bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trataka Kriya in Individuals with Digital Eye Strain: A Pre–Post Experimental Design
Authors: Kumar K.U. Dhanesh , Shetty Sparsha , Amin Hrishikesh , Rashmitha A. P. , Rani P. Shilna 
Published: July 2021

Abstract
Introduction Digital eye strain is the physical discomfort felt after 2 or more hours in front of a digital screen, including cell phones. Digital eye strain is otherwise known as computer vision syndrome. Trataka is to look at or to gaze—it is a preliminary step for meditation that involves staring at a single point such as a small object, black dot, or candle flame.
Objective This study aimed to analyze the effect of trataka kriya in the management of digital eye strain.
Materials and Methods Thirty participants of the age group 18 to 40 years were recruited in the study. The study design was a pre–post experiment. A convenient sampling technique was used to recruit the participants. The study included participants who use laptops or smartphones for a minimum of 2 hours daily and also participants having eye strain, dry eyes, burning sensation in the eyes, headache, and eye fatigue. They performed trataka kriya exercises once a day on alternative days for 1 month. Outcome measures was a computer vision syndrome questionnaire to assess the visual fatigue experienced by the study participants and the Schrimer test to find out whether the eye produces enough tears to keep it moist.
Statistical Analysis and Results Statistical analysis was done using SPSS version 16.0. To compare the computer vision syndrome questionnaire and Schrimer test before and after interventions paired t-test was used. A p-value of less than 0.05 is considered significant for the study.
Conclusion The study concludes that there was an improvement in the subjects with digital eye strain after performing trataka kriya. The clinical implication of the study is that this method can be used as one of the nonpharmacological interventions for digital eye strain.
Outcomes of Cardiopulmonary Resuscitation in the Pediatric Intensive Care of a Tertiary Center
Authors: Al-Eyadhy Ayman , Almazyad Mohammed , Hasan Gamal , AlKhudhayri Nawaf , AlSaeed Abdullah F. , Habib Mohammed , Alhaboob Ali A. N. , AlAyed Mohammed , AlSehibani Yazeed , Alsohime Fahad , Alabdulhafid Majed , Temsah Mohamad-Hani 
Published: July 2021

AbstractUnderstanding the factors affecting survival and modifying the preventable factors may improve patient outcomes following cardiopulmonary resuscitation (CPR). The aim of this study was to assess the prevalence and outcomes of cardiac arrest and CPR events in a tertiary pediatric intensive care unit (PICU). Outcomes of interest were the return of spontaneous circulation (ROSC) lasting more than 20 minutes, survival for 24 hours post-CPR, and survival to hospital discharge. We analyzed data from the PICU CPR registry from January 1, 2011 to January 1, 2018. All patients who underwent at least 2 minutes of CPR in the PICU were included. CPR was administered in 65 PICU instances, with a prevalence of 1.85%. The mean patient age was 32.7 months. ROSC occurred in 38 (58.5%) patients, 30 (46.2%) achieved 24-hour survival, and 21 (32.3%) survived to hospital discharge. Younger age (p < 0.018), respiratory cause (p < 0.001), bradycardia (p < 0.018), and short duration of CPR (p < 0.001) were associated with better outcomes, while sodium bicarbonate, norepinephrine, and vasopressin were associated with worse outcome (p < 0.009). The off-hour CPR had no impact on the outcome. The patients' cumulative predicted survival declined by an average of 8.7% for an additional 1 minute duration of CPR (p = 0.001). The study concludes that the duration of CPR, therefore, remains one of the crucial factors determining CPR outcomes and needs to be considered in parallel with the guideline emphasis on CPR quality. The lower survival rate post-ROSC needs careful consideration during parental counseling. Better anticipation and prevention of CPR remain ongoing challenges.
Tea or Thrush?: A Case of Nonaccidental Oral Injury in an Infant
Authors: Jan Meryam , Dully Kathleen , Kostecki Carissa , Alexander Randell C. 
Published: July 2021

AbstractA 5-month-old girl child patient presented to the emergency department for oral thrush and poor feeding but instead demonstrated concern for abuse after physical exam, as findings were consistent with oral injury. Correct identification of the oral findings as traumatic necessitated navigating language and cultural issues before the mechanism of injury and abuse determination could be made. Exploring the involvement of other caregivers was a crucial piece for investigation of the clinical scenario. The incidence of child abuse and pediatric oral injuries concerning for abuse were reviewed in this case report.
Transient Hyperammonemic Encephalopathy in a Child with Relapsed Acute Lymphoblastic Leukemia and Severe Tumor Lysis Syndrome
Authors: Dubinski Ilja , Feuchtinger Tobias , Maier Esther , Tacke Moritz , Hoffmann Florian 
Published: July 2021

