bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vitamin D in gynecological diseases
Authors: Chu Ta-Wei , Jhao Jing-Yun , Lin Ta-Jen , Lin Tzu-Wei , Wang Chia-Lin , Chang Huan-Shuo , Liu Li-Chun , Chang Cheng-Chang 
Published: August 2021

Background:
Most reproductive system studies suggest the protective effects of vitamin D, but vitamin D deficiency and insufficiency are growing global health issues. The present study investigates the association between vitamin D deficiency/insufficiency and gynecologic diseases to identify illness risks at different serum vitamin D levels in Taiwan.

Methods:
A total of 7699 female adults aged ≥20 years with results for both serum vitamin D and gynecologic-associated diseases were drawn from the Taiwan MJ cohort. We analyzed the correlation between serum vitamin D levels and results from reproductive system evaluations, including history of dysmenorrhea, results of Pap smear, high-risk human papillomavirus (HPV) infection of the cervix, mammography, and ultrasound of breast and pelvis.

Results:
Over 80% of participants showed vitamin D deficiency/insufficiency. Participants with abnormal Pap smear results, high-risk HPV infection, and history of dysmenorrhea showed significantly lower levels of serum vitamin D (p < 0.001–0.05). Serum vitamin D deficiency was significantly associated with positive high-risk HPV infection of the cervix (p < 0.05) and dysmenorrhea (p < 0.001). After controlling for age as a confounding variable for each gynecologic disease, level of serum vitamin D was significantly associated with abnormal breast ultrasound (odds ratio = 0.724) and uterus ultrasound (odds ratio = 0.673 – 0.8), and dysmenorrhea (odds ratio = 0.829).

Conclusion:
Associations were found between vitamin D deficiency and endometriosis, uterine myoma, dysmenorrhea, abnormal Pap smear results, and high-risk HPV infection of the cervix. Therefore, vitamin D supplements may present a cost-effective benefit for the prevention and treatment of gynecologic diseases, and thus reduction of healthcare expenditures.
Long-term Use of Hormone Replacement Therapy is Associated With a Lower Risk of Developing High-risk Serrated Polyps in Women
Authors: O’Sullivan Dylan E. , Ruan Yibing , Forbes Nauzer , Heitman Steven J. , Hilsden Robert J. , Pader Joy , Brenner Darren R. 
Published: August 2021

Goals/Background:
Hormone replacement therapy (HRT) and parity have been suggested protective factors against the development of colorectal polyps. However, there are a limited number of studies that have examined the relationship of these factors with high-risk adenomatous polyps (HRAP) or high-risk serrated polyps (HRSP), which may have different causes and therefore implications for screening programs.

Study:
Data from a cross-sectional study of 1384 women undergoing screening-related colonoscopy between 2008 and 2016 were analyzed. Modified Poisson regression models with robust error variance were used to determine the relative risk of developing adenomatous polyps, serrated polyps, HRAPs, and HRSPs associated with pregnancy, menopausal status, and the use of HRT (duration and type).

Results:
Women that used HRT for ≥6 years were at a significantly lower risk of developing a HRSP [risk ratios (RR): 0.53; 95% confidence interval (CI): 0.29-0.97]. Irrespective of the duration of use, the use of HRT that included progesterone alone or with estrogen was associated with a significantly lower risk of developing a HRSP (RR: 0.54; 95% CI: 0.30-0.95). The use HRT with progesterone for ≥6 years was associated with a nonsignificant lower risk of developing a HRSP (RR: 0.42; 95% CI: 0.17-1.04). None of the reproductive factors assessed or HRT were associated with the development of adenomatous polyps or HRAPs.

Conclusions:
The results of this study suggests that the long-term use of HRT, and therapies that include progesterone are associated with a lower risk of developing HRSPs. These results could have implications for targeted screening for serrated polyps among women.
Geographic disparities in transplantation
Authors: Salvalaggio Paolo R. 
Published: August 2021

Purpose of review
The Final Rule clearly states that geography should not be a determinant of a chance of a potential candidate being transplanted. There have been multiple concerns about geographic disparities in patients in need of solid organ transplantation. Allocation policy adjustments have been designed to address these concerns, but there is little evidence that the disparities have been solved. The purpose of this review is to describe the main drivers of geographic disparities in solid organ transplantation and how allocation policy changes and other potential actions could impact these inequalities.

