bluuebunny/crossref_metadata_2025_split huggingface dataset:
Seasonal trends of Cyclospora cayetanensis infections in a community of Falcon State, Northwestern Venezuela
Authors: Chacin-Bonilla L , Sanchez Y 
Published: November 2021

Abstract

Background
Cyclosporiasis has a marked seasonality. Few community-based studies have addressed this issue and there are no reports from Venezuela. A study was conducted to determine the seasonal variation of infection in a community from Falcon State, Venezuela.

Methods
A sample of 732 individuals was collected for 1 y. Stools were examined with modified Ziehl-Neelsen carbolfuchsin staining of ethyl acetate-formalin concentrates and ultraviolet epiflorescence of wet mounts.

Results
Cyclospora prevalence was 9.9% (73/732) with monthly variation from 0% to 35.3%. A trend of increased infections coinciding with the rainy time was observed (p&lt;0.001).

Conclusions
Cyclosporiasis is common in this area with high endemicity during the rainy periods.
The Use of the Video, “Dear 16-Year-Old Me,” as a Melanoma Education Tool in Ambulatory Dermatology
Authors: Olayiwola Oluwatobi , Lazovich DeAnn , Wipf Angela , Goldfarb Noah , Lindgren Bruce , Bellefeuille Gretchen , Farah Ronda S. 
Published: November 2021

BACKGROUND
Skin cancer continues to be the most common cancer in the United States. The rise of social media platforms and internet use offers an opportunity to present health information through video-based education. The video “Dear 16-Year-OldMe,” addresses the risks associated with tanning and sun exposure, the importance of practicing sun protection, and shares stories from melanoma survivors.

OBJECTIVE
To evaluate the video “Dear 16-Year-Old Me,” as a patient education tool in dermatology clinics and to investigate whether viewing a short educational video can change knowledge about skin cancer risks and intention to improve skin cancer prevention behavior.

PATIENTS AND METHODS/MATERIALS AND METHODS/METHODS
English-speaking clinic patients between the ages of 14 to 45 years old were recruited. Exclusion criteria include both a personal or family history of skin cancer, dysplastic nevi, or other medical comorbidities. Forty-five participants agreed to participate; 38 were eligible for analysis.

RESULTS
Comparison of prevideo and postvideo responses demonstrated a statistically significant reduction in participants reporting they were likely to tan outdoors (p-value = .001). A significant increase was observed in the reported likelihood to have a professional skin examination (p-value < .001) or self-examination (p-value < .001) in the future.

CONCLUSION
and Relevance: Viewing “Dear 16-Year-Old Me,” resulted in reported participant changes in intention to tan outdoors and participate in skin surveillance. Although these are encouraging results, future studies with a comparison group are needed to elucidate whether these results correspond to changes in behavior. In the age of viral videos and readily accessible health information via the internet, continued investigation of video media on patient health behaviors should be pursued.
Inferiorly Based Rotation Flaps for Infraorbital Cheek Defects
Authors: Donigan Jessica M. , Taylor Oliver , Greif Charlotte , Srivastava Divya , Nijhawan Rajiv I. 
Published: November 2021

BACKGROUND
The infraorbital cheek is a common location for cutaneous malignancy and thus surgical defects. Reconstruction in this region must maintain nearby free margins to ensure optimal cosmetic and functional outcomes. Large defects may require a flap using lateral or inferior tissue reservoirs.

OBJECTIVE
To examine outcomes of inferiorly based rotation flaps in the repair of infraorbital cheek defects and highlight pearls for optimal long-term results.

METHODS
Chart review of patients with a defect of the infraorbital cheek repaired with an inferiorly based rotation flap between February 2010 and December 2018 at a single academic institution. The Visual Analog Scale (VAS) was used for scar assessment.

RESULTS
Sixty-five patients underwent extirpation of a cutaneous malignancy resulting in defects ranging from 1.0 × 1.0 to 4.5 × 5.5 cm (mean area = 4.8 cm2). Most of the patients did not experience complications. Ectropion occurred in 7 patients. The mean VAS score was 11.6.

CONCLUSION
An inferiorly based rotation flap yields acceptable outcomes for infraorbital cheek defects and can be considered for defects as large as 5.5 cm. Using pearls for surgical execution presented in this article may allow reconstructive surgeons to include this flap in their repertoire.
Age at menopause among rural and urban women in the state of Campeche, Mexico
Authors: Sievert Lynnette Leidy , Huicochea-Gómez Laura , Cahuich-Campos Diana , Whitcomb Brian W. , Brown Daniel E. 
Published: November 2021

Abstract

Objective:
The purpose of this study was to examine age at natural menopause among women of Maya and non-Maya ancestry living in urban and rural communities in the state of Campeche, Mexico.

