bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Persistent Breech Presentation With External Cephalic Version Success
Authors: Lauterbach Roy , Bachar Gal , Ben-David Chen , Matanes Emad , Ginsberg Yuval , Beloosesky Ron , Ganem Nadir , Weiner Zeev , Zipori Yaniv 
Published: January 2021

OBJECTIVE:
To evaluate a possible correlation between a new variable—persistent breech presentation—and the success rate of external cephalic version (ECV).

METHODS:
This was a retrospective study of ECVs performed from January 2008 through January 2019 in an Israeli tertiary care hospital. The study group included all pregnant women who underwent an ECV at or beyond 37 weeks of gestation. Persistent breech presentation was defined as persistent breech presentation during all ultrasound examinations performed between the anatomy scan at mid-pregnancy and the gestational week when ECV was attempted. Women in whom cephalic presentation was documented at least once on these ultrasound examinations were defined as not having persistent breech presentation. The primary outcome was defined as the success rate of ECV, and the secondary outcome was defined as the mode of delivery after a successful ECV.

RESULTS:
We identified 1,271 women with breech presentation during the study period. They had undergone median of five (range 2–7) ultrasound examinations. External cephalic version was attempted in 684 women (53.8%), with a success rate of 61.5%. External cephalic version succeeded in 19.6% of those with persistent breech presentation (44/224) compared with 82.0% (377/460) of those without persistent breech presentation (P<.001). Ultimately, women with persistent breech presentation and successful ECV experienced a lower rate of vaginal delivery (27.3% vs 79%, P<.001), and a higher rate of instrumental (29% vs 13%, P<.001) and cesarean deliveries (43% vs 7%, P<.001) compared with the nonpersistent breech presentation group. The rate of noninstrumental vaginal delivery among women with persistent breech presentation, regardless of ECV, was 5.4%.

CONCLUSION:
Women with persistent breech presentation experienced a high rate of ECV failure and a low rate of spontaneous vaginal delivery.
Evaluation of Hypertriglyceridemia in Critically Ill Patients With Coronavirus Disease 2019 Receiving Propofol
Authors: Kovacevic Mary P. , Dube Kevin M. , Lupi Kenneth E. , Szumita Paul M. , DeGrado Jeremy R. 
Published: January 2021

Objectives:
To report the prevalence of, and evaluate risk factors for, the development of hypertriglyceridemia (defined as a serum triglyceride level of > 400 mg/dL) in patients with coronavirus disease 2019 who received propofol.

Design:
Single-center, retrospective, observational analysis.

Setting:
Brigham and Women’s Hospital, a tertiary academic medical center in Boston, MA.

Patients:
All ICU patients who with coronavirus disease 19 who received propofol between March 1, 2020, and April 20, 2020.

Interventions:
None.

Measurements and Main Results:
The major outcome of this analysis was to report the prevalence of, and risk factors for, the development of hypertriglyceridemia in patients with coronavirus disease 19 who received propofol. Minor outcomes included the development of acute pancreatitis and description of propofol metrics. Of the 106 patients that were included, 60 (56.6%) developed hypertriglyceridemia, with a median time to development of 46 hours. A total of five patients had clinical suspicion of acute pancreatitis, with one patient having confirmatory imaging. There was no difference in the dose or duration of propofol in patients who developed hypertriglyceridemia compared with those who did not. In the patients who developed hypertriglyceridemia, 35 patients (58.5%) continued receiving propofol for a median duration of 105 hours. Patients who developed hypertriglyceridemia had elevated levels of inflammatory markers.

Conclusions:
Hypertriglyceridemia was commonly observed in critically ill patients with coronavirus disease 2019 who received propofol. Neither the cumulative dose nor duration of propofol were identified as a risk factor for the development of hypertriglyceridemia. Due to the incidence of hypertriglyceridemia in this patient population, monitoring of serum triglyceride levels should be done frequently in patients who require more than 24 hours of propofol. Many patients who developed hypertriglyceridemia were able to continue propofol in our analysis after reducing the dose.
Autism-Focused Online Training in Shared Decision-Making: A Randomized Controlled Trial
Authors: Huffman Lynne C. , Hubner Lauren M. , Hansen Robin L. 
Published: January 2021

ABSTRACT:

Objective:
This medical education quasi-randomized controlled trial (quasi-RCT), involving 97 developmental-behavioral pediatrics fellows across the United States, examined differential effects of 2 autism-focused, online, interactive case-based trainings on shared decision-making (SDM).

