bluuebunny/crossref_metadata_2025_split huggingface dataset:
Seroprevalence estimate and risk factors for Coxiella burnetii infections among humans in a highly urbanised Brazilian state
Authors: Meurer Igor Rosa , Silva Marcio Roberto , Silva Marcos Vinícius Ferreira , de Lima Duré Ana Íris , Adelino Talita Émile Ribeiro , da Costa Alana Vitor Barbosa , Vanelli Chislene Pereira , de Paula Souza e Guimarães Ricardo José , Rozental Tatiana , de Lemos Elba Regina Sampaio , Corrêa José Otávio do Amaral 
Published: July 2021

Abstract

Background
Q fever is among the top 13 global priority zoonoses, however, it is still neglected and under-reported in most of the world, including Brazil. Thus, we evaluated the seroprevalence of and the risk factors for Coxiella burnetii infections in humans from Minas Gerais, a highly urbanised Brazilian state.

Methods
Coxiella burnetii was searched for patient samples (n=437), which were suspected of then later confirmed as negative for dengue fever, by the indirect immunofluorescence technique and real-time PCR. Risk factors for infections and spatial clusters for both C. burnetii-seropositive individuals and livestock concentration were evaluated.

Results
We found that 21 samples (4.8%; 95% CI 3.0 to 7.2%) were reactive for at least one class of anti-C. burnetii antibodies (titer of ≥64), with rural residence (p=0.036) being a risk factor. Also, two spatial clusters of seropositivity were found within a significant area by Scan, and a probable relationship between the Scan result and the livestock concentration by area was found.

Conclusions
Seropositive individuals were associated with rural residence, with a likely relationship with the livestock concentration. Thus, this study establishes baseline figures for C. burnetii seroprevalence in humans in a state of Brazil, allowing the monitoring of trends and setting of control targets, as well as more representative longitudinal and risk analysis studies.
New record of the wood-associated sea starCaymanostella, with notes on the phylogenetic position of the family Caymanostellidae (Asteroidea)
Authors: Dilman Anna B , Minin Kirill V , Petrov Nikolay B 
Published: July 2021

AbstractIn 2016, three specimens of Caymanostella were collected from the Kuril-Kamchatka Trench area at depths of 5101–5134 m. Comparative morphological analysis revealed that the new specimens are similar to Caymanostella spinimarginata, the most geographically distant species (Atlantic Ocean). The new specimens were identified as C. cf. spinimarginata. Multilocus genetic data were obtained for the family Caymanostellidae for the first time in this study. Molecular evidence based on the analyses of three mitochondrial and two nuclear markers recovers the family Caymanostellidae as a sister-taxon to Ophidiasteridae (order Valvatida). Phylogenetic data indicate that morphological features, which were previously used to imply asterinid, xyloplacid or korethrasterid affinities for the family Caymanostellidae, emerged independently. It is suggested that the family Caymanostellidae should be placed within the order Valvatida.
Extracorporeal Membrane Oxygenation Complications in Heparin- and Bivalirudin-Treated Patients
Authors: Giuliano Katherine , Bigelow Benjamin F. , Etchill Eric W. , Velez Ana K. , Ong Chin Siang , Choi Chun W. , Bush Errol , Cho Sung-Min , Whitman Glenn J. R. 
Published: July 2021

OBJECTIVES:
Extracorporeal membrane oxygenation is a potentially life-saving intervention in refractory cardiopulmonary failure, but it requires anticoagulation to prevent circuit thromboses, which exposes the patient to hemorrhagic complications. Heparin has traditionally been the anticoagulant of choice, but the direct thrombin inhibitor bivalirudin is routinely used in cases of heparin-induced thrombocytopenia and has been suggested as a superior choice. We sought to examine the timing of hemorrhagic and thrombotic complications after extracorporeal membrane oxygenation cannulation and to compare the rates of such complications between patients anticoagulated with heparin versus bivalirudin.

DESIGN:
Retrospective cohort study.

SETTING:
Johns Hopkins Hospital patients between January 2016 and July 2019.

PATIENTS:
Adult (> 18 yr) extracorporeal membrane oxygenation patients.

INTERVENTIONS:
Patients were anticoagulated either with heparin or bivalirudin.

MEASUREMENTS AND MAIN RESULTS:
We compared rates of hemorrhagic and thrombotic complications by time on heparin versus bivalirudin and characterized the average time to each complication. Of 144 extracorporeal membrane oxygenation patients (mean age 55.3 yr; 58% male), 41% were on central venoarterial extracorporeal membrane oxygenation, 40% on peripheral venoarterial extracorporeal membrane oxygenation, and 19% on venovenous extracorporeal membrane oxygenation. Thirteen patients (9%) received bivalirudin during their extracorporeal membrane oxygenation run, due to concern for (n = 8) or diagnosis of (n = 4) heparin-induced thrombocytopenia or for heparin resistance (n = 1). The rate of hemorrhagic or thrombotic complications did not differ between heparin (0.13/d) and bivalirudin (0.06/d; p = 0.633), but patients on bivalirudin received significantly fewer blood transfusions (1.0 U of RBCs/d vs 2.9/d on heparin; p < 0.001).

CONCLUSIONS:
Our results confirm the safety and efficacy of bivalirudin as an alternative anticoagulant in extracorporeal membrane oxygenation and suggest a potential benefit in less blood product transfusion, although prospective studies are needed to evaluate the true effect of bivalirudin versus the disease processes that prompted its use in our study population.
Lymphatic Endothelial Cell Defects in Congenital Cardiac Patients With Postoperative Chylothorax
Authors: Shakoor Aqsa , Wu June K. , Muley Ajit , Kitajewski Christopher , McCarron Joseph D. , Shapiro-Franklin Noa , Corda Rozelle , Chrisomalis-Dring Sophia , Chai Paul J. , Shawber Carrie J. 
Published: July 2021

Objectives:
Chylothorax following cardiac surgery for congenital cardiac anomalies is a complication associated with severe morbidities and mortality. We hypothesize that there are intrinsic defects in the lymphatics of congenital cardiac patients.

Methods:
Postsurgical chylothorax lymphatic endothelial cells (pcLECs) (n = 10) were isolated from the chylous fluid from congenital cardiac defect patients, and characterized by fluorescent-activated cell sorting, immunofluorescent staining, and quantitative RT-PCR. Results were compared to normal human dermal lymphatic endothelial cells (HdLECs). pcLECs (n = 3) and HdLECs were xenografted into immunocompromised mice. Implants and postoperative chylothorax patient’s pulmonary tissues were characterized by immunostaining for lymphatic endothelial proteins.

Results:
pcLECs expressed endothelial markers VECADHERIN, CD31, VEGFR2, lymphatic endothelial markers PROX1, podoplanin, VEGFR3, and progenitor endothelial markers CD90 and CD146. However, pcLECs had key differences relative to HdLECs, including altered expression and mislocalization of junctional proteins (VECADHERIN and CD31), and essential endothelial proteins, VEGFR2, VEGFR3, and PROX1. When xenografted in mice, pcLECs formed dilated lymphatic channels with poor cell–cell association. Similar to congenital lymphatic anomalies, the pulmonary lymphatics were dilated in a patient who developed postoperative chylothorax after cardiac surgery.

Conclusions:
Recent studies have shown that some postoperative chylothoraces in congenital cardiac anomalies are associated with anatomical lymphatic defects. We found that pcLECs have defects in expression and localization of proteins necessary to maintain lymphatic specification and function. This pcLEC phenotype is similar to that observed in lymphatic endothelial cells from congenital lymphatic anomalies. Co-existence of lymphatic anomalies should be considