bluuebunny/crossref_metadata_2025_split huggingface dataset:
COMBINED CENTRAL RETINAL ARTERIAL AND VENOUS OCCLUSIONS DUE TO LEUKEMIC INFILTRATION
Authors: De La Porte Vincent M. , Lammens Martin , Dekeyzer Sven , Van Lint Michel 
Published: July 2021

Purpose:
To report combined central arterial and venous occlusions secondary to bilateral leukemic interfascicular optic nerve infiltration in a 56-year-old man. This was the sole presentation of a relapse in T/myeloid mixed-phenotype acute leukemia after 5 months of remission.

Methods:
Case report with clinical photography.

Results:
A 56-year-old man reported to be in complete remission of T/myeloid mixed-phenotype acute leukemia presented with sudden painless loss of vision in his left eye. Fundoscopy showed unilateral severe optic disk swelling with characteristic findings of a central retinal vein occlusion, namely, intraretinal and preretinal hemorrhages and cotton-wool spots, as well as the features of a central retinal artery occlusion resulting in a pale, edematous retina and a characteristic cherry-red spot. Blood analysis, cerebrospinal fluid evaluation, and bone marrow analysis were performed in combination with medical imaging. No evidence of leukemic relapse was found. An optic nerve biopsy was indicated because of decompensation of the contralateral eye and ultimately confirmed leukemic infiltration.

Conclusion:
Regardless of no hematological and nonspecific imaging findings, optic nerve biopsy may be crucial for clinical decision-making in a patient with acute complete vision loss and a history of leukemia.
Decline in the Incidence of Neonatal Sepsis in Rural Gadchiroli, India During the Twenty-one Years (1998–2019) Following the Home-based Neonatal Care Field-trial
Authors: Bang Abhay , Deshmukh Mahesh , Baitule Sanjay , Duby Jessica 
Published: July 2021

Background:
Sepsis is a leading cause of neonatal mortality globally. The home-based neonatal care (HBNC) field trial (1995–1998) in rural Gadchiroli demonstrated a reduction in the incidence of neonatal sepsis. The current study examines the trend of neonatal sepsis during the twenty-one years (1998–2019) following the trial’s completion.

Methods:
We conducted a retrospective cohort study based on the HBNC program data in rural Gadchiroli, India, from April 1998 to March 2019. All live-born neonates who spent all or part of the neonatal period in the 39 study villages and received HBNC were eligible for inclusion. Sepsis was diagnosed during regular home visits by trained village health workers if pre-specified clinical criteria were present. Sepsis incidence was computed for seven 3-year periods. Trend analyses were conducted using the Mann-Kendall test.

Results:
Of the total 17,289 live births, 16,339 (94.5%) home visited were included. In this cohort, 1069 (65 per 1000 live births) neonates were diagnosed with sepsis. The incidence of neonatal sepsis declined from 111 per 1000 live births in 1998 to 2001 to 19 per 1000 live births in 2016 to 2019, an 82.9% decrease (P < 0.0001), mean 4% decrease per year. The incidence of neonatal sepsis declined for early-onset sepsis (P < 0.0001), late-onset sepsis (P < 0.0001), home births (P = 0.006), facility births (P < 0.0001), preterm neonates (P < 0.0001) and full-term neonates (P < 0.0001).

Conclusions:
The incidence of neonatal sepsis in rural Gadchiroli has continued to decline during the past twenty-one years. We hypothesize that the decline is due to the ongoing practice of HBNC, improved socioeconomic conditions, and new governmental health policies.
High anti‐TNFα Concentrations Are Not Associated With More Adverse Events in Pediatric Inflammatory Bowel Disease
Authors: Zvuloni Maya , Matar Manar , Levi Rachel , Shouval Dror S. , Shamir Raanan , Assa Amit 
Published: July 2021