Methods:
Women ages 40 to 60 (n = 543) participated in semi-structured interviews and anthropometric measures. The last names, languages spoken, and the birthplace of the woman, her parents, and her grandparents were used to determine Maya or non-Maya ethnicity. Recalled age at natural menopause was compared across four communities; analysis of variance was used to compare means and Kaplan-Meier analyses were used to compare medians. Probit analysis was also used to estimate median ages at menopause. Cox regression analyses were applied to identify variables associated with age at menopause.

Results:
Mean recalled age at natural menopause across all sites was 46.7 years, ranging from 47.8 years in the city of Campeche to 43.9 years in the rural Maya communities in the municipality of Hopelchén. Median ages at menopause across all sites were 50.55 years by probit analysis and 50.5 years by Kaplan-Meier. Variables associated with a later age at menopause included higher socioeconomic status, higher parity, and a later age at menarche.

Conclusions:
The early mean recalled age at menopause in southern Hopelchén was consistent with previous studies in the Yucatán peninsula. As expected, probit and Kaplan-Meier analyses demonstrated later ages at menopause. Contrary to our expectations, Maya/non-Maya ethnicity was not associated with age at menopause. Demographic and reproductive factors were more important than ethnicity in explaining variation in age at menopause within the state of Campeche, Mexico.
Prognostic value of neutrophil-to-lymphocyte ratio in cirrhosis patients undergoing transjugular intrahepatic portosystemic shunt
Authors: Zhang Wei , Aryan Mahmoud , Chen Zhiguo , Khan Walid , Thompson Blake , Kwenda Elizabeth , Geller Brian , Morelli Giuseppe 
Published: November 2021

Background and aims
The neutrophil-to-lymphocyte-ratio (NLR) is used as an inflammatory index and has proven to be an accurate prognostic indicator for decompensated cirrhotics; however, its role in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) has not been evaluated. We examined whether NLR is associated with mortality in decompensated cirrhosis patients undergoing TIPS.

Methods
We performed a retrospective review of 268 decompensated cirrhotics who underwent TIPS from January 2011 to December 2015 at an academic medical center. NLR, patient demographics, manifestations of cirrhosis, TIPS indications and mortality were recorded. Univariate and multivariate Cox regression analyses for prognostic factors associated with 30-day and 90-day post TIPS mortality were performed.

Results
A total of 129 (48%) patients received TIPS for refractory ascites with 79 (29%) for variceal bleeding, 14 (5%) for hepatic hydrothorax, and 46 (17%) for other indications. Cirrhosis etiology included hepatitis C (36%), alcohol (28%), nonalcoholic steatohepatitis (20%), or other (15%). Median NLR was 4.42 (IQR 2.75–7.19). Univariate and multivariate analysis showed NLR as an independent predictive factor of 30-day and 90-day mortality. Furthermore, in patients with a Model of End-Stage Liver Disease (MELD) ≤ 15, NLR is superior to MELD/MELD-Na score in predicting 30-day and 90-day mortality. In patients with MELD > 15, MELD/MELD-Na score is superior to NLR.

Conclusion
Our data indicate that elevated NLR independently predicts 30-day and 90-day mortality. In patients with a MELD ≤ 15, NLR is a better prognostic factor than MELD or MELD-Na in predicting short-term mortality.
Novel approaches to hypoglycemia and burnt-out diabetes in chronic kidney disease
Authors: Rhee Connie M. , Kalantar-Zadeh Kamyar , Tuttle Katherine R. 
Published: November 2021

Purpose of review
Diabetes mellitus is a leading cause of chronic kidney disease (CKD) that confers faster kidney disease progression, higher mortality, and various metabolic derangements including hypoglycemia.

Recent findings
Even in the absence of diabetes mellitus, growing research demonstrates that CKD patients are at heightened risk for hypoglycemia via multiple pathways. In CKD patients transitioning to end-stage renal disease (ESRD), spontaneous resolution of hyperglycemia and frequent hypoglycemia resulting in reduction and/or cessation of glucose-lowering medications are frequently observed in a phenomenon described as ‘burnt-out diabetes’. In non-CKD patients, it is well established that hypoglycemia is causally associated with mortality, with pathways including arrhythmias, sudden cardiac death, stroke, and seizures. Increasing evidence shows that, in CKD and ESRD patients with and without diabetes mellitus, hypoglycemia is associated with cardiovascular complications and mortality risk.

