bluuebunny/crossref_metadata_2025_split huggingface dataset:
SARS-CoV-2 in eight municipalities of the Colombian tropics: high immunity, clinical and sociodemographic outcomes
Authors: Garay Evelin , Serrano-Coll Héctor , Rivero Ricardo , Gastelbondo Bertha , Faccini-Martínez Álvaro , Berrocal José , Pérez Alejandra , Badillo María , Martínez-Bravo Caty , Botero Yesica , Arrieta Germán , Calderón Alfonso , Galeano Ketty , López Yesica , Miranda Jorge , Guzmán Camilo , Contreras Verónica , Arosemena Alejandra , Contreras Héctor , Brango-Tarra Eimi , Oviedo Misael , Mattar Salim 
Published: June 2021

Abstract

Background
Serological evaluation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an alternative that allows us to determine the prevalence and dynamics of this infection in populations. The goal of this study was to determine the clinical and sociodemographic dynamics of SARS-CoV-2 infection in a region of the Colombian Caribbean.

Methods
Between July and November 2020, a cross-sectional observational study was carried out in Córdoba, located in northeast Colombia in the Caribbean area. Eight municipalities with the largest populations were chosen and 2564 blood samples were taken. A commercial enzyme-linked immunosorbent assay was used with the recombinant protein antigen N of SARS-CoV-2. The people included in the study were asked for sociodemographic and clinical data, which were analysed by statistical methods.

Results
A seroprevalence of 40.8% was obtained for SARS-CoV-2 in the Córdoba region. In the bivariate analysis, no differences were observed in seropositivity against SARS-CoV-2 for gender or age range (p&gt;0.05). Higher seropositivity was found in low socio-economic status and symptomatic patients (p&lt;0.0001). A total of 30.7% of the asymptomatic patients were seropositive for SARS-CoV-2, which could be linked to the spread of this infection. In the multivariate analysis, seroconversion was related to poverty and clinical manifestations such as anosmia and ageusia (p&lt;0.05).

Conclusions
The high seropositivity in Córdoba is due to widespread SARS-CoV-2 in this population. The relationship between seropositivity and socio-economic status suggests a higher exposure risk to the virus caused by informal economic activities in low-income groups. Clinical manifestations such as anosmia and ageusia could be clinical predictors of infection by the new emergent coronavirus.
Inches, Centimeters, and Yards
Authors: Dasgupta Nabarun , Wang Yanning , Bae Jungjun , Kinlaw Alan C. , Chidgey Brooke A. , Cooper Toska , Delcher Chris 
Published: June 2021

Objective:
Morphine-standardized doses are used in clinical practice and research to account for molecular potency. Ninety milligrams of morphine equivalents (MME) per day are considered a “high dose” risk threshold in guidelines, laws, and by payers. Although ubiquitously cited, the “CDC definition” of daily MME lacks a clearly defined denominator. Our objective was to assess denominator-dependency on “high dose” classification across competing definitions.

Methods:
To identify definitional variants, we reviewed literature and electronic prescribing tools, yielding 4 unique definitions. Using Prescription Drug Monitoring Programs data (July to September 2018), we conducted a population-based cohort study of 3,916,461 patients receiving outpatient opioid analgesics in California (CA) and Florida (FL). The binary outcome was whether patients were deemed “high dose” (>90 MME/d) compared across 4 definitions. We calculated I
2 for heterogeneity attributable to the definition.

Results:
Among 9,436,640 prescriptions, 42% overlapped, which led denominator definitions to impact daily MME values. Across definitions, average daily MME varied 3-fold (range: 17 to 52 [CA] and 23 to 65 mg [FL]). Across definitions, prevalence of “high dose” individuals ranged 5.9% to 14.2% (FL) and 3.5% to 10.3% (CA). Definitional variation alone would impact a hypothetical surveillance study trying to establish how much more “high dose” prescribing was present in FL than CA: from 39% to 84% more. Meta-analyses revealed strong heterogeneity (I
2 range: 86% to 99%). In sensitivity analysis, including unit interval 90.0 to 90.9 increased “high dose” population fraction by 15%.

Discussion:
While 90 MME may have cautionary mnemonic benefits, without harmonization of calculation, its utility is limited. Comparison between studies using daily MME requires explicit attention to definitional variation.
Preclinical Safety of a 3D-Printed Hydroxyapatite-Demineralized Bone Matrix Scaffold for Spinal Fusion
Authors: Plantz Mark , Lyons Joseph , Yamaguchi Jonathan T. , Greene Allison C. , Ellenbogen David J. , Hallman Mitchell J. , Shah Vivek , Yun Chawon , Jakus Adam E. , Procissi Daniele , Minardi Silvia , Shah Ramille N. , Hsu Wellington K. , Hsu Erin L. 
Published: June 2021

Study Design.
Prospective, randomized, controlled preclinical study.

Objective.
The objective of this study was to compare the host inflammatory response of our previously described hyperelastic, 3D-printed (3DP) hydroxyapatite (HA)-demineralized bone matrix (DBM) composite scaffold to the response elicited with the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in a preclinical rat posterolateral lumbar fusion model.

Summary of Background Data.
Our group previously found that this 3D-printed HA-DBM composite material shows promise as a bone graft substitute in a preclinical rodent model, but its safety profile had yet to be assessed.

Methods.
Sixty female Sprague-Dawley rats underwent bilateral posterolateral intertransverse lumbar spinal fusion using with the following implants: 1) type I absorbable collagen sponge (ACS) alone; 2) 10 μg rhBMP-2/ACS; or 3) the 3DP HA-DBM composite scaffold (n = 20). The host inflammatory response was assessed using magnetic resonance imaging, while the local and circulating cytokine expression levels were evaluated by enzyme-linked immunosorbent assays at subsequent postoperative time points (N = 5/time point).

Results.
At both 2 and 5 days postoperatively, treatment with the HA-DBM scaffold produced significantly less soft tissue edema at the fusion bed site relative to rhBMP-2-treated animals as quantified on magnetic resonance imaging. At every postoperative time point evaluated, the level of soft tissue edema in HA-DBM-treated animals was comparable to that of the ACS control group. At 2 days postoperatively, serum concentrations of tumor necrosis factor-α and macrophage chemoattractant protein-1 were significantly elevated in the rhBMP-2 treatment group relative to ACS controls, whereas these cytokines were not elevated in the HA-DBM-treated animals.

Conclusion.
The 3D-printed HA-DBM composite induces a significantly reduced host inflammatory response in a preclinical spinal fusion model relative to rhBMP-2.

Level of Evidence: N/A
Setting the Beta-Lactam Therapeutic Range for Critically Ill Patients: Is There a Floor or Even a Ceiling?
Authors: Barreto Erin F. , Webb Andrew J. , Pais Gwendolyn M. , Rule Andrew D. , Jannetto Paul J. , Scheetz Marc H. 
Published: June 2021

OBJECTIVES:
Beta-lactam antibiotics exhibit high interindividual variability in drug concentrations in patients with critical illness which led to an interest in the use of therapeutic drug monitoring to improve effectiveness and safety. To implement therapeutic drug monitoring, it is necessary to define the beta-lactam therapeutic range—in essence, what drug concentration would prompt a clinician to make dose adjustments up or down. This objective of this narrative review was to summarize evidence for the “floor” (for effectiveness) and “ceiling” (for toxicity) for the beta-lactam therapeutic range to be used with individualized therapeutic drug monitoring.

DATA SOURCES:
Research articles were sourced from PubMed using search term combinations of “pharmacokinetics,” “pharmacodynamics,” “toxicity,” “neurotoxicity,” “therapeutic drug monitoring,” “beta-lactam,” “cefepime,” “meropenem,” “piperacillin/tazobactam,” “ICU,” and “critical illness.”

STUDY SELECTION:
Articles were selected if they included preclinical, translational, or clinical data on pharmacokinetic and pharmacodynamic thresholds for effectiveness and safety for beta-lactams in critical illness.

DATA SYNTHESIS:
Experimental data indicate a beta-lactam concentration above the minimum inhibitory concentration of the organism for greater than or equal to 40–60% of the dosing interval is needed, but clinical data indicate that higher concentrations may be preferrable. In the first 48 hours of critical illness, a free beta-lactam concentration at or above the susceptibility breakpoint of the most likely pathogen for 100% of the dosing interval would be reasonable (typically based on Pseudomonas aeruginosa). After 48 hours, the lowest acceptable concentration could be tailored to 1–2× the observed minimum inhibitory concentration of the organism for 100% of the dosing interval (often a more susceptible organism). Neurotoxicity is the primary dose-dependent adverse effect of beta-lactams, but the evidence remains insufficient to link a specific drug concentration to greater risk.

CONCLUSIONS:
As studies advance the understanding of beta-lactam exposure and response in critically ill patients, it is essential to clearly define the acceptable therapeutic range to guide regimen selection and adjustment.
Operationalizing Ethical Guidance for Ventilator Allocation in Minnesota: Saving the Most Lives or Exacerbating Health Disparities?
Authors: Kesler Sarah M. , Wu Joel T. , Kalland Krystina R. , Peter Logan G. , Wothe Jillian K. , Needle Jennifer K. , Wang Qi , Weinert Craig R. 
Published: June 2021

OBJECTIVES:
A statewide working group in Minnesota created a ventilator allocation scoring system in anticipation of functioning under a Crisis Standards of Care declaration. The scoring system was intended for patients with and without coronavirus disease 2019. There was disagreement about whether the scoring system might exacerbate health disparities and about whether the score should include age. We measured the relationship of ventilator scores to in-hospital and 3-month mortality. We analyzed our findings in the context of ethical and legal guidance for the triage of scarce resources.

DESIGN:
Retrospective cohort study.

SETTING:
Multihospital within a single healthcare system.

PATIENTS:
Five-hundred four patients emergently intubated and admitted to the ICU.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
The Ventilator Allocation Score was positively associated with higher mortality (p < 0.0001). The 3-month mortality rate for patients with a score of 6 or higher was 96% (42/44 patients). Age was positively associated with mortality. The 3-month mortality rate for patients 80 and older with scores of 4 or greater was 93% (40/43 patients). Of patients assigned a score of 5, those with end stage renal disease had lower mortality than patients without end stage renal disease although the difference did not achieve statistical significance (n = 27; 25% vs 58%; p = 0.2).

CONCLUSIONS:
The Ventilator Allocation Score can accurately identify patients with high rates of short-term mortality. However, these high mortality patients only represent 27% of all the patients who died, limiting the utility of the score for allocation of scarce resources. The score may unfairly prioritize older patients and inadvertently exacerbate racial health disparities through the inclusion of specific comorbidities such as end stage renal disease. Triage frameworks that include age should be considered. Purposeful efforts must be taken to ensure that triage protocols do not perpetuate or exacerbate prevailing inequities. Further work on the allocation of scarce resources in critical care settings would benefit from consensus on the primary ethical objective.
Simultaneous Application of High-Intensity Focused Electromagnetic and Synchronized Radiofrequency for Fat Disruption: Histological and Electron Microscopy Porcine Model Study
Authors: Weiss Robert A. , Bernardy Jan , Tichy Frantisek 
Published: June 2021

BACKGROUND
Radiofrequency (RF) and high-intensity focused electromagnetic (HIFEM) technologies are used for noninvasive body shaping as standalone modalities.

OBJECTIVE
To examine the effects of novel synchronized RF and HIFEM on subcutaneous adipose tissue in a porcine animal model.

MATERIALS AND METHODS
Seven large white pigs aged 6 months received 3 abdominal treatments of simultaneous application of synchronized RF and HIFEM (30 minutes, once per week). Punch biopsies of treated and control subcutaneous tissue were collected at the baseline, 4 days, 2 weeks, 1 month, and 2 months. Specimens were examined by light and scanning electron microscopy. Adipocyte volume was analyzed. Fat tissue temperature was measured in situ (fiber optic probes) and superficially (thermal imager).

RESULTS
Fat layer was heated to temperatures of 42 to 45°C. Signs of fat apoptosis (shape alternations and pyknotic nuclei) appeared at day 4 and peaked between 2 weeks and 1 month. Adipocyte volume decreased significantly (p < .001) by 31.1% at 2 weeks, 1 month (−23.6%), and 2 months (−22.0%). Control samples showed healthy adipocytes. Scanning electron microscopy micrographs corroborated histology findings, showing flattened, volume-depleted and disrupted adipocytes.

CONCLUSION
Synchronized RF with HIFEM procedure resulted in a significant and sustained fat reduction with no adverse events.
Long-Term Utility of Follicular Unit Excision in Lichen Planopilaris—Correlation of Graft Survival With Histopathological and Ultrasound Biomicroscopic Parameters
Authors: Daruwalla Sanober Burzin , Dhurat Rachita , Ghate Smita , Bhatt Kalpana 
Published: June 2021

BACKGROUND
Hair transplantation in scarring alopecia is challenging and transplant surgeons are hesitant due to fear of poor graft survival apart from the risk of reactivating the disease.

OBJECTIVE
Survival rate of hair follicles transplanted in cases of lichen planopilaris (LPP). To correlate histopathological and ultrasonography findings and their impact on graft survival.

