bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pilot Test of a Definitive Prosthetic Socket Made with 3D Printing Technology
Authors: Nickel Eric , Cataldo Alana , Walker Nicole , Santa Ana Christine , Barrons Kyle , Gravely Amy , Hand Barry , Hansen Andrew 
Published: November 2021

ABSTRACT

Introduction
Additive manufacturing (also known as 3D printing) as a fabrication method is ideally suited to merging the organic shapes of human anatomy with engineered components. Many early adopters are exploring the application of these technologies for the fabrication of 3D-printed sockets, but questions remain regarding the ability to fabricate strong, well-fitting definitive sockets. The goal of the present study was to examine the real-world effect of using 3D-printed sockets with regards to mobility, comfort, balance confidence, and user acceptance.

Materials and Methods
Nine veterans with transtibial amputations participated in the study, three each using pin, sealing sleeve, or seal-in liner for suspension. Participants had their conventional definitive socket duplicated using 3D printing. When the 3D-printed socket was ready, using their conventional socket, participants performed a 2-minute walk test, followed by socket comfort score and rating of perceived exertion (10-point scale), Prosthetic Limb Users Survey of Mobility, Activities-Specific Balance Confidence, select subscales of the Prosthesis Evaluation Questionnaire, and the Amputee Body Image Scale–Revised. After completing the baseline data, participants were fitted with the 3D-printed socket and, after using it for 2 weeks, we repeated the data collection.

Results
Three participants were not able to complete the study. No large differences were observed for any of the measures. Participants were generally satisfied with the fit of the 3D-printed sockets, but there were challenges with getting the 3D-printed sockets to support elevated vacuum with the sealing sleeve and seal-in liner suspension methods.

Conclusions
No differences in performance or user acceptance were identified for pin suspension, but the 3D-printed sockets were not able to reliably support suction or elevated vacuum; further development will be needed before they are ready for clinical application.

Clinical Relevance
The present study has demonstrated the ability to achieve satisfactory fit and outcomes using 3D printing to fabricate definitive prosthetic sockets, but the printing method was unable to deliver consistent air-tight sealing for suction or elevated vacuum suspension. Other 3D printing methods and some secondary processing steps may be able to correct this deficiency.
An Update on Vitamin D Deficiency in the twenty-first century: nature and nurture
Authors: Stoffers Ashley J. , Weber David R. , Levine Michael A. 
Published: November 2021

Purpose of review
Here, we review the most up-to-date understanding of the pathogenesis, prevention and treatment of vitamin D deficient rickets in children. This will include recent advances in the genetic determinants of abnormal vitamin D metabolism, with the intention of aiding clinicians with establishing the diagnosis and implementing treatment plans for children presenting with vitamin D deficiency rickets.

Recent findings
Vitamin D deficiency rickets is a frequently encountered, but entirely preventable, disorder of bone mineral metabolism. Risk factors for developing vitamin D deficiency rickets include inadequate exposure to sunlight, exclusive breast feeding without vitamin D supplementation and inadequate intake of vitamin D, calcium or phosphorus. Other factors that may influence the development of vitamin D deficiency and/or rickets include genetic alterations or medications that alter vitamin D metabolism.

Summary
Vitamin D levels in individuals are influenced by environmental factors, as well as genetic factors. A thorough understanding of these factors is critical for the evaluation and treatment of a child presenting with rickets. There remains a great need for additional research to determine ideal vitamin D status across diverse populations, and to better understand how vitamin D status affects overall health.
How many is too many? Polyposis syndromes and what to do next
Authors: Gupta Nina , Drogan Christine , Kupfer Sonia S. 
Published: November 2021

Purpose of review
The goal of this review is to help providers recognize, diagnose and manage gastrointestinal (GI) polyposis syndromes.

Recent findings
Intestinal polyps include a number of histological sub-types such as adenomas, serrated, hamartomas among others. Over a quarter of individuals undergoing screening colonoscopy are expected to have colonic adenomas. Although it is not uncommon for adults to have a few GI polyps in their lifetime, some individuals are found to have multiple polyps of varying histology throughout the GI tract. In these individuals, depending on polyp histology, number, location and size as well as extra-intestinal features and/or family history, a polyposis syndrome should be considered with appropriate testing and management.

