bluuebunny/crossref_metadata_2025_split huggingface dataset:
Passive immune therapies: another tool against COVID-19
Authors: Estcourt Lise J. 
Published: December 2021

AbstractPassive immune therapy consists of several different therapies, convalescent plasma, hyperimmune globulin, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) neutralizing monoclonal antibodies. Although these treatments were not part of any pandemic planning prior to coronavirus disease 2019 (COVID-19), due to the absence of high-quality evidence demonstrating benefit in other severe respiratory infections, a large amount of research has now been performed to demonstrate their benefit or lack of benefit in different patient groups. This review summarizes the evidence up to July 2021 on their use and also when they should not be used or when additional data are required. Vaccination against SARS-CoV-2 is the most important method of preventing severe and fatal COVID-19 in people who have an intact immune system. Passive immune therapy should only be considered for patients at high risk of severe or fatal COVID-19. The only therapy that has received full regulatory approval is the casirivimab/imdevimab monoclonal cocktail; all other treatments are being used under emergency use authorizations. In Japan, it has been licensed to treat patients with mild to moderate COVID-19, and in the United Kingdom, it has also been licensed to prevent infection.
β-Thalassemia: evolving treatment options beyond transfusion and iron chelation
Authors: Langer Arielle L. , Esrick Erica B. 
Published: December 2021

Abstract
After years of reliance on transfusion alone to address anemia and suppress ineffective erythropoiesis in β-thalassemia, many new therapies are now in development. Luspatercept, a transforming growth factor–β inhibitor, has demonstrated efficacy in reducing ineffective erythropoiesis, improving anemia, and possibly reducing iron loading. However, many patients do not respond to luspatercept, so additional therapeutics are needed. Several medications in development aim to induce hemoglobin F (HbF): sirolimus, benserazide, and IMR-687 (a phosphodiesterase 9 inhibitor). Another group of agents seeks to ameliorate ineffective erythropoiesis and improve anemia by targeting abnormal iron metabolism in thalassemia: apotransferrin, VIT-2763 (a ferroportin inhibitor), PTG-300 (a hepcidin mimetic), and an erythroferrone antibody in early development. Mitapivat, a pyruvate kinase activator, represents a unique mechanism to mitigate ineffective erythropoiesis. Genetically modified autologous hematopoietic stem cell transplantation offers the potential for lifelong transfusion independence. Through a gene addition approach, lentiviral vectors have been used to introduce a β-globin gene into autologous hematopoietic stem cells. One such product, betibeglogene autotemcel (beti-cel), has reached phase 3 trials with promising results. In addition, 2 gene editing techniques (CRISPR-Cas9 and zinc-finger nucleases) are under investigation as a means to silence BCL11A to induce HbF with agents designated CTX001 and ST-400, respectively. Results from the many clinical trials for these agents will yield results in the next few years, which may end the era of relying on transfusion alone as the mainstay of thalassemia therapy.
Morphological analysis of posterior malleolar fractures with intra-articular impacted fragment in computed tomography scans
Authors: Xie Wenyong , Lu Hao , Xu Hailin , Quan Yuan , Liu Yijun , Fu Zhongguo , Zhang Dianying , Jiang Baoguo 
Published: December 2021

Abstract
Background
Intraarticular impacted fragment (IAIF) of posterior malleolar fractures has been reported by a few studies. However its location, morphology, and the correlation of posterior malleolar fractures have not been described in detail. The aim of this study was to describe the morphology of IAIF in posterior malleolar fractures, to analyze the related factors between IAIF and posterior malleolar fragments, and explore the treatment of IAIF.

Materials and methods
Between January 2013 and December 2018, 108 consecutive patients with unilateral posterior malleolar fractures were managed in our hospital. Basic demographic and computed tomography (CT) data were collected and classified by Lauge–Hansen, OTA/AO, Haraguchi, and Mason classification. Additional radiographic data, including the length and area of posterior malleolar fragment, IAIF, and stable tibial plafond were measured. The location of IAIF was described, and involvement of the fibular notch and medial malleolus was also observed. Statistics were analyzed based on univariate analysis (Chi-square test, t-test, Mann–Whitney U test, Fisher’s test) and Spearman’s correlation test.

