bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of Short‐term Outcomes of Tracheostomy Procedures in a NICU Population With High Ventilator Settings
Authors: Banks Laura , Worobetz Noah , Hamersley Erin , Onwuka Amanda , Shepherd Edward , Wiet Gregory 
Published: March 2021

ObjectiveTo investigate whether tracheostomy placement in infants requiring high ventilator pressure is safe and effective.Study DesignCase series with chart review.SettingTertiary children’s hospital.MethodsFifty ventilator‐dependent neonatal intensive care unit patients who underwent tracheotomy from 2009 to 2018 were included. Patients requiring high ventilator pressures were compared to those requiring low ventilator pressures. Demographics, comorbidities, and surgical and clinical data were recorded.ResultsThirty‐two percent (n = 16) had low ventilator settings at the time of tracheostomy tube placement, and 68% (n = 34) had high ventilator settings. The median peak inspiratory pressure of the high ventilator group was 29.5 cm H2O, positive end‐expiratory pressure (PEEP) was 8 cm H2O, mean airway pressure was 13 cm H2O, pressure support (PS) was 14 cm H2O, PS above PEEP was 6 cm H2O, and inspiratory time was 0.65 seconds. The high ventilator cohort had a higher median age at the time of surgery compared to the low ventilator group (P =. 02). Female patients were more likely to have high ventilator settings (P =. 02). There were no intraoperative complications or deaths within the first 7 days of tracheostomy tube placement. Pneumonia incidence and rate of mortality during admission did not vary by ventilator settings (P =. 92 and P =. 94, respectively).ConclusionFew differences in tracheostomy tube placement outcomes were observed for patients with high ventilator settings compared to low ventilator settings. These data demonstrate that patients requiring high ventilator pressures can benefit from tracheostomy tube placement with no additional short‐term risks.
Arousability, Personality, and Decision-Making Ability in Dissociative Disorder
Authors: Ghosh Doyel , Mukhopadhyay Pritha , Chatterjee Ishani , Roy Prasanta Kumar 
Published: March 2021

Background: There is a gap in understanding the pathogenesis of dissociative conversion disorder (DCD), despite the disorder having a strong historical root. The role of personality and neurocognitive factors are now highlighted; however, inconsistencies are reported. This study explores the personality disposition, arousability, and decision-making ability of patients with DCD, in reference to a healthy control group (HCG). Methods: In this cross-sectional study, the sample comprised ten adult psychiatric patients with DCD. Ten participants of the HCG were matched according to age, gender, education, economic status, domicile, religious background, and handedness. The study assessed personality disposition with Temperament and Character Inventory, arousability with reaction time task, and decision-making ability with the Iowa Gambling Task (IGT PEBL version). Results: The DCD group differed significantly on personality disposition related to both temperament and character. There was also evidence of easy arousability and frustration along with deficit in executive function related to decision-making ability. Conclusion: This study highlights the presence of both temperamental and characterological factors associated with DCD. Moreover, this study identifies the role of cognitive arousability and decision-making or feedback utilization ability in the psychopathology of DCD.
Superior oblique split tendon elongation for Brown’s syndrome: Long-term outcomes
Authors: Dubinsky-Pertzov Biana , Pras Eran , Morad Yair 
Published: March 2021

Purpose: To report the outcomes of superior oblique split tendon elongation in Brown’s syndrome. Methods: Charts of 17 consecutive Brown’s syndrome patients who underwent superior oblique split tendon elongation were reviewed and clinical data regarding preoperative, intraoperative, and postoperative data were collected. Results: About 17 eyes of 17 children with congenital Brown’s syndrome underwent superior oblique split tendon elongation between January 2012 and March 2020 by a single surgeon. Mean age at surgery was 5.47 ± 2.82 (range 1.50–13.2). Eight (47.1%) were female. Preoperative deficit of elevation in adduction was −4 in all children. At the end of surgery, all eyes were freely elevated on adduction, on forced duction test. Mean follow-up time of 26.24 ± 11.22 (range 11–53) months. In 15 of 17 children (88.2%), motility improved, orthotropia in primary position was achieved, and head posture eliminated ( p < 0.001). Superior oblique palsy occurred in two children, who after reoperation, achieved an acceptable outcome. No intraoperative complications were recorded. Conclusion: The superior oblique split tendon elongation procedure is a useful surgical technique with stable and satisfying outcomes for the treatment of severe congenital Brown’s syndrome.
Intraocular pressure control after combined phacotrabeculectomy versus trabeculectomy alone
Authors: Sacchi Matteo , Monsellato Gianluca , Villani Edoardo , Lizzio Rosario Alfio Umberto , Cremonesi Elena , Luccarelli Saverio , Nucci Paolo 
Published: March 2021