AbstractIdiopathic hyperammonemia (IHA) is a severe condition, which has been reported in intensive chemotherapy and bone marrow transplantation. This case elucidates the diagnostic dilemma in children undergoing initiation of chemotherapy and developing severe disorders of qualitative and quantitative consciousness in the presence of hyperammonemia (HA) and lactic acidosis. The role of mitoxantrone as a causative agent for IHA in children is elusive. Children undergoing chemotherapy are often in a poor general condition, and the clinical presentation of HA is heterogeneous. This case should be a reminder for clinicians to check for HA in children with tumor lysis syndrome and acute neurological deterioration.
Pulmonary Embolism in a Critically Ill Infant with Univentricular Parallel Circulation
Authors: Shoya Kazuhiro , Maeda Jun , Nagamine Hiroki , Shimotakahara Akihiro , Yoshimura Yukihiro , Saito Osamu 
Published: July 2021

AbstractA 3-month-old infant patient with hypoplastic left heart syndrome diagnosed in the prenatal period required long-term intensive care for refractory chylothorax and chylous ascites after undergoing bilateral pulmonary artery banding at age 6 days. Weaning from mechanical ventilation was difficult due to massive edema, and a central venous catheter was required because enteral feeding was hampered by the refractory chyle leakage, for which surgery was ineffective. On the evening after central venous catheter replacement was performed, his respiratory condition suddenly deteriorated; cardiac ultrasound revealed that the left pulmonary arterial blood flow had decreased, and enhanced computed tomography demonstrated a left pulmonary embolism (PE), which was identified as the cause of a sudden decrease in the pulmonary blood flow. The patient died due to refractory septic shock at age 5 months. PEs in children, especially patients with cyanotic congenital heart disease, are difficult to diagnose because of their atypical presentation. Current diagnostic criteria are based on adult guidelines, and a few factors in the criteria, such as tachycardia and hypoxia, are difficult to apply for pediatric cyanotic patients with intracardiac or extracardiac right-to-left shunt. In fact, those criteria have lower specificities in children. In conclusion, the present case suggested that a sudden decrease in the pulmonary blood flow can aid the physicians in diagnosing PE in patients with cyanotic congenital heart disease. We need more pediatric cases and evidence of PE in children to make a PE guideline, which is specific to pediatric patients including cyanotic congenital heart disease.
A Case Series of Unusual or Infrequent Locations of Breast Cancer Metastases
Authors: Liew Amanda Ling Fung , Yu Ern Yu , Chotai Niketa 
Published: July 2021

AbstractBreast cancer metastasis to unusual locations may present as a diagnostic challenge. Recognizing the different manifestations of metastatic breast disease can help to guide patient treatment and assist in disease prognosis. The purpose of this article is to illustrate the imaging findings of some of the unusual or infrequent locations of breast metastases through a series of interesting cases and to revisit this uncommon clinical issue.
Acute effects of an injury preventive warmup programme on unanticipated jump‐landing‐task performance in adult football players: A crossover trial
Authors: Friebe David , Giesche Florian , Niederer Daniel , Ashigbi Evans Y. K. , Groneberg David A. , Banzer Winfried 
Published: July 2021