Methods:
An intervention case provided direct teaching about SDM, addressing autism treatment options. A comparison case focused on evidence-based practice (EBP) related to medication use in autism with no specific SDM teaching. Measured outcomes included self-reported SDM and attitudes toward concordance in medication-prescribing.

Results:
After the intervention, both groups showed significantly increased SDM, but not medication-prescribing concordance (controlling for trainee level, autism patient numbers, and past SDM training).

Conclusion:
This quasi-RCT presents evidence that knowledge of SDM in care of children with autism can be enhanced by online case-based training focused either indirectly on evidence-based practice or directly on SDM. Consistent online SDM training can be provided to all trainees, irrespective of the location.
The effect of moderate intraoperative blood loss and norepinephrine therapy on sublingual microcirculatory perfusion in patients having open radical prostatectomy
Authors: Flick Moritz , Briesenick Luisa , Peine Sven , Scheeren Thomas W.L. , Duranteau Jacques , Saugel Bernd 
Published: January 2021

BACKGROUND
It is not clear whether moderate intraoperative blood loss and norepinephrine used to restore the macrocirculation impair the microcirculation and affect microcirculation/macrocirculation coherence.

OBJECTIVE
We sought to investigate the effect of moderate intraoperative blood loss and norepinephrine therapy administered to treat intraoperative hypotension on the sublingual microcirculation.

DESIGN
Prospective observational study.

SETTING
University Medical Center Hamburg-Eppendorf, Hamburg, Germany, from November 2018 to March 2019.

PATIENTS
Thirty patients scheduled for open radical prostatectomy and 29 healthy volunteer blood donors.

INTERVENTION
Simultaneous assessment of the macrocirculation using a noninvasive finger-cuff method and the sublingual microcirculation using vital microscopy.

MAIN OUTCOME MEASURES
The main outcome measures were changes in the sublingual microcirculation caused by moderate intraoperative blood loss and norepinephrine therapy.

RESULTS
General anaesthesia decreased median [IQR] mean arterial pressure from 100 [90 to 104] to 79 [69 to 87] mmHg (P < 0.001), median heart rate from 69 [63 to 79] to 53 [44 to 62] beats per minute (P < 0.001), median cardiac index from 2.67 [2.42 to 3.17] to 2.09 [1.74 to 2.49] l min−1 m−2 (P < 0.001), and median microvascular flow index from 2.75 [2.66 to 2.85] to 2.50 [2.35 to 2.63] (P = 0.001). A median blood loss of 600 [438 to 913] ml until the time of prostate removal and norepinephrine therapy to treat intraoperative hypotension had no detrimental effect on the sublingual microcirculation: There were no clinically important changes in the microvascular flow index, the proportion of perfused vessels, the total vessel density, and the perfused vessel density. Blood donation resulted in no clinically important changes in any of the macrocirculatory or microcirculatory variables.

CONCLUSION
Moderate intraoperative blood loss and norepinephrine therapy administered to treat intraoperative hypotension have no detrimental effect on the sublingual microcirculation and the coherence between the macrocirculation and microcirculation in patients having open radical prostatectomy.
Patient-specific Extravasation Dosimetry Using Uptake Probe Measurements
Authors: Osborne Dustin , Kiser Jackson W. , Knowland Josh , Townsend David , Fisher Darrell R. 
Published: January 2021

