bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Antibiotic Stewardship among Asymptomatic Newborns Using the Early-onset Sepsis Risk Calculator
Authors: Ellington Marty , Kasat Kavita , Williams Kim , Reichman Victoria , Stoffels Guillaume , Ming Leung Tung , Degoy Ana , Fisk Rebecca , Gonzalez-Ballesteros Luisa , Peralta-Reich Dinabel , Potash Aaron , Rao Kavya 
Published: August 2021

Introduction:
Neonatologists have long struggled with identifying and treating early-onset sepsis (EOS) without overexposing newborns to unnecessary antibiotics.

Methods:
In January 2016, we instituted an EOS protocol based mainly on the 2012 AAP guidelines. We subsequently conducted 2 additional plan-do-study-act cycles to decrease antibiotic usage by integrating the EOS risk calculator into our algorithm. For the periods January 2016–June 2017 (period 1), June 2017–February 2018 (period 2), and February 2018–December 2018 (period 3), we tracked all asymptomatic newborns older than 36 weeks, including those admitted to the neonatal intensive care unit for evaluation of EOS. We monitored the monthly variation in asymptomatic newborns older than 36 weeks who received antibiotics using statistical process control. The number of asymptomatic infants treated with antibiotics during the 3 periods was analyzed. Pairwise comparisons were made using post hoc chi-square analysis.

Results:
The addition of the EOS calculator score to our guidelines reduced the number of asymptomatic infants older than 36 weeks treated with antibiotics by 73% (P < 0.0001). Adopting the EOS calculator score after clinical examination further reduced the number of infants treated by 89% (P < 0.0001). For period 1, the percentage of asymptomatic infants older than 36 weeks treated with antibiotics was 4.3%; for period 2, it was 1.16%, and for period 3, it was 0.12% (P < 0.0001).

Conclusions:
The addition of the EOS calculator score to our AAP-based guidelines reduced antibiotic use among asymptomatic infants older than 36 weeks by 73%. Further adoption of the EOS calculator score after the clinical examination enabled our team to defer antibiotics in almost all asymptomatic infants safely.
Case Volume-Dependent Changes in Operative Morbidity following Free Flap Breast Reconstruction: A 15-Year Single-Center Analysis
Authors: Ochoa Oscar , Pisano Steven , Ledoux Peter , Nastala Chet , Arishita Gary , Garza Ramon , Ketchum Norma , Song Xuemei , Michalek Joel , Chrysopoulo Minas 
Published: August 2021

Background:
Operative morbidity is a common yet modifiable feature of complex surgical procedures. With increasing case volume, improvement in morbidity has been reported through designated procedural processes and greater repetition. Defined as a volume-outcome association, improvement in breast reconstruction morbidity with increasing free flap volume requires further characterization.

Methods:
A retrospective analysis was conducted among consecutive free flap patients using a two-microsurgeon model between January of 2002 and December of 2017. Patient demographics and operative characteristics were obtained from medical records. Complications including unplanned surgical intervention (take-back) and flap loss were obtained from prospectively kept databases. Individual surgeon operative volume was estimated by considering overall practice volume and correcting for the number of surgeons at any given time.

Results:
During the study period, 3949 patients met inclusion criteria. A total of 6607 breasts underwent reconstruction with 6675 free flaps. Mean patient age was 50 ± 9.4 years and mean body mass index was 28.8 ± 5.0 kg/m2. Bilateral reconstruction was performed on 2633 patients (66.5 percent), with 4626 breasts (70.5 percent) reconstructed in the immediate setting. Overall, breast and donor-site complications were reported in 507 breasts (7.7 percent) and 607 cases (15.4 percent), respectively. Take-back was required in 375 cases (9.5 percent), with complete flap loss occurring in 57 cases (0.9 percent). Based on annual flaps per surgeon, the incidence of complications decreased with increasing volume (slope = −0.12; p = 0.056).

Conclusion:
Through procedural efficiency and execution of defined clinical processes using a two-microsurgeon model, increases in microsurgical breast reconstruction case volume result in decreased morbidity.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Mandibular Subcondylar Fracture: Improved Functional Outcomes in Selected Patients with Open Treatment
Authors: Gibstein Alexander R. , Chen Kevin , Nakfoor Bruce , Gargano Francesco , Bradley James P. 
Published: August 2021

Background:
Subcondylar fractures represent 25 to 35 percent of all mandibular fractures, yet the treatment paradigm has remained controversial. Closed treatment relies on the plasticity of the condyle head during recovery, whereas open treatment is challenging and risks facial nerve injury. Perioperative, functional, and patient-reported outcomes were measured to compare methods of open versus closed treatment of subcondylar fractures.

