bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective Study to Assess the Response to Therapy and Its Predictors in Children with Scrub Typhus
Authors: Arun Babu Thirunavukkarasu , Narayanasamy Dinesh Kumar , Jamir Limalemla 
Published: September 2021

Abstract
Doxycycline is the drug of choice for pediatric scrub typhus (ST) while azithromycin is considered as an equally effective alternative. This study was undertaken to assess the response to therapy and its predictors in pediatric ST cases treated with doxycycline and azithromycin. Children ≤12 year with fever ≥7 days were screened for ST by IgM ELISA (positive if optical density &gt;0.5). All positive cases were divided into two groups based on whether treated with doxycycline or azithromycin. Fever clearance time (FCT), duration of hospitalization and other clinical characteristics of cases in both groups were compared. Out of 2710 children admitted with fever for more than 7 days, 660 cases (24.35%) tested positive for ST by IgM ELISA. Cases treated with azithromycin and doxycycline were 316 (47.87%) and 344 (52.12%), respectively. In our study, the FCT (p = 0.004), mean duration of hospital stay (p = 0.011), persistence of fever for &gt;48 h after starting antibiotic therapy (p = 0.001) and severe ST requiring ICU admission (p = 0.046) were significantly lower in children who received doxycycline. The logistic regression analysis revealed that the presence of splenomegaly (Adjusted Odds Ratio (AOR) 2.60; 95% Confidence interval (CI) = 1.49–4.53; p = 0.001) and lung crepts (AOR 2.02; 95% CI = 1.06–3.85; p = 0.032) in azithromycin-treated group and presence of meningeal signs (AOR 16.11; 95% CI = 5.47–47.45; p &lt; 0.001), anemia (AOR 2.28; 95% CI = 1.02–5.08; p = 0.044), lung crepts (AOR 2.66; 95% CI = 1.16–6.05; p = 0.020) and absence of eschar (AOR 3.48; 95% CI = 1.70–7.13; p = 0.001) in the doxycycline group was significantly associated with prolonged FCT (&gt;48 h). Doxycycline is superior to azithromycin in defervescing fever, reducing hospital stay and preventing severity in pediatric ST.
Isolation and identification of potentially pathogenic free-living amoeba in dialysis fluid samples of hydraulic systems in hemodialysis units
Authors: Biglarnia Farzaneh , Solhjoo Kavous , Rezanezhad Hassan , Taghipour Ali , Armand Belal 
Published: September 2021

Abstract

Background
Free-living amoeba (FLA), including Acanthamoeba, Naegleria, Balamuthia and Vermamoeba, have been isolated from water, sand, soil, dust and air. Numerous studies considered that FLA are a significant cause of neurological and ocular complications in high-risk groups, including immunocompromised individuals. The present study aimed to identify morphological and molecular characteristics of FLA isolates in dialysis fluid samples of hydraulic systems in hemodialysis units in Iran.

Methods
A total of 328 dialysis fluid samples were collected from 16 dialysis machines, including 164 samples before hemodialysis sessions (after cleaning) and 164 samples after hemodialysis sessions (before cleaning). Filtration and cultivation were performed on non-nutrient agar medium. Also, PCR and sequencing were applied by using the genus-specific primers along with a common primer set on positive samples.

Results
Both morphology and molecular investigations showed that 22.5% (74/328) of dialysis fluid samples were positive for FLA. There was a positive relationship between the high frequency of FLA after hemodialysis sessions (before cleaning) compared with before hemodialysis sessions (after cleaning) (OR=2.86; 95% CI 1.5 to 5.45). Considering the PCR assay, 16.46% (54/328) samples were identified as Acanthamoeba spp. (belonging to T3 and T4 genotypes), 5.18% (17/328) as Vermamoeba vermiformis and 0.91% (3/328) as Vahlkampfiidae family (Naegleria australiensis, Naegleria pagei and Allovahlkampfia).