Abstract
Extravasation is a common problem in radiopharmaceutical administration and can result in significant radiation dose to underlying tissue and skin. The resulting radiation effects are rarely studied and should be more fully evaluated to guide patient care and meet regulatory obligations. The purpose of this work was to show that a dedicated radiopharmaceutical injection monitoring system can help clinicians characterize extravasations for calculating tissue and skin doses. We employed a commercially available radiopharmaceutical injection monitoring system to identify suspected extravasation of 18F-fluorodeoxyglucose and 99mTc-methylene diphosphonate in 26 patients and to characterize their rates of biological clearance. We calculated the self-dose to infiltrated tissue using Monte Carlo simulation and standard MIRD dosimetry methods, and we used VARSKIN software to calculate the shallow dose equivalent to the epithelial basal-cell layer of overlying skin. For 26 patients, injection-site count rate data were used to characterize extravasation clearance. For each, the absorbed dose was calculated using representative tissue geometries. Resulting tissue-absorbed doses ranged from 0.6 to 11.2 Gy, and the shallow dose equivalent to a 10 cm2 area of adjacent skin in these patients ranged from about 0.1 to 5.4 Sv. Extravasated injections of radiopharmaceuticals can result in unintentional doses that exceed well-established radiation protection and regulatory limits; they should be identified and characterized. An external injection monitoring system may help to promptly identify and characterize extravasations and improve dosimetry calculations. Patient-specific characterization can help clinicians determine extravasation severity and whether the patient should be followed for adverse tissue reactions that may present later in time.
Preliminary Experiences with the Rexon UL-320-FDR: An Automated Thermoluminescent Dosimeter Reader with Removable Contact Heating Planchets and an Infrared Temperature Feedback System
Authors: Kuchta John R. , Thiesen Jack H. , Noey Jordan D. , Chung Long Kiu , Kearfott Kimberlee J. 
Published: January 2021

Abstract
The Rexon UL-320 FDR is a novel resistive-heating thermoluminescent dosimeter reader with a unique temperature measurement system and an automated dosimeter processing mechanism. The removable contact heating planchets have black-body adhesives on the back for capturing temperature information with infrared sensors. A heating cycle feedback loop ensures accurate, precise, and reproducible heating sequences. Heating rates between 0.8 and 40°C s−1 for up to 1,000 s are possible. Photomultiplier tube sensitivity and drift, dark current counts, and planchet glow were measured experimentally. Additionally, 25 LiF:Mg,Ti dosimeters were calibrated to demonstrate reader performance. Sensitivity was optimized at 1,200 V, which produced the highest reference light count to dark current count ratio while extending photomultiplier tube life. Dark current counts measured with typical time-temperature profiles for LiF:Mg,Ti were below 10 counts per channel but increased by up to 2.5% for more extreme heating cycles. Reader sensitivity drifts of up to 10% were observed during extended automated operations with typical time-temperature profiles. Total counts resulting from planchet glow decreased with faster heating rates. Calibrations performed with LiF:Mg,Ti dosimeters yielded results comparable to more established reader designs. Spikes were observed in ~3% of the glow curves from planchet dust and oil burning off at elevated temperatures. The use of N2 gas and sensitivity drift corrections are recommended to improve dosimetry performance for the UL-320 FDR reader.
A genome-wide screen reveals microRNAs in peripheral sensory neurons driving painful diabetic neuropathy
Authors: Bali Kiran Kumar , Gandla Jagadeesh , Rangel Daniel Rojas , Castaldi Laura , Mouritzen Peter , Agarwal Nitin , Schmelz Martin , Heppenstall Paul , Kuner Rohini 
Published: January 2021

Abstract
Diabetes is a leading cause of peripheral neuropathy (diabetic peripheral neuropathy, DPN), and uncontrolled long-lasting hyperglycemia leads to severe complications. A major proportion of diabetics develop excruciating pain with a variable course. Mechanisms leading to painful DPN are not completely understood and treatment options limited. We hypothesized that epigenetic modulation at the level of microRNA (miRNA) expression triggered by metabolic imbalance and nerve damage regulates the course of pain development. We used clinically relevant preclinical models, genome-wide screening, in silico analyses, cellular assays, miRNA fluorescent in situ hybridization, in vivo molecular manipulations, and behavioral analyses in the current study. We identified miRNAs and their targets that critically impact on nociceptive hypersensitivity in painful DPN. Our analyses identify miR-33 and miR-380 expressed in nociceptive neurons as critical denominators of diabetic pain and miR-124-1 as a mediator of physiological nociception. Our comprehensive analyses on the putative mRNA targets for miR-33 or miR-124-1 identified a set of mRNAs that are regulated after miR-33 or miR-124-1 overexpression in dorsal root ganglia in vivo. Our results shed light on the regulation of DPN pathophysiology and implicate specific miRNAs as novel therapeutic targets for treating painful DPN.
A peptide encoded within a 5′ untranslated region promotes pain sensitization in mice
Authors: Barragan-Iglesias Paulino , Kunder Nikesh , Wanghzou Andi , Black Bryan , Ray Pradipta R. , Lou Tzu-Fang , Bryan de la Peña June , Atmaramani Rahul , Shukla Tarjani , Pancrazio Joseph J. , Price Theodore J. , Campbell Zachary T. 
Published: January 2021