Purpose: We compared the efficacy and safety of trabeculectomy and phacotrabeculectomy in patients with glaucoma. Materials and methods: We retrospectively analyzed consecutive patients who underwent trabeculectomy or phacotrabeculectomy. Patients in the trabeculectomy group were pseudophakic. We established three different intraocular pressure (IOP) thresholds (A: <21 mmHg, B: <18 mmHg, and C: <15 mmHg) to measure complete (without medication) and qualified (with medication) success. Success criteria were analyzed through Kaplan-Meier survival curves. Results: Sixty-seven eyes were included (40 trabeculectomy, 27 phacotrabeculectomy). The mean follow-up period was 25.70 ± 14.439 months. The baseline characteristics were similar between the groups. The complete and qualified success rates according to criterion C were significantly higher in the trabeculectomy group ( p = 0.033, p = 0.021, respectively); however, there was a trend toward a higher success rate for all criteria in favor of trabeculectomy. Bleb needling was more frequent in the phacotrabeculectomy group. The mean IOP significantly decreased from 26.46 ± 7.07 to 12.27 ± 4.06 at 12 months ( p < 0.001). The final mean IOP was significantly lower in the trabeculectomy than in the phacotrabeculectomy group (10.95 ± 3.08 vs 13.00 ± 4.56, p = 0.0003). Conclusion: In pseudophakic eyes, trabeculectomy alone achieves a higher success rate, lower mean IOP, and less frequent bleb needlings. More frequent follow-up and prolonged postoperative use of high-dose topical steroids should be considered in patients undergoing phacotrabeculectomy.
Psychometric properties of the Assessment of Positive Occupation 15 final version in individuals with mental illness
Authors: Noguchi Takuya , Kyougoku Makoto 
Published: March 2021

Aims This study was to test the reliability and validity of the Assessment of Positive Occupational 15 (APO-15) for individuals experiencing mental illness. Methods A sample of 408 people experiencing mental illness living in communities or admitted to hospitalized was recruited. The sample has completed demographic information, the Assessment of Positive Occupation 15 (APO-15), the Japanese version of the Self-identified Stage of Recovery Part-B (SISR-B), the Japanese version of the Recovery Assessment Scale (RAS), the General Health Questionnaire 12 (GHQ-12). APO-15 is a measure of how engaged one is in occupations that promote well-being. The final version of the APO-15 was developed by assessing the validity and reliability by mainly using confirmatory factor analysis (CFA), item response theory (IRT). Results This study indicated satisfactory the validity and reliability of APO-15 in a group of individuals experiencing mental illness. CFA showed acceptable values for all indices of fit, namely comparative fit index (CFI), Tucker-Lewis index (TLI) (i.e., greater than .90), and the value of root mean square error of approximation (RMSEA) was .087, which was acceptable. The IRT showed satisfactory responses for the item slope parameter (α) and item difficulty parameter (β) in APO-15. Discussion APO-15 was demonstrated good psychometric properties in measuring involvement in the occupation to promote well-being in individuals experiencing mental illness. In conclusion, the APO-15 is an important tool to enable occupational therapists to assess clients who are not engaged in well-being promoting occupations and thus enable them to participate in such occupations.
Functional and Radiographic Outcomes of Intraoperatively Decreasing the Coracoclavicular Distance to 50% of the Unaffected Side in Stabilization of Acute Acromioclavicular Joint Injury: A Retrospective Evaluation
Authors: Klabklay Prapakorn , Chuaychoosakoon Chaiwat 
Published: March 2021