Recent findings
Geographical disparities have been reported in kidney, pancreas, liver, and lung transplantation. Organ Procurement and Transplant Network has modified organ allocation rules to underplay geography as a key determinant of a candidates’ chance of receiving an organ. Thus, heart, lung, and more recently liver and Kidney Allocation Systems have incorporated broader organ sharing to reduce geographical disparities. Whether these policy adjustments will indeed eliminate geographical disparities are still unclear.

Summary
Modern allocation policy focus in patients need, regardless of geography. Innovative actions to further reduce geographical disparities are needed.
Validation of a Tool to Assess the Multidimensional Needs of the Parents of Children With Cancer
Authors: Zucchetti Giulia , Candela Filippo , Ciappina Sabrina , Mastrazzo Camilla , Roccia Elvia , Bertolotti Marina , Fagioli Franca 
Published: August 2021

Background
An assessment of the supportive care needs that parents whose children are suffering from cancer is crucial to providing maximum quality care in pediatric oncology.

Objective
To examine the psychometric properties of the Cancer Patient Needs Questionnaire (CPNQ) and validate the revised version (rCPNQ) of this multidimensional tool that evaluates the needs of parents whose child has cancer.

Methods
The original rCPNQ comprised 45 items and 6 dimensions of need. The original rCPNQ was first translated into Italian and then validated for use by performing an exploratory factor analysis with a subsequent reliability analysis for the entire scale and each factor found.

Results
One hundred forty-nine parents completed the Italian version of the rCPNQ, where a preliminary correlation analysis revealed the need for different psychometric item properties in the Italian population, with 22 items being excluded in the final model. The results of an exploratory factor analysis indicated a structure encompassing 4 factors of needs: (1) child-related emotional, (2) functional, (3) healthcare-related, and (4) emotional. The final version showed satisfactory internal consistency (subscales’ Cronbach’s α all >.80) and stability.

Conclusion
The Italian version of the rCPNQ is a shorter statistically validated version of the original scale and is a valid measure for professionals to use when assessing parents’ supportive care requirements.

Implications for Practice
The Italian version of rCPNQ can be used with professionals when assessing parents of children with cancer to assess their perceptions of their ill child’s emotional, functional, and healthcare needs.
A New Risk Assessment Model for Hospital-Acquired Venous Thromboembolism in Critically Ill Children: A Report From the Children’s Hospital-Acquired Thrombosis Consortium
Authors: Jaffray Julie , Mahajerin Arash , Branchford Brian , Nguyen Anh Thy H. , Faustino E. Vincent S. , Silvey Michael , Croteau Stacy E. , Fargo John H. , Cooper James D. , Bakeer Nihal , Zakai Neil A. , Stillings Amy , Krava Emily , Amankwah Ernest K. , Young Guy , Goldenberg Neil A. 
Published: August 2021

OBJECTIVES:
To create a risk model for hospital-acquired venous thromboembolism in critically ill children upon admission to an ICU.

DESIGN:
Case-control study.

SETTING:
ICUs from eight children’s hospitals throughout the United States.