Abstract
Translational regulation permeates neuronal function. Nociceptors are sensory neurons responsible for the detection of harmful stimuli. Changes in their activity, termed plasticity, are intimately linked to the persistence of pain. Although inhibitors of protein synthesis robustly attenuate pain-associated behavior, the underlying targets that support plasticity are largely unknown. Here, we examine the contribution of protein synthesis in regions of RNA annotated as noncoding. Based on analyses of previously reported ribosome profiling data, we provide evidence for widespread translation in noncoding transcripts and regulatory regions of mRNAs. We identify an increase in ribosome occupancy in the 5′ untranslated regions of the calcitonin gene-related peptide (CGRP/Calca). We validate the existence of an upstream open reading frame (uORF) using a series of reporter assays. Fusion of the uORF to a luciferase reporter revealed active translation in dorsal root ganglion neurons after nucleofection. Injection of the peptide corresponding to the calcitonin gene-related peptide–encoded uORF resulted in pain-associated behavioral responses in vivo and nociceptor sensitization in vitro. An inhibitor of heterotrimeric G protein signaling blocks both effects. Collectively, the data suggest pervasive translation in regions of the transcriptome annotated as noncoding in dorsal root ganglion neurons and identify a specific uORF-encoded peptide that promotes pain sensitization through GPCR signaling.
Disease Burden and Treatment Patterns Associated With Eosinophilic Esophagitis in the United States
Authors: Lu Mei , Goodwin Bridgett , Vera-Llonch Montserrat , Williams James 
Published: January 2021

Goals:
This US-based, retrospective claims study aimed to investigate disease burden and treatment patterns in patients with eosinophilic esophagitis (EoE), and to compare health care resource use (HCRU) in patients with EoE and matched controls without EoE.

Materials and Methods:
Patients with a diagnosis of EoE and ≥12 months of prediagnosis data were identified from the Truven Health MarketScan Research databases (January 2008 to September 2016) and followed up from the diagnosis date until termination of eligibility for a health plan. Patient clinical characteristics and HCRU were recorded in the 12 months before diagnosis; HCRU and treatment patterns were recorded during follow-up. HCRU in patients with EoE and matched controls was compared during the 12-month postdiagnosis period.

Results:
Among the 23,003 patients with EoE (mean age: 34.3 y; 64.8% male), gastroesophageal reflux disease was the most common prediagnosis condition (34.6%). After diagnosis, the most common off-label, first-line treatments were proton pump inhibitor monotherapy (52.8%) and topical corticosteroid monotherapy (21.5%). Overall, 3336 patients (14.5%) received at least 3 lines of off-label pharmacotherapy. Outpatient visits (recorded in 99.9% of patients on and postdiagnosis) were most frequently to gastroenterologists/pediatric gastroenterologists (49.5% prediagnosis, 72.6% on and postdiagnosis). Inpatient admissions and outpatient and emergency room visits were more likely in patients with EoE than in matched controls (P<0.0001).

Conclusions:
Patients with EoE in the USA experience a high disease burden both before and after diagnosis, which requires significant HCRU. Our findings highlight the unmet need for adequate control of EoE-related symptoms.
Primary cystic and solid neuroendocrine tumor of the retroperitoneum
Authors: Shi Dan , Dong Guo-Qiu , Shen Ke-Ren , Pan Yao , Wei Shu-Mei , Chen Ying , Yu Ri-Sheng 
Published: January 2021

Abstract

Rationale:
Primary neuroendocrine tumors (NETs) of the retroperitoneum are extremely rare. The purpose of this case report is to highlight the unusual growth pattern and radiologic features of primary retroperitoneal NETs.

Patient concerns:
A 46-year-old woman was found to have a retroperitoneal cystic and solid mass during a physical checkup.

Diagnoses:
The mass was mainly multiseptated in the cystic portion and had a bead-like, lobulated appearance. The solid portion showed restricted diffusion on diffusion-weighted imaging and obvious homogeneous enhancement. The cystic portion showed ring-like and septal enhancement. The patient was diagnosed with a grade 2 (G2) NET of the retroperitoneum after surgery.

Interventions:
The patient underwent resection of the large retroperitoneal tumor.

Outcomes:
The patient returned 20 months later with tumor recurrence in the retroperitoneum. She was enrolled in a clinical trial for sulfatinib, and the mass was considerably reduced in size after 4 months. During a nearly 1.5-year follow-up, the mass gradually became slightly enlarged. The expression of somatostatin receptor 2 (SSTR2) was detected, and somatuline was administered as the current treatment.

Lessons subsections:
When a retroperitoneal mass presents as a well-defined cystic or solid hypervascular mass with a fibrous capsule, a primary retroperitoneal NET should be considered in the differential diagnosis.
Adenylate kinase 7 is a prognostic indicator of overall survival in ovarian cancer
Authors: Zhang Xue-ying , Zhou Li-li , Jiao Yan , Li Yan-qing , Guan Yi-nuo , Zhao Yue-chen , Zheng Lian-wen 
Published: January 2021

Abstract
Ovarian cancer (OC), a common malignant heterogeneous gynecological tumor, is the primary cause of cancer-related death in women worldwide. Adenylate kinase (AK) 7 belongs to the adenylate kinase (AK) family and is a cytosolic isoform of AK. Recent studies have demonstrated that AK7 is expressed in several human diseases, including cancer. However, there is a scarcity of reports on the relationship between AK7 and OC. Here, we compared the expression of AK7 in normal and cancerous ovarian tissues from The Cancer Genome Atlas database and used the c2 test to assess the correlation between AK7 levels and the clinical symptoms of OC. Finally, the prognostic significance of AK7 in OC was determined using the Kaplan–Meier analyses and Cox regression and performed gene set enrichment analysis to detect any relevant signaling pathways. We found that AK7 levels were substantially downregulated in OC than that in normal ovarian tissues (P < .001). Low AK7 levels were related to the patients’ age (P = .0093) in OC. The median overall survival (OS) of patients with low AK7-expressing OC was shorter than patients with high AK7-expressing OC (P = .019). The Cox regression analysis (multivariate) identified low AK7 levels were independently related to the prognosis of OC (HR 1.34; P = .048). Our study demonstrated that the downregulated levels of AK7 could serve as an independent prognostic indicator for the OS in OC. Additionally, gene set enrichment analysis revealed that EMT, apical junction, TGF-b signaling, UV response, and myogenesis were associated in the low AK7 expression phenotype (NOM P < .05).
Infantile hepatic hemangioma misdiagnosed by prenatal ultrasonography
Authors: Jin Ya , Li Lin , Yang Fan 
Published: January 2021

Abstract

Rationale:
The drastic differences in treatment and prognosis of infantile hepatic hemangioma (IHH) and hepatoblastoma (HBL) make accurate prenatal diagnosis imperative. The retrospective comparisons of ultrasonic features between fetal IHH and HBL have been reported before, but clinically, the differential diagnosis in utero is very difficult and can lead to prenatal misdiagnosis.

Patient concerns:
A 27-year-old woman at 30 gestational weeks underwent the routine prenatal examination. A heterogeneous solid mass of the fetus, with close relationship to the liver, was recognized by ultrasound.

Diagnosis:
A diagnosis of HBL was highly considered.

Interventions:
The fetus was aborted and the autopsy was performed.

Outcomes:
The histological outcome was IHH.

Lessons:
The prognosis of fetal IHH and HBL is very different, so an accurate diagnosis prenatally is crucial and indispensable. The radiologist and clinician should differentiate between IHH and HBL, especially since the fetus can have serious complications.