Summary
Diagnosis and management of polyposis syndromes has evolved with advent of multigene panel testing and new data on optimal surveillance strategies. Evidence-based recommendations and current practice guidelines for polyposis syndromes are reviewed here. Areas of uncertainty and future research are also highlighted.
Repeatability and Reproducibility of ADC Measurements and MRI Signal Intensity Measurements of Bone Marrow in Monoclonal Plasma Cell Disorders
Authors: Wennmann Markus , Thierjung Heidi , Bauer Fabian , Weru Vivienn , Hielscher Thomas , Grözinger Martin , Gnirs Regula , Sauer Sandra , Goldschmidt Hartmut , Weinhold Niels , Bonekamp David , Schlemmer Heinz-Peter , Weber Tim Frederik , Delorme Stefan , Rotkopf Lukas Thomas 
Published: November 2021

Background/Objectives
Apparent diffusion coefficient (ADC) and signal intensity (SI) measurements play an increasing role in magnetic resonance imaging (MRI) of monoclonal plasma cell disorders. The purpose of this study was to assess interrater variability, repeatability, and reproducibility of ADC and SI measurements from bone marrow (BM) under variation of MRI protocols and scanners.

Patients and Methods
Fifty-five patients with suspected or confirmed monoclonal plasma cell disorder were prospectively included in this institutional review board–approved study and underwent several measurements after the standard clinical whole-body MR scan, including repeated scan after repositioning, scan with a second MRI protocol, scan at a second 1.5 T scanner with a harmonized MRI protocol, and scan at a 3 T scanner. For T1-weighted, T2-weighted STIR, B800 images, and ADC maps, regions of interest were placed in the BM of the iliac crest and sacral bone, and in muscle tissue for image normalization. Bland-Altman plots were constructed, and absolute bias, relative bias to mean, limits of agreement, and coefficients of variation were calculated.

Results
Interrater variability and repeatability experiments showed a maximal relative bias of −0.077 and a maximal coefficient of variation of 16.2% for all sequences. Although the deviations at the second 1.5 T scanner with harmonized MRI protocol to the first 1.5 T scanner showed a maximal relative bias of 0.124 for all sequences, the variation of the MRI protocol and scan at the 3 T scanner led to large relative biases of up to −0.357 and −0.526, respectively. When comparing the 3 T scanner to the 1.5 T scanner, normalization to muscle reduced the bias of T1-weighted and T2-weighted sequences, but not of ADC maps.

Conclusions
The MRI scanners with identical field strength and harmonized MRI protocols can provide relatively stable quantitative measurements of BM ADC and SI. Deviations in MRI field strength and MRI protocol should be avoided when applying ADC cutoff values, which were established at other scanners or when performing multicentric imaging trials.
Guiding, Intermediating, Facilitating, and Teaching (GIFT)
Authors: Roze des Ordons Amanda L. , Eppich Walter , Lockyer Jocelyn , Wilkie Ryan D. , Grant Vincent , Cheng Adam 
Published: November 2021

Introduction
Use of frameworks for simulation debriefing represents best practice, although available frameworks provide only general guidance. Debriefers may experience difficulties implementing broad recommendations, especially in challenging debriefing situations that require more specific strategies. This study describes how debriefers approach challenges in postsimulation debriefing.

Methods
Ten experienced simulation educators participated in 3 simulated debriefings. Think-aloud interviews before and after the simulations were used to explore roles that debriefers adopted and the associated strategies they used to achieve specific goals. All data were audio recorded and transcribed, and a constructivist grounded theory approach was used for analysis.

Results
4 roles in debriefing were identified: guiding, (inter)mediating, facilitating integration, and teaching. Each role was associated with specific goals and strategies that were adopted to achieve these goals. The goal of creating and maintaining a psychologically safe learning environment was common across all roles. These findings were conceptualized as the GIFT debriefing framework.

