxis May Be Inadequate in the Hypercoagulable State of Severe Coronavirus Disease 2019
Authors: Maatman Thomas K. , Jalali Farid , Feizpour Cyrus , Douglas Anthony , McGuire Sean P. , Kinnaman Gabriel , Hartwell Jennifer L. , Maatman Benjamin T. , Kreutz Rolf P. , Kapoor Rajat , Rahman Omar , Zyromski Nicholas J. , Meagher Ashley D. 
Published: May 2020

Objectives:
The aim of this study was to determine the frequency of venous thromboembolism in critically ill coronavirus disease 2019 patients and associate a degree of inflammatory marker elevation to venous thromboembolism development.

Design:
An observational study that identified patients with severe coronavirus disease 2019 between March 12, 2020, and March 31, 2020. Data reported are those available through May 6, 2020.

Setting:
A multicenter study including three Indianapolis area academic hospitals.

Patients:
Two-hundred forty consecutive patients with confirmed severe acute respiratory syndrome coronavirus 2 infection were admitted to one of three hospitals. One-hundred nine critically ill coronavirus disease 2019 patients admitted to the ICU were included in the analysis.

Interventions:
All patients received routine subcutaneous chemical venous thromboembolism prophylaxis.

Measurements and Main Results:
The primary outcome of this study was to determine the frequency of venous thromboembolism and the degree of inflammatory and coagulation marker elevation associated with venous thromboembolism development. Descriptive statistics outlined the frequency of venous thromboembolism at any time during severe coronavirus disease 2019. Clinical course and laboratory metrics were compared between patients that developed venous thromboembolism and patients that did not develop venous thromboembolism. Hypercoagulable thromboelastography was defined as two or more hypercoagulable parameters.

Main Results:
One-hundred nine patients developed severe coronavirus disease 2019 requiring ICU care. The mean (± sd) age was 61 ± 16 years and 57% were male. Seventy-five patients (69%) were discharged home, 7 patients (6%) remain in the hospital, and 27 patients (25%) died. Venous thromboembolism was diagnosed in 31 patients (28%) 8 ± 7 days after hospital admission, including two patients diagnosed with venous thromboembolism at presentation to the hospital. Elevated admission d-dimer and peak d-dimer were associated with venous thromboembolism development (p < 0.05). d-dimer greater than 2,600 ng/mL predicted venous thromboembolism with an area under the receiver operating characteristic curve of 0.760 (95% CI, 0.661–0.858; p < 0.0001), sensitivity of 89.7%, and specificity of 59.5%. Twelve patients (11%) had thromboelastography performed and 58% of these patients had a hypercoagulable study. The calculated coagulation index was hypercoagulable in 50% of patients with thromboelastography.

Conclusions:
These data show that coronavirus disease 2019 results in a hypercoagulable state. Routine chemical venous thromboembolism prophylaxis may be inadequate in preventing venous thromboembolism in severe coronavirus disease 2019.
A Comparison of Common Plastic Surgery Operations Using the NSQIP and TOPS Databases
Authors: Veith Jacob , Collier Willem , Simpson Andrew , Magno-Padron David , Mast Bruce , Murphy Robert X. , Agarwal Jayant , Kwok Alvin 
Published: May 2020

Background:
Both the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) and the American Society of Plastic Surgeons Tracking Operations and Outcomes for Plastic Surgeons (TOPS) databases track 30-day outcomes.

Methods:
Using the 2008–2016 TOPS and NSQIP databases, we compared patient characteristics and postoperative outcomes for 5 common plastic surgery procedures. A weighted TOPS population was used to mirror the NSQIP population in clinical and demographic characteristics to compare postoperative outcomes.

Results:
We identified 154,181 cases. Compared with NSQIP patients, TOPS patients were more likely to be younger (47.9 versus 50.0 years), have American Society of Anesthesiologists class I-II (92.1% versus 74.6%), be outpatient (66.0% versus 49.3%), and be smokers (18.7% versus 11.7%). TOPS had extensive missing data: body mass index (40.6%), American Society of Anesthesiologists class (34.9%), diabetes (39.3%), and smoking status (37.2%). NSQIP was missing <1% of all shared categories except race (15.6%). The entire TOPS cohort versus only TOPS patients without missing data had higher rates of dehiscence (5.1% versus 3.5%) and infection (2.1% versus 1.7%). TOPS versus NSQIP patients had higher dehiscence rates (5.1% versus 1.0%) but lower rates of return to the operating room (3.1% versus 6.6%), infection (2.1% versus 3.0%), and medical complications (0.3% versus 2.2%). Nonweighted and weighted TOPS cohorts had similar 30-day outcomes.