SUBJECTS:
Critically ill children with hospital-acquired venous thromboembolism (cases) 0–21 years old and similar children without hospital-acquired venous thromboembolism (controls) from January 2012 to December 2016. Children with a recent cardiac surgery, asymptomatic venous thromboembolism, or a venous thromboembolism diagnosed before ICU admission were excluded.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
The multi-institutional Children’s Hospital-Acquired Thrombosis registry was used to identify cases and controls. Multivariable logistic regression was used to determine the association between hospital-acquired venous thromboembolism and putative risk factors present at or within 24 hours of ICU admission to develop the final model. A total of 548 hospital-acquired venous thromboembolism cases (median age, 0.8 yr; interquartile range, 0.1–10.2) and 187 controls (median age, 2.4 yr; interquartile range, 0.2–8.3) were analyzed. In the multivariable model, recent central venous catheter placement (odds ratio, 4.4; 95% CI, 2.7–7.1), immobility (odds ratio 3.6, 95% CI, 2.1–6.2), congenital heart disease (odds ratio 2.9, 95% CI, 1.7-4.7), length of hospital stay prior to ICU admission greater than or equal to 3 days (odds ratio, 2.5; 95% CI, 1.1–5.6), and history of autoimmune/inflammatory condition or current infection (odds ratio, 2.1; 95% CI, 1.2–3.4) were each independently associated with hospital-acquired venous thromboembolism. The risk model had an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.73–0.84).

CONCLUSIONS:
Using the multicenter Children’s Hospital-Acquired Thrombosis registry, we identified five independent risk factors for hospital-acquired venous thromboembolism in critically ill children, deriving a new hospital-acquired venous thromboembolism risk assessment model. A prospective validation study is underway to define a high-risk group for risk-stratified interventional trials investigating the efficacy and safety of prophylactic anticoagulation in critically ill children.
Antipsychiatric Medication Errors in Children Boarded in a Pediatric Emergency Department
Authors: Sethuraman Usha , Kannikeswaran Nirupama , Farooqi Ahmad , Richards Kimone , Chamberlain James 
Published: August 2021

Objectives
Mental health visits to the pediatric emergency department (PED) have increased significantly. Our objective was to describe medication errors in children with mental health illness who were boarded in a PED for more than 6 hours.

Methods
We conducted a retrospective study from 2014 to 2015 of children 6 to 18 years with psychiatric complaints and a length of stay of more than 6 hours. Admitted patients and those not on home medications were excluded. We collected demographics, number, types, and doses of antipsychiatric medications and errors.

Results
A total of 676 patients (53.1% males) with a median age of 14 (interquartile range, 12, 15) years were included. The median length of stay was 11.7 (interquartile range, 8.5, 20.5) hours. A total of 974 medication errors occurred in 491 (72.7%) patients. Omission errors were noted in 376 patients (76.6%), commission in 44 patients (9.0%), and both in 71 patients (14.4%). Among commission errors, 8 (18.1%) were serious and 8 (18.1%) were significant. One third of patients (30.5%) had 1 medication error, 23.9% had 2, 11.7% had 3, and 5% had 4.
Medication errors were most commonly noted in antidepressant and antipsychotic classes. One third (35.8%) of errors involved 2 medication classes. Being on 3 (odds ratio, 1.8; 95% confidence interval, 1.09–2.9) or 4 or more (odds ratio, 2.81; 95% confidence interval, 1.54–5.34) antipsychiatric medications was significantly associated with a prescription error.

Conclusion
There is a high incidence of medication errors, particularly those of omission, among antipsychiatric prescriptions in children boarded in the PED. A refinement of current medication reconciliation and integration of psychiatric medication databases between the PED and pharmacies are urgently needed to reduce these errors.
Computer-Aided Three-Dimensional Virtual Surgical Planning in Complex Skull Base Reconstruction for Sphenoid Wing Dysplasia in Neurofibromatosis Type 1
Authors: Hsu Hao-Hsiang , Wong Chia-En , Lee Jing-Wei , Huang Chi-Chen , Lee Jung-Shun 
Published: August 2021