ABSTRACTAnti‐tumor necrosis factor alpha (anti‐TNFα) therapy is commonly used to treat refractory pediatric inflammatory bowel disease (IBD) and carry risks for adverse events. We aimed to assess the relationship between anti‐TNFα trough concentrations and adverse events rate among pediatric patients with IBD. The medical records of pediatric patients with IBD who were treated with anti‐TNFα agents from 2015 to 2020 and had sequential monitoring of trough concentration (TC) were reviewed retrospectively for the presence of adverse events. The study cohort included 135 eligible patients (59 [43.7%] girls, mean age at diagnosis 12.9 [±3] years, 111 [82.2%] Crohn disease) who had 1589 measurements of TCs (1037 [63%] infliximab). During a median follow‐up period of 1.7 years (IQR 1.1–2.7), we recorded 156 adverse events in 50 patients (37%). Higher TCs were not associated with higher rate of anti‐TNFα‐related adverse events whereas these events (excluding increase in liver transaminases) were associated with younger age.
An ESPGHAN Position Paper on the Use of Breath Testing in Paediatric Gastroenterology
Authors: Broekaert Ilse Julia , Borrelli Osvaldo , Dolinsek Jernej , Martin‐de‐Carpi Javier , Mas Emmanuel , Miele Erasmo , Pienar Corina , Ribes‐Koninckx Carmen , Thomassen Rut , Thomson Mike , Tzivinikos Christos , Benninga Marc 
Published: July 2021

ABSTRACTObjectives:Given a lack of a systematic approach to the use of breath testing in paediatric patients, the aim of this position paper is to provide expert guidance regarding the indications for its use and practical considerations to optimise its utility and safety.Methods:Nine clinical questions regarding methodology, interpretation, and specific indications of breath testing and treatment of carbohydrate malabsorption were addressed by members of the Gastroenterology Committee (GIC) of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN).A systematic literature search was performed from 1983 to 2020 using PubMed, the MEDLINE and Cochrane Database of Systematic Reviews. Grading of Recommendations, Assessment, Development, and Evaluation was applied to evaluate the outcomes.During a consensus meeting, all recommendations were discussed and finalised. In the absence of evidence from randomised controlled trials, recommendations reflect the expert opinion of the authors.Results:A total of 22 recommendations were voted on using the nominal voting technique. At first, recommendations on prerequisites and preparation for as well as on interpretation of breath tests are given. Then, recommendations on the usefulness of H2‐lactose breath testing, H2‐fructose breath testing as well as of breath tests for other types of carbohydrate malabsorption are provided. Furthermore, breath testing is recommended to diagnose small intestinal bacterial overgrowth (SIBO), to control for success of Helicobacter pylori eradication therapy and to diagnose and monitor therapy of exocrine pancreatic insufficiency, but not to estimate oro‐caecal transit time (OCTT) or to diagnose and follow‐up on celiac disease.Conclusions:Breath tests are frequently used in paediatric gastroenterology mainly assessing carbohydrate malabsorption, but also in the diagnosis of small intestinal overgrowth, fat malabsorption, H. pylori infection as well as for measuring gastrointestinal transit times. Interpretation of the results can be challenging and in addition, pertinent symptoms should be considered to evaluate clinical tolerance.
Incidence and Associated Risk Factors for Falls in Older Adults After Elective Total Knee Replacement Surgery
Authors: Hill Anne-Marie , Ross-Adjie Gail , McPhail Steven M. , Jacques, MBiostat Angela , Bulsara Max , Cranfield Alexis , Etherton-Beer Christopher , Azlan, MN Natasya Raja , Powell Sarah-Jayne , Hardisty Gerard , Monterosso Leanne 
Published: July 2021

Objective
The aim of the study was to determine the incidence and associated risk factors for falls in older adults in the 12 mos after elective, primary total knee replacement surgery.

Design
A prospective observational cohort of older adults undergoing total knee replacement were followed. Baseline measurements included risk factors of history of falls, using a gait aid and number of medications. Falls data were recorded after discharge for 12 mos alongside patient reported outcomes (Oxford Knee Score). Analyses used logistic and negative binomial regression modeling.

Results
There were 267 participants (mean age = 70 [6.7] yrs) enrolled. Participants who fell (n = 102 [40.6%]) reported 200 falls in the 12 mos after surgery. The incidence of falls was 2.4 falls per 1000 patient days in the 12 mos after surgery, with the highest incidence (2.6 falls per 1000 patient days) in month 1. Risk factors for falling were a history of falls (adjusted odds ratio = 2.41, 95% confidence interval = 1.35–4.31) and number of central nervous system acting medications taken before surgery (adjusted odds ratio = 1.66, 95% confidence interval = 1.25–2.21). Using a walking aid at baseline was associated with falls after discharge (adjusted incident rate ratio = 2.38, 95% confidence interval = 1.57–3.60).