Summary
Given the high prevalence of hypoglycemia in CKD patients and the morbidity and mortality associated with this metabolic complication, a multimodal strategy is needed to prevent dysglycemia, including individualization of glycemic targets, selection of glucose-lowering medications less likely to induce hypoglycemia, medical nutrition therapy administered by trained dietitians, and accurate and precise hypoglycemia detection methods, such as self-monitored blood glucose or continuous glucose monitoring including during dialysis treatment.
Medical nutrition therapy using plant-focused low-protein meal plans for management of chronic kidney disease in diabetes
Authors: Kalantar-Zadeh Kamyar , Rhee Connie M. , Joshi Shivam , Brown-Tortorici Amanda , Kramer Holly M. 
Published: November 2021

Purpose of review
Nearly half of all Americans with chronic kidney disease (CKD) also have type-2-diabetes (T2D). Whereas traditional and emerging pharmacotherapies are increasingly frequently used for the management of CKD in diabetes (CKD/DM), the role of integrated or multimodal interventions including the potentially synergistic and additive effect of diet and lifestyle modifications in addition to pharmacotherapy has not been well examined, in sharp contrast to the well-known integrated approaches to heart disease.

Recent findings
Low-carbohydrate low-fat diets are often recommended in T2D, whereas low-protein diets (LPD) are recommended by guidelines for nondiabetic CKD with increasing emphasis on plant-based protein sources. High-protein diets with greater animal protein lead to glomerular hyperfiltration, especially in patients with T2D, and faster decline in renal function. Guidelines provide differing recommendations regarding the amount (low vs high) and source (plant vs animal) of dietary protein intake (DPI) in CKD/DM. Some such as KDIGO recommend 0.8 g/kg/day based on insufficient evidence for DPI restriction in CKD/DM, whereas KDOQI and ISRNM recommend a DPI of 0.6 to <0.8 g/kg/day. A patient-centered plant-focused LPD for the nutritional management of CKD/DM (PLAFOND), a type of PLADO diet comprising DPI of 0.6 to <0.8 g/kg/day with >50% plant-based sources, high dietary fiber, low glycemic index, and 25–35 Cal/kg/day energy, can be implemented by renal dietitians under Medical Nutrition Therapy.

Summary
Potential risks vs benefits of high vs low protein intake in CKD/DM is unknown, for which expert recommendations remain opinion based. Randomized controlled studies are needed to examine safety, acceptability and efficacy of PLAFOND.
Update on penile sparing surgery for penile cancer
Authors: Anastasiadis Eleni , Ayres Benjamin , Watkin Nick 
Published: November 2021

Purpose of review
Penile sparing surgery (PSS) is considered the standard of care in penile cancer where appropriate, as preservation of the penis may enable the patient to maintain urinary and sexual function. This review will focus on the latest developments over the past two years.

Recent findings
In this review, we discuss the latest findings in oncological outcomes in PSS, specifically glansectomy. We also introduce technology that may be useful in improving the precision of surgical resection margins in PSS. Finally, we consider the value of patient-reported outcome measures (PROMs) and consider how research in this area can be improved.

Summary
A recent study has found a correlation between local recurrences (LR) and worse overall and cancer-specific survival in glansectomy, which challenges the belief that LR do not confer worse oncological outcomes. Despite numerous studies evaluating PROMs in penile cancer/PSS, few of these studies provide quality evidence of the ‘supportive care needs’. A shift in research is required to identify those men at most risk of distress and to identify ways to support men diagnosed with penile cancer.
Epstein–Barr virus posttransplant lymphoproliferative disorder: update on management and outcomes
Authors: Lindsay Julian , Othman Jad , Heldman Madeleine R. , Slavin Monica A. 
Published: November 2021

Purpose of review
Management of Epstein–Barr virus posttransplant lymphoproliferative disorder (EBV PTLD) is complex, involving risk stratification, prevention and/or preemptive measures involving monitoring EBV DNAemia and balancing treatment options, using a combination of reduction of immune suppression, anti-B cell therapy, and cytotoxic T lymphocytes (CTLs).