Methods:
Selected displaced subcondylar fracture cases with open (open reduction and internal fixation of subcondylar fracture with maxillomandibular fixation) versus closed (maxillomandibular fixation) treatment were compared (n = 60). Demographics, perioperative data, complications, persistent symptoms, chin deviation, malocclusion, change in mouth opening, functional scores, and FACE-Q patient satisfaction were recorded.

Results:
Open versus closed groups had similar demographics and perioperative data, except the open group had longer operating room time (76.39 minutes versus 56.15 minutes). In long-term follow-up, open-treated patients had fewer symptoms (9 percent versus 67 percent), less chin deviation (0 percent versus 40 percent), a less restricted mouth opening (3mm versus 5mm), and better functional scores (1.92 versus 0.861). Transient facial nerve weakness was seen in 6 percent of open cases.

Conclusion:
For selected subcondylar fracture patients, open treatment with endoscopic assistance, nerve monitoring, and specialized plates provides superior long-term results compared to closed treatment when considering symptoms and functional parameters.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Fifteen-Year Experience with the Ghent Technique of Penile Inversion Vaginoplasty
Authors: Opsomer Dries , Vyncke Tom , Mertens Delphine , Ceulemans Aline , Claes Karel E. Y. , Buncamper Marlon , Monstrey Stan 
Published: August 2021

Background:
Demand for male-to-female gender-affirmation surgery is rising. Creation of a vaginal vault and a feminine vulva remains challenging, especially in circumcised patients. The authors present the 15-year results of the technique developed by the senior author (S.M.).

Methods:
A retrospective case review was performed of all penile inversion vaginoplasties carried out by the senior author between 2003 and 2017. Age, hormonal therapy time, body mass index, smoking, diabetes, circumcision, and the need for full-thickness skin grafts to lengthen the vaginal vault were investigated as potential risk factors for postoperative complications.

Results:
A total of 384 penile inversion vaginoplasties were retained, with 85.7 percent of patients requiring a full-thickness skin graft to lengthen the vaginal vault. Rectum perforation occurred in six patients (1.6 percent). Early revisions were necessary in 8.4 percent of patients and late revision surgery was performed in 37.1 percent of cases. There was no independent risk factor for early complications. Diabetes was an independent risk factor for late revision surgery. After vaginoplasty, 97.2 percent of patients reported being able to engage in penetrative intercourse, and 83.4 percent of patients reported having orgasms.

Conclusions:
Vaginoplasty is possible in all trans women, with most patients being able to engage in penetrative intercourse and reach an orgasm. To reach the desired depth of 14 cm, the neovaginal vault is usually lined with full-thickness skin grafts from the scrotum and/or abdomen. Diabetes was the only independent risk factor for revision surgery. Rectal tears are a rare complication and can usually be managed conservatively.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
TRIM22 genotype is not associated with markers of disease progression in children with HIV-1 infection
Authors: Boswell Michael T. , Yindom Louis-Marie , Hameiri-Bowen Dan , McHugh Grace , Dauya Ethel , Bandason Tsitsi , Mujuru Hilda , Esbjörnsson Joakim , Ferrand Rashida A. , Rowland-Jones Sarah 
Published: August 2021

Objective:
Untreated perinatal HIV-1 infection is often associated with rapid disease progression in children with HIV (CWH), characterized by high viral loads and early mortality. TRIM22 is a host restriction factor, which directly inhibits HIV-1 transcription, and its genotype variation is associated with disease progression in adults. We tested the hypothesis that TRIM22 genotype is associated with disease progression in CWH.

Design:
ART-naive CWH, aged 6–16 years, were recruited from primary care clinics in Harare, Zimbabwe. We performed a candidate gene association study of TRIM22 genotype and haplotypes with markers of disease progression and indicators of advanced disease.

Methods:

TRIM22 exons three and four were sequenced by Sanger sequencing and single nucleotide polymorphisms were associated with markers of disease progression (CD4+ T-cell count and HIV viral load) and clinical indicators of advanced HIV disease (presence of stunting and chronic diarrhoea). Associations were tested using multivariate linear and logistic regression models.