Abstract
Unilateral sphenoid dysplasia is a rare but distinctive manifestation of neurofibromatosis type 1, causing pulsatile exophthalmos, decreased vision, and facial deformity. Surgical intervention is required to prevent visual deterioration. However, the reconstruction of a complex cranial base defect while fulfilling cosmetic needs is challenging. The asymmetric anatomy impedes identification and preservation of vital structures, and the use of bone grafts is often unsustainable due to resorption. Here we demonstrate a multimodal technique combining mirror-image-based virtual surgical planning, stereolithography, and neuronavigation to achieve skull base reconstruction and restore facial symmetry in an neurofibromatosis type 1 patient with sphenoid dysplasia. Preoperative surgical planning involved mirror-image simulation based on the unaffected contralateral counterpart and a stereolithographic skull-base model fabricated to design a patient-specific titanium mesh. Surgical reconstruction via the transcranial approach under intraoperative neuronavigation was performed. Immediate resolution of pulsatile proptosis was observed postoperatively. With the help of virtual surgical planning, stereolithography, and neuronavigation, precise and sustainable reconstruction with patient-specific implants can be tailored for a complex skull base defect.
The Relevance of Fluid and Blood Management Using Microcirculatory Parameters in Children Undergoing Craniofacial Surgery
Authors: Kilicaslan Banu , Canbay Ozgur , Saylan Alev , Akinci Seda Banu , Tuncbilek Gokhan , Ince Can 
Published: August 2021

Abstract
Perioperative management of bleeding in children can be challenging. Microvascular imaging techniques have allowed evaluating the effect of blood transfusion on the microcirculation, but little is known about these effects in children. We aimed to investigate the effects of blood management using macro- and micro-hemodynamic parameters measurement in children undergoing craniofacial surgery. This is a prospective observational repeated measurement study including fourteen children. The indications for blood transfusion were changes of hemoglobin/hematocrit (Hct) levels, the presence of signs of altered tissue perfusion and impaired microcirculation images. Total and perfused vessel densities, proportion of perfused vessels, microvascular flow index, and systemic parameters (hemoglobin, Hct, lactate, mixed venous oxygen saturation, K+, heart rate, mean arterial blood pressure) were evaluated baseline (T1), at the end of the surgical bleeding (T2) and end of the operation (T3). Four patients did not need a blood transfusion. In the other 10 patients who received a blood transfusion, capillary perfusion was higher at T3 (13[9–16]) when compared with the values of at T2 (11[8–12]) (P < 0.05) but only 6 patients reached their baseline values. Although blood transfusions increased Hct values (17 ± 2.4 [T2]-19 ± 2.8 [T3]) (P < 0.05), there was no correlation between microvascular changes and systemic hemodynamic parameters (P > 0.05). The sublingual microcirculation could change by blood transfusion but there was not any correlation between microcirculation changes, hemodynamic, and tissue perfusion parameters even with Hct values. The indication, guidance, and timing of fluid and blood therapy may be assessed by bedside microvascular analysis in combination with standard hemodynamic and biochemical monitoring for intraoperative bleeding in children.
Evaluating Ciliary Body Damage Induced by Blunt Low Speed Impact Using Finite Element Simulation
Authors: Cheng Qiong , Zhang Feng , Chen Zhongshan , Wu Lan , Chen Min , Xu Qiuyi , Wang Yi 
Published: August 2021

Purpose:
To evaluate the ciliary body mechanical load during low speed impact using finite element method to explain the mechanism of the cause of angle recession and cyclodialysis cleft.

Methods:
Optical coherence tomography images were obtained to assess the patient's ciliary body angle recession. A finite element eye model was established based on Virginia Tech eye model with the consideration of dynamic impact of a projectile striking an eye. The mechanical properties of the ocular tissues were obtained from literatures. The stress and strain were evaluated.

Results:
The stress distribution of the eye was calculated. The stress concentration at zonules was observed after 0.75 ms of the impact. The maximum stress at the cornea reached 3.8 MPa. The maximum stress at ciliary body was 57 KPa, which has high probability to cause ciliary body injury. The maximum stress at zonules was 0.98 MPa. The lateral expansion also reduces the forces transmitted along the sclera to the rear part of the eye.

Conclusions:
The eye under frontal impact will result in lateral expansion, which increase the stretch force of the lens, zonules and ciliary body. This mechanism can be seen as the protection for retina. The boundary of ciliary body is the most vulnerable position, where angle recession and cyclodialyses cleft will occur before retina damage occurrence.