Background: The postoperative failure rate of acromioclavicular (AC) joint fixation using the coracoclavicular (CC) stabilization technique is high. Studies have reported that compared with normal intraoperative anatomic reduction, intraoperative overreduction of the AC joint is more successful in achieving a satisfactory anatomic radiographic outcome at 1- to 2-year follow-up. Purpose: To evaluate the functional and radiographic outcomes and complications in patients with acute AC joint injury who underwent combined CC stabilization and AC capsular repair in which the CC distance was intraoperatively decreased to 50% of the unaffected side. Study Design: Case series; Level of evidence, 4. Methods: In this retrospective study, we collected and analyzed the data of patients with an acute AC joint injury (Rockwood type 5) who underwent combined CC stabilization and AC capsular repair during which the CC distance was decreased 50% compared with the unaffected side. At 2-year follow-up, we evaluated functional outcomes (American Shoulder and Elbow Surgeons [ASES] score), radiographic outcomes (alignment of the AC joint in the vertical and horizontal planes, tunnel widening), and complications (infection, clavicular fracture). Results: The study included 20 patients with a mean ± SD age of 42.20 ± 10.10 years. The mean follow-up period was 33.75 ± 11.50 months. At the 2-year follow-up, the mean ASES score was 95.13 ± 5.61. The overreduction alignment, anatomic alignment, and loss reduction alignment rates were 0% (0/20 patients), 95% (19/20 patients), and 5% (1/ 20 patients), respectively. No statistically significant difference was found in the mean CC distance between the affected and unaffected sides on radiographic evaluation. The mean medial clavicular tunnel width and lateral clavicular tunnel width were 5.03 ± 0.68 mm and 4.47 ± 0.67 mm, respectively. None of the patients experienced fractures or infections. Conclusion: Excellent functional and radiographic outcomes and no complications were seen at 2-year follow-up in patients with acute AC joint injury who underwent combined CC stabilization and AC capsular repair with the CC distance intraoperatively decreased to 50% of the unaffected side.
Pi-starvation induced transcriptional changes in barley revealed by a comprehensive RNA-Seq and degradome analyses
Authors: Sega Pawel , Kruszka Katarzyna , Bielewicz Dawid , Karlowski Wojciech , Nuc Przemyslaw , Szweykowska-Kulinska Zofia , Pacak Andrzej 
Published: March 2021

Abstract
Background
Small RNAs (sRNAs) are 20–30 nt regulatory elements which are responsible for plant development regulation and participate in many plant stress responses. Insufficient inorganic phosphate (Pi) concentration triggers plant responses to balance the internal Pi level.

Results
In this study, we describe Pi-starvation-responsive small RNAs and transcriptome changes in barley (Hordeum vulgare L.) using Next-Generation Sequencing (NGS) RNA-Seq data derived from three different types of NGS libraries: (i) small RNAs, (ii) degraded RNAs, and (iii) functional mRNAs. We find that differentially and significantly expressed miRNAs (DEMs, Bonferroni adjusted p-value < 0.05) are represented by 15 molecules in shoot and 13 in root; mainly various miR399 and miR827 isomiRs. The remaining small RNAs (i.e., those without perfect match to reference sequences deposited in miRBase) are considered as differentially expressed other sRNAs (DESs, p-value Bonferroni correction < 0.05). In roots, a more abundant and diverse set of other sRNAs (DESs, 1796 unique sequences, 0.13% from the average of the unique small RNA expressed under low-Pi) contributes more to the compensation of low-Pi stress than that in shoots (DESs, 199 unique sequences, 0.01%). More than 80% of differentially expressed other sRNAs are up-regulated in both organs. Additionally, in barley shoots, up-regulation of small RNAs is accompanied by strong induction of two nucleases (S1/P1 endonuclease and 3′-5′ exonuclease). This suggests that most small RNAs may be generated upon nucleolytic cleavage to increase the internal Pi pool. Transcriptomic profiling of Pi-starved barley shoots identifies 98 differentially expressed genes (DEGs). A majority of the DEGs possess characteristic Pi-responsive cis-regulatory elements (P1BS and/or PHO element), located mostly in the proximal promoter regions. GO analysis shows that the discovered DEGs primarily alter plant defense, plant stress response, nutrient mobilization, or pathways involved in the gathering and recycling of phosphorus from organic pools.

Conclusions
Our results provide comprehensive data to demonstrate complex responses at the RNA level in barley to maintain Pi homeostasis and indicate that barley adapts to Pi-starvation through elicitation of RNA degradation. Novel P-responsive genes were selected as putative candidates to overcome low-Pi stress in barley plants.
Conversion of an oral to nasal intubation in difficult nasal anatomy patients: two case reports
Authors: Kim Dong Won , Kim Kyu Nam , Sun Jung Eun , Lim Hyun Jin 
Published: March 2021

Abstract
Background
Nasal intubation is indispensable for some cases that require intraoral surgical access, and the fiberoptic bronchoscope is the best tool for difficult airways. However, fiberoptic bronchoscopy is not always possible in cases with altered pharyngeal anatomy.