Conclusions
Our findings highlight the multiple roles debriefers play and how these roles are enacted in postsimulation debriefing. These results may inform future professional development and mentorship programs for debriefing in both simulation-based education and healthcare settings.
Single-cell mtDNA heteroplasmy in colorectal cancer
Authors: Almeida João , Pérez-Figueroa Andrés , Alves João M. , Valecha Monica , Prado-López Sonia , Alvariño Pilar , Cameselle-Teijeiro Jose Manuel , Chantada Debora , Fonseca Miguel M. , Posada David 
Published: November 2021

AbstractHuman mitochondria can be genetically distinct within the same individual, a phenomenon known as heteroplasmy. In cancer, this phenomenon seems exacerbated, and most mitochondrial mutations seem to be heteroplasmic. How this genetic variation is arranged within and among normal and tumor cells is not well understood. To address this question, here we sequenced single-cell mitochondrial genomes from multiple normal and tumoral locations in four colorectal cancer patients. Our results suggest that single cells, both normal and tumoral, can carry various mitochondrial haplotypes. Remarkably, this intra-cell heteroplasmy can arise before tumor development and be maintained afterward in specific tumoral cell subpopulations. At least in the colorectal patients studied here, the somatic mutations in the single-cells do not seem to have a prominent role in tumorigenesis.
Management and containment of a SARS-CoV-2 Beta variant outbreak at the Malawi University of Science and Technology
Authors: Bandawe Gama , Chigwechokha Petros , Kunyenje Precious , Kazembe Yohane , Mwale Jeverson , Kamaliza Madalitso , Mpakati Mtisunge , Nyakanyaka Yanjanani , Makamo Charles , Kimu Saizi , Madanitsa Mwayiwawo , Bangoh Joseph Bitilinyu , Nyirenda Tonney , Luhanga Richard , Sambani Martha , Mvula Benard , Giandhari Jennifer , Pillay Sureshnee , Naidoo Yeshnee , Ramphal Upasana , San James Emmanuel , Tegally Houriiyah , Wilkinson Eduan , de Oliveira Tulio , Malata Address 
Published: November 2021

AbstractOutbreaks of COVID at university campuses can spread rapidly and threaten the broader community. We describe the management of an outbreak at a Malawian university in April-May 2021 during Malawi’s second wave. Classes were suspended following detection of infections by routine testing and campus-wide PCR mass testing was conducted. Fifty seven cases were recorded, 55 among students, two among staff. Classes resumed 28 days after suspension following two weeks without cases. Just 6.3% of full-time staff and 87.4% of outsourced staff tested while 65% of students at the main campus and 74% at the extension campus were tested. Final year students had significantly higher positivity and lower testing coverage compared to freshmen. All viruses sequenced were beta variant and at least four separate virus introductions onto campus were observed. These findings are useful for development of campus outbreak responses and indicate the need to emphasize staff, males and senior students in testing.Article Summary LineSuccessful management of a campus outbreak using test trace and isolate approach with resumption within a month following suspension of all in-person classes. Trends in voluntary testing by gender, age and year of study that can help in formation of future management approaches.
A fourth dose of the mRNA-1273 SARS-CoV-2 vaccine improves serum neutralization against the delta variant in kidney transplant recipients
Authors: Benotmane Ilies , Bruel Timothée , Planas Delphine , Fafi-Kremer Samira , Schwartz Olivier , Caillard Sophie 
Published: November 2021