Conclusions:
NSQIP and TOPS populations are different in characteristics and outcomes, likely due to differences in collection methodology and the types physicians using the databases. The strengths of each dataset can be used together for research and quality improvement.
Prepectoral 2-stage Breast Reconstruction with Carbon Dioxide Tissue Expansion
Authors: Kraenzlin Franca S. , Darrach Halley , Chopra Karan , Rosson Gedge D. , Broderick Kristen P. , Sacks Justin M. 
Published: May 2020

Background:
Roughly 80% of patients undergoing mastectomy in the United States opt for reconstruction with implants. The introduction of acellular dermal matrices has allowed for placement of breast prostheses in the prepectoral plane, while a new carbon dioxide tissue expander (TE) (AeroForm) allows for needle-free, patient-controlled expansion. These 2 novel technologies have ushered in a new patient-centered era of breast reconstruction, with the possibility of reducing patient morbidity for the first time in decades. We hypothesize that AeroForm expanders placed in the prepectoral plane reduce time to second-stage reconstruction, reduce the number of clinic visits, and have lower complications than traditional saline TEs.

Methods:
This is a retrospective review of all patients undergoing breast mastectomy and TE placement in the prepectoral plane over a 21-month period (169 patients, 267 breasts), comparing AeroForm expanders to TEs.

Results:
The AeroForm group (n = 57) had a shorter period to second-stage reconstruction than the TE group (n = 210) (135.4 versus 181.7 days; P = 0.01) and required fewer clinic visits (5.1 versus 6.9; P < 0.01). Partial thickness (25.6% versus 12.3%, P = 0.03) and full thickness (8.7% versus 0.0%, P = 0.02) necrosis were more common in the saline cohort. The rates of infection, hematoma, and seroma requiring drainage were not statistically significant between the 2 groups.

Conclusions:
Two-staged breast reconstruction with the use of AeroForm expanders in the prepectoral space marks progress in improving care for breast cancer patients by demonstrating a reduction in some adverse events, the number of clinic visits, and the time to second-stage reconstruction.
Elective Surgery during SARS-Cov-2/COVID-19 Pandemic: Safety Protocols with Literature Review
Authors: Cárdenas-Camarena Lázaro , Bayter-Marin Jorge Enrique , Durán Héctor , Hoyos Alfredo , López-Romero César Octavio , Robles-Cervantes José Antonio , Echeagaray-Guerrero Ernesto Eduardo 
Published: May 2020

Background:
Health care systems worldwide have been affected by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emergence since December 2019. The coronavirus disease 2019 (COVID-19) pandemic caused a steep decrease in elective surgery scheduling, to the extent of complete cancellation without future planning of safe development.

Purpose:
We performed a review of the literature and diagnosis data analysis with the aim to reduce the risk of operating a patient infected with SARS-CoV-2/COVID-19 during the incubation period.

Methods:
We searched for specific words and phrases about SARS-CoV-2 and COVID-19 in the PubMed database (US National Library of Medicine) from December 2019 to April 2020. A detailed analysis of the clinical picture and existing diagnostic tests for COVID-19 was performed to achieve the desired objectives.

Results:
A total of 1273 out of 5930 articles about COVID-19/SARS-CoV-2 did meet the criteria for the searched terms. We reviewed 105 articles, and 60 were selected for analysis. Specific recommendations were described based on our revision.

Conclusions:
With the combination of immunoglobulin M and immunoglobulin G antibody tests + real-time polymerase chain reaction for SARS-CoV-2 implemented in different time periods by taking into account the natural history of the disease, it is possible to decrease the risk of operating a patient during the incubation period higher than 93%. Adding other security measures can further increase this percentage. As long as there is no immunity to COVID-19, these measures will help us to perform safer elective surgeries.
Current Trends in Tonometry and Tonometer Tip Disinfection
Authors: Junk Anna K. , Chang Ta Chen , Vanner Elizabeth , Chen Teresa 
Published: May 2020

Precis:
A survey among members of the American Glaucoma Society (AGS) and the American Optometry Association (AOA) on tonometer preference and tonometer disinfection indicates a shift to disposable tonometer tips compared with 1987.