Conclusion
The present results support a need to improve filtration and purification methods for dialysis fluid of hydraulic systems in hemodialysis units. They also highlight the relevance of periodic screenings for FLA-related diseases in hemodialysis patients.
7Psychoanalysis
Authors: Vashisht Jivitesh 
Published: September 2021

Abstract
Psychoanalysis has served as a time-tested, albeit occasionally contentious, method for interpreting a range of literary and cultural works, but how might we account for its own textual cultures and practices? For that matter, are psychoanalytic and literary genres distinct entities, or is their interface significantly more porous than we might imagine at first? In what follows, I review four critical texts published in 2020 (a double issue of a journal and two monographs) that grapple with various aspects of these questions and offer rich, formally attentive studies of psychoanalytic writing and its entanglements with literary genres such as the novella, memoir, and autobiography. The review is organized into four sections: 1. Introduction. Psychoanalysis: A Writing Cure? 2. After John Forrester: Reopening the Psychoanalytic Case, which discusses Felicity Callard and Chris Millard’s guest-edited issue of History of the Human Sciences entitled Thinking In, With, Beyond, and Across Cases with John Forrester; 3. The Freudian Case History and its Literary Legacies, devoted to Arne Höcker’s The Case of Literature: Forensic Narratives from Goethe to Kafka; and 4. Recovering the Analysand’s Voice, which explores Anat Tzur Mahalel’s Reading Freud’s Patients: Memoir, Narrative, and the Analysand.
An Improved Assembly of theAlbugo candidaAc2V Genome Reveals the Expansion of the “CCG” Class of Effectors
Authors: Furzer Oliver J. , Cevik Volkan , Fairhead Sebastian , Bailey Kate , Redkar Amey , Schudoma Christian , MacLean Dan , Holub Eric B. , Jones Jonathan D. G. 
Published: September 2021

Albugo candida is an obligate oomycete pathogen that infects many plants in the Brassicaceae family. We resequenced the genome of isolate Ac2V using PacBio long reads and constructed an assembly augmented by Illumina reads. The Ac2VPB genome assembly is 10% larger and more contiguous compared with a previous version. Our annotation of the new assembly, aided by RNA-sequencing information, revealed a 175% expansion (40 to 110) in the CHxC effector class, which we redefined as “CCG” based on motif analysis. This class of effectors consist of arrays of phylogenetically related paralogs residing in gene sparse regions, and shows signatures of positive selection and presence/absence polymorphism. This work provides a resource that allows the dissection of the genomic components underlying A. candida adaptation and, particularly, the role of CCG effectors in virulence and avirulence on different hosts.[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Factors Influencing Hypertrophic Scarring after Thyroidectomy
Authors: Xie Hang , Xiang Ying , Yang E. , Zhang HengShu 
Published: September 2021

ABSTRACT

OBJECTIVE
To identify the risk factors of hypertrophic scarring (HS) after thyroidectomy and construct a risk prediction model.

METHODS
From November 2018 to March 2019, the clinical data of patients undergoing thyroidectomy were collected for retrospective analysis. According to the occurrence of HS, the patients were divided into an HS group and a non-HS group. Univariate analysis and binary logistic regression analysis were conducted to explore the independent risk factors for HS. Receiver operating characteristic analysis was also carried out.

RESULTS
In this sample, 121 of 385 patients developed HS, an incidence of 31.4%. Univariate analysis showed significant differences in sex, age, postoperative infection, history of abnormal wound healing, history of pathologic scar, family history of pathologic scar, and scar prevention measures between the two groups (P < .05). Binary logistic regression analysis indicated that age 45 years or younger (odds ratio [OR], 1.815), history of abnormal wound healing (OR, 4.247), history of pathologic scarring (OR, 9.840), family history of pathologic scarring (OR, 5.708), and absence of preventive scar measures (OR, 5.566) were independent factors for HS after thyroidectomy. The area under the receiver operating characteristic curve was 0.837. When the optimal diagnostic cutoff value was 0.206, the sensitivity was 0.661, and the specificity was 0.932.

CONCLUSIONS
The development of HS after thyroidectomy is related to many factors, and the proposed risk prediction model based on the combined risk factors shows a good predictive value for postoperative HS. When researchers consider the prevention and treatment of scarring in patients at risk, the incidence of HS in different populations can provide theoretical support for clinical decision-making.
Effectiveness of Ozone Therapy as an Adjunct Treatment for Lower-Limb Ulcers: A Systematic Review
Authors: Bomfim Tássia Lima , Gomes Isla Alcântara , Meneses Daniele de Vasconcelos Cerqueira , Araujo Adriano Antunes de Souza 
Published: September 2021

ABSTRACT

OBJECTIVE
To evaluate the effectiveness of topical ozone therapy as an adjuvant treatment in the healing of lower limb ulcers through a systematic literature review.