Results:
A total of 241 children, median age 11.4 years, 50% female, were included. Stunting was present in 16% of participants. Five SNPs were analyzed including rs7935564, rs2291842, rs78484876, rs1063303 and rs61735273. The median CD4+ count was 342 (IQR: 195–533) cells/μl and median HIV-1 viral load 34 199 (IQR: 8211–90 662) IU/ml. TRIM22 genotype and haplotypes were not associated with CD4+ T-cell count, HIV-1 viral load, stunting or chronic diarrhoea.

Conclusion:

TRIM22 genotype was not associated with markers of HIV disease progression markers or advanced disease in CWH.
Longitudinal trajectories of brain volume in combined antiretroviral therapy treated and untreated simian immunodeficiency virus-infected rhesus macaques
Authors: Liu Dan , Liu Jiaojiao , Xu Tingting , Qiao Hongwei , Qi Yu , Gao Yuxun , Ailixire  , Gao Lei , Li Chunlin , Xia Mingrui , Li Hongjun 
Published: August 2021

Objectives:
We used simian immunodeficiency virus (SIV)-infected nonhuman primates to investigate longitudinal changes of brain volume caused by SIV and the effect of combined antiretroviral therapy (cART). In addition, the relation between viral load, immune status, and brain volume were explored.

Design:
A longitudinal study of two healthy controls, five SIVmac239-infected macaques received cART (SIV+cART+) at 40 days postinnoculation, and five SIVmac239-infected macaques received no therapy (SIV+cART−).

Methods:
Structural T1-weighted MRI, blood and cerebrospinal fluid testing were acquired at multiple time points for 48 weeks postinfection (wpi). Brain volume was estimated using region of interest (ROI)-based analysis. Volume differences were compared among three groups. Linear regression models tested the associations between brain volumes and biomarkers (viral load, CD4+ T-cell count, CD4+/CD8+ ratio).

Results:
In our model, brain volume alteration in SIV-infected macaques can be detected at 12 wpi in several brain regions. As the infection progresses, the SIV+cART− macaques displayed generalized gray matter atrophy at the endpoint. Though initiate cART right after acute infection, SIV+cART+ macaques still displayed brain atrophy but showed signs of reversibility. Plasma viral load is mainly associated with subcortical nucleus volume whereas CD4+ T-cell count and CD4+/CD8+ ratio in plasma were associated with widespread cortical volume.

Conclusion:
The SIVmac239-infected Chinese origin macaque is a valid model for neuroHIV. Brain atrophy caused by SIV infection can be relieved, even reversed, by cART. Our model also provides new insights into understanding the pathogenesis of brain injury in people with HIV (PWH).
Coronavirus disease 2019 hospitalization outcomes in persons with and without HIV in Spain
Authors: Olalla-Sierra Julián , Martín-Escalante María Dolores , García-Alegría Javier , Rubio-Rivas Manuel , de Miguel-Campo Borja , Zurita-Etayo María , Arbones-Fernández Laia , Alcalá-Pedrajas José N. , Roldán-Silvestre Alicia , Cortés-Rodríguez Begoña , Casas-Rojo José Manuel , Núñez-Cortés Jesús Millán 
Published: August 2021

Objective:
To compare coronavirus disease 2019 (COVID-19) hospitalization outcomes between persons with and without HIV.

Design:
Retrospective observational cohort study in 150 hospitals in Spain.

Methods:
Patients admitted from 1 March to 8 October 2020 with COVID-19 diagnosis confirmed by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 positive) PCR test in respiratory tract samples. The primary data source was the COVID-19 Sociedad Española de Medicina Interna's registry (SEMI-COVID-19). Demographics, comorbidities, vital signs, laboratory parameters, and clinical severity as well as treatments received during admission, treatment duration, ICU admission, use of invasive mechanical ventilation, and death were recorded. Factors associated with mortality and the composite of ICU admission, invasive mechanical ventilation, and death, were analyzed.

Results:
Data from 16 563 admissions were collected, 98 (0.59%) of which were of persons with HIV infection. These patients were younger, the percentage of male patients was higher, and their Charlson comorbidity index was also higher. Rates of mortality and composite outcome of ICU admission, invasive mechanical ventilation or death were lower among patients with HIV infection. In the logistic regression analysis, HIV infection was associated with an adjusted odds ratio of 0.53 [95% confidence interval (CI) 0.29-0.96] for the composite outcome.

