bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes in Head and Neck Free Flap Reconstruction Among Patients With a History of Venous Thromboembolism
Authors: Crippen Meghan M. , Ganti Rohan S. , Xu Vivian , Swendseid Brian , Tzeng Diana L. , Curry Joseph 
Published: June 2021

ObjectiveTo investigate if a history of venous thromboembolism (VTE) is a risk factor for complications in head and neck free flap surgery by assessing outcomes among patients with a history of deep vein thrombosis (DVT) and/or pulmonary embolism (PE).Study DesignRetrospective cohort study.SettingSingle tertiary care center.MethodsAll patients undergoing head and neck free flap reconstruction at our institution between September 1, 2006, and April 2, 2020, were assessed for inclusion. Patients with and without a history of DVT or PE preoperatively were identified and grouped for comparison. Groups were compared for demographics, comorbidities, and 30‐day complications. Significance was assessed with chi‐square and binary logistic regression analyses.ResultsOf the 1061 patients meeting inclusion criteria, 40 (3.8%) had a history of VTE. These patients were significantly older (mean [SD], years: 67.8 [11.7] vs 63.0 [14.1], P =. 038) and significantly more likely to have history of chemotherapy (35.0% vs 18.7%, P =. 010) and stroke (27.5% vs 4.5%, P <. 001). After accounting for patient characteristics via binary logistic regression, VTE was independently associated with an increased risk for postoperative thrombosis of the free flap pedicle (odds ratio [95% CI] = 3.65 [1.12‐11.90], P =. 032) and reoperation (2.45 [1.25‐4.80], P =. 009). Patients with history of PE had a significantly increased risk for flap failure (7.70 [1.77‐33.52], P =. 007). Prior VTE was not independently associated with an increased risk for medical complications or readmission.ConclusionPatients with a history of VTE may be at an increased risk for free flap compromise secondary to postoperative pedicle thrombosis. This risk should be considered in preoperative workup and postoperative monitoring.
Evaluation of a Clinical Pharmacist Specialist Transition of Care Pathway to Manage Heart Failure Readmissions During a Provider Shortage
Authors: Benge Cassandra , Pouliot Jonathon , Muldowney James A. S. 
Published: June 2021

Background: Evidence supports scheduling early follow-up after heart failure (HF) hospitalization with a provider capable of managing hypervolemia. Often this service is provided by cardiologists or specialty nurse practitioners. Continuity or “familiar” providers may be better positioned to identify decompensating HF in patients who have advanced HF and/or multiple complicating medical problems. The objective of this study was to evaluate whether a clinical pharmacy specialist (CPS) service, covering the role of a “familiar” provider in an advanced HF specialty clinic (AHFC) during a staffing shortage, may prevent readmission metrics from worsening. Methods: We evaluated the entire, eligible concurrent cohorts, representing 175 AHFC-CPS and 273 control patient-admissions, respectively. Study- and disease-specific predictors for readmission were assessed. A matched cohort of 202 patient-admissions (101 AHFC-CPS:101 NO-CPS) were evaluated. Results: Subjects were predominantly white, elderly males. While overall “clinic [performance] profiling” outcomes for readmissions (p = 0.43) and mortality (p = 0.66) did not statistically differ between the AHFC-CPS and NO-CPS groups, an imbalance in severity of illness persisted. A survival curve and analysis were constructed, and the hazard ratio for all-cause mortality was 0.69 (p = 0.033). Conclusions: This retrospective project supports the premise that AHFC-CPS intervention may be a suitable alternative to maintain the volume status for AHFC patients during a staffing short-fall. More work needs to be done to determine intervention effect size, predictors for readmission, specifically in advanced cardiovascular disease, and to evaluate CPS opportunities in the provision of independent HF care, particularly for patients with advanced HF.
Investigating the structure of trait rumination in autistic adults: A network analysis
Authors: Williams Zachary J , McKenney Erin E , Gotham Katherine O 
Published: June 2021