ABSTRACTIn football, unpredictable events (e.g. unexpected landings) seem to play a crucial role in the mechanism of non‐contact knee injuries. This study investigated the effects of a single bout of an injury preventive warmup protocol on biomechanical landing stability and decision‐making quality during preplanned and unanticipated jump‐landings. A crossover study on 18 male amateur football players was performed. The participants completed a standard (ergometer) and an injury‐preventive warmup protocol (Prevent injury and Enhance Performance (PEP)) on two different test days. After each protocol, participants performed countermovement jumps with preplanned (landing side displayed before takeoff) and unanticipated (landing side shown after takeoff) single‐leg landings on a force plate. Outcomes were landing stability (height and time of the maximum vertical ground reaction force (pGRF), centre of pressure (CoP), the number of standing errors (ground contact with free leg)) and decision‐making quality (landing error (wrong foot) count). Carry‐over and crossover‐tests were performed to find potential between‐condition‐differences. No carry‐over effects occurred (p > .05). The PEP led to a reduced CoP trace length (−18.4 ± 32.2%, p = .021) and earlier occurrence of pGRF (−4.72 ± 6.78%, p = .017) in the preplanned condition. No significant between‐treatment‐differences occurred within the unanticipated landings and decision‐making quality (p > .05). The primarily neuromuscular warmup protocol affects landing stability in the preplanned condition. However, it does not seem to better prepare football players for unpredictable events than a standard warmup.Trial registration: German Clinical Trials Register identifier: DRKS00016942.Highlights
Adapting movements rapidly to unanticipated external stimuli (e.g. unexpected landings) is crutial to prevent injuries in football
It is unclear wether popular neuromuscular injury preventive warmup programmes (e.g. Prevent injury and Enhance Performance (PEP)) adaquatly prepare athletes for these situations
Our study shows that the PEP warm up programme has acute effects on anticipated landing stability, but no influence on unanticipated landings or decision making quality
Classic neuromuscular warm up programmes may not be the optimal choice to prepare athletes properly for the upcoming motor‐cognitive demands in a football match
Progress in Microdermal Grafting for Color Regeneration of White Scars
Authors: Tsao Su-Ben , Jong Lih-Ren , Su Yue-Chiu , Kuo Yur-Ren 
Published: July 2021

Abstract

Background
Microdermal grafting with knife-cut, partially de-epithelialized skin can regenerate color in white (hypopigmented) scars. However, the scalp has more melanocytes, and dermabrasion can preserve more melanocytes than knife cutting during partial de-epithelialization.

Objectives
The aim of this study was to evaluate the color regeneration results and complications of various microdermal grafting procedures for white scar color regeneration.

Methods
Two refinements to an existing microdermal grafting technique for treating white scars were described: dermabrasion, rather than knife cutting, was used to partially de-epithelialize skin, and melanocyte donor sites were harvested from the scalp, rather than from skin. A review was performed of 65 cases in which various combinations of these refinements were used to treat scars on the face and forearms.

Results
Sixty-five patients (36 forearms; 29 faces) were treated, 40 receiving 1 session, 23 receiving 2 sessions, and 2 receiving 3 sessions of treatment. The follow-up was 6.5 months (range, 4-16 months). The use of both technique refinements produced approximately 15% better color generation than the original procedure after 1 session of treatment and approximately 20% better than the original procedure after 2 sessions. Histologic immunostaining showed that the dermabrasion method preserved more melanocytes around the epidermal-dermal region, and that the scalp has richer melanocytes than skin. The complication rate was reduced.

Conclusions
The use of the scalp as the donor site and partial de-epithelialization by dermabrasion can be safely incorporated into a previously developed microdermal grafting procedure for better color regeneration of white scars.

Level of Evidence: 4
An integrated computational pipeline for designing high-affinity nanobodies with expanded genetic codes
Authors: Padhi Aditya K , Kumar Ashutosh , Haruna Ken-ichi , Sato Haruna , Tamura Hiroko , Nagatoishi Satoru , Tsumoto Kouhei , Yamaguchi Atushi , Iraha Fumie , Takahashi Mihoko , Sakamoto Kensaku , Zhang Kam Y J 
Published: July 2021

Abstract
Protein engineering and design principles employing the 20 standard amino acids have been extensively used to achieve stable protein scaffolds and deliver their specific activities. Although this confers some advantages, it often restricts the sequence, chemical space, and ultimately the functional diversity of proteins. Moreover, although site-specific incorporation of non-natural amino acids (nnAAs) has been proven to be a valuable strategy in protein engineering and therapeutics development, its utility in the affinity-maturation of nanobodies is not fully explored. Besides, current experimental methods do not routinely employ nnAAs due to their enormous library size and infinite combinations. To address this, we have developed an integrated computational pipeline employing structure-based protein design methodologies, molecular dynamics simulations and free energy calculations, for the binding affinity prediction of an nnAA-incorporated nanobody toward its target and selection of potent binders. We show that by incorporating halogenated tyrosines, the affinity of 9G8 nanobody can be improved toward epidermal growth factor receptor (EGFR), a crucial cancer target. Surface plasmon resonance (SPR) assays showed that the binding of several 3-chloro-l-tyrosine (3MY)-incorporated nanobodies were improved up to 6-fold into a picomolar range, and the computationally estimated binding affinities shared a Pearson’s r of 0.87 with SPR results. The improved affinity was found to be due to enhanced van der Waals interactions of key 3MY-proximate nanobody residues with EGFR, and an overall increase in the nanobody’s structural stability. In conclusion, we show that our method can facilitate screening large libraries and predict potent site-specific nnAA-incorporated nanobody binders against crucial disease-targets.
Recent omics-based computational methods for COVID-19 drug discovery and repurposing
Authors: Tayara Hilal , Abdelbaky Ibrahim , To Chong Kil 
Published: July 2021