Recent findings
The highest risk factor for the development of EBV PTLD in hematopoietic cell transplant (HCT) remains T cell depletion, with increasing use of antithymocyte globulin (ATG) or alemtuzumab in conditioning. In solid organ transplantation (SOT), the incidence of PTLD is highest among EBV seronegative recipients who are at risk for primary EBV infection following transplant in the first 12 months. Prevention is a critical component of the management of EBV PTLD. Although preemptive therapy remains standard of care, there continues to be heterogenicity and debate over the optimal choice of EBV DNA quantification and the threshold to use. Novel therapies such as donor-derived multipathogen and EBV specific CTLs for the prevention and third party CTLs for the treatment of EBV PTLD are promising, with rapidly expanding evidence, including large scale Phase III trials currently underway.

Summary
With an increasing number of risk groups for developing EBV PTLD in HCT and SOT, management strategies using prophylaxis or preemptive therapy remain standard of care, however the use of prophylactic or preemptive EBV specific or multipathogen CTLs show promising results and safety profiles.
Effect of the Neutralizing SARS-CoV-2 Antibody Sotrovimab in Preventing Progression of COVID-19: A Randomized Clinical Trial
Authors: Gupta Anil , Gonzalez-Rojas Yaneicy , Juarez Erick , Casal Manuel Crespo , Moya Jaynier , Falci Diego Rodrigues , Sarkis Elias , Solis Joel , Zheng Hanzhe , Scott Nicola , Cathcart Andrea L. , Parra Sergio , Sager Jennifer E. , Austin Daren , Peppercorn Amanda , Alexander Elizabeth , Yeh Wendy W. , Brinson Cynthia , Aldinger Melissa , Shapiro Adrienne E. 
Published: November 2021

AbstractImportanceOlder patients and those with underlying comorbidities infected with SARS-CoV-2 may be at increased risk of hospitalization and death from COVID-19. Sotrovimab is a neutralizing antibody designed for treatment of high-risk patients to prevent COVID-19 progression.ObjectiveTo evaluate the efficacy and safety of sotrovimab in preventing progression of mild to moderate COVID-19 to severe disease.DesignRandomized, double-blind, multicenter, placebo-controlled, phase 3 study.Setting57 centers in 5 countries.ParticipantsNonhospitalized patients with symptomatic, mild to moderate COVID-19 and at least 1 risk factor for disease progression.InterventionPatients were randomized (1:1) to an intravenous infusion of sotrovimab 500 mg or placebo.Main Outcomes and MeasuresThe primary efficacy outcome was the proportion of patients with COVID-19 progression, defined as all-cause hospitalization longer than 24 hours for acute illness management or death through day 29. Key secondary outcomes included the proportion of patients with COVID-19 progression, defined as emergency room visit, hospitalization of any duration, or death, and proportion of patients developing severe/critical respiratory COVID-19 requiring supplemental oxygen.ResultsAmong 1057 patients randomized (sotrovimab, 528; placebo, 529), all-cause hospitalization longer than 24 hours or death was significantly reduced with sotrovimab (6/528 [1%]) vs placebo (30/529 [6%]) by 79% (95% CI, 50% to 91%; P<.001). Secondary outcome results further demonstrated the effect of sotrovimab in reducing emergency room visits, hospitalization of any duration, or death, which was reduced by 66% (95% CI, 37% to 81%; P<.001), and severe/critical respiratory COVID-19, which was reduced by 74% (95% CI, 41% to 88%; P=.002). No patients receiving sotrovimab required high-flow oxygen, oxygen via nonrebreather mask, or mechanical ventilation compared with 14 patients receiving placebo. The proportion of patients reporting adverse events was similar between treatment groups; sotrovimab was well tolerated, and no safety concerns were identified.Conclusions and RelevanceAmong nonhospitalized patients with mild to moderate COVID-19, a single 500-mg intravenous dose of sotrovimab prevented progression of COVID-19, with a reduction in hospitalization and need for supplemental oxygen. Sotrovimab is a well-tolerated, effective treatment option for patients at high risk for severe morbidity and mortality from COVID-19.Trial RegistrationClinicalTrials.gov Identifier: NCT04545060
Validation of a rapid, saliva-based, and ultra-sensitive SARS-CoV-2 screening system for a pandemic-scale infection surveillance
Authors: Dewhurst Robert E , Heinrich Tatjana , Watt Paul , Ostergaard Paul , Marimon Jose Maria , Moreira Mariana , Houldsworth Philip E , Rudrum Jack D , Wood David , Kõks Sulev 
Published: November 2021

