bluuebunny/crossref_metadata_2025_split huggingface dataset:
POSTOPERATIVE POSTERIOR SEGMENT COMPLICATIONS AFTER BOSTON TYPE 1 KERATOPROSTHESIS
Authors: Bonnet Clémence , Chehaibou Ismael , Chen Angela , Bourges Jean-Louis , Markovic Daniela , Hubschman Jean-Pierre , Aldave Anthony J. 
Published: June 2021

Purpose:
To identify the incidence of, risk factors for, and outcomes of posterior segment complications (PSC) after Boston Type 1 keratoprosthesis (KPro) implantation.

Methods:
Retrospective, consecutive case series of KPro procedures at the Stein Eye Institute. Data regarding ocular history, intraoperative details, postoperative management, and outcomes were collected. Eyes with at least one PSC (PSC group) were compared with eyes without PSC (No PSC group), and risk factors for PSC were determined.

Results:
Ninety-five PSC occurred in 69/169 eyes (40.8%), at a mean of 20.1 months after KPro implantation (0.01 complications/eye month). The median follow-up after KPro implantation was 44.0 months (range 3.0–174.4). The most common PSC were epiretinal membrane (16.6%), cystoid macular edema (12.4%), vitritis (11.2%), and retinal detachment (9.5%). Previous retinal detachment repair, concomitant intraocular lens removal, postoperative aphakia, and vitritis were risk factors for retinal detachment. Postoperative infectious keratitis was a risk factor for epiretinal membrane, cystoid macular edema, and vitritis. The posterior segment complication group had a significantly higher rate of eyes failing to maintain visual acuity ≥20/200 (HR = 2.28; 95% CI = 1.35–3.85) and KPro retention failure rate (HR = 1.66; 95% CI = 0.95–2.91).

Conclusion:
Posterior segment complications occur in approximately 40% of eyes after KPro implantation, resulting in reduced visual outcomes and KPro retention.
A differential privacy protection query language for medical data: a proof-of-concept system validation
Authors: Wang Huanhuan , Zhang Yongting , Yin Hongsheng , Li Ruirui , Wu Xiang 
Published: June 2021

Objective:
Medical data mining and sharing is an important process in E-Health applications. However, because these data consist of a large amount of personal private information of patients, there is the risk of privacy disclosure when sharing and mining. Therefore, ensuring the security of medical big data in the process of publishing, sharing, and mining has become the focus of current research. The objective of our study is to design a framework based on a differential privacy protection mechanism to ensure the secure sharing of medical data. We developed a privacy protection query language (PQL) that integrates multiple data mining methods and provides a secure sharing function.

Methods:
This study is mainly performed in Xuzhou Medical University, China and designs three sub-modules: a parsing module, mining module, and noising module. Each module encapsulates different computing methods, such as a composite parser and a noise theory. In the PQL framework, we apply the differential privacy theory to the results of the computing between modules to guarantee the security of various mining algorithms. These computing devices operate independently, but the mining results depend on their cooperation. In addition, PQL is encapsulated in MNSSp3 that is a data mining and security sharing platform and the data comes from public data sets, such as UCBI. The public data set (NCBI database) was used as the experimental data, and the data collection time was January 2020.

Results:
We designed and developed a query language that provides functions for medical data mining, sharing, and privacy preservation. We theoretically proved the performance of the PQL framework. The experimental results show that the PQL framework can ensure the security of each mining result and the availability of the output results is above 97%.

Conclusion:
Our framework enables medical data providers to securely share health data or treatment data and develops a usable query language, based on a differential privacy mechanism, that enables researchers to mine information securely using data mining algorithms.
Antipsychotic Polypharmacy Is Associated With Adverse Drug Events in Psychiatric Inpatients
Authors: Ayani Nobutaka , Morimoto Takeshi , Sakuma Mio , Kikuchi Toshiaki , Watanabe Koichiro , Narumoto Jin 
Published: June 2021

Abstract

Background
Antipsychotic (AP) polypharmacy (APP), the coprescription of more than 1 AP, is frequently practiced in psychiatric inpatients and is considered to be a risk factor for adverse drug events (ADEs). However, the association between APP and ADEs among psychiatric inpatients has not been well investigated.

Methods
The Japan Adverse Drug Events (JADE) study was a series of cohort studies conducted in several clinical settings. In particular, the JADE study for psychiatric inpatients was a retrospective cohort study of 448 psychiatric inpatients with a cumulative 22,733 patient-days. We investigated the relationship between APP, defined as a concurrent prescription of 2 or more APs and ADEs. We also assessed the relationship between potential risk factors for ADEs due to APs.

Results
Among the 448 patients included in this study, 106 patients (24%) had APP and the remaining 342 patients were prescribed 1 AP or none. Risperidone was the most frequent drug (25%, 109/442 AP prescriptions) used, and levomepromazine was most frequently prescribed as a concurrent medication with other APs (91%, 29/32). The median number of ADEs among the patients with APP was significantly higher than in those without APP (P = 0.001). Antipsychotic polypharmacy was a risk factor for the occurrence of first (adjusted hazard ratio, 1.54; 95% confidence interval, 1.15–2.04) and second (adjusted hazard ratio, 1.99; 95% confidence interval, 1.40–2.79) ADEs.

Conclusions
Antipsychotic polypharmacy was a risk factor for the occurrence of single and multiple ADEs. Antipsychotic polypharmacy should be conservatively and minimally practiced.
Effectiveness of Physical Therapy on Ataxia-Telangiectasia: A Case Report
Authors: Unes Sefa , Tuncdemir Merve , Eroglu-Ertugrul Nesibe Gevher , Kerem Gunel Mintaze 
Published: June 2021

Background and Purpose:
This case report investigated the benefits of a 12-week physical therapy program for a child with ataxia-telangiectasia (AT).

Case Description:
A 9-year-old girl with a diagnosis of AT participated. The physical therapy program consisted of balance and strength exercise and Wii Fit Balance-based video games training with a pediatric physical therapist for 12 weeks.

Measurements:
The motor performance, Gross Motor Function Measurement (GMFM), Pediatric Berg Balance Scale (PBBS), Trunk Control Measurement Scale (TCMS), participation as measured by the Life Habits Questionnaire (LIFE-H), and the Pediatric Quality of Life Inventory (PedsQL).

Outcomes:
Positive changes were observed in the TCMS, PBBS, GMFM, and motor performance, participation, and quality of life.

Conclusions:
Notable improvements were observed in both body structure and function, and activities and participation level.

What This Adds to Evidence:
This case report is the first to support the effectiveness of physical therapy in a child with AT.
Association of Maternal Viral Load and CD4 Count With Perinatal HIV-1 Transmission Risk During Breastfeeding in the PROMISE Postpartum Component
Authors: Flynn Patricia M. , Taha Taha E. , Cababasay Mae , Butler Kevin , Fowler Mary G. , Mofenson Lynne M. , Owor Maxensia , Fiscus Susan , Stranix-Chibanda Lynda , Coutsoudis Anna , Gnanashanmugam Devasena , Chakhtoura Nahida , McCarthy Katie , Frenkel Lisa , Beck Ingrid , Mukuzunga Cornelius , Makanani Bonus , Moodley Dhayendre , Nematadzira Teacler , Kusakara Bangani , Patil Sandesh , Vhembo Tichaona , Bobat Raziya , Mmbaga Blandina T. , Masenya Maysseb , Nyati Mandisa , Theron Gerhard , Mulenga Helen , Shapiro David E. ,   the PROMISE Study Team
Published: June 2021

Background:
Breastfeeding mothers with HIV infection not qualifying for antiretroviral therapy (ART) based on country-specific guidelines at the time of the Promoting Maternal-Infant Survival Everywhere trial and their uninfected neonates were randomized to maternal ART (mART) or infant nevirapine prophylaxis (iNVP) postpartum. HIV transmission proportions were similar (<1%) in the 2 arms. We assessed whether maternal viral load (MVL) and CD4 cell counts were associated with breastfeeding HIV transmission.

Methods:
MVL was collected at entry (7–14 days postpartum) and at weeks 6, 14, 26, and 50 postpartum. CD4 cell counts were collected at entry and weeks 14, 26, 38, and 50 postpartum. Infant HIV-1 nucleic acid test was performed at weeks 1 and 6, every 4 weeks until week 26, and then every 12 weeks. The associations of baseline and time-varying MVL and CD4 cell counts with transmission risk were assessed using time-to-event analyses by randomized treatment arm.

Results:
Two thousand four hundred thirty-one mother–infant pairs were enrolled in the study. Baseline MVL (P = 0.11) and CD4 cell counts (P = 0.51) were not significantly associated with infant HIV-1 infection. Time-varying MVL was significantly associated with infant HIV-1 infection {hazard ratio [95% confidence interval (CI)]: 13.96 (3.12 to 62.45)} in the mART arm but not in the iNVP arm [hazard ratio (95% CI): 1.04 (0.20 to 5.39)]. Time-varying CD4 cell counts were also significantly associated with infant HIV-1 infection [hazard ratio (95% CI): 0.18 (0.03 to 0.93)] in the mART arm but not in the iNVP arm [hazard ratio (95% CI): 0.38 (0.08 to 1.77)].

Conclusions:
In women receiving mART, increased MVL and decreased CD4 cell counts during breastfeeding were associated with increased risk of infant HIV-1 infection.
Extracellular vesicles derived from cardiosphere-derived cells as a potential antishock therapeutic
Authors: Chance Tiffani C. , Wu Xiaowu , Keesee Jeffrey D. , Garcia-Marcano Josue , Salgado Christi L. , Liu Bin , Moseley Jennifer J. , Peck Kiel A. , R.-Borlado Luis , Atai Nadia A. , Gould Stephen J. , Marban Linda S. , Cap Andrew P. , Rathbone Christopher R. , Bynum James A. 
Published: June 2021

BACKGROUND
Extracellular vesicles (EVs) isolated from cardiosphere-derived cells (CDC-EVs) are coming to light as a unique cell-free therapeutic. Because of their novelty, however, there still exist prominent gaps in knowledge regarding their therapeutic potential. Herein the therapeutic potential of CDC-EVs in a rat model of acute traumatic coagulopathy induced by multiple injuries and hemorrhagic shock is outlined.

METHODS
Extracellular vesicle surface expression of procoagulant molecules (tissue factor and phosphatidylserine) was evaluated by flow cytometry. Extracellular vesicle thrombogenicity was tested using calibrated thrombogram, and clotting parameters were assessed using a flow-based adhesion model simulating blood flow over a collagen-expressing surface. The therapeutic efficacy of EVs was then determined in a rat model of acute traumatic coagulopathy induced by multiple injuries and hemorrhagic shock.

RESULTS
Extracellular vesicles isolated from cardiosphere-derived cells are not functionally procoagulant and do not interfere with platelet function. In a rat model of multiple injuries and hemorrhagic shock, early administration of EVs significantly reduced the elevation of lactate and creatinine and did not significantly enhance coagulopathy in rats with acute traumatic coagulopathy.

CONCLUSION
The results of this study are of great relevance to the development of EV products for use in combat casualty care, as our studies show that CDC-EVs have the potential to be an antishock therapeutic if administered early. These results demonstrate that research using CDC-EVs in trauma care needs to be considered and expanded beyond their reported cardioprotective benefits.
Surgeon-performed ultrasound for the staging of acute diverticulitis: Preliminary results of a prospective study
Authors: Zago Mauro , Biloslavo Alan , Mariani Diego , Pestalozza Maria Alessandra , Poillucci Gabriele , Bellio Gabriele 
Published: June 2021

INTRODUCTION
Although contrast-enhanced abdominal computed tomography (CEACT) is still considered the criterion standard for the assessment of suspected acute diverticulitis, in recent years, the use of point-of-care ultrasound (POCUS) has been spreading more and more in this setting. The aim of this study was to compare CEACT to POCUS for the diagnosis and staging of suspected acute diverticulitis.

METHODS
This is a prospective study conducted on 55 patients admitted to the emergency department of two Italian Hospitals with a clinical suspicion of acute diverticulitis between January 2014 and December 2017. All the patients included underwent POCUS first and CEACT immediately afterward, with the diagnosis and the staging reported according to the Hinchey (H) classification modified by Wasvary et al. [Wasvary H, Turfah F, Kadro O, Beauregard W. Same hospitalization resection for acute diverticulitis. Am Surg. 1999;65:632–635.] Three surgeons performed all the POCUS, and the same two radiologists retrospectively analyzed all the CEACT images. The radiologists were informed of the clinical suspicion but unaware of the POCUS findings. The CEACT was used as the criterion standard for the comparison.

RESULTS
The final cohort included 30 females (55%) and 25 males (45%). The median age was 62 years (range, 24–88 years), and the median body mass index was 26 kg/m2 (range, 19–42 kg/m2). Forty-six of 55 patients had a confirmed diagnosis of acute diverticulitis on both POCUS and CEACT, whereas, in 7 patients, the diagnosis was not confirmed by both methods. Point-of-care ultrasound sensitivity and specificity were 98% and 88%, respectively. Point-of-care ultrasound positive and negative predictive values were 98% and 88%, respectively. Point-of-care ultrasound accuracy was 96%. Point-of-care ultrasound classified 33 H1a, 11 H1b, 1 H2, and 1 H3 acute diverticulitis. This staging was confirmed in all patients but three (93%) by CEACT.

CONCLUSION
Point-of-care ultrasound appeared a reliable technique for the diagnosis and the staging of clinically suspected H1 and H2 acute diverticulitis. It could contribute in saving time and resources and in avoiding unnecessary radiation exposure to most patients.

LEVEL OF EVIDENCE
Diagnostic test, level III.
Perceived social support is strongly associated with recovery after injury
Authors: Orlas Claudia P. , Herrera-Escobar Juan P. , Hau Ka Man , Velmahos Andriana , Patel Nikita , Sanchez Sabrina , Kaafarani Haytham M.A. , Salim Ali , Nehra Deepika 
Published: June 2021

BACKGROUND
The strength of one’s social support network is a potentially modifiable factor that may have a significant impact on recovery after injury. We sought to assess the association between one’s perceived social support (PSS) and physical and mental health outcomes 6 months to 12 months postinjury.

METHODS
Moderate to severely injured patients admitted to one of three Level I trauma centers were asked to complete a phone-based survey assessing physical and mental health outcomes in addition to return to work and chronic pain 6 months to 12 months postinjury. Patients were also asked to rate the strength of their PSS on a 5-point Likert scale. Multivariate linear and logistic regression models were built to determine the association between PSS and postdischarge outcome metrics.

RESULTS
Of 907 patients included in this study, 653 (72.0%) identified themselves as having very strong/strong, 182 (20.1%) as average, and 72 (7.9%) as weak/nonexistent PSS. Patients who reported a weak/nonexistent PSS were younger and were more likely to be male, Black, and to have a lower level of education than those who reported a very strong/strong PSS. After adjusting for potential confounders, patients with a weak/nonexistent PSS were more likely to have new functional limitations and chronic pain in addition to being less likely to be back at work/school and being more likely to screen positive for symptoms of posttraumatic stress disorder, depression and anxiety at 6 months to 12 months postinjury than those with a strong/very strong PSS.

CONCLUSION
Lower PSS is strongly correlated with worse functional and mental health outcome metrics postdischarge. The strength of one’s social support network should be considered when trying to identify patients who are at greatest risk for poor postdischarge outcomes after injury. Our data also lend support to creating a system wherein we strive to build a stronger support network for these high-risk individuals.

LEVEL OF EVIDENCE
Prognostic/epidemiologic, level III
Certification in endovascular hemostasis for trauma surgeons: Possible and practical?
Authors: Herrold Joseph Alden , Adnan Sakib , Romagnoli Anna , Madurska Marta J. , Betzold Richard , DuBose Joseph , Scalea Thomas , Morrison Jonathan J. 
Published: June 2021

BACKGROUND
Endovascular hemostasis is commonplace with many practitioners providing services. Accruing sufficient experience during training could allow acute care surgeons (ACSs) to expand their practice. We quantified case load and training opportunities at our center, where dedicated dual-trained ACS/vascular surgery faculty perform these cases. Our aim was to assess whether ACS fellows could obtain sufficient experience in 6 months of their fellowship in order to certify in these techniques, per the requirements of other specialties.

METHODS
We performed a retrospective case series where we reviewed 6 years (2013–2018) of endovascular activity at an academic, level I trauma center quantifying arterial access, angiography, embolization, stent and stent graft placement, and IVC filter procedures. This was compared with the certification requirements for interventional radiology, vascular surgery, cardiothoracic surgery, and interventional cardiology.

RESULTS
Between 2013 and 2018, 1,179 patients with a mean ± SD Injury Severity Score of 22.47 ± 13.24, underwent 4960 procedures. Annual rates per procedure, expressed as median (interquartile range), were arterial access 193.5 (181–195.5), diagnostic angiography 352 (321.5–364.5), embolization 90.5 (89.25–93.25), stent placement 24 (13.5–29.25), and IVC filter procedures 16.5 (10–23.75). Our 6-month case volume exceeded or was within 85% of the required number of cases for vascular surgery and interventional radiology training, with the exception of stent-graft deployment for both specialties, and therapeutic procedures for vascular surgery.

CONCLUSION
The case volume at a large trauma center with a dedicated endovascular trauma service is sufficient to satisfy the case requirements for endovascular certification. Our trainees are already acquiring this experience informally. An endovascular trauma curriculum should now be developed to support certification within ACS fellowship training.
Kidney Transplant Recipient Attitudes Toward a SARS-CoV-2 Vaccine
Authors: Ou Michael T. , Boyarsky Brian J. , Zeiser Laura B. , Po-Yu Chiang Teresa , Ruddy Jake , Van Pilsum Rasmussen Sarah E. , Martin Jennifer , St. Clair Russell Jennifer , Durand Christine M. , Avery Robin K. , Werbel William A. , Cooper Matthew , Massie Allan B. , Segev Dorry L. , Garonzik-Wang Jacqueline M. 
Published: June 2021

Background.
A widely accepted severe acute respiratory syndrome 2 (SARS-CoV-2) vaccine could protect vulnerable populations, but the willingness of solid organ transplant recipients (SOTRs) to accept a potential vaccine remains unknown.

Methods.
We conducted a national survey of 1308 SOTRs and 1617 non-SOTRs between November 11 and December 2, 2020 through the network of the National Kidney Foundation.

Results.
Respondents were largely White (73.2%), female (61.1%), and college graduates (56.2%). Among SOTRs, half (49.5%) were unsure or would be unwilling to receive a SARS-CoV-2 vaccine once available. Major concerns included potential side effects (85.2%), lack of rigor in the testing and development process (69.7%), and fear of incompatibility with organ transplants (75.4%). Even after the announcement of the high efficacy of the mRNA-1273 vaccine (Moderna Inc.) at the time of survey distribution, likeliness to receive a vaccine only slightly increased (53.5% before announcement versus 57.8% after the announcement). However, 86.8% of SOTRs would accept a vaccine if recommended by a transplant provider.

Conclusions.
SOTRs reported skepticism in receiving a potential SARS-CoV-2 vaccine, even after announcements of high vaccine efficacy. Reassuringly, transplant providers may be the defining influence in vaccine acceptance and will likely have a critical role to play in promoting vaccine adherence.
Optic Neuritis–Independent Retinal Atrophy in Neuromyelitis Optica Spectrum Disorder
Authors: Filippatou Angeliki G. , Vasileiou Eleni S. , He Yufan , Fitzgerald Kathryn C. , Kalaitzidis Grigorios , Lambe Jeffrey , Mealy Maureen A. , Levy Michael , Liu Yihao , Prince Jerry L. , Mowry Ellen M. , Saidha Shiv , Calabresi Peter A. , Sotirchos Elias S. 
Published: June 2021

Background:
A limited number of studies have investigated the presence of ongoing disease activity independent of clinical relapses in neuromyelitis optica spectrum disorder (NMOSD), and data are conflicting. The objective of our study was to examine whether patients with aquaporin-4 (AQP4)-IgG seropositive NMOSD exhibit progressive retinal neuroaxonal loss, independently of optic neuritis (ON) attacks.

Methods:
In this single-center, longitudinal study, 32 AQP4-IgG+ NMOSD patients and 48 healthy controls (HC) were followed with serial spectral-domain optical coherence tomography and visual acuity (VA) assessments. NMOSD patients with ON less than 6 months before baseline were excluded, whereas data from patients with ON during follow-up were censored at the last visit before ON. VA worsening was defined as a decrease in monocular letter acuity ≥5 letters for high-contrast VA and ≥7 letters for low-contrast VA. Analyses were performed with mixed-effects linear regression models adjusted for age, sex, and race.

Results:
The median follow-up duration was 4.2 years (interquartile range: 1.8–7.5). Relative to HC, NMOSD eyes had faster peripapillary retinal nerve fiber layer (pRNFL) (β = −0.25 µm/year faster, 95% confidence interval [CI]: −0.45 to −0.05, P = 0.014) and GCIPL thinning (β = −0.09 µm/year faster, 95% CI: −0.17 to 0, P = 0.05). This difference seemed to be driven by faster pRNFL and GCIPL thinning in NMOSD eyes without a history of ON compared with HC (GCIPL: β = −0.15 µm/year faster; P = 0.005; pRNFL: β = −0.43 µm/year faster, P < 0.001), whereas rates of pRNFL (β: −0.07 µm/year, P = 0.53) and GCIPL (β = −0.01 µm/year, P = 0.90) thinning did not differ between NMOSD-ON and HC eyes. Nine NMOSD eyes had VA worsening during follow-up.

Conclusions:
In this longitudinal study, we observed progressive pRNFL and GCIPL atrophy in AQP4-IgG+ NMOSD eyes unaffected by ON. These results support that subclinical involvement of the anterior visual pathway may occur in AQP4-IgG+ NMOSD.