Results
Among the 108 cases of posterior malleolar fractures, 75 (69.4%) were with IAIF and 33 (30.6%) cases were without. There were 74 (68.5%) females and 34 (31.5%) males, and the average age of the patients was 49 years (18–89 years). The average LIFN/(LIFN + LSFN) [length of involving fibular notch/(length of involving fibular + length of stable notch fibular notch)] was 32.9% (11.6–64.9%). The APMF/(APMF + ASTP + AIAIF) [area of posterior malleolar fragment/(area of posterior malleolar fragment + area of IAIF + area of stable tibial plafond)] and AIAIF/APMF (area of IAIF/area of posterior malleolar fragment) were 13.1% (0.8–39.7%) and 52.6% (1.2–235.4%), respectively. Involvement of medial malleolus (fracture line extended to medial malleolus, P = 0.022), involvement of fibular notch (P = 0.021), LIFN/(LIFN + LSFN) (P = 0.037), LMPMF (P = 0.004), and APMF were significantly related to the occurrence of IAIF.

Conclusion
Our research indicates a high incidence of IAIF in posterior malleolar fractures. All IAIFs were found in posterior malleolar, and the most common location was within the lateral area A. Posterior malleolar fracture lines that extend to medial malleolus or fibular notch herald the incidence of IAIF. LIFN/(LIFN + LSFN), LMPMF and APMF are also associated with the incidence of IAIF. CT scans are useful for posterior malleolar fractures to determine the occurrence of IAIF and make operational plans. Operation approach selection should be based on the morphology of posterior malleolar fragments and the location of IAIF.

Level of evidence
Level III, retrospective case analysis.
Unexpected difficult extubation of double lumen bronchial intubation: a case report
Authors: Zhang Xingcai , Tang Shumiao , Lu Zihui , Chen Yijun 
Published: December 2021

AbstractBackgroundThe anesthetist and other members of the perioperative team need to be extremely cautious for successful completion of any surgery. If the final step of any general anesthetic-extubation is not sufficiently well planned, it can lead to critical airway incidents during the extubation and hinder transportation of the patient to the post-anesthesia care unit.Case presentationA 48-year-old female underwent video-assisted thoracoscopic surgery (VATS) combined with left lower lobectomy. The distal end of the left branch of the tracheal tube was lodged by surgical sutures. In this case, the respiratory physician burned the sutures using an argon electrode, after discussion with the thoracic surgery experts.ConclusionsTeamwork is essential when caring for a patient with a shared airway. The anesthetist and surgeon must communicate well with each other to achieve optimal surgical outcomes. Importantly, testing the patency of the ETT prior to extubation should be a regular procedure, which is practical significance to guide safe extubation.
Is measurement of central venous pressure required to estimate systemic vascular resistance? A retrospective cohort study
Authors: Oh Chahyun , Noh Chan , Hong Boohwi , Shin Suyeon , Jeong Kuhee , Lim Chaeseong , Kim Yoon-Hee , Lee Soomin , Lee Sun Yeul 
Published: December 2021

Abstract
Background
The clinical range of central venous pressure (CVP) (typically 5 to 15 mmHg) is much less than the range of mean arterial blood pressure (60 to 120 mmHg), suggesting that CVP may have little impact on estimation of systemic vascular resistance (SVR). The accuracy and feasibility of using an arbitrary CVP rather than actual CVP for the estimation of SVR during intraoperative period is not known.

Methods
Using vital records obtained from patients who underwent neurological and cardiac surgery, the present study retrospectively calculated SVR using fixed values of CVP (0, 5, 10, 15, and 20 mmHg) and randomly changing values of CVP (5 to 15 mmHg) and compared these calculated SVRs with actual SVR, calculated using actual CVP. Differences between actual SVR and SVRs based on fixed and random CVPs were quantified as root mean square error (RMSE) and mean absolute percentage error (MAPE). Bland-Altman analysis and four-quadrant plot analysis were performed.