DATA SOURCES
Three databases were used to search for studies conducted in the period up to and including September 2020: PubMed, Scopus, and the Web of Science.

STUDY SELECTION
The search identified 44 studies, 7 of which met the eligibility criteria and were evaluated.

DATA EXTRACTION
Study design, study location, number of patients, patient age, type of control, wound type, intervention type, equipment used to generate ozone (ozone generation), evaluation methodology, and main results were extracted from each study.

DATA SYNTHESIS
A total of 506 patients 18 years or older with chronic wounds, such as venous or diabetic ulcers, on the lower limbs were enrolled. The majority of studies addressed diabetic foot ulcers.

CONCLUSIONS
The ozone therapy protocols demonstrated a healing effect in all included studies, and none reported adverse effects. This reinforces the need for more controlled and randomized clinical trials to determine the effectiveness of this treatment and establish clinical criteria for its use.
Colocating Wound Care for Patients with Sickle Cell Ulcers in a Hematology Clinic
Authors: Flattau Anna , Vinces Giacomo , You Shuo , Crouch Andrew S. , Minniti Caterina P. 
Published: September 2021

ABSTRACT

OBJECTIVE
Leg ulcers affect 15% of people with sickle cell disease. However, wound centers typically treat few people with this condition, which makes it difficult to concentrate clinical expertise or support the scientific study of this orphan disease. This article describes an initiative to increase engagement in care through a partnership between wound healing and hematology leadership that led to colocating wound services within a sickle cell clinic.

METHODS
Via a retrospective chart review, the authors collected records of all adult patients with sickle cell disease who received wound care in the last decade, including 7 years of wound center data and 3 years of data from the colocated services. Patient and visit characteristics were analyzed using descriptive analytics.

RESULTS
The general wound center had previously treated 35 patients with sickle cell ulcers over 7 years. In contrast, colocated services engaged 56 patients within 3 years, including 20 who transferred care and 36 new patients. The majority of patients at the colocated site were women, unlike at the wound center (58% vs 47%, P = .07). Results indicated that 36% of patients healed initial wounds, and 45% had new wound occurrences.

CONCLUSIONS
Colocation successfully increases the number of patients with sickle cell ulcers who will engage in wound care at a single site, laying the foundation for clinical studies to improve the evidence base for this difficult-to-treat condition.
Biological therapies, asthma and coronavirus disease 2019
Authors: Ribeiro Amélia , Aguiar Rita , Morais-Almeida Mário 
Published: September 2021

Purpose of review
As of June 2021, coronavirus disease 2019 (COVID-19) exceeded 180 million reported cases and was responsible for almost 4 million deaths globally. Asthma affects approximately 262 million people worldwide and is an important cause of morbidity and mortality. Presently, it appears asthma is neither associated with an increased risk of contracting COVID-19 nor with a risk of severe COVID-19 or COVID-19 related death. Regarding the severe asthma patients on biologics, questions remain. The purpose of this review is to discuss the evidence regarding the relationship between asthma, biologics and COVID-19.

Recent findings
The available evidence does not suggest that severe asthmatics on treatment with biologics have a higher risk of severe acute respiratory syndrome coronavirus 2 infection compared to the general population. It does not appear that they have a higher risk of severe disease or COVID-19 related death either.

Summary
This review suggests that treatment with biologics for severe asthma is safe and should be maintained during the COVID-19 pandemic. However, more studies are needed to address this question and the role of biological therapy on different asthma phenotypes.
Expect postoperative care disruptions for orthopaedic trauma patients during the COVID-19 pandemic: a retrospective review of patient care trends
Authors: Christiano Anthony V. , Xiao Ryan C. , Barbera Joseph P. , Selverian Stephen R. , Podolnick Jeremy D. , Forsh David A. 
Published: September 2021

Background:
With the global COVID-19 pandemic arriving in New York City (NYC) public health measures were instituted to prevent disease spread. Orthopaedic trauma continued despite the pandemic, and patients were left attempting to obtain postoperative care while the city’s focus shifted to the pandemic. The purpose of this study was to evaluate postoperative care of patients treated for orthopaedic trauma during the COVID-19 pandemic in NYC and identify areas for improvement in the event of an expected second wave.