Purpose:
This survey’s purpose was to determine how eye care providers responded to the 2008 Centers of Disease Control (CDC) tonometer disinfection guidelines, which recommend 10% hypochlorite (dilute bleach) for reusable tonometers. Tonometers measure the eye pressure when they touch the cornea, an essential part of the eye examination.

Methods:
AGS and AOA members were surveyed on tonometer preference, tonometer use, disinfection process, disinfectants, disinfection timing, and tonometer damage.

Results:
Survey responses from 79 AOA members and 197 AGS members are included. The Goldmann tonometer is considered most accurate (70, 89% AOA and 161, 82% AGS). It is preferred by 54 (70%) AOA and 193 (98%) AGS members. Many providers (165) use reusable Goldmann tonometer tips (77, 79% AOA, 88, 45% AGS), and most clean with 70% isopropyl alcohol wipes 59 (77%) AOA and 54 (61%) AGS. In summary, 126 of 276 participants (8, 10% AOA and 118, 60% AGS) follow CDC guidelines by using disposable tips (2 AOA and 109 AGS) or disinfecting reusable tips with 10% hypochlorite (6 AOA and 9 AGS).

Conclusions:
The majority of AGS providers follow current CDC tonometer disinfection guidelines by shifting to disposable Goldmann tonometer tips. Only a minority of providers who use reusable tonometer tips disinfect with dilute bleach. Continued education on proper tonometer disinfection is critical to prevent eye-care related infection due to improper disinfection.
The Effect of Age on the Rate of Correction in Infants with Head Shape Deformities Treated with Cranial Remolding Orthoses
Authors: Weersma Lance A. , Cordial-Stout Melissa L. , Gascho Briana R. , Nolin Rachael L. 
Published: May 2020

ABSTRACT

Introduction
Often, health care professionals question when the opportune time is to refer a child for cranial remolding treatment and at what age the child will have the best outcome. This study was designed to observe the rate of change of a cranial deformity when treated with a cranial remolding orthosis and how age affects that rate of correction.

Materials and Methods
A total of 670 participants with positional head deformities were included in this retrospective study. Participants were placed into three groups: plagiocephaly, brachycephaly, and asymmetrical brachycephaly. A medical record review was completed on each infant, and 200 of the 670 participants were excluded for conflicts with criteria. The STARscan for the remaining candidates (N = 470) were obtained in the office using the STARscanner™ system. Seventy-one of the remaining 470 participants were excluded for conflicts with the scan review criteria.

Results
A total of 398 participants were included in this retrospective study. Ninety-eight participants were categorized in the plagiocephaly group, 156 were categorized in the brachycephaly group, and 144 were categorized in the asymmetrical brachycephaly group. A rate of in-orthosis correction was calculated for each participant. Rate of change for plagiocephaly was calculated as initial CVAI − discharge CVAI) / length of treatment. This calculation provided an average improvement in cranial vault asymmetry index (CVAI) per day. Rate of change for brachycephaly was calculated as (initial cephalic ratio − discharge cephalic ratio) / length of treatment. This calculation provided an average decrease in cephalic ratio per day. For asymmetrical brachycephaly, rate of in-orthosis correction was obtained by finding both the average rate of change for CVAI and cephalic ratio. In addition, participants were separated into age groups and deformity type to more precisely understand the relationship and note any differences.

Conclusions
Each deformity type showed an increased rate of correction when treatment was initiated at a younger age. By quantitatively showing that the rate of correction decreases as the child age increases, we can provide valuable information on the opportune time to provide cranial remolding treatment. The results of this study show that the fastest rate of correction occurs when started at the age of 4 to 6 months and declines quickly as the child ages.
Composite Lipid Emulsion for the Infant at Risk of Intestinal Failure–associated Liver Disease
Authors: Silverman Jason A. , Turner Justine M. , Wales Paul W. 
Published: May 2020

ABSTRACTCurrently, in North America we are fortunate to have a number of available options for lipid emulsions to be used in the parenteral nutrition regimens for infants and children, including for long‐term parenteral nutrition given intestinal failure. Neonates and infants in particular are at risk for intestinal failure–associated liver disease (IFALD). The choice of parenteral lipid emulsion will influence the risk and severity of IFALD. The purpose of this review is to discuss the rationale for the composite lipid emulsion SMOFlipid that includes soybean, medium‐chain triglycerides, olive and fish oils for IFALD, with focus on the Canadian practice and experience.
Improving Concussion Management by Including Driving Recommendations for Adolescents with Concussions: A Quality Improvement Project
Authors: Santana Jonathan A. , Martinie Rebecca , Gomez Jorge 
Published: May 2020