Results
A total of 34 patients are included, including 18 who underwent neurosurgery and 16 who underwent cardiac surgery; 501,380 s (139.3 h) of data was analyzed. The SVR derived from a fixed CVP of 10 mmHg (SVRf10) showed the highest accuracy (RMSE: 115 and 104 [dynes/sec/cm− 5] and MAPE: 6.3 and 5.7% in neurological and cardiac surgery, respectively). The 95% limits of agreement between SVRf10 and actual SVR were − 208.5 (95% confidence interval [CI], − 306.3 to − 148.1) and 242.2 (95% CI, 181.8 to 340.0) dynes/sec/cm− 5 in neurosurgery and − 268.1 (95% CI, − 367.5 to − 207.7) and 163.2 (95% CI, 102.9 to 262.6) dynes/sec/cm− 5 in cardiac surgery. All the SVRs derived from the fixed CVPs (regardless of its absolute value) showed excellent trending ability (concordance rate > 0.99).

Conclusions
SVR can be estimated from a fixed value of CVP without causing significant deviation or a loss of trending ability. However, caution is needed when using point estimates of SVR when the actual CVP is expected to be out of the typical clinical range.

Trial registration
This study was registered Clinical Research Information Service, a clinical trial registry in South Korea (KCT0006187).
The effects of erector spinae plane block on perioperative opioid consumption and rehabilitation in video assisted thoracic surgery
Authors: Zhang Sen , Han Xiaodan , Zhou Di , Sun Minli , Cang Jing , Miao Changhong , Liang Chao 
Published: December 2021

Abstract
Background
This study aimed to determine whether ultrasound-guided continuous erector spinae plane block (ESPB) had an effect on opioid consumption and postoperative rehabilitation in patients undergoing video-assisted thoracic surgery (VATS).

Methods
In this prospective study, 120 patients aged 20–70 years who underwent elective VATS were randomly allocated to one of three groups: group C (general anesthesia with patient-controlled intravenous analgesia [PCIA]), group T (general anesthesia with patient-controlled epidural analgesia [PCEA]), or group E (general anesthesia with continuous ESPB and PCIA). Perioperative opioid consumption, visual analog scale (VAS) scores, preoperative and postoperative Quality of Recovery-15 scores, and postoperative opioid-related adverse events were all assessed.

Results
Intraoperative sufentanil consumption in groups T and E was significantly lower than that in group C (both P < 0.001), and the postoperative sufentanil consumption in group E was also significantly lower than that in group C (P = 0.001). Compared with group C, the VAS scores at rest or during coughing immediately out of the post-anesthesia care unit at 6 h, 12 h, and 24 h postoperatively were significantly lower in group T (P < 0.05). However, the VAS scores at rest at 6 h and 12 h postoperatively in group E were lower than those of group C (P < 0.05), but were significantly higher than those of group T at all study times (P < 0.05).

Conclusion
Ultrasound-guided continuous ESPB significantly reduced perioperative opioid consumption during VATS and improved postoperative rehabilitation. However, these effects were inferior to those of thoracic epidural anesthesia.

Trial registration
The present study was prospectively registered at http://www.chictr.org/cn /(registration number: ChiCTR1900023050); registration date: May 82,019.
Parkinson’s disease with a typical clinical course of 17 years overlapped by Creutzfeldt–Jakob disease: an autopsy case report
Authors: Kubo Shin-ichiro , Matsubara Tomoyasu , Taguchi Takeshi , Sengoku Renpei , Takeuchi Atsuko , Saito Yuko 
Published: December 2021

Abstract
Background
Late-stage Parkinson’s disease (PD) often presents with neuropsychiatric symptoms such as dementia, psychosis, excessive daytime sleepiness, apathy, depression, and anxiety. However, neuropsychiatric symptoms are the cardinal features of Creutzfeldt–Jakob disease (CJD), raising the possibility that CJD may be an overlooked condition when it accompanies late-stage PD.

Case presentation
We describe a female autopsy case of PD with a typical clinical course of 17 years, in which CJD overlapped with PD during the final year of the patient’s life. The patient died aged 85 years. Neuropathological features included widespread Lewy body-related α-synucleinopathy predominantly in the brainstem and limbic system, as well as the typical pathology of methionine/methionine type 1 CJD in the brain.