Case presentation
In this report, we introduce a novel technique for retrograde endotracheal oral-to-nasal conversion with an ordinary endotracheal tube exchange catheter. A 49-year-old male with a fractured mandible angle and symphysis was scheduled to undergo mandible reconstruction. Secondly, a 45-year-old male who had a bone defect in the mandible angle and ramus was scheduled for mandible and oral cavity reconstruction. We chose to intubate orally first and successfully converted the endotracheal tube from oral to nasal retrogressively using a tube exchange catheter.

Conclusions
Our simple and safe technique, which use a tube exchange catheter retrogressively, provides an alternative method for a difficult airway in which the fiberscope is not helpful.
A qualitative study exploring the lived experiences of deconditioning in hospital in Ontario, Canada
Authors: Guilcher Sara J. T. , Everall Amanda C. , Cadel Lauren , Li Joyce , Kuluski Kerry 
Published: March 2021

Abstract
Background
Older adults, especially those with physical and social complexities are at risk of hospital-associated deconditioning. Hospital-associated deconditioning is linked to increased length of stay in hospital, stress, and readmission rates. To date, there is a paucity of research on the experiences and implications of deconditioning in hospital from different perspectives. Therefore, the objectives of this exploratory, descriptive qualitative study were to explore hospital-associated deconditioning from the views of different stakeholders and to develop an understanding of deconditioning from physical, social, and cognitive perspectives.

Methods
Between August 2018 and July 2019, in-depth, semi-structured interviews were conducted with patients 50 years or older, who had a hip fracture or delay in discharge, as well as caregivers, providers, and decision-makers who provided support or impacted care processes for these patients. Participants were recruited from one urban and one rural health region located in Ontario, Canada. All interviews were audio-recorded, transcribed, and analyzed using a constant comparison approach.

Results
A total of 80 individuals participated in this study. Participants described insufficient activities in hospital leading to boredom and mental and physical deconditioning. Patients were frustrated with experiencing deconditioning and their decline in function seemed to impact their sense of self and identity. Deconditioning had substantive impacts on patients’ ability to leave hospital to their next point of care. Providers and decision-makers understood the potential for deconditioning but felt constrained by factors beyond their control. Factors that appeared to impact deconditioning included the hospital’s built environment and social capital resources (e.g., family, roommates, volunteers, staff).

Conclusions
Participants described a substantial lack of physical, cognitive, and social activities, which led to deconditioning. Recommendations to address deconditioning include: (1) measuring physical/psychological function and well-being throughout hospitalization; (2) redesigning hospital environments (e.g., create social spaces); and (3) increasing access to rehabilitation during acute hospital stays, while patients wait for the next point-of-care.
Clinical outcomes and healthcare costs of inpatients with tetanus in Korea, 2011–2019
Authors: Bae Sohyun , Go Minsik , Kim Yoonjung , Hwang Soyoon , Kim Shin-Woo , Kwon Ki Tae , Jung Sook-In , Chang Hyun-Ha 
Published: March 2021

Abstract
Background
Tetanus is a rare, vaccine-preventable but extremely serious disease. We investigated the recent trend of the clinical outcomes and medical costs for inpatients with tetanus in South Korea over 10 years.

Methods
We conducted a retrospective review to determine the clinical factors and medical costs associated with tetanus at two national university hospitals in South Korea between January 2011 and October 2019.

Results
Forty-nine patients were admitted for tetanus (mean age, 67.0 years [range, 53.0–80.0 years]; 32 women [57.1%]). All the patients had generalized tetanus, and 5 (10.2%) died during hospitalization. The median duration from symptom onset to hospital admission was 4 days. Trismus (85.7%) was the most common symptom, and the median hospital stay was 39 days. Thirty-two patients (65.3%) required mechanical ventilation, and 20 (40.8%) developed aspiration pneumonia. The median total healthcare cost per patient was US $18,011. After discharge, 35 patients (71.4%) recovered sufficiently to walk without disability.

