bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intestinal Microbiota in Children With Symptomatic Dientamoeba fragilis Infection: A Case-control Study
Authors: van Kalleveen Michael W. , Budding Andries E. , Benninga Marc A. , Savelkoul Paul H.M. , van Gool Tom , van Maldeghem Iris , Dorigo-Zetsma J. W. , Bart Aldert , Plötz Frans B. , de Meij Tim G.J. 
Published: November 2020

Background:

Dientamoeba fragilis in children has been associated with gastrointestinal symptoms, like abdominal pain and diarrhea. The mechanism underlying these symptoms in children with D. fragilis remains unclear. We hypothesized that concomitant microbial alterations, which have been described in other parasitic infections, may be associated with gastrointestinal symptoms in D. fragilis.

Methods:
In this case-control study performed in 2 centers, 19 children referred to a pediatrician because of gastrointestinal symptoms and with a positive fecal PCR for D. fragilis were included as cases. We included 19 healthy children as controls and matched for age and gender, selected from an existing cohort of 63 children. A PCR for D. fragilis was performed on fecal samples of the 19 controls to assess D. fragilis carriership in this asymptomatic group. Microbiota was analyzed with the IS-pro technique, and the intestinal microbiota composition and diversity were compared between the 2 groups.

Results:
Microbiota of children with D. fragilis and gastrointestinal symptoms did not significantly differ in terms of composition and diversity compared with controls, both on phylum and species level. In the asymptomatic controls, a positive fecal PCR for D. fragilis was found in 16 of 19 (84.2%).

Conclusion:
Intestinal microbiota does not seem to play a key role in the presence of clinical symptoms in children with D. fragilis. The pathogenicity of D. fragilis and pathophysiologic pathways underlying the development of gastrointestinal symptoms remains yet to be clarified.
Therapeutic targeting of nitroglycerin-mediated trigeminovascular neuronal hypersensitivity predicts clinical outcomes of migraine abortives
Authors: Akerman Simon , Romero-Reyes Marcela , Karsan Nazia , Bose Pyari , Hoffmann Jan R. , Holland Philip R. , Goadsby Peter J. 
Published: November 2020

Abstract
Cranial hypersensitivity is a prominent symptom of migraine, exhibited as migraine headache exacerbated with physical activity, and cutaneous facial allodynia and hyperalgesia. The underlying mechanism is believed to be, in part, activation and sensitization of dural-responsive trigeminocervical neurons. Validated preclinical models that exhibit this phenotype have great utility for understanding putative mechanisms and as a tool to screen therapeutics. We have previously shown that nitroglycerin triggers cranial allodynia in association with migraine-like headache, and this translates to neuronal cranial hypersensitivity in rats. Furthermore, responses in both humans and rats are aborted by triptan administration, similar to responses in spontaneous migraine. Here, our objective was to study the nitroglycerin model examining the effects on therapeutic targets with newly approved treatments, specifically gepants and ditans, for the acute treatment of migraine. Using electrophysiological methods, we determined changes to ongoing firing and somatosensory-evoked cranial sensitivity, in response to nitroglycerin, followed by treatment with a calcitonin gene-related peptide receptor antagonist, gepant (olcegepant), a 5-HT1F receptor agonist, ditan (LY344864), and an NK1 receptor antagonist (GR205171). Nitroglycerin induced activation of migraine-like central trigeminocervical neurons, and intracranial and extracranial neuronal hypersensitivity. These responses were aborted by olcegepant and LY344864. However, GR205171, which failed in clinical trial for both abortive and preventive treatment of migraine, had no effect. These data support the nitroglycerin model as a valid approach to study cranial hypersensitivity and putative mechanisms involved in migraine and as a screen to dissect potentially efficacious migraine therapeutic targets.
Hippocampus shape deformation: a potential diagnostic biomarker for chronic back pain in women
Authors: Reckziegel Diane , Abdullah Taha , Wu Binbin , Wu Bo , Huang Lejian , Schnitzer Thomas J. , Apkarian A. Vania 
Published: November 2020