Introduction:Motor vehicle collisions are the leading cause of death in adolescents. A concussion is a common injury sustained by adolescents and may impair their driving abilities during the acute phase of recovery. Healthcare providers do not consistently perform counseling of adolescents regarding driving after a concussion. This quality improvement project’s goal was to increase the incidence of primary care sports medicine physicians providing driving recommendations to 75% of adolescents who suffered from concussions.Methods:Between August 2017 to August 2018, a “smart phrase” implemented in the electronic health record system reminded providers during office visits to provide driving recommendations to patients 15 years old and older who presented to the sports medicine clinic for evaluation of concussion. Performing monthly retrospective chart reviews determined the frequency of patients who received driving recommendations during the initial visit.Results:We achieved the goal of providing driving recommendations to 75% of concussed patients by the second month. This progress was maintained through the remainder of the year, except for 1 month (December). Forty-three percent of patients with concussions evaluated met inclusion criteria, and of those, 48% were actively driving before their concussion. The most common medical reason for restricting driving was vestibular or ocular dysfunction.Conclusion:This quality improvement project showed that providing driving instructions to concussion patients by implementing a smart phrase into the electronic health record system was impactful and sustainable.
A Novel Standalone Microfluidic Device for Local Control of Oxygen Tension for Intestinal-Bacteria Interactions
Authors: Wang Chengyao , Dang Thao , Baste Jasmine , Joshi Advait Anil , Bhushan Abhinav 
Published: May 2020

AbstractThe intestinal environment is unique because it supports the intestinal epithelial cells under a normal oxygen environment and the microbiota under an anoxic environment. Due to importance of understanding the interactions between the epithelium and the microbiota, there is a strong need for developing representative and simple experimental models. Current approaches do not capture the dual-oxygen environment, require external anaerobic chambers, or are complex. Another major limitation is that in the solutions that can mimic the dual-oxygen environment, the oxygenation level of the epithelial cells is not known, raising the question whether the cells are hypoxic. We report standalone microfluidic devices that form a dual-oxygen environment without the use of an external anaerobic chamber or oxygen scavengers to coculture intestinal epithelial and bacterial cells. By changing the thickness of the device cover, the oxygen tension in the chamber could be modulated. We verified the oxygen levels using several tests: microscale oxygen sensitive sensors incorporated within the devices, hypoxic immunostaining of Caco-2 cells, and genetically encoded bacteria. Collectively, these methods monitored oxygen concentrations in devices more comprehensively than previous reports and allowed for control of oxygen tension to match the requirements of both intestinal cells and anaerobic bacteria. Our experimental model is supported by the mathematical model that considers diffusion of oxygen into the top chamber and the cellular oxygen consumption rate. This allowed us to experimentally determine the oxygen consumption rate of the epithelial cells more precisely.
OptiMol : Optimization of binding affinities in chemical space for drug discovery
Authors: Boitreaud Jacques , Oliver Carlos , Mallet Vincent , Waldispühl Jerome 
Published: May 2020

AbstractLigand-based drug design has recently benefited from the boost of deep generative models. These models enable extensive explorations of the chemical space, and provide a platform for molecular optimization. However, current state of the art methods do not leverage the structure of the target, which is known to play a key role in the interaction.We propose an optimization pipeline that leverages complementary structure-based and ligand-based methods. Instead of performing docking on a fixed drug bank, we iteratively select promising compounds in the whole chemical space using a ligand-centered generative model. Molecular docking is then used as an oracle to guide compound optimization. This allows to iteratively generate leads that better fit the target structure, in a closed optimization loop, without prior knowledge about bio-actives. For this purpose, we introduce a new graph to selfies VAE which benefits from a seventeen times faster decoding than graph to graph methods while being competitive with the state of the art. We then successfully optimize the generation of molecules towards high docking scores, enabling a ten-fold augmentation of high-scoring compounds found with a fixed computational budget.AvailabilityCode is available on GitHubContactjeromew@mcgill.ca
Autism genetics perturb prenatal neurodevelopment through a hierarchy of broadly-expressed and brain-specific genes
Authors: Gazestani Vahid H. , Chiang Austin WT , Courchesne Eric , Lewis Nathan E. 
Published: May 2020