Conclusions
Tetanus requires long hospital stays and high medical expenditures in South Korea; however, the vaccination completion rate is low. Medical staff should therefore promote medical advice and policies on the management of tetanus to the general South Korean population.
A novel variant in the COL6A1 gene causing Ullrich congenital muscular dystrophy in a consanguineous family: a case report
Authors: Sirisena Nirmala Dushyanthi , Samaranayake U. M. Jayami Eshana , Neto Osorio Lopes Abath , Foley A. Reghan , Pathirana B. A. P. Sajeewani , Neththikumara Nilaksha , Paththinige C. Sampath , Rathnayake Pyara , Donkervoort Sandra , Bönnemann Carsten G. , Dissanayake Vajira H. W. 
Published: March 2021

Abstract
Background
Collagen VI-related dystrophies are a subtype of congenital muscular dystrophy caused by pathogenic variants in COL6A1, COL6A2 or COL6A3 genes affecting skeletal muscles and connective tissue. The clinical phenotype ranges from the milder Bethlem myopathy to the severe Ullrich congenital muscular dystrophy (UCMD). Herein, we report the first consanguineous Sri Lankan family with two children affected with UCMD due to a novel variant in the COL6A1 gene.

Case presentation
Two sisters, aged 10-years and 7-years, presented with progressive, bilateral proximal muscle weakness. Both probands had delayed motor milestones and demonstrated difficulty in standing from a squatting position, climbing stairs and raising arms above the shoulders. Cognitive, language and social development were age appropriate. Examination showed proximal muscle weakness of the upper and lower extremities and hyperlaxity of the wrist and fingers in both with some variability in clinical severity noted between the two siblings. Serum creatine kinase levels were elevated, and electromyography showed low polyphasic motor unit potentials in the 10-year-old and myopathic features with short duration motor unit potentials with no polyphasia in the 7-year-old. Whole exome sequencing (WES) was performed and a novel, homozygous missense, likely pathogenic variant in exon 25 of COL6A1 gene [NM_001848: c.1667G > T;NP_001839.2:p.Gly556Val] was identified in both probands. This variant was validated by Sanger sequencing in proband 1 as well as proband 2, and the parents and an unaffected sibling were found to be heterozygote carriers for the same variant.

Conclusions
The findings in this family add to the expanding number of COL6A1 variants identified and provides a better understanding of the genotype-phenotype correlations associated with UCMD.
Visual outcomes and complications following one-way air-fluid exchange technique for vitreous hemorrhage post vitrectomy in proliferative diabetic retinopathy patients
Authors: Wang Qun , Zhao Jie , Xu Qing , Han Cui , Hou Baojie , Huang Yifei 
Published: March 2021

AbstractBackgroundTo evaluate the efficacy and outcomes of one-way surgical technique for the treatment of vitreous hemorrhage post vitrectomy on proliferative diabetic retinopathy (PDR) patients.MethodsThis retrospective case series include 47 PDR patients who had vitrectomy with balanced saline solution tamponade and have developed vitreous hemorrhage without significant absorption. The one-way air-fluid exchange procedure which involves the application of a 0.22-μm pore size filter to exchange about 4.5–5.5 ml of fluid with a 10 ml syringe was performed on 47 patients (47 eyes). Post procedure, additional treatments were administered when needed. Best corrected visual acuity (BCVA), occurrence of intra-procedural and post-procedural complications were recorded and analyzed.ResultsA total of 47 eyes of 47 PDR patients with a mean age of 50.8 ± 12.0 years were reviewed. Because of vitreous hemorrhage or tractional retinal detachment of PDR, all 47 eyes underwent vitrectomy with balanced saline solution tamponade prior to the exchange procedure. Four patients (8.51%) and 43 patients (91.5%) were diagnosed with type 1 diabetes mellitus (T1DM), or type 2 diabetes mellitus (T2DM), respectively. All 47 eyes were given the one-way air-fluid exchange procedure in the treatment room. Forty-two cases (89.4%) needed the air-fluid exchange procedure only once, 4 cases (8.51%) underwent the procedure twice, and 1 case (2.13%) was given the procedure three times, followed by additional retinal photocoagulation and one intravitreal injection of Conbercept. In addition to the procedure, no further treatment was needed for 5 eyes (10.6%) while additional retinal laser treatment was provided for 41 eyes (87.2%). The BCVA at the final follow-up was significantly improved from the initial acuity baseline in all cases. No complications were observed during the follow-ups.ConclusionThis one-way air-fluid exchange procedure can effectively exchange the vitreous hemorrhage and improve visual acuity of PDR patients who develop vitreous rehemorrhage post vitrectomy without obvious complications.