METHODS
In 32 patients of inactive LPP included, a 5-cm2 recipient area was tattooed. The follicular unit density of the transplanted area was 20 to 25 FU/cm2. Postoperative follow-up was conducted at 6, 12, and 24 months. The recipient area density and ultrasound biomicroscopic parameters were assessed at each follow-up visit.

RESULTS
The survival of grafts was 78.62% at 12 months, and 79.96% at 24 months. Histopathology variables studied at the time of transplantation such as epidermal atrophy, fibrosis, and inflammatory infiltrate were not found to have any effect on the graft survival. Ultrasonography parameters of the involved scalp skin were found to be markedly improved on follow-up. This suggests that the overall health of the scalp improved after hair transplantation.

CONCLUSION
Follicular unit excision is a ray of hope for cases of primary cicatricial alopecia such as LPP because the result is satisfying to both the patient as well as the doctor.
Ten-Year Follow-up of Lamellar Keratoplasty Treatment With Acellular Porcine Corneal Stroma: A Case Report
Authors: Xiao Yu-Ting , Zhao Xin-Yue , Liu Xin , Xie Hua-Tao , Zhang Ming-Chang 
Published: June 2021

Purpose:
To report a 10-year follow-up case of the first lamellar keratoplasty treatment with acellular porcine corneal stroma (APCS).

Methods:
A 62-year-old woman was diagnosed with a fungal corneal ulcer and received lamellar keratoplasty treatment with APCS in 2010. The 10-year follow-up results were evaluated by slit lamp biomicroscopy, anterior segment optical coherence tomography, in vivo confocal microscopy, and corneal biomechanics analysis.

Results:
The APCS graft maintained good biocompatibility and physical properties in transparency, stromal regeneration, elasticity, and deformation resistance. However, some disadvantages were observed, including a protracted course to eventual clearing, a decreased thickness, corneal depositions, sparsely distributed neural fibers, and low stiffness.

Conclusions:
This case indicated that APCS remains stable over a 10-year follow-up period. APCS can serve as a functional stromal surrogate where donor human corneal tissue is unavailable.
Keratoconus: Diagnosis and Staging
Authors: Belin Michael W. , Jang Hyun Soo , Borgstrom Mark 
Published: June 2021

Abstract:
The advent of refractive surgery and corneal cross-linking for ectatic disease has further highlighted the need to recognize early or subclinical ectatic disease. Historical systems depend on anterior corneal changes that occur late in the disease course and are commonly associated with visual loss. Tomographic imaging allows for the acquisition of posterior corneal surface data and corneal thickness distribution. This led to the development of modalities to diagnose early or subclinical keratoconus and to screen patients for refractive surgery.
This article reviews the modern methods for assessing changes in posterior corneal surface and pachymetric distribution, now accepted by the major cornea societies to be the hallmarks of ectatic disease. Screening tools utilized by the commonly used tomographic imaging devices are discussed, and the difference between screening for ectasia and diagnosing keratoconus is highlighted. The Belin ABCD staging and classification system and the ABCD Progression Display are reviewed as a new grading and monitoring system that can be used for earlier intervention and prevention of visual loss in keratoconus.
Effectiveness of a Tele-Ophthalmology Vision Center in Treating Corneal Disorders and Its Associated Economic Benefits
Authors: Komal Sangoi , Radhakrishnan Naveen , Vardhan S Ashok , Prajna N. Venkatesh 
Published: June 2021

Purpose:
The aim of this study was to study the clinical and economic impact of a teleophthalmology-based vision center (VC) in the management of corneal diseases in rural south India.

Methods:
Data of patients with corneal disorders who visited the VC in the year 2019 were analyzed for the total number of outpatient visits, the proportion of corneal cases that were treated at the VC, those referred to the base hospital (BH), and the costs of treatment.

Results:
In 2019, 1131 (10%) of 10,850 patients who visited the VC were diagnosed with corneal disorders. Of these, 950 (84%) patients were treated at the VC itself and did not require to be referred. The remaining 181 (16%) were referred to the BH. Of these 1131 patients, 836 (74%) patients presented with a painful acute corneal disorder. The most common painful acute corneal disorders included corneal foreign body (376, 33%), epithelial abrasions (205, 18%), and infectious keratitis (124, 11%). A patient can save approximately a minimum of INR 1200 (USD 16) by attending the VC rather than the BH. In 2019, by treating 950 patients, the VC saved approximately INR 114,0000 (USD 15,200) for the community. A similar calculation extrapolated to a 10-year period (2009–2019) revealed that by providing care for these corneal disorders at the community level, the VC saved approximately INR 705,8400 (USD 94,112) for the community.