Translational Relevance:
The finite element model explains the blunt low speed impact induced ciliary body related injuries, which enables us to assess the ocular injury for low energy impact and better diagnosis and treatment in clinics.
Pediatric surgical rib fixation: A collected case series of a rare entity
Authors: Polycarpou Andreas , Kim Brian D. 
Published: August 2021

BACKGROUND
Rib fractures are uncommon in children and are markers of extreme traumatic force from high-energy or nonaccidental etiology. Traditional care includes nonoperative management, with analgesia, ventilator support, and pulmonary physiotherapy. Surgical stabilization of rib fractures (SSRFs) has been associated with improved outcomes in adults. In children, SSRF is performed and its role remains unclear, with data only available from case reports. We created a collected case series of published pediatric SSRF cases, with the aim to provide a descriptive summary of the existing data.

METHODS
Published cases of SSRF following thoracic trauma in patients younger than 18 years were identified. Collected data included demographics, injury mechanism, associated injuries, surgical indication(s), surgical technique, time to extubation, postoperative hospital stay, and postoperative follow-up.

RESULTS
Six cases were identified. All were boys, with age range 6 to 16 years. Injury mechanism was high-energy blunt force in all cases, and all patients suffered multiple associated injuries. Five of six cases were related to motor vehicles, and one was horse-related. Indication(s) for surgery included ventilator dependence in five, significant chest deformity in two, and poor pain control in one case. Plating systems were used for rib stabilization in five of six cases, while intramedullary splint was used in one. All patients were extubated within 7 days following SSRF, and all were discharged by postoperative Day 20. On postoperative follow-up, no SSRF-related major issues were reported. One patient underwent hardware removal at 2 months.

CONCLUSION
Surgical stabilization of rib fractures in children is safe and feasible, and should be considered as an alternative to nonoperative therapy in select pediatric thoracic trauma cases. Potential indications for SSRF in pediatric patients include poor pain control, chest wall deformity, or ventilator dependence. Further studies are needed to establish the role and possible benefits of SSRF in pediatric thoracic trauma.

LEVEL OF EVIDENCE
Collected case series, level V.
Whole Genome Sequencing Analysis of Spike D614G Mutation Reveals Unique SARS-CoV-2 Lineages of B.1.524 and AU.2 in Malaysia
Authors: Zainulabid Ummu Afeera , Mat Yassim Aini Syahida , Soffian Sharmeen Nellisa , Mohd Ibrahim Mohamad Shafiq , Kamarudin Norhidayah , Kamarulzaman Mohd Nazli , Hin How Soon , Ahmad Hajar Fauzan 
Published: August 2021

AbstractThe SARS-CoV-2 has spread throughout the world since its discovery in China, and Malaysia is no exception. WGS has been a crucial approach in studying the evolution and genetic diversity of SARS-CoV-2 in the ongoing pandemic, and while an exceptional number of SARS-CoV-2 complete genomes have since been submitted to GISAID and NCBI, there is a scarcity of data from Malaysia. This study aims to report new Malaysian lineages responsible for the sustained spikes in COVID-19 cases during the third wave of the pandemic. Patients whose nasopharyngeal and oropharyngeal swabs were confirmed positive by real-time RT-PCR with Ct-value < 25 were chosen for WGS. The 10 SARS-CoV-2 isolates obtained were then sequenced, characterized and analyzed, including 1356 sequences of the dominant lineages of D614G variant currently circulating throughout Malaysia. The prevalence of clade GH and G formed strong ground of the discovery of two Malaysian lineages that caused sustained spikes of cases locally. Statistical analysis on the association of gender and age group with Malaysian lineages revealed a significant association (p < 0.05). Phylogenetic analysis revealed dispersion of 41 lineages, for which 22 lineages are still active. Mutational analysis observed unique G1223C missense mutation in Transmembrane Domain of Spike protein. Thus, calls for the large-scale WGS analysis of strains found around the world for greater understanding of viral evolution and genetic diversity especially in addressing the question of the effect of deleterious substitution mutation in transmembrane region of Spike protein.