AbstractWithout any realistic prospect of comprehensive global vaccine coverage and lasting immunity, control of pandemics such as COVID-19 will require implementation of large-scale, rapid identification and isolation of infectious individuals to limit further transmission. Here, we describe an automated, high-throughput integrated screening platform, incorporating saliva-based loop-mediated isothermal amplification (LAMP) technology, that is designed for population-scale sensitive detection of infectious carriers of SARS-CoV-2 RNA. Central to this surveillance system is the “Sentinel” testing instrument, which is capable of reporting results within 25 minutes of saliva sample collection with a throughput of up to 3,840 results per hour. It incorporates continuous flow loading of samples at random intervals to cost-effectively adjust for fluctuations in testing demand. Independent validation of our saliva-based RT-LAMP technology on an automated LAMP instrument coined the “Sentinel”, found 98.7% sensitivity, 97.6% specificity, and 98% efficiency against a RT-PCR comparator assay, confirming its suitability for surveillance screening. This Sentinel surveillance system offers a feasible and scalable approach to complement vaccination, to curb the spread of COVID-19 variants, and control future pandemics to save lives.One-Sentence SummaryDevelopment of a high-throughput LAMP-based automated continuous flow, random access SARS-CoV-2 screening platform with sufficient sensitivity and specificity to enable pandemic-scale population testing of infectious individuals using saliva sampling.
Genetic Continuity of Indo-Iranian Speakers Since the Iron Age in Southern Central Asia
Authors: Guarino-Vignon Perle , Marchi Nina , Bendezu-Sarmiento Julio , Heyer Evelyne , Bon Céline 
Published: November 2021

ABSTRACTSince prehistoric times, South Central Asia has been at the crossroads of the movement of people, culture, and goods. Today, the Central Asia’s populations are divided into two cultural and linguistic groups: the Indo-Iranian and the Turko-Mongolian groups. Previous genetic studies unveiled that migrations from East Asia contributed to the spread of Turko-Mongolian populations in Central Asia and the partial replacement of the Indo-Iranian population. However, little is known about the origin of the latter. To shed light on this, we compare the genetic data on two current-day populations– Yaghnobis and Tajiks – with genome-wide data from published ancient individuals. The present Indo-Iranian populations from Central Asia display a strong genetic continuity with Iron Age samples from Turkmenistan and Tajikistan. We model Yaghnobis as a mixture of 93% Iron Age individual from Turkmenistan and 7% from Baikal. For the Tajiks, we observe a higher Baikal ancestry and an additional admixture event with a South Asian population. Our results, therefore, suggest that in addition to a complex history, Central Asia shows a remarkable genetic continuity since the Iron Age, with only limited gene flow.
Genetics of Myocardial Interstitial Fibrosis in the Human Heart and Association with Disease
Authors: Nauffal Victor , Di Achille Paolo , Klarqvist Marcus. D. R. , Cunningham Jonathan W. , Pirruccello James P. , Weng Lu-Chen , Morrill Valerie N. , Choi Seung Hoan , Khurshid Shaan , Friedman Samuel F. , Nekoui Mahan , Roselli Carolina , Ng Kenney , Philippakis Anthony A. , Batra Puneet , Ellinor Patrick T. , Lubitz Steven A. 
Published: November 2021

ABSTRACTMyocardial interstitial fibrosis is a common thread in multiple cardiovascular diseases including heart failure, atrial fibrillation, conduction disease and sudden cardiac death. To investigate the biologic pathways that underlie interstitial fibrosis in the human heart, we developed a machine learning model to measure myocardial T1 time, a marker of myocardial interstitial fibrosis, in 42,654 UK Biobank participants. Greater T1 time was associated with impaired glucose metabolism, systemic inflammation, renal disease, aortic stenosis, cardiomyopathy, heart failure, atrial fibrillation and conduction disease. In genome-wide association analysis, we identified 12 independent loci associated with native myocardial T1 time with evidence of high genetic correlation between the interventricular septum and left ventricle free wall (r2g = 0.82). The identified loci implicated genes involved in glucose homeostasis (SLC2A12), iron homeostasis (HFE, TMPRSS6), tissue repair (ADAMTSL1, VEGFC), oxidative stress (SOD2), cardiac hypertrophy (MYH7B) and calcium signaling (CAMK2D). Transcriptome-wide association studies highlighted the role of expression of ADAMTSL1 and SLC2A12 in human cardiac tissue in modulating myocardial tissue characteristics and interstitial fibrosis. Harnessing machine learning to perform large-scale phenotyping of interstitial fibrosis in the human heart, our results yield novel insights into biologically relevant pathways for myocardial fibrosis and prioritize investigation of pathways for the development of anti-fibrotic therapies.