Conclusions
Our case demonstrates the clinicopathological co-occurrence of PD and CJD in a sporadic patient. The possibility of mixed pathology, including prion pathology, should be taken into account when neuropsychiatric symptoms are noted during the disease course of PD.
Selective termination of the fetus in multiple pregnancies using ultrasound-guided radiofrequency ablation
Authors: Li Nan , Sun Jimei , Wang Jiayan , Jian Wei , Lu Jing , Miao Yonghui , Li Yufan , Chen Fei , Chen Dunjin , Ye Xiaoqing , Chen Min 
Published: December 2021

Abstract
Background
To evaluate the perinatal outcomes in women with selective termination using ultrasound-guided radiofrequency ablation (RFA).

Methods
Complicated monochorionic (MC) twin pregnancies and multiple pregnancies with an indication for selective termination by ultrasound-guided coagulation of the umbilical cord with RFA under local anesthesia between July 2013 and Jan 2020 were reviewed. We analyzed the indications, gestational age at the time of the procedure, cycles of RFA, duration of the procedure, and perinatal outcome.

Results
Three hundred and thirteen patients were treated during this period. Seven of whom were lost of follow-up. The remaining 306 cases, including 266 pairs of monochorionic diamniotic (MCDA) twins (86.93%), two pairs of monoamniotic twins (0.65%), 30 dichorionic triamniotic (DCTA) triplets (1%), and three monochorionic triamniotic (MCTA) triplets (0.98%), were analyzed. Indications included twin-to-twin transfusion syndrome (TTTS) (n = 91), selective fetal growth restriction (sFGR) (n = 83), severe discordant structural malformation (n = 78), multifetal pregnancy reduction (MFPR) (n = 78), twin reverse arterial perfusion sequence (TRAPS) (n = 19), and twin anemia-polycythemia sequence (TAPS) (n = 3). Upon comparison of RFA performed before and after 20 weeks, the co-twin loss rate (20.9% vs. 21.5%), the incidence of preterm premature rupture of membranes (PPROM) within 24 h (1.5% vs. 1.2%), and the median gestational age at delivery [35.93 (28–38) weeks vs. 36 (28.54–38.14) weeks] were similar (p > 0.05).

Conclusions
RFA is a reasonable option when indicated in multiple pregnancies and complicated monochorionic pregnancies. In our experience, the overall survival rate was 78.76% with RFA in selective feticide, and early treatment increases the likelihood of survival for the remaining fetus because the fetal loss rate is similar before and after 20 weeks.
Red flags of poor prognosis in pediatric cases of COVID-19: the first 6610 hospitalized children in Iran
Authors: Madani Sedigheh , Shahin Sarvenaz , Yoosefi Moein , Ahmadi Naser , Ghasemi Erfan , Koolaji Sogol , Mohammadi Esmaeil , Mohammadi Fateh Sahar , Hajebi Amirali , Kazemi Ameneh , Pakatchian Erfan , Rezaei Negar , Jamshidi Hamidreza , Larijani Bagher , Farzadfar Farshad 
Published: December 2021

Abstract
Introduction
COVID-19 clinical course, effective therapeutic regimen, and poor prognosis risk factors in pediatric cases are still under investigation and no approved vaccinehas been introduced for them.

Methods
This cross-sectional study evaluated different aspect of COVID-19 infection in hospitalized COVID-19 positive children (≺18 years oldwith laboratory confirmed COVID-19 infection, using the national COVID-19 registry for all admitted COVID-19 positive cases from February 19 until November 13,2020, in Iran.

Results
We evaluated 6610 hospitalized children. Fifty-four percent (3268) were male and one third of them were infants younger than 1 year. Mortality rate in total hospitalized children was 5.3% and in children with underlying co-morbidities (14.4%) was significantly higher (OR: 3.6 [2.7-4.7]). Chronic kidney disease (OR: 3.42 [1.75-6.67]), Cardiovascular diseases (OR: 3.2 [2.09-5.11]), chronic pulmonary diseases (OR: 3.21 [1.59-6.47]), and diabetes mellitus (OR: 2.5 [1.38-4.55]), resulted in higher mortality rates in hospitalized COVID-19 children. Fever (41%), cough (36%), and dyspnea (27%) were the most frequent symptoms in hospitalized children and dyspnea was associated with near three times higher mortality rate among children with COVID-19 infection (OR: 2.65 [2.13-3.29]).

Conclusion
Iran has relatively high COVID-19 mortality in hospitalized children. Pediatricians should consider children presenting with dyspnea, infants≺ 1 year and children with underlying co-morbidities, as high-risk groups for hospitalization, ICU admission, and death.
Community-based interventions to reduce dental caries among 24-month old children: a pilot study of a field trial
Authors: Deghatipour Marzie , Ghorbani Zahra , Mokhlesi Amir Hossein , Ghanbari Shahla , Namdari Mahshid 
Published: December 2021

Abstract
Background
Early childhood caries (ECC) is the most common dental disease among children worldwide, leading to many difficulties on child’s growth. As WHO mentioned, educational interventions in addition to interprofessional collaboration are needed to achieve proper ECC prevention. In present study we’ve aimed to evaluate the effectiveness of some oral health promotion interventions to reduce dental caries among 24-month old children.

Methods
A field trial study was conducted amongst 439 mothers from pregnancy up to 24 months after delivery in Public Health Centers in Varamin, Tehran, Iran. Participants were allocated to intervention (n = 239) and control groups (n = 200). Demographic, socioeconomic status and dental care behavior data were collected using a questionnaire. The content of our study intervention consisted of nutritional and behavioral oral health-related messages. Mothers received messages via either of four methods (A: comprehensive method including all other methods together (n = 74), B: group discussion by dentists (n = 59), C: face to face education by primary health care providers (n = 53), and D: social network (n = 53). The control group received routine maternal and oral health care. To assess the effectiveness of interventions on promoting children’s oral health, the oral health-related behaviors data, the number of decayed teeth (d), and being caries free at the age of two were considered.

Results
Among the 436 examined children, with a mean age of 23.7 months, 48.2% were male. The frequency of using finger toothbrush increased from 53.4% to 89.8% in all intervention groups. The mean (SD) of decayed teeth at 24 months in intervention and control group were 0.36 (0.93) and 1.61 (2.61), respectively. All the four intervention groups, except social network, had more chance of being caries free compared to control group (P value < 0.05). Analysis showed that children in comprehensive intervention group had a higher chance of being caries free compared to all other groups, after adjustment for covariates.

Conclusions
Performing oral health interventions could help the prevention of dental caries in newborn children. Also, using a combination of different methods of sending messages can have the best results in promoting oral health.
Qualitative assessment of the intention of Chinese community health workers to implement advance care planning using theory of planned behavior
Authors: Xing Bingyu , Liang Guanmian , Zhang Jing , Zhang Jinsheng , Jiang Zhizhi , Miao Qunfang 
Published: December 2021

AbstractBackgroundThe aging population coupled with progressive medical technology has increased the demand for improved quality of end-of-life in China. However, implementation of an advance care planning (ACP) program in mainland China is still in its infancy owing to the significant influence of filial piety in Chinese culture. Research on implementation of ACP program among community health workers (CHWs) is limited. The current study sought to explore the willingness of CHWs to implement ACP based on the theory of planned behavior (TPB) and provide a reference for promotion of ACP in Chinese communities.MethodsPhenomenological qualitative study using semi-structured face-to-face interviews. Interviews were audio-recorded. Colaizzi’s method was used for data analysis. The study received ethical approval and all participants provided written consent.ResultsThirteen CHWs from 3 community health service centers (CHSCs) in Hangzhou, Zhejiang Province, China were interviewed. Through the analysis of the interview content, we determined that most CHWs have a supportive attitude towards the implementation of ACP, the reasons for which are as follows: relieve suffering of patients and respect their medical autonomy; relieve economic and psychological burden on family members; promote development of community palliative care. However, some CHWs believe that the implementation of ACP will lead to doctor-patient disputes and medical risks. CHWs reported that the support of patients and their families, community lawyers, psychosocial professionals, and CHSCs senior managers helped them to implement ACP. In addition, they indicated that the improvement of doctor-patient communication ability, the improvement of community medical environment, the support of government policy, and the training of CHWs were the promoting factors influencing their implementation of ACP. The hindrance factors include insufficient allocation of community health human resources, imperfect ACP legislation in China, and deep-rooted traditional culture.ConclusionFindings demonstrated that Chinese CHWs tend to support the implementation of ACP, but their willingness to implement is affected by different factors. CHSCs should actively organize standardized ACP training and comprehensively consider community medical environment, organizational norms, and human resources in implementation of ACP.