AbstractThe coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the main reason for the increasing number of deaths worldwide. Although strict quarantine measures were followed in many countries, the disease situation is still intractable. Thus, it is needed to utilize all possible means to confront this pandemic. Therefore, researchers are in a race against the time to produce potential treatments to cure or reduce the increasing infections of COVID-19. Computational methods are widely proving rapid successes in biological related problems, including diagnosis and treatment of diseases. Many efforts in recent months utilized Artificial Intelligence (AI) techniques in the context of fighting the spread of COVID-19. Providing periodic reviews and discussions of recent efforts saves the time of researchers and helps to link their endeavors for a faster and efficient confrontation of the pandemic. In this review, we discuss the recent promising studies that used Omics-based data and utilized AI algorithms and other computational tools to achieve this goal. We review the established datasets and the developed methods that were basically directed to new or repurposed drugs, vaccinations and diagnosis. The tools and methods varied depending on the level of details in the available information such as structures, sequences or metabolic data.
O5 Dose mean opening pressure predominantly assess internal anal sphincter function
Authors: Byrne C M , Sharma A , Kiff E S , Telford K J 
Published: July 2021

Abstract

Introduction
We have suggested that mean Opening Pressure (Op) recorded during Anal Acoustic Reflectometry (AAR) predominantly represents IAS function however, the extent remains unknown. The aim was to investigate this by excluding the external anal sphincter during general anaesthetic (GA) with confirmed neuromuscular blockade (NMB).

Method
Patients undergoing elective abdominal surgery requiring GA+NMB were approached. Patients had pre-operative (awake) and during GA + NMB (asleep) AAR measurements performed. The rectoanal inhibitory reflex (RAIR) was assessed permitting the Op value to also be recorded when the IAS was inhibited. Op was recorded at prerectal distension and then after 100 mls of air was inflated within a balloon in the rectum (post-rectal distension).

Result
19 patients were included. The values of Op (cmH20) and the reductions observed during the RAIR when awake/asleep are as follows:
Awake Op: prerectal distension (64.94) and post-rectal distension (35.35) therefore mean change 29.59 cmH2O i.e. 44.6% reduction
Asleep Op: prerectal distension (37.64) and post-rectal distension (15.55) therefore mean change 22.1 i.e. 55.3% reduction
The contribution of the IAS to Op is calculated as follows: (Mean change Op awake x 100)/% reduction in RAIR asleep = IAS contribution awake (29.59cmH20 x 100)/55.3 = 53.51cmH20 Total mean Op awake—IAS contribution awake = EAS contribution awake 64.94cmH20–53.51cmH20 (82.4%) = 11.43cmH20 (17.6%)

Conclusion
The IAS accounts for 82.4% of Op at rest and it remains our hypothesis that Op primarily represents IAS function.

Take-home Message
Opening pressure primarily represents internal anal sphincter function.
O7 Toll-like receptor 3 mediates osteoblastic phenotype switch in calcific aortic valve disease
Authors: Gollmann-Tepeköylü C , Graber M , Pölzl L , Hirsch J , Nägele F , Naschberger A , Kirchmair E , Degenhart G , Demetz E , Lobenwein D , Lener D , Fuchs C , Feuchtner G , Hackl H , Meyer D , Grimm M , Tancevski I , Holfeld J 
Published: July 2021

Abstract

Introduction
Calcific aortic valve disease (CAVD) is caused by an osteoblastic phenotype switch of valvular interstitial cells (VICs), the predominant cell type in heart valves. However, the trigger for the phenotype switch remains unknown. Toll-like receptor 3 (TLR3) is part of the innate immune system activated by viral and endogenous RNA released from injured cells. We hypothesized that mechanical strain leads to TLR3 activation leading to an osteoblastic phenotype switch of VICs with subsequent initiation of CAVD.