Abstract
Sex differences in the quality and prevalence of chronic pain are manifold, with women generally presenting higher incidence and severity. Uncovering chronic pain–related sex differences inform neural mechanisms and may lead to novel treatment routes. In a multicenter morphological study (total n = 374), we investigated whether the shape of subcortical regions would reflect sex differences in back pain. Given the hormone-dependent functions of the hippocampus, and its role in the transition to chronic pain, this region constituted our primary candidate. We found that the anterior part of the left hippocampus (alHP) presented outer deformation in women with chronic back pain (CBP), identified in CBP in the United States (n = 77 women vs n = 78 men) and validated in a Chinese data set (n = 29 women vs n = 58 men with CBP, in contrast to n = 53 female and n = 43 male healthy controls). Next, we examined this region in subacute back pain who persisted with back pain a year later (SBPp; n = 18 women vs n = 18 men) and in a subgroup with persistent back pain for 3 years. Weeks after onset of back pain, there was no deformation within alHP, but at 1 and 3 years women exhibited a trend for outer deformation. The alHP partly overlapped with the subiculum and entorhinal cortex, whose functional connectivity, in healthy subjects, was associated with emotional and episodic memory related terms (Neurosynth, reverse inference). These findings suggest that in women the alHP undergoes anatomical changes with pain persistence, highlighting sexually dimorphic involvement of emotional and episodic memory–related circuitry with chronic pain.
The Toll of Student Debt: Stress Among Health Professions Students and the Promising Role of Financial Self-Efficacy on Career Choices
Authors: Dickson Tara , Mulligan Edward P. , DeVahl Julie 
Published: November 2020

Introduction.
As the cost of higher education rises, the debt associated with degree attainment also increases, including that of the Doctor of Physical Therapy degree. Research suggests that a relationship between financial debt and postprofessional career aspirations may exist, and financial self-efficacy could attenuate debt-related stress. These relationships have not been studied in the health professions outside of medicine.

Methods.
A total of 139 participants among 6 health professions programs housed in one public, academic medical center were surveyed. Surveys administered to participants provided Likert scale data for a multiple regression analysis.

Results.
Eighty-one percent of students reported having a medium, large, or extreme amount of stress from the total amount of debt they are accruing. More than 70% of student responses indicated that the amount of student loan debt they expect to accumulate will influence their posttraining career selection to some extent. The regression model indicated some predictive ability of stress from student debt. Two of the covariates, self-efficacy and career selection, were statistically significant. Self-efficacy accounted for 36% of the variance explained in students' self-reported stress from debt by itself. Students' career selection and stress were strongly associated, with career selection explaining 85% of the variance explained in students' self-reported stress by itself.

Discussion.
Health professions students in a public academic medical center had a “medium amount” of stress, on average, from financial debt. Stress was associated with the amount of student loans students expect to accrue and their financial self-efficacy. Students also appeared to base their postprofessional career aspirations, at least in part, on the stress they experienced from financial debt. Financial self-efficacy appears to be a promising moderator for debt-related stress.

Conclusion.
Stress appears to be associated with higher student loan debt, but financial self-efficacy may moderate this trend.

Level of Evidence.
IV, Cross-sectional descriptive survey design.

What Is Known About the Subject?
Costs of physical therapy programs continue to rise, requiring more physical therapy students to use loans to pay for their education. Other professions, including medicine, have noted that student loan debt can cause high amounts of stress and has the potential to influence career choices.

What This Study Adds to the Existing Literature?
Health professions students in one academic medical center appear to base their postprofessional career aspirations, at least in part based on the stress they experience from financial debt. Financial self-efficacy appears to attenuate the amount of stress students feel from student loan debt.
Branch Retinal Vein Occlusion and Venous Abnormalities in CADASIL
Authors: Goldstein Eric D. , Shakoor Akbar , Majersik Jennifer J. 
Published: November 2020

Introduction:
Individuals with the inherited progressive microangiopathy Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts (CADASIL) most classically develop migraine with aura and recurrent subcortical ischemic infarcts with progressive cognitive decline, gait dysfunction, psychiatric disturbances culminating in early death. However, clinically important venous pathologies may not be anticipated by treating neurologists such as branch retinal vein occlusions (BRVOs). Herein we describe a case of CADASIL with a BRVO and a brief review of venous pathology in CADASIL.