Rumination, a form of passive, repetitive negative thinking, predicts the development of depressive disorders in non-autistic individuals, and recent work suggests higher levels of rumination may contribute to elevated rates of depression in the autistic population. Using psychological network analysis, this study sought to investigate the structure of rumination in autistic individuals and the relationships between rumination and individual depressive symptoms. Non-regularized partial correlation networks were estimated using cross-sectional data from 608 autistic adults who completed the Ruminative Responses Scale and Beck Depression Inventory–II. Node centrality indices were calculated to determine which specific symptoms may have a disproportionate influence on the network of repetitive negative thoughts. Nodes were also grouped into communities, and specific “bridge” nodes were identified that most strongly connected these different communities. Results demonstrated strong positive relationships between all facets of ruminative thinking, similar to a prior study in non-autistic adults. Self-directed negative cognitions appeared to be particularly central in this network. The depression symptoms most strongly related to rumination in autistic adults were sadness and guilt. Although these findings are preliminary, they highlight specific facets of rumination that warrant future study as depression risk factors and potential intervention targets in the autistic population. Lay abstract Autistic adults are substantially more likely to develop depression than individuals in the general population, and recent research has indicated that certain differences in thinking styles associated with autism may play a role in this association. Rumination, the act of thinking about the same thing over and over without a functional outcome, is a significant risk factor for depression in both autistic and non-autistic adults. However, little is known about how different kinds of rumination relate to each other and to depressive symptoms in the autistic population specifically. To fill this gap in knowledge, we recruited a large online sample of autistic adults, who completed questionnaire measures of both the tendency to ruminate and symptoms of depression. By examining the interacting network of rumination and depression symptoms, this study was able to identify particular aspects of rumination—such as thinking repetitively about one’s guilty feelings or criticizing oneself—that may be particularly important in maintaining these harmful thought patterns in autistic adults. Although further study is needed, it is possible that the symptoms identified as most “influential” in the network may be particularly good targets for future interventions for mood and anxiety disorders in the autistic population.
The use of hysteroscopic metroplasty with diode laser to increase endometrial volume in women with septate uterus: preliminary results
Authors: Nappi Luigi , Falagario Maddalena , Angioni Stefano , De Feo Vincenzo , Bollino Michele , Sorrentino Felice 
Published: June 2021

Abstract
Background
Septate uterus is a common Mullerian ducts anomaly. The aim of our pilot study was the evaluation of diode laser hysteroscopic metroplasty efficacy to increase endometrial volume in women with septate uterus.

Results
We prospectively enrolled 10 consecutive patients with septate uterus undergoing office hysteroscopic metroplasty with diode laser between February and November 2019. Endometrial volume was evaluated before and 3 months after surgery using 3D transvaginal ultrasound. The surgical procedure was uncomplicated in all patients, the endometrial volume increased at 3 months follow-up (the median increase was 1.9 cm3 (range 1.7–2.1), and there was a complete removal of septum with no intrauterine synechiae at follow-up hysteroscopy.

Conclusions
Office hysteroscopic metroplasty with diode laser is a safe procedure and has preliminary showed to increase endometrial volume. The increase in endometrial volume by 3D-TV US could be used as a prognostic factor for the reproductive outcomes.
Drought of early time in growing season decreases community aboveground biomass, but increases belowground biomass in a desert steppe
Authors: Li Xiangyun , Zuo Xiaoan , Yue Ping , Zhao Xueyong , Hu Ya , Guo Xinxin , Guo Aixia , Xu Chong , Yu Qiang 
Published: June 2021

Abstract
Background
Increasing drought induced by global climate changes is altering the structure and function of grassland ecosystems. However, there is a lack of understanding of how drought affects the trade-off of above- and belowground biomass in desert steppe. We conducted a four-year (2015–2018) drought experiment to examine the responses of community above-and belowground biomass (AGB and BGB) to manipulated drought and natural drought in the early period of growing season (from March to June) in a desert steppe. We compared the associations of drought with species diversity (species richness and density), community-weighted means (CWM) of five traits, and soil factors (soil Water, soil carbon content, and soil nitrogen content) for grass communities. Meanwhile, we used the structural equation modeling (SEM) to elucidate whether drought affects AGB and BGB by altering species diversity, functional traits, or soil factors.