Conclusions
Older adults experience a high incidence of falls after elective total knee replacement. Further research that investigates falls prevention after total knee replacement is required.
A New Technique of Unilateral Cleft Lip Repair with Scarless Cupid’s Bow Peaks
Authors: Masuoka Hiromu 
Published: July 2021

Background:
A novel technique for primary unilateral cleft lip repair with scarless Cupid’s bow peaks is described. This technique focuses on the curvature of the Cupid’s bow and the preservation of the minute three-dimensional structure around the cleft-side peak of the Cupid’s bow, such as the cutaneous roll and white skin roll. This technique has been used in 50 consecutive unilateral cleft lip repairs by a single surgeon.

Methods:
The flap from the lateral lip is expanded into a three-stair flap, including a lateral white lip flap, a cutaneous roll flap, and a quadrangular mucovermilion flap as partial flaps. The cleft-side peak of the Cupid’s bow is made to form a curved peak with the cutaneous roll. The suture lines pass through the lip columellar crease, philtrum ridge, and upper lip groove. These lines are stepwise, just like W-plasty, and do not cross the peak of the Cupid’s bow. Measurements were obtained from three-dimensional photographs, and a visual assessment was performed by standard photographs taken 1 year or later postoperatively with no additional surgery, except for palatoplasty.

Results:
The Noordhoff point was kept as the peak of the Cupid’s bow with no scar. The three-dimensional structure, including the cutaneous roll around the cleft-side peak of the Cupid’s bow, was well maintained.

Conclusion:
The present technique allows for the fashioning of a reliable intended peak of the Cupid’s bow without scarring on its point and preserves the three-dimensional structure, including the cutaneous roll.
Surgical Angiogenesis of Decellularized Nerve Allografts Improves Early Functional Recovery in a Rat Sciatic Nerve Defect Model
Authors: Saffari Tiam M. , Mathot Femke , Friedrich Patricia F. , Bishop Allen T. , Shin Alexander Y. 
Published: July 2021

Background:
Surgical angiogenesis applied to nerve grafts has been suggested to enhance nerve regeneration after nerve injury. The authors hypothesized that surgical angiogenesis to decellularized nerve allografts would improve functional recovery in a rat sciatic nerve defect model.

Methods:
Sixty Lewis rats were divided in three groups of 20 animals each. Unilateral sciatic nerve defects were repaired with (1) autografts, (2) decellularized allografts, and (3) decellularized allografts wrapped with a superficial inferior epigastric artery fascial flap to add surgical angiogenesis. Twelve and 16 weeks after surgery, nerve regeneration was assessed using functional, electrophysiologic, histologic, and immunofluorescence analyses. Ultrasonography was used during the survival period to noninvasively evaluate muscle atrophy and reinnervation by measuring cross-sectional muscle area.

Results:
Surgical angiogenesis of allografts demonstrated significantly improved isometric tetanic force recovery at 12 weeks, compared to allograft alone, which normalized between groups at 16 weeks. Cross-sectional muscle areas showed no differences between groups. Electrophysiology showed superiority of autografts at both time points. No differences were found in histologic analysis, besides a significantly inferior N ratio in allografts at 12 weeks. Immunofluorescent expression of CD34, indicating vascularity, was significantly enhanced in the superficial inferior epigastric artery fascial group compared to allografts at 12 weeks, with highest expression at 16 weeks compared to all groups.

Conclusion:
Surgical angiogenesis with an adipofascial flap to the nerve allograft increases vascularity in the nerve graft, with subsequent improvement of early muscle force recovery, comparable to autografts.
SITAgliptin for Depressive Symptoms in Type 2 Diabetes: A Feasibility Randomized Controlled Trial
Authors: Moulton Calum D. , Rokakis Anna S. , Pickup John C. , Young Allan H. , Stahl Daniel , Ismail Khalida 
Published: July 2021

ABSTRACT

Objective
We tested the feasibility of using sitagliptin—a dipeptidyl peptidase-IV inhibitor—for depressive symptoms in type 2 diabetes (T2D).

Methods
In a feasibility, double-blind, randomized controlled trial, we recruited people aged 18 to 75 years with T2D (glycated hemoglobin A1c levels ≥53 and ≤86 mmol/mol prescribed oral hypoglycemic therapy) and comorbid depressive symptoms (Patient Health Questionnaire-9 score ≥10) from family practices in South London. Eligible patients were randomized to sitagliptin 100 mg per day or matched placebo for 12 weeks. The primary feasibility outcomes were participation rates, attrition rates, and adverse events. The primary clinical outcomes were depressive symptoms (Patient Health Questionnaire-9 and 16-item Quick Inventory of Depressive Symptomatology scores) at 12 weeks as assessed using analyses of covariance. Ranges of treatment effects were estimated using Cohen d and associated 95% confidence intervals, where negative values favored sitagliptin over placebo.

Results
Of 153 people screened across 32 practices, 44 were randomized (22 to each arm). The mean (standard deviation) age was 58.8 (8.3) years, 46% were female, and 52% were of non-white ethnicity. Of those treated, 1 patient (4.5%) in each arm withdrew, and there were no group differences in adverse events. Despite improving 12-week glycated hemoglobin A1c (d = −1.19 [95% confidence interval = −1.90 to −0.48), improvement in 12-week Quick Inventory of Depressive Symptomatology score with sitagliptin was inferior to placebo across the range of estimated treatment effects (d = 0.71 [0.13 to 1.30]). Effects of sitagliptin on inflammation were inconsistent (d = −0.32 [−0.81 to 0.17] for high-sensitivity C-reactive protein).

Conclusions
Repositioning of oral hypoglycemic therapy for depressive symptoms in T2D is feasible. However, in this unpowered feasibility study, we did not detect evidence of superiority of sitagliptin over placebo. The results are cautioned by the small sample size and limited treatment duration.

Trial Registration: EudraCT: 2015–004527-32.
Volumetric and Morphological Analysis of Mandibular Condyles of Angle Class 2 and 3 Malocclusion Patients
Authors: Lentzen Max-Philipp , Riekert Maximilian , Buller Johannes , Zirk Matthias , Zöller Joachim E. , Kreppel Matthias 
Published: July 2021

AbstractThis study was conducted to provide diametric and volumetric data of mandibular condyles from patients with Angle class 2 and 3 malocclusions by semiautomatic segmentation based upon cone-beam computed tomography.Cone-beam computed tomography images of 79 patients were analyzed. By using the open-source software “ITK-SNAP”, diametric and volumetric measurements of 158 mandibular condyles were performed. Descriptive statistics were calculated for all normally distributed variables. Correlations between patients with Angle class 2 and 3 were calculated with the independent Student t test.PvaluesP < 0.05 were considered significant.Irrespective of the side, patients with class 2 malocclusion showed smaller mandibular condyles (right: 1.128 ± 0.504 cm3; left: 1.222 ± 0.596 cm3) than patients with class 3 (right: 1.504 ± 0.361 cm3; left: 1.493 ± 0.335 cm3). These results were reproducible also in accordance with the diametric measurement (class 2 right: 16.75 ± 2.72 mm; left: 17.04 ± 3.01 mm) (class 3 right: 18.24 ± 2.54 mm; left: 18.32 ± 2.13 mm). However, volumetric differences were highly statistically significant (right:P = 0.001; left:P = 0.018) while diametric differences were slightly significant for the right and not significant for the left side (right:P = 0.042; left:P = 0.053).Diametric and volumetric analyses offer important additional information based on 3D images of cone-beam computed tomography technology. Significant differences in diameter and volume of mandibular condyles could be assessed between different classes of malocclusion.
Biomechanical Examination of Osseointegration of Titanium Implants Placed Simultaneously With Allogeneic Bone Transfer
Authors: Acikan Izzet , Dundar Serkan 
Published: July 2021

Abstract
The aim of this study was to conduct a biomechanical analysis of the early period bone-implant connection of titanium implants in the same type of subjects. In this study, 18 Sprague Dawley rats were used. Four rats were killed to provide the allogeneic bone before the experiment, and the remaining were divided into a control group and an experimental allogeneic bone transfer group. Titanium machined surfaced implants were integrated in tibias in the controls and in the experimental group; simultaneously, implants were integrated into allogeneic bone in the bone transfer group. All the rats were sacrificed 14 days later. Bone tissues with titanium implants were removed for biomechanical analysis, which found that the resistance to force of the control group and the allogeneic graft group was 2.04 and 2.00 Newtons, respectively, and there was no significant difference between the two groups at 14 days, although numerically a higher figure was detected in the controls (P > 0.05). It was concluded, within the limitations of this study, that an allogeneic bone transfer can be used as an alternative to an autogenous graft.
Effect of Premature Tube Extrusion for Simple Congenital Nasolacrimal Duct Obstruction: A Comparison of Monocanalicular and Bicanalicular Intubation
Authors: Dryden Stephen C. , Meador Andrew G. , Awh Caroline , Smith Barbara D. , Eder Adrianna E. , Bohn Shiva N. , Hoehn Mary E. , Fowler Brian , Fleming James C. 
Published: July 2021

Abstract
The objective of this article is to compare the incidence of premature dislocation of silicone tubes and the effect on treatment success between monocanalicular (MCI) and bicanalicular (BCI) intubation in pediatric patients with simple congenital nasolacrimal duct obstruction. Retrospective comparative case series of 108 eyes of 78 pediatric patients with simple congenital nasolacrimal duct obstruction who underwent probing with either BCI (n = 38 eyes) or MCI (n = 70 eyes) from 2017 to 2020. Premature tube extrusion was defined as any tube removed prior to the 3 month postoperative appointment. Success was defined as resolution of tearing 3 months post tube removal. Ages ranged from 10 months to 5.35 years (mean, 1.95 years; Standard deviation (SD), 0.91). Premature tube extrusion occurred in 15 eyes with BCI and 29 eyes with MCI. Success rates were not significantly different regardless of intubation type between the planned tube removal (90.6%) and the premature tube extrusion cohorts (84.1%), P = 0.89. There was no significant difference in treatment success between the planned tube removal (92.7% MCI, 87% BCI) and the premature tube extrusion cohorts (86.2% MCI, 80% BCI). Complications included 2 infections (1 MCI, 1 BCI) and 2 cases of tube related keratopathy (1 MCI, 1 BCI) that all resolved with tube removal. There were 2 BCI patients that presented to the emergency department for premature tube extrusion. Silicone intubation regardless of stent type is an effective treatment for simple congenital nasolacrimal duct obstruction. There was no significant difference in treatment success between tubes that extrude prematurely, and tubes removed at term based on type of intubation.
School Teaching Posture Correlates with COVID-19 Disease Outcomes in Ohio
Authors: Ehman Cheyenne , Luo Yixuan , Yang Zi , Zhu Ziyan , Donovan Sara , Avery Annika J. , Wang Jiayi , Lawler James , Nugent Rebecca , Ventura Valerie , Lakdawala Seema S. 
Published: July 2021

AbstractAt the start of the COVID-19 pandemic, most US K-12 schools shutdown and millions of students began remote learning. By September 2020, little guidance had been provided to school districts to inform fall teaching. This indecision led to a variety of teaching postures within a given state. In this report we examine Ohio school districts in-depth, to address whether on-premises teaching impacted COVID-19 disease outcomes in that community. We observed that counties with on-premises teaching had more cumulative deaths at the end of fall semester than counties with predominantly online teaching. To provide a measure of disease progression, we developed an observational disease model and examined multiple possible confounders, such as population size, mobility, and demographics. Examination of micropolitan counties revealed that the progression of COVID-19 disease was faster during the fall semester in counties with predominantly on-premises teaching. The relationship between increased disease prevalence in counties with on-premises teaching was not related to deaths at the start of the fall semester, population size, or the mobility within that county. This research addresses the critical question whether on-premises schooling can impact the spread of epidemic and pandemic viruses and will help inform future public policy decisions on school openings.
Access to COVID-19 Vaccines in High-, Middle-, and Low-Income Countries Hosting Clinical Trials
Authors: Ramachandran Reshma , Ross Joseph S. , Miller Jennifer E. 
Published: July 2021

AbstractThe COVID-19 pandemic has led to the rapid development of multiple vaccines, vaccines that were tested in clinical trials located in several countries around the world. Because prior research has shown that pharmaceuticals do not receive consistent and timely authorization for use in lower-income countries where they are tested, we conducted a cross-sectional study examining the authorization or approval and delivery for COVID-19 vaccines recommended by the World Health Organization (WHO) in the countries where they were tested. While countries of varying incomes have largely authorized the COVID-19 vaccines tested within their populations for use, high-income countries have received proportionately more doses, enabling them to more fully vaccinate their populations. As many lower-income countries continue to experience inequitable shortfalls in COVID-19 vaccine supply amid the ongoing pandemic, efforts must be undertaken to ensure timely access in countries across all income groups, including those hosting clinical trials.