Case Report:
A 66-year-old man with CADASIL and clinical symptoms of chronic migraine with aura, episodic “CADASIL coma,” recurrent subcortical ischemic infarcts and normal cognition presented with an asymptomatic superior BRVO. Retinal analysis by wide-field fluorescein angiography revealed dye extravasation and optical coherence tomography identified macular edema prompting a monthly regimen of intravitreal bevacizumab. Systemic investigations for provoking etiologies was unfruitful tentatively attributing the BRVO to his underlying CADASIL.

Conclusions:
Within CADASIL, the venous circulation undergoes similar pathologic changes as compared with the arterial circulation. The retinal veins of CADASIL exhibit increased venous compliance, vessel wall diameter and wall thickness which may represent a structurally causative factor for retinal venous disease. However, these findings are not isolated to the retina as lower extremity varicose veins have associated with a family pedigree of CADASIL. Although presently it is uncertain whether those with CADASIL should undergo routine retinal screening, neurologists, and ophthalmologists, need to be cognizant of the extra-arterial manifestations of CADASIL to provide comprehensive clinical care.
A Telesimulation Elective to Provide Medical Students With Pediatric Patient Care Experiences During the COVID Pandemic
Authors: Yang Thomas , Buck Samuel , Evans Leigh , Auerbach Marc 
Published: November 2020

Objectives/Introduction
The Association of American Medical Colleges suggested that medical students not be involved in direct patient care activities in the United States because of the COVID pandemic. Our objectives are to (1) describe the rapid creation and implementation of a fully online simulation-based pediatric emergency medicine training intervention for medical student learners using existing simulation center staff (faculty, technicians, actors) and resources (simulation technology, scenario files) and (2) report student and faculty feedback on the intervention.

Methods
The sessions involved the use of our existing simulation center faculty, staff, and resources. Feedbacks on the sessions were collected via a survey from faculty and students at the end of each session.

Results
Sixteen simulation sessions were conducted (8 febrile infant, 8 anaphylactic toddler). Forty-eight students, 2 technicians, 2 actors, and 10 faculty participated. Ninety percent of the students agreed with the statements, “I am more comfortable with pediatrics after this session,” “participating improved my pediatric knowledge/skills,” “this session was more useful than other learning activities I am involved in at this time.” Seventy percent of the students agreed with the statement, “I learned as much from observing as when I was actively involved.” All faculty agreed with the statement, “this was an effective educational strategy compared to other distance learning.” Most faculty (60%) disagreed with the statement, “virtual simulation was equal to or superior to in-person simulation.” All students and faculty strongly agreed with the statement, “I would highly recommend this to others.”

Conclusions
A telesimulation intervention involving all medical students, staff, and facilitators interacting remotely for pediatric emergency training during COVID was associated with high levels of satisfaction by the majority of learners and faculty.
Muscle Strength and Physical Performance in Patients Without Previous Disabilities Recovering From COVID-19 Pneumonia
Authors: Paneroni Mara , Simonelli Carla , Saleri Manuela , Bertacchini Laura , Venturelli Massimo , Troosters Thierry , Ambrosino Nicolino , Vitacca Michele 
Published: November 2020

Abstract
In this cross-sectional study, we evaluated skeletal muscle strength and physical performance (1-min sit-to-stand and short physical performance battery tests), dyspnea, fatigue, and single-breath counting at discharge from a postacute COVID department, in patients recovering from COVID-19 pneumonia who had no locomotor disability before the infection.
Quadriceps and biceps were weak in 86% and 73% of the patients, respectively. Maximal voluntary contraction for quadriceps was 18.9 (6.8) kg and for biceps 15.0 (5.5) kg (i.e., 54% and 69% of the predicted normal value, respectively). The number of chair rises in the 1-min sit-to-stand test was 22.1 (7.3 corresponding to 63% of the predicted normal value), whereas the short physical performance battery score was 7.9 (3.3 corresponding to 74% of the predicted normal value). At the end of the 1-min sit-to-stand test, 24% of the patients showed exercise-induced desaturation. The single-breath counting count was 35.4 (12.3) corresponding to 72% that of healthy controls. Mild-to-moderate dyspnea and fatigue were found during activities of daily living (Borg scale score, median value = 0.5 [0–2] and 1 [0–2]) and after the 1-min sit-to-stand (Borg scale score, median value = 3 [2–5] and 1 [0–3]). Significant correlations were observed between muscle strength and physical performance indices (R = 0.31–0.69).
The high prevalence of impairment in skeletal muscle strength and physical performance in hospitalized patients recovering from COVID-19 pneumonia without previous locomotor disabilities suggests the need for rehabilitation programs after discharge.
Scalp Micropigmentation Procedure: A Useful Procedure for Hair Restoration
Authors: Seyhan Tamer , Kapi Emin 
Published: November 2020

Abstract
Medical tattooing of the skin to camouflage scars or to mimic hair or nipple/areola regions has gained popularity in Aesthetic Surgery and Dermatology clinics. The SMP procedure was used in 22 patients to correct scalp pigmentary problems between 2017 and 2020. The study included 16 men and 6 women; all female subjects had female pattern hair loss, while one of them also had alopecia areata. There were 10 male patients with male pattern hair loss and 6 of them were corrected using micropigmentation. The rest were subjected to an adjunctive procedure for hair transplantation. There were six male patients that had scalp scars. All patients had three micropigmentation sessions weekly and a fourth touchup procedure that was included one month after the last session. The follow-up period ranged from 7 to 32 months with a mean of 20 months. The amount of fading observed after the follow-up was minimal. There was an allergic reaction in just one patient following the procedure. There were no serious adverse effects or complications due to the procedure. The questionnaire the authors sent the patients at least six months following the procedure showed 80% of the patients (100% of the women) were very satisfied with the result and 100% of the patients would recommend the procedure to others with similar problems. SMP appears to be good solution for patients who don’t want the hair transplantation or who underwent previous hair transplantation surgeries with unsatisfactory results. Also, SMP can be used to camouflage any type of scalp scars.
Worldwide Techniques and Outcomes in Robot-assisted Minimally Invasive Esophagectomy (RAMIE)
Authors: Kingma B. Feike , Grimminger Peter P. , van der Sluis Pieter C. , van Det Marc J. , Kouwenhoven Ewout A. , Chao Yin-Kai , Tsai Chun-Yi , Fuchs Hans F. , Bruns Christiane J. , Sarkaria Inderpal S. , Luketich James D. , Haveman Jan W. , Etten Boudewijn van , Chiu Philip W. , Chan Shannon M. , Rouanet Philippe , Mourregot Anne , Hölzen Jens-Peter , Sallum Rubens A. , Cecconello Ivan , Egberts Jan-Hendrik , Benedix Frank , van Berge Henegouwen Mark I. , Gisbertz Suzanne S. , Perez Daniel , Jansen Kristina , Hubka Michal , Low Donald E. , Biebl Matthias , Pratschke Johann , Turner Paul , Pursnani Kish , Chaudry Asif , Smith Myles , Mazza Elena , Strignano Paolo , Ruurda Jelle P. , van Hillegersberg Richard ,   UGIRA Study Group
Published: November 2020

Objective:
This international multicenter study by the Upper GI International Robotic Association aimed to gain insight in current techniques and outcomes of RAMIE worldwide.

Background:
Current evidence for RAMIE originates from single-center studies, which may not be generalizable to the international multicenter experience.

Methods:
Twenty centers from Europe, Asia, North-America, and South-America participated from 2016 to 2019. Main endpoints included the surgical techniques, clinical outcomes, and early oncological results of ramie.

Results:
A total of 856 patients undergoing transthoracic RAMIE were included. Robotic surgery was applied for both the thoracic and abdominal phase (45%), only the thoracic phase (49%), or only the abdominal phase (6%). In most cases, the mediastinal lymphadenectomy included the low paraesophageal nodes (n=815, 95%), subcarinal nodes (n = 774, 90%), and paratracheal nodes (n = 537, 63%). When paratracheal lymphadenectomy was performed during an Ivor Lewis or a McKeown RAMIE procedure, recurrent laryngeal nerve injury occurred in 3% and 11% of patients, respectively. Circular stapled (52%), hand-sewn (30%), and linear stapled (18%) anastomotic techniques were used. In Ivor Lewis RAMIE, robot-assisted hand-sewing showed the highest anastomotic leakage rate (33%), while lower rates were observed with circular stapling (17%) and linear stapling (15%). In McKeown RAMIE, a hand-sewn anastomotic technique showed the highest leakage rate (27%), followed by linear stapling (18%) and circular stapling (6%).