Methods:
All patients who received operative care for orthopaedic trauma during the pandemic time period by two fellowship-trained orthopaedic traumatologists were identified, and their records were reviewed.

Results:
Forty-nine patients were included for analysis. Six patients (12%) tested positive for COVID-19. Six of 24 patients (25%) who were recommended to be discharged to inpatient rehabilitation refused. Of the 31 patients discharged home, nine patients (29%) refused in-home services. Thirteen of 31 patients (42%) reported a delay in receiving outpatient physical therapy, and five patients (16%) reported difficulty filling prescriptions. There were 1,814 scheduled visits in the orthopaedic trauma clinic from March to May 2019 with 1,126 attended visits (62%). During the pandemic there were 295 scheduled visits with 175 attended visits (59%, P=0.367). At the peak of the pandemic in April 2020 there were 58 scheduled visits with 27 attended visits (47%, P=0.017).

Conclusions:
Patients treated for orthopaedic trauma during the COVID-19 pandemic were at increased risk of improper discharge, delay in outpatient services, and absent follow-up, which may together pose an increased risk of adverse events.

Level of Evidence:
Level IV.
Distribution and Polarization of Hematogenous Macrophages Associated with the Progression of Intervertebral Disc Degeneration
Authors: Yamamoto Yusuke , Kokubo Yasuo , Nakajima Hideaki , Honjoh Kazuya , Watanabe Shuji , Matsumine Akihiko 
Published: September 2021

Study Design.

In vivo study using immunostaining and immunoblot analysis.

Objective.
To determine the distribution of bone marrow-derived macrophages (BMDMs), macrophage polarization and cytokine expression in the process of intervertebral disc (IVD) degeneration.

Summary of Background Data.
Knowledge of the detailed distribution of exogeneous macrophages in the disc degeneration process is important for understanding the pathomechanisms and establishing novel therapeutic targets.

Methods.
To distinguish BMDMs, GFP-labeled bone marrow chimeric rats (n = 12) were generated. The degenerative process of the intervertebral disc was reproduced in a rat caudal disc puncture model (n = 49). Immunofluorescence staining was performed to observe the distribution of BMDMs, Iba-1 and GFP double-positive cells, and Iba-1 and iNOS (M1 macrophage) or arginase-1 (M2 macrophage) double-positive cells. Immunoblot analysis was used to evaluate differences in cytokines (TNF-α, IL-1β, IL-6, TGF-β, IL-4, and IL-10) depending on the distribution of BMDMs.

Results.
BMDMs infiltrated into the outer annulus fibrosus and endplate, while increasing tissue-resident macrophage was observed inside the annulus fibrosus/nucleus pulposus. The ratio of BMDMs and the polarity change differed among the regions. Especially in the endplate, BMDMs increased gradually and the macrophage phenotype was M2 dominant. Expression of IL-1β decreased gradually at endplate, and that of IL-4 increased early after disc puncture at inside of the annulus fibrosus.

Conclusion.
During the disc degeneration process, BMDMs were observed mainly around the endplate and outside area of the annulus fibrosus, with few in the inside area of annulus fibrosus and nucleus pulposus. Compared to other IVD area, macrophage polarity and cytokine expression is concomitantly M2-dominant in endplate. Increased hematogenous M2-phenotype macrophages in endplate with progression of IVD degeneration could enhance our understanding of the underlying mechanisms of disc degeneration.

Level of Evidence: N/A
Intraoperative Cone Beam CT in Hybrid Operation Room for Pediatric Scoliosis Patients
Authors: Tanikawa Yusuke , Oba Hiroki , Fujii Masahiro , Ikegami Shota , Uehara Masashi , Mimura Tetsuhiko , Miyagawa Jun , Hatakenaka Terue , Kuraishi Shugo , Takizawa Takashi , Munakata Ryo , Kamanaka Takayuki , Miyaoka Yoshinari , Michihiko Koseki , Takahashi Jun 
Published: September 2021

Study Design.
Retrospective observational study.