ABSTRACTNumerous genes are associated with autism spectrum disorder (ASD); however, it remains unclear how most ASD risk genes influence neurodevelopment and result in similar traits. Recent genetic models of complex traits suggest non-tissue-specific genes converge on core disease genes; so we analyzed ASD genetics in this context. We found ASD risk genes partition cleanly into broadly-expressed and brain-specific genes. The two groups show sequential roles during neurodevelopment with broadly-expressed genes modulating chromatin remodeling, proliferation, and cell fate, while brain-specific risk genes are involved in neural maturation and synapse functioning. Broadly-expressed risk genes converge onto brain-specific risk genes and core neurodevelopmental genes through regulatory networks including PI3K/AKT, RAS/ERK, and WNT/β-catenin signaling pathways. Broadly-expressed and brain-specific risk genes show unique properties, wherein the broadly-expressed risk gene network is expressed prenatally and conserved in non-neuronal cells like microglia. However, the brain-specific gene network expression is limited to excitatory and inhibitory neurons, spanning prenatal to adulthood. Furthermore, the two groups are linked differently to comorbidities associated with ASD. Collectively, we describe here the organization of the genetic architecture of ASD as a hierarchy of broadly-expressed and brain-specific genes that disrupt successive stages of core neurodevelopmental processes.
TLR9-activated B cells improve their regulatory function by endogenously produced catecholamines
Authors: Honke Nadine , Lowin Torsten , Opgenoorth Birgit , Shaabani Namir , Lautwein Alexander , Teijaro John R. , Schneider Matthias , Pongratz Georg 
Published: May 2020

AbstractThe sympathetic nervous system (SNS) contributes to immune balance by promoting anti-inflammatory B cells. However, whether B cells possess a self-regulating mechanism by which they modulate regulatory B cell (Breg) function is not well understood. In this study, we investigated the ability of B cells to synthesize catecholamines upon stimulation with different B cell activators. We found, that expression of the enzymes required to generate catecholamines, is upregulated by TLR9. TLR-9-specific expression of tyrosine hydroxylase (TH) correlated with upregulation of adrenergic receptors, enhanced IL-10 production, and with an overexpression of the co-inhibitory ligands PD-L1 and FasL. Moreover, concomitant stimulation of ß1-3-adrenergic receptors together with a BCR/TLR9 stimulus enhances the anti-inflammatory potential of Bregs to suppress CD4 T cells, a crucial population in the pathogenesis of autoimmune diseases, like rheumatoid arthritis. In conclusion, our data show that B cells possess autonomous mechanisms to modulate their regulatory function. These findings help to better understand the function of Bregs in autoimmune diseases and the interplay of sympathetic nervous system and B cell function.
Moyamoya Disease-AssociatedRNF213Alleles Encode Dominant Negative Alleles That Globally Impair Ubiquitylation
Authors: Bhardwaj Abhishek , Banh Robert S. , Zhang Wei , Sidhu Sachdev S. , Neel Benjamin G. 
Published: May 2020

AbstractSingle nucleotide polymorphisms (SNPs) inRNF213, which encodes a 591kDa protein with AAA+ ATPase and RING E3 domains, are associated with a rare, autosomal dominant cerebrovascular disorder, Moyamoya disease (MMD). MMD-associated SNPs primarily localize to the C-terminal region of RNF213, and some affect conserved residues in the RING domain. Although the autosomal dominant inheritance of MMD could most easily be explained by RNF213 gain-of-function, the type of ubiquitylation catalyzed by RNF213 and the effects of MMD-associated SNPs on its E3-ligase activity have remained unclear. We found that the RING domain of RNF213 uses the E2-conjugating enzyme UBE2D2 to catalyze predominantly K6-dependent poly-ubiquitination events comprising a mixture of typical and atypical ubiquitin linkages. MMD-associated SNPs encode proteins with decreased E3-ligase activity and the most frequent MMD allele,RNF213R4810K, is a dominant negative mutant that decreases ubiquitylation globally. By contrast, MMD-associatedRNF213SNPs do not affect ATPase activity. We propose that decreased RNF213 E3-ligase activity is central to MMD pathogenesis.