Conclusion:
This study is the first to provide an overview of the current techniques and outcomes of transthoracic RAMIE worldwide. Although these results indicate high quality of the procedure, the optimal approach should be further defined.
Bare Versus Hair: Do Pubic Hair Grooming Preferences Dictate the Urogenital Microbiome?
Authors: Geynisman-Tan Julia , Kenton Kimberly , Tavathia Meera , Yee Alyson , Gilbert Jack A. , Collins Sarah , Lewicky-Gaupp Christina , Mueller Margaret 
Published: November 2020

Objective
The aim of the study was to determine whether the genitourinary microbiome differs between and within women with and without pubic hair.

Methods
Premenopausal women who self-identified into 2 groups were recruited: in the “hair” group, women did not remove any pubic hair, and in the “bare” group, all pubic hair was removed routinely. Participants submitted a vaginal swab, a voided urine sample, and a catheterized urine sample, and then “crossed over.” The “hair” group removed all hair for 1 month, and the “bare” group grew hair for 2 months. After crossover, participants again submitted a vaginal swab, a voided urine sample, and a catheterized urine sample. Ten participants acted as controls. DNA was extracted, and the V4 region of 16S rRNA gene was amplified and sequenced using the MiSeq platform. Paired-end sequences were imported into QIIME2-2018.6. Alpha diversity (the number and proportion of species in an individual sample) and beta diversity (differences in microbial composition between samples) were evaluated.

Results
Forty-two participants were analyzed: 16 “bare to hair” crossovers, 16 “hair-to-bare” crossovers, and 10 controls. The microbiome varied by sample type: vaginal swabs had the lowest alpha diversity and catheterized urine had the highest (P < 0.001). At baseline, there were no differences in the alpha or beta diversity of urine or vaginal microbiomes between groups. Vaginal beta diversity at visit 2 was greater within crossovers than controls (P = 0.004), suggesting that altering hair status alters the microbiome composition. Urinary beta diversity was not different at visit 2 (P = 0.40).

Conclusions
Pubic hair status does not determine one’s baseline genitourinary microbiome, but women who change their hair status may alter their vaginal microbiome.
Electroconvulsive Therapy in Refractory Obsessive-Compulsive Disorder
Authors: Martins-Correia João , Rodrigues-Silva Nuno , Nunes Susana 
Published: November 2020

Abstract
Electroconvulsive therapy (ECT) is a treatment of undisputed efficacy for severe and treatment-resistant psychiatric disorders. Notwithstanding extensive data on efficacy and safety, it is significantly underused, corresponding to one of the most stigmatized approaches in psychiatry. The list of problems for which ECT is potentially effective does not include obsessive-compulsive disorder (OCD), resulting in only a few available case reports in the literature in which OCD is the target of this specific therapeutic strategy. The authors describe a patient with refractory OCD for whom ECT was prescribed, with remarkable clinical response and functional improvement. The existence of a clear response to ECT in reported cases of OCD, albeit in a globally small number of patients, should make it essential to identify predictors of ECT response that could assist clinicians in assessing and guiding such cases, particularly those labeled as refractory to treatment.
Effects of continuous improvement in streamlining HRM practices
Authors: Wickramasinghe Vathsala , Chathurani M.N. 
Published: November 2020

PurposeThis study investigates the effect of continuous improvement initiatives in streamlining HRM practices in Sri Lanka.Design/methodology/approachSurvey methodology was used and 217 respondents who fulfilled the selection criteria set for the study responded. Structural equation modelling was performed to examine the hypothesized relationships.FindingsThe analysis supported the hypotheses that continuous improvement initiatives significantly positively influence to streamline HRM practices of performance management, job-related training, employee involvement and team work.Practical implicationsContinuous improvement initiatives that are aligned with the strategic direction of firms guide to design and implement better focused HRM practices.Originality/valueThe failure to streamline HRM practices in accordance with continuous improvement initiatives has been identified as a key barrier for the effective utilization of human resources. Although continuous improvement initiatives demand changes in the way HRM is practiced, so far, little empirical attention has been paid to understand the implications of continuous improvement initiatives for HRM practices.