AbstractIn immunocompetent subjects, the effectiveness of SARS-CoV-2 vaccines against the delta variant appears three- to five-fold lower than that observed against the alpha variant. Additionally, three doses of SARS-CoV-2 mRNA-based vaccines might be unable to elicit a sufficient immune response against any variant in immunocompromised kidney transplant recipients. This study describes the kinetics of the neutralizing antibody (NAbs) response against the delta strain before and after a fourth dose of a mRNA vaccine in 67 kidney transplant recipients who had experienced a weak antibody response after three doses. While only 16% of patients harbored NAbs against the delta strain prior to the fourth injection – this percentage raised to 66% afterwards. We also found that, after the fourth dose, the NAbs titer increased significantly (p=0.0001) from <7.5 (IQR : <7.5−15.1) to 47.1 (IQR <7.5−284.2). Collectively, our data indicate that a fourth dose of the mRNA-1273 vaccine in kidney transplant recipients with a weak antibody response after three previous doses improves serum neutralization against the delta variant.
Seven chain adaptive immune receptor repertoire analysis in rheumatoid arthritis: association to disease and clinically relevant phenotypes
Authors: Aterido Adrià , López-Lasanta María , Blanco Francisco , Juan-Mas Antonio , García-Vivar María Luz , Erra Alba , Pérez-García Carolina , Sánchez-Fernández Simón Ángel , Sanmartí Raimon , Fernández-Nebro Antonio , Alperi-López Mercedes , Tornero Jesús , Ortiz Ana María , Fernández-Cid Carlos Marras , Palau Núria , Pan Wenjing , Byrne-Steele Miranda , Starenki Dmytro , Weber Daniel , Rodriguez-Nunez Ivan , Han Jian , Myers Richard M. , Marsal Sara , Julià Antonio 
Published: November 2021

ABSTRACTRheumatoid arthritis (RA) is an immune-mediated inflammatory disease characterized by a defective adaptive immune receptor repertoire (AIRR) that fails to distinguish self from non-self antigens. The AIRR is vast, encompassing four T cell receptor (TCR) and three B cell receptor (BCR) chains, each of which displays an extraordinary amino acid sequence variability in the antigen-binding site. How the concerted action of T and B cell clones is associated with the development and clinical evolution of immune-mediated diseases is still not known. Using a new immunosequencing technology that allows the unbiased amplification of the seven receptor chains, we conducted an in-depth quantitative analysis of the seven-receptor chain variability in RA. Compared to healthy controls, the AIRR in RA was found to be characterized by a lower BCR diversity, the depletion of highly similar BCR clones, an isotype-specific signature as well as a skewed IGL chain and gene segment usage. A predictor based on quantitative multi-chain AIRR information was able to accurately predict disease, including the elusive seronegative subset of RA patients. AIRR features of the seven immune receptor chains were also different between patients with distinct clinically relevant phenotypes. Incorporating HLA variation data, we were able to identify the TCR clones that are specifically associated with the main disease risk variants. The longitudinal analysis of the AIRR revealed that treatment with Tumor Necrosis Factor (TNF) inhibitors selectively restores the diversity of B cell clones in RA patients by reducing the frequency of clones with a similar biochemical profile. The biochemical properties of the TNFi-modulated clones were also found to differ between responders and non-responders, supporting a different antigenic reactivity in the B cell compartment of these two groups of RA patients. Our comprehensive analysis of the TCR and BCR repertoire reveals a complex T and B cell architecture in RA, and provides the basis for precision medicine strategies based on the highly informative features of the adaptive immune response.
Evaluation of Mycobacterium tuberculosis-specific IFN-γ, TNF-α, CXCL10, IL2, CCL2, CCL7 and CCL4 levels for active tuberculosis diagnosis
Authors: Fries Anastasia , Mandagere Vinayak , Parker Robert , Tolosa-Wright Mica , Berrocal-Almanza Luis C. , Hoang Long , Boakye Aime , Halliday Alice , Lalvani Ajit 
Published: November 2021

AbstractOur study evaluates seven previously reported biomarkers for active tuberculosis (ATB) diagnosis. We compared Mycobacterium tuberculosis-specific IFN-γ, TNF-α, CXCL10, IL2, CCL2, CCL7 and CCL4 levels in patients with ATB and non-tuberculosis respiratory diseases. Our ATB group included equal numbers of patients with positive and negative QuantiFERON-TB Gold In-Tube (QFT-GIT) results, to assess whether any biomarker offered superior diagnostic accuracy to IFN-γ. No biomarker achieved higher sensitivity than QFT-GIT for ATB diagnosis without significant loss of specificity. Our study design provides an efficient strategy for rapidly gating future biomarkers by using clinically relevant and representative patient groups in whom current QFT-GIT tests fail.
Modelling the interplay of SARS-CoV-2 variants in the United Kingdom
Authors: Barreiro N. L. , Govezensky T. , Ventura C. I. , Núñez M. , Bolcatto P. G. , Barrio R. A. 
Published: November 2021