Methods
Aortic valves were obtained from patients undergoing aortic valve replacement or from explanted hearts. VICs were isolated and treated with TLR3 agonist poly (I: C) or a TLR3/dsRNA complex inhibitor. Osteoblastic gene expression was evaluated via RNA sequencing. Cells were challenged with osteoblastic medium and analyzed for alkaline phosphatase activity and calcific nodule formation. Zebrafish were treated with TLR3/dsRNA complex inhibitor. A Flexcell system was used to apply mechanical strain to VICs. Aortic valve morphology and function of aged wild-type (WT) and TLR3-/- mice were analyzed via transthoracic echocardiography, microCT and histological evaluation. To confirm results in a second model, experiments were repeated in ApoE-/- and ApoE-/-/TLR3-/- mice.

Results
Aortic valves and VICs showed abundant TLR3 expression. Mechanical stimulation of VICs resulted in TLR3 activation. Stimulation of TLR3 lead to expression of TNF-a, IL-6, IFN-y, IL-10, Runx2 and BMP2 and, caused a phenotype switch towards osteoblasts as revealed by RNA sequencing and resulted in enhanced calcific nodule production. Mice showed age-dependent TLR3 expression. Aortic valves as well as VICs derived from CAVD patients showed increased TLR3 expression compared to healthy control valves and VICs. TLR3 Inhibition resulted in prevention of osteogenic phenotype switch in conditioned VICs. Zebrafish exhibited decreased calcification after TLR3 inhibition. Aged WT mice showed significantly increased mean gradients and mean velocity in transthoracic echocardiographs. MicroCT and histological analyses revealed thickened valve leaflets and commissural atherosclerotic plaques. These changes were missing completely in age-matched TLR3-/- mice. ApoE-/- mice under high fat diet exhibited clear signs of CAVD with decreased aortic valve opening diameters and increased valve leaflet thickness. However, these findings were completely missing in ApoE-/-/TLR3-/- mice.

Conclusion
TLR3 stimulation leads to an osteoblastic phenotype switch of VICs, whereas inhibition of TLR3 prevents from osteoblastic activity. TLR3 expression is increased in aortic valves from CAVD patients. TLR3-/- mice show no phenotype of CAVD. TLR3 could become an effective target for the pharmacological prevention of CAVD.
O8 Tracking wound infection with smartphone technology (twist): a randomised controlled trial in emergency surgery patients
Authors: McLean K A , Mountain K E , Shaw C A , Drake T M , Ots Riinu , Knight Stephen R , Fairfield Cameron J , Sgrò Alessandro , Skipworth Richard J E , Wigmore Stephen J , Potter Mark A , Harrison Ewen M ,   TWIST collaborators
Published: July 2021

Abstract

Introduction
Surgical site infections (SSI) complicate 2%–10% of general surgery cases, and represent a significant burden on acute healthcare services. We aim to investigate if a smartphone-delivered wound assessment tool results in earlier treatment.

Method
This parallel, single-blinded randomised control trial enrolled adult emergency abdominal surgery patients in two tertiary hospitals (ClinicalTrials.gov number, NCT02704897). Patients were randomised (1:1 ratio) between standard postoperative care and additional access to a smartphone-delivered wound assessment tool for 30-days postoperatively. Patients routinely submitted wound questionnaires and photos for surgical review at postoperative days 3, 7, and 15. The primary outcome measure was time-to-diagnosis of SSI (CDC definition) within 30 postoperative days.

Result
492 patients undergoing emergency surgery were randomised (smartphone intervention = 223; standard care = 269). There was no significant difference (P = 0.513) in the 30-day SSI rate between trial arms: 21 (9.4%) in smartphone vs 20 (7.4%) in standard care. While the mean time-to-diagnosis of SSI was 9.3 days (SD = 6.3) in the smartphone group, and 11.8 days (SD = 6.7) in the control group, this did not demonstrate a significant difference for the primary outcome (P = 0.255). However, patients in the smartphone group had 3.7-fold higher odds to be diagnosed in first 7 postoperative days (95% CI: 1.02 to 13.51, P = 0.043).

Conclusion
Digital patient-driven postoperative wound follow-up can be feasibly delivered in a broad cohort of emergency surgery patients. This can facilitate triage of patients to the appropriate level of assessment required, allowing diagnosis of SSI earlier in the postoperative period.

Take-home Message
Digital patient-driven postoperative wound follow-up can be feasibly delivered in a broad cohort of emergency surgery patients. This can facilitate triage of patients to the appropriate level of assessment required, allowing diagnosis of SSI earlier in the postoperative period.