Objective.
This study aimed to determine the effect of reducing the radiation dose of intraoperative cone beam computed tomography (CBCT) during posterior spinal fusion (PSF) for pediatric scoliosis on the rate of pedicle screw (PS) violation.

Summary of Background Data.
Intraoperative CBCT for pediatric scoliosis improves the accuracy of PS insertion in PSF. However, few reports have addressed the PS perforation rate from reduced radiation doses in hybrid navigation.

Methods.
We evaluated 855 PSs inserted into 58 pediatric scoliosis patients (11 male and 47 female, mean age: 16.6 yr) who underwent PSF using CBCT. A radiation dose of 1/3 or 1/5 of the normal dose (ND) was defined as a low dose (LD). After PS insertion, intraoperative CBCT images were reviewed to assess the degree of PS perforation. G2–3 (i.e., perforations of 4 mm or more) was defined as a violation. The PS violation rate was compared between the groups, and factors associated with violations were examined.

Results.
A total of 567 and 288 screws were inserted in the ND group and LD group, respectively. The PS violation rate was comparable at 1.8% in the ND group and 1.7% in the LD group. Multiple logistic regression analysis showed that distance from the upper instrumented vertebra (UIV) was an independently associated factor of PS violation (+1 vertebra, operation room 0.73, P
= 0.038). In addition, the mean height of patients with PS violations (148.8 ± 3.6 cm) was significantly shorter than that of patients without violations (157.9 ± 1.2 cm) (P = 0.034).

Conclusion.
There was no increase in PS violation rate with lower doses of radiation for intraoperative navigation CBCT. Extra care is warranted for vertebrae close to the UIV and patients of shorter stature.

Level of Evidence: 3
Hepatotoxicity of contemporary antiretroviral drugs
Authors: Rivera Christina G. , Otto Ashley O. , Zeuli John D. , Temesgen Zelalem 
Published: September 2021

Purpose of review
To date, more than 30 antiretroviral drugs have been approved by the Food and Drug Administration for the treatment of HIV infection. As new drugs with better efficacy and safety profile become available for clinical practice, older drugs are either withdrawn from the market or become no longer actively prescribed. We review hepatotoxicity associated with contemporary antiretroviral drugs, with emphasis on data from the past 3 years.

Recent findings
Although less robust data exists for side effects of contemporary antiretroviral medications recently approved for the management of HIV (i.e., doravirine, ibalizumab, fostemsavir, cabotegravir), the risks of substantial hepatotoxicity appears to be minimal with these agents.

Summary
Although newer antiretroviral drugs are better tolerated than their earlier counterparts, they are not completely devoid of adverse drug reactions, including hepatotoxicity. Monitoring patients on antiretroviral therapy for treatment-emergent liver injury should continue to be part of routine clinical care.
Characterization of Morphologic and Cytochemical Staining Properties of Exogenous Materials Mimicking Fungal Organisms Encountered in Skin Biopsies
Authors: Lindsey Miki , Vishal Sagar , Gardner Jerad M. , Shalin Sara C. 
Published: September 2021

Background:
Exogenous materials may be encountered in skin biopsies as contamination. Contamination may occur during the biopsy procedure in the clinic or during tissue processing in the laboratory. Although the experienced pathologist may often instinctively ignore clear examples of contamination, such tissue may be a source of confusion for young pathologists and those in training. Foreign materials can typically be recognized as exogenous by morphology, polarizability, and the presence or absence of a tissue reaction, but we have rarely encountered situations in which exogenous materials could be misinterpreted as organisms, either by their morphologic appearance or staining properties.

Methods:
Exogenous materials used during skin biopsy and grossing were embedded in a nonhuman tissue scaffold and prepared into histologic slides. Hematoxylin and eosin (H&E), periodic acid-Schiff with diastase, and Grocott methenamine silver stains were performed, and each material was evaluated under polarized microscopy.

Results:
Exogenous materials were divided into the following 3 categories with shared morphologic appearances and staining properties: suture materials, plant-based materials, and synthetic materials.

Conclusion:
We present a comprehensive characterization of the morphologic and cytochemical staining properties of multiple exogenous materials that may contaminate a skin biopsy. This characterization will aid the pathologist by providing a mechanism to identify potential contaminants in skin biopsies.