ABSTRACTMost COVID-19 vaccines have proved to be effective to combat the pandemic and to prevent severe disease but their distribution proceeds in a context of global vaccine shortage Their uneven distribution favors the appearance of new variants of concern, as the highly transmissible Delta variant, affecting especially non-vaccinated people. We consider that devising reliable models to analyse the spread of the different variants is crucial. These models should include the effects of vaccination as well as non-pharmaceutical measures used to contain the pandemic by modifying social behaviour. In this work, we present a stochastic geographical model that fulfills these requirements. It consists of an extended compartmental model that includes various strains and vaccination strategies, allowing to study the emergence and dynamics of the new COVID-19 variants. The models conveniently separates the parameters related to the disease from the ones related to social behavior and mobility restrictions. The geographical spread of the virus is modeled taking into account the actual population distribution in any given country of interest. Here we choose the UK as model system, taking advantage of the reliable available data, in order to fit the recurrence of the currently prevalent variants. Our computer simulations allow to describe some global features observed in the daily number of cases, as the appearance of periodic waves and the features that determine the prevalence of certain variants. They also provide useful predictions aiming to help planning future vaccination boosters. We stress that the model could be applied to any other country of interest.
Persistent racial/ethnic associated disparity in anti-tumor effectiveness of immune checkpoint inhibitors despite equal access
Authors: Florez M.A. , Kemnade J.O. , Chen N. , Du W. , Sabichi A. L. , Wang D.Y. , Huang Q. , Miller-Chism C.N. , Jotwani A , Chen A.C. , Hernandez D. , Sandulache V.C. 
Published: November 2021

AbstractImmune checkpoint inhibitors (ICIs) have revolutionized the treatment of both lung cancer and head and neck squamous cell carcinoma demonstrating clear benefit over traditional chemotherapy alone in the metastatic setting. While the overwhelming majority of ICI trial participants have been White patients, results of these trials have been broadly applied to patients of all ethnic/racial backgrounds. It has, therefore, not been well defined if response to ICIs differs between ethnic/racial populations or socio-economic groups.We reviewed response to ICI of 208 patients with diagnoses of lung or head and neck cancers treated with ICI between 2015 and 2020 at one of three clinical pavilions associated with the Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine in Houston, TX. Two of these pavilions (Harris Health System and the Michael E. DeBakey Veterans Affairs Medical Center) serve large minority patient populations and provide equal access of care to patients regardless of means. Of the 208 patients, 175 had a diagnosis of lung cancer [non-small cell lung carcinoma (NSCLC) or small cell lung cancer (SCLC)] and 33 had a diagnosis of head and neck squamous cell carcinoma (HNSCC); 38% self-identified as Black, 45% as non-Hispanic White, and 18% as Hispanic. The objective response rate (ORR) was similar for lung cancer (31.4%) and HNSCC patients (27.3%) (p=0.894). Statistically, the ORR for Hispanic and Black patients did not differ compared to non-Hispanic White patients (H 23.7%, B 28.6%, W 35.5%; H vs. W p=0.189; B vs. W p=0.338). When considering patients treated with ICI monotherapy, the ORR for Hispanic patients dropped to 13.3% and was significantly lower than the ORR of the non-Hispanic White patients while the ORR of Black and non-Hispanic White patients remained about the same (B 29.3% and W 34.6%, H vs. W p=0.0285; B vs. W p=0.5131). Immune related adverse events (irAEs) were the lowest in the Hispanic population occurring in only 30% of patients compared to 50% of patients exhibiting irAEs in the Black and non-Hispanic white cohorts.ICIs demonstrate comparable anti-tumor effects in lung cancer (NSCLC + SCLC) and HNSCC during routine clinical practice regardless of race or ethnicity. The significantly lower ORR observed in our cohort for Hispanic patients, particularly when used as monotherapy, is an unexpected finding and will require additional study to identify potential biological and non-biological confounders which could contribute to reduced ICI effectiveness in this patient population.