Conclusion:
HIV infection was associated with a lower probability of ICU admission, invasive mechanical ventilation, or death.
Cost-effectiveness of testing for latent tuberculosis infection in people with HIV
Authors: Auguste Peter E. , Mistry Hema , McCarthy Noel D. , Sutcliffe Paul A. , Clarke Aileen E. 
Published: August 2021

Objective:
The aim of this study was to estimate the cost-effectiveness of screening strategies for predicting LTBI that progresses to active tuberculosis (TB) in people with HIV.

Design:
We developed a decision-analytical model that constituted a decision tree covering diagnosis of LTBI and a Markov model covering progression to active TB. The model represents the lifetime experience following testing for LTBI, and discounting costs, and benefits at 3.5% per annum in line with UK standards. We undertook probabilistic and one-way sensitivity analyses.

Setting:
UK National Health Service and Personal Social Service perspective in a primary care setting.

Participants:
Hypothetical cohort of adults recently diagnosed with HIV.

Interventions:
Interferon-gamma release assays and tuberculin skin test.

Main outcome measure:
Cost per quality-adjusted life year (QALY).

Results:
All strategies except T-SPOT.TB were cost-effective at identifying LTBI, with the QFT-GIT-negative followed by TST5mm strategy being the most costly and effective. Results indicated that there was little preference between strategies at a willingness-to-pay threshold of £20 000. At thresholds above £40 000 per QALY, there was a clear preference for the QFT-GIT-negative followed by TST5mm, with a probability of 0.41 of being cost-effective. Results showed that specificity for QFT-GIT and TST5mm were the main drivers of the economic model.

Conclusion:
Screening for LTBI has important public health and clinical benefits. Most of the strategies are cost-effective. These results should be interpreted with caution because of the paucity of studies included in the meta-analysis of test accuracy studies. Additional high-quality primary studies are needed to have a definitive answer about, which strategy is the most effective.
Effects of Noninvasive Brain Stimulation (NIBS) on Cognitive Impairment in Mild Cognitive Impairment and Alzheimer Disease
Authors: Wang Tao , Guo Zhiwei , Du Yonghui , Xiong Ming , Yang Zhengcong , Ren Long , He Lin , Jiang Yi , McClure Morgan A. , Mu Qiwen 
Published: August 2021

Objective:
The purpose of this meta-analysis was to evaluate the beneficial effects and optimal stimulation protocol of noninvasive brain stimulation (NIBS) including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) on patients with mild cognitive impairment and Alzheimer disease.

Materials and Methods:
PubMed, Web of Science, Embase, and the Cochrane Library were searched until March 2020. The cognitive outcomes were extracted and the standardized mean difference with 95% confidence interval was calculated.

Results:
Twenty-eight studies were included. The result of NIBS showed significant effect on global cognition (P<0.05). Low-frequency rTMS over right dorsolateral prefrontal cortex (DLPFC), high-frequency rTMS (HF-rTMS) over left DLPFC, and the tDCS over left DLPFC and temporal lobe can significantly improve the memory function (P<0.05). HF-rTMS over left, right, or bilateral DLPFC can significantly improve the language function (P<0.05). Both HF-rTMS and tDCS over left DLPFC can obviously improve the executive function (P<0.05). Multiple sessions of rTMS with 80% to 100% intensity and anode tDCS with 2 mA current density are more suitable for all these functions.

Conclusions:
NIBS has a beneficial effect on cognitive performance in both mild cognitive impairment and Alzheimer disease patients. Distinct optimal stimulation parameters were observed for different cognitive functions.
Michael Mark Woolfson. 9 January 1927—23 December 2019
Authors: Wilson Keith S. , Dodson Eleanor J. 
Published: August 2021