Conclusions:
VC reduces the barriers to care by increasing the accessibility and affordability of treatment for patients with corneal disorders, resulting in a significant cost saving to the community.
Comparison of DMEK and DSAEK in Eyes With Endothelial Decompensation After Previous Penetrating Keratoplasty
Authors: Kiel Marian , Bu Julia Bing , Gericke Adrian , Vossmerbaeumer Urs , Schuster Alexander K. , Pfeiffer Norbert , Wasielica-Poslednik Joanna 
Published: June 2021

Purpose:
Posterior lamellar keratoplasty is increasingly applied in patients with endothelial decompensation after penetrating keratoplasty (PK). The aim of this study was to compare the results of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) after PK.

Methods:
In this retrospective study, clinical data of 30 patients who received DMEK (n = 19) or DSAEK (n = 11) for endothelial decompensation after PK were evaluated. All lamellar keratoplasties were performed at the Department of Ophthalmology at University Hospital Mainz, Germany. Primary end point included best-corrected visual acuity, and secondary end points included endothelial cell density, rebubbling, and rejection rates, all at 6 and 12 months.

Results:
After 6 months and 12 months, 89% of DMEK and 73% of DSAEK grafts and 63% of DMEK and 64% of DSAEK grafts provided sufficient corneal deturgescence, respectively, represented by improvement in best-corrected visual acuity. DMEK group median preoperative Logarithm of the Minimum Angle of Resolution visual acuity of 1 increased to 0.5 after 6 and 12 months. DSAEK group median Logarithm of the Minimum Angle of Resolution visual acuity increased from 3 to 2 and 1.3 after 6 and 12 months. After 12 months, graft endothelial cell density had decreased by 58% in the DMEK group and by 59% in the DSAEK group. The proportion of patients requiring a rebubbling were 63% in the DMEK and 64% in the DSAEK group. No lamellar graft rejection occurred in either trial arm.

Conclusions:
Both DMEK and DSAEK significantly improved visual acuity in patients after PK. Lamellar graft survival, loss of endothelial cells, and mean rebubbling rates were similar in both groups.
Old drugs for a new indication: a review of chloroquine and analogue in COVID-19 treatment
Authors: Ehianeta Teddy S. , Akinyeye Richard O. , Orege Joshua I. , Ejeromedoghene Onome , Adebule Adeniyi P. , Okonkwo Bright O. 
Published: June 2021

Abstract
As an innovative therapeutic strategy, drug repurposing affords old, approved, and already established drugs a chance at new indications. In the wake of the COVID-19 pandemic and the accompanied urgency for a lasting treatment, drug repurposing has come in handy to stem the debilitating effects of the disease. Among other therapeutic options currently in clinical trials, chloroquine (CQ) and the hydroxylated analogue, hydroxychloroquine (HCQ) have been frontline therapeutic options in most formal and informal clinical settings with varying degrees of efficacy against this life-threatening disease. Their status in randomized clinical trials is related to the biochemical and pharmacological profiles as validated by in vitro, in vivo and case studies. With the aim to bear a balance for their use in the long run, this review not only synopsizes findings from recent studies on the degrees of efficacy and roles of CQ/HCQ as potential anti-COVID-19 agents but also highlights our perspectives for their consideration in rational drug repositioning and use.
Beliefs and Experience of Journaling in Mothers of Adult Children With Substance Use Problems
Authors: Kim-Godwin Yeoun Soo 
Published: June 2021

Abstract

Background
The challenges experienced by mothers supporting an adult child with substance use problems suggest intervention is needed to improve such mothers' psychosocial well-being through adaptive coping.

Aims
This study examined beliefs about journaling as well as changes in stress, cortisol levels, and mental health after a 6-week intervention by mothers whose adult children had substance use problems. In addition, the study explored coping methods used and the experience of writing among these mothers.

Methods
A purposeful sample of 17 mothers completed the pretest and posttest. Participating mothers were asked to make journal entries at least 3 times per week for 6 weeks.

Results
The mothers used diverse adaptive coping methods to manage stress. In particular, they frequently used religious and meaning-focused coping. The mothers perceived journaling as a highly valuable coping method for daily stress. The findings of paired t tests indicated no statistically significant differences in the stress, mental health variables, and cortisol levels between pretest and posttest. However, participants shared the positive experiences of journaling: emotional well-being, stress management, perspective changes, focus, self-regulation, clarity, and gratitude.

Conclusion
The present finding suggests journaling is a practical means to promoting adaptive coping in mothers with adult children who have substance use problems.