Results
We found that manipulated drought affected soil water content, but not on soil carbon and nitrogen content. Experimental drought reduced the species richness, and species modified the CWM of traits to cope with a natural drought of an early time in the growing season. We also found that the experimental and natural drought decreased AGB, while natural drought increased BGB. AGB was positively correlated with species richness, density, CWM of plant height, and soil water. BGB was negatively correlated with CWM of plant height, CWM of leaf dry matter content, and soil nitrogen content, while was positively correlated with CWM of specific leaf area, CWM of leaf nitrogen content, soil water, and soil carbon content. The SEM results indicated that the experimental and natural drought indirectly decreased AGB by reducing species richness and plant height, while natural drought and soil nitrogen content directly affected BGB.

Conclusions
These results suggest that species richness and functional traits can modulate the effects of drought on AGB, however natural drought and soil nitrogen determine BGB. Our findings demonstrate that the long-term observation and experiment are necessary to understand the underlying mechanism of the allocation and trade-off of community above-and belowground biomass.
IPDfromKM: reconstruct individual patient data from published Kaplan-Meier survival curves
Authors: Liu Na , Zhou Yanhong , Lee J. Jack 
Published: June 2021

Abstract
Background
When applying secondary analysis on published survival data, it is critical to obtain each patient’s raw data, because the individual patient data (IPD) approach has been considered as the gold standard of data analysis. However, researchers often lack access to IPD. We aim to propose a straightforward and robust approach to obtain IPD from published survival curves with a user-friendly software platform.

Results
Improving upon existing methods, we propose an easy-to-use, two-stage approach to reconstruct IPD from published Kaplan-Meier (K-M) curves. Stage 1 extracts raw data coordinates and Stage 2 reconstructs IPD using the proposed method. To facilitate the use of the proposed method, we developed the R package IPDfromKM and an accompanying web-based Shiny application. Both the R package and Shiny application have an “all-in-one” feature such that users can use them to extract raw data coordinates from published K-M curves, reconstruct IPD from the extracted data coordinates, visualize the reconstructed IPD, assess the accuracy of the reconstruction, and perform secondary analysis on the basis of the reconstructed IPD. We illustrate the use of the R package and the Shiny application with K-M curves from published studies. Extensive simulations and real-world data applications demonstrate that the proposed method has high accuracy and great reliability in estimating the number of events, number of patients at risk, survival probabilities, median survival times, and hazard ratios.

Conclusions
IPDfromKM has great flexibility and accuracy to reconstruct IPD from published K-M curves with different shapes. We believe that the R package and the Shiny application will greatly facilitate the potential use of quality IPD and advance the use of secondary data to facilitate informed decision making in medical research.
Baseline Xpert MTB/RIF ct values predict sputum conversion during the intensive phase of anti-TB treatment in HIV infected patients in Kampala, Uganda: a retrospective study
Authors: Namugenyi Juliet , Musaazi Joseph , Katamba Achilles , Kalyango Joan , Sendaula Emmanuel , Kambugu Andrew , Fehr Jan , Castelnouvo Barbara , Manabe Yukari C. , Ssengooba Willy , Sekaggya-Wiltshire Christine 
Published: June 2021

Abstract
Background
In resource-limited settings, sputum smear conversion is used to document treatment response. Many People living with HIV (PLHIV) are smear-negative at baseline. The Xpert MTB/RIF test can indirectly measure bacterial load through cycle threshold (ct) values. This study aimed to determine if baseline Xpert MTB/RIF could predict time to culture negativity in PLHIV with newly diagnosed TB.

Methods
A subset of 138 PLHIV from the ‘SOUTH’ study on outcomes related to TB and antiretroviral drug concentrations were included. Bacterial load was estimated by Mycobacterium Growth Indicator Tubes (MGIT) culture time-to-positivity (TTP) and Lowenstein Jensen (LJ) colony counts. Changes in TTP and colony counts were analyzed with Poisson Generalised Estimating Equations (GEE) and multilevel ordered logistic regression models, respectively, while time to culture negativity analysed with Cox proportional hazard models. ROC curves were used to explore the accuracy of the ct value in predicting culture negativity.

Results
A total of 81 patients (58.7%) were males, median age 34 (IQR 29 ̶ 40) years, median CD4 cell count of 180 (IQR 68 ̶ 345) cells/μL and 77.5% were ART naive. The median baseline ct value was 25.1 (IQR 21.0 ̶ 30.1). A unit Increase in the ct value was associated with a 5% (IRR = 1.05 95% CI 1.04 ̶ 1.06) and 3% (IRR = 1.03 95% CI 1.03 ̶ 1.04) increase in TTP at week 2 and 4 respectively. With LJ culture, a patient’s colony grade was reduced by 0.86 times (0R = 0.86 95% CI 0.74 ̶ 0.97) at week 2 and 0.84 times (OR = 0.84 95% CI 0.79 ̶ 0.95 P = 0.002) at week 4 for every unit increase in the baseline ct value. There was a 3% higher likelihood of earlier conversion to negativity for every unit increase in the ct value. A ct cut point ≥28 best predicted culture negativity at week 4 with a sensitivity of 91. 7% & specificity 53.7% while a cut point ≥23 best predicted culture negativity at week 8.

Conclusion
Baseline Xpert MTB/RIF ct values predict sputum conversion in PLHIV on anti-TB treatment. Surrogate biomarkers for sputum conversion in PLHIV are still a research priority.
Clinical characteristics and risk factors for poor prognosis among HIV patients with Talaromyces marneffei bloodstream infection
Authors: Sun Jianjun , Sun Weiwei , Tang Yang , Zhang Renfang , Liu Li , Shen Yinzhong , Wang Jiangrong , Chen Jun , Qi Tangkai , Wang Zhenyan , Song Wei , Lin Yixiao , Xu Shuibao , Lu Hongzhou 
Published: June 2021

Abstract
Background
Talaromyces marneffei (TM) bloodstream infection is common in Acquired Immunodeficiency Syndrome (AIDS) patients with extreme immunodeficiency in Southeast Asia and South China, however, clinical case study on TM bloodstream infection is scarce. We retrospectively analyzed the clinical characteristics of TM bloodstream infection in hospitalized AIDS patients and determined the outcomes of hospitalization after diagnosis in our hospital over the past 5 years.

Methods
From January 2015 to July 2020, 87 cases of TM detected by blood culture in patients admitted to our center were collected. The admission complaints, blood cells, biochemistry, CD4 and CD8 cell counts and 1,3-β-D-glucan (BDG), procalcitonin (PCT), CRP level on the day of blood culture test, and outcomes during hospitalization were analyzed. Logistic regression analysis was performed for the risk factors for poor prognosis (60 cases). Spearman correlation analysis was used to analyze the correlation between peripheral blood cells, albumin and the time required for TM turnaround in blood culture. The difference was statistically significant when the P value was < 0.05.

Results
A total of 87 patients were collected, with a median age of 34 years, a median hemoglobin of 94 g/L and CD4 count of 7/μl. The rate of TM bloodstream infection among all in-hospital patients increased from 0.99% in 2015 to 2.09% in 2020(half year). Patients with TM bloodstream infection with CD8 count < 200/μl had a 12.6-fold higher risk of poor prognosis than those with CD8 count > 200/μl (p = 0.04), and those with BDG < 100 pg/mL had a 34.9-fold higher risk of poor prognosis than those with BDG > 100 pg/mL (p = 0.01).

Conclusions
TM bloodstream infection is becoming more common in advanced AIDS patients in endemic areas. For those patients with extremely low CD4 and CD8 cell counts below 200/μl is with an increased risk of poor prognosis.
Plasma Epstein-Barr virus DNA and risk of nasopharyngeal carcinoma in a prospective seropositive population
Authors: Chen Wen-Jie , Xu Wen-Na , Wang Hai-Yun , Chen Xiao-Xia , Li Xue-Qi , Xie Shang-Hang , Lin Dong-Feng , Cao Su-Mei 
Published: June 2021

Abstract
Objective
Plasma Epstein-Barr virus (EBV) DNA is considered a biomarker for nasopharyngeal carcinoma (NPC). However, its long-term role in NPC development is unclear.

Materials and methods
A total of 1363 participants seropositive for EBV VCA-IgA and EBNA1-IgA in a community-based NPC screening program in southern China were tested for plasma EBV DNA levels by real-time qPCR between 2008 and 2015. New NPC cases were confirmed by active follow-up approach and linkage to local cancer registry through the end of 2016. Cox proportional hazards regression analysis was performed to calculate the hazard ratios (HRs) for NPC risk with plasma EBV DNA.

Results
Thirty patients were newly diagnosed during a median 7.5 years follow-up. NPC incidence increased with the plasma EBV DNA load ranging from 281.46 to 10,074.47 per 100,000 person-years in participants with undetectable and ≥ 1000 copies/ml levels; the corresponding cumulative incidence rates were 1.73 and 50%. Furthermore, plasma EBV DNA loads conferred an independent risk for NPC development after adjustment for other risk factors, with HRs of 7.63 for > 3–999 copies/ml and 39.79 for ≥1000 copies/ml. However, the HRs decreased gradually after excluding NPC cases detected in the first 2 to 3 years and became statistically nonsignificant by excluding cases detected during the first 4 years.

Conclusion
Elevated plasma EBV DNA can predict NPC risk over 3 years. Monitoring plasma EBV DNA can be used as a complementary approach to EBV serological antibody-based screening for NPC.
A Chinese patient with developmental and epileptic encephalopathies (DEE) carrying a TRPM3 gene mutation: a paediatric case report
Authors: Kang Qingyun , Yang Liming , Liao Hongmei , Yang Sai , Kuang Xiaojun , Ning Zeshu , Liao Caishi , Chen Bo 
Published: June 2021

Abstract
Background
Developmental and epileptic encephalopathies (DEEs) are a heterogeneous group of chronic encephalopathies characterized by epilepsy with comorbid intellectual disability that are frequently associated with de novo nonsynonymous coding variants in ion channels, cell-surface receptors, and other neuronally expressed genes. Mutations in TRPM3 were identified as the cause of DEE. We report a novel patient with DEE carrying a de novo missense mutation in TRPM3, p.(S1202T); this missense mutation has never been reported.

Case presentation
A 7-year and 2-month-old Chinese patient who had recurrent polymorphic seizures was clinically diagnosed with DEE. A de novo missense mutation in TRPM3, which has not yet been reported, was identified in this case. The patient had a clinical phenotype consistent with previous reports.

Conclusions
These findings could expand the spectrum of TRPM3 mutations and might also support that de novo substitutions of TRPM3 are a cause of DEE.
Promoting healthy foods among urban school children in Bangladesh: a qualitative inquiry of the challenges and opportunities
Authors: Hasan A. M. Rumayan , Smith George , Rashid Md Harunor , Selim Mohammad Abdus , Rasheed Sabrina 
Published: June 2021

Abstract
Background
In Bangladesh overweight and obesity among urban school children are on the rise. Urban school children tend to consume foods dense in calories and few fruits and vegetables which is associated with overweight and obesity. The current study explored the barriers and opportunities for promoting healthy diets among school children from the perspective of teachers and parents in Dhaka, Bangladesh.

Methods
We conducted 14 key informant interviews with teachers and principals, six focus group discussions with 31 mothers of school children (5 to 15 year old) and 14 structured observations of the school food environment. Inductive thematic analysis was performed manually.

Results
Schools were important for development of food preferences of children, however, most school cafeterias provided foods based on profit rather than health considerations. A shift in food culture resulted in making eating out acquire many meanings beyond convenience. Mothers, especially those who were employed, struggled to prepare healthy foods due to time pressure. Mothers were generally concerned about chemicals added to raw foods in markets which led to limited fruit and vegetable consumption.

Conclusions
There were many challenges to promoting healthy foods to school children within and outside the school. It is important to formulate policies and guidance to create a supportive environment for healthy foods in and in the proximity of schools. It is also important to educate consumers about identifying and choosing healthy foods. Laws related to food safety should be adequately implemented to boost the population’s confidence in safety of available healthy foods in the food system.