Michael Woolfson contributed enormously to the theory and practice of X-ray crystallography for almost 60 years. He extended the theory of ‘direct methods’, which provided a general solution of the crystallographic phase problem from the measured diffraction data alone, and provided tools to exploit this theory. Software developed in his laboratory, such as the computer package MULTAN, was responsible for about half of the structures determined around the world in the 1970s and 1980s. His parallel work on the origin of the Solar System renewed interest in the Capture theory, and he contributed numerous stimulating ideas to the general study of the origin and dynamical evolution of the Solar System.
Michael was a great educator and mentor for both undergraduates and young researchers, and many of these went on to make significant scientific contributions.
Associations between gestational weight gain adequacy and neonatal outcomes in Tanzania
Authors: Perumal Nandita , Wang Dongqing , Darling Anne Marie , Wang Molin , Liu Enju , Urassa Willy , Pembe Andrea , Fawzi Wafaie W. 
Published: August 2021

AbstractIntroductionGestational weight gain (GWG) is associated with fetal and newborn health; however, data from sub-Saharan Africa are limited.MethodsWe used data from a prenatal micronutrient supplementation trial among a cohort of HIV-negative pregnant women in Dar es Salaam, Tanzania to estimate the relationships between GWG and newborn outcomes. GWG adequacy was defined as the ratio of the total observed weight gain over the recommended weight gain based on the Institute of Medicine body mass index (BMI)-specific guidelines. Newborn outcomes assessed were: stillbirth, perinatal death, preterm birth, low birthweight, macrosomia, small-for-gestational age (SGA), large-for-gestational age (LGA), stunting at birth, and microcephaly. Modified Poisson regressions with robust standard error were used to estimate the relative risk of newborn outcomes as a function of GWG adequacy.ResultsOf 7561 women included in this study, 51% had severely inadequate (<70%) or inadequate GWG (70-90%), 31% had adequate GWG (90-125%), and 18% had excessive GWG (≥125%). Compared to adequate GWG, severely inadequate GWG was associated with a higher risk of low birthweight, SGA, stunting at birth, and microcephaly; whereas excessive GWG was associated with a higher risk of LGA and macrosomia.ConclusionInterventions to support optimal gestational weight gain are needed and are likely to improve newborn outcomes.
Monocyte and neutrophil levels are potentially linked to progression to IPF for patients with indeterminate UIP CT pattern
Authors: Achaiah A. , Rathnapala A. , Pereira A. , Bothwell H. , Dwivedi K. , Barker R. , Benamore R , Hoyles R. , Iotchkova V , Ho L.P. 
Published: August 2021

AbstractRationaleIdiopathic pulmonary fibrosis (IPF) is a progressive fibrotic lung disease with poor prognosis. Identifying patients early may allow intervention which could limit progression. The ‘indeterminate for UIP’ (iUIP) CT pattern, defined in the 2018 IPF guidelines, could be a precursor to IPF but there is limited data on how patients with iUIP progress over time.ObjectiveTo evaluate the radiological progression of iUIP and explore factors linked to progression to IPF.MethodsWe performed a retrospective analysis of a lung fibrosis clinic cohort (n=230) seen between 2013-2017. Cases with iUIP were identified; first ever CTs for each patient found and categorised as ‘non-progressor’ or ‘progressors’ (the latter defined as increase in extent of disease or to ‘definite’ or ‘probable’ UIP CT pattern) during their follow up. Lung function trends, haematological data and patient demographics were examined to explore disease evolution and potential contribution to progression.Results48 cases with iUIP CT pattern were identified. Of these, 32 had follow up CT scans, of which 23 demonstrated progression. 17 patients in this cohort were diagnosed with IPF over a mean (S.D.) period of 3.9 (±1.9) years. Monocyte [HR 23, CI 1.6-340, p=0.03] and neutrophil levels [HR 1.8, CI 1.3-2.3, p<0.001] obtained around the time of initial CT, were associated with progression to IPF using Cox proportional hazard modelling.Conclusion53% of our evaluable iUIP patients progressed to IPF over a mean of four years. Monocyte and neutrophil levels at initial CT were significantly associated with progression in disease. These data provide a single-centre analysis of the evolution of patients with iUIP CT pattern, and first signal for potential factors associated with progression to IPF.Key messageWhat is the key question?How does the ‘indeterminate for UIP’ (iUIP) interstitial CT pattern evolve over time and what factors are associated with progression to definite and probable UIP pattern.What is the bottom line?In this retrospective single centre analysis, 53% of evaluable cases with iUIP on initial CT scan progressed to probable or definite UIP CT pattern over an average of 4 years. Monocyte and neutrophil levels performed around the time of initial CT were significantly associated with progression to definite and probable UIP pattern.Why read on?We discuss the implications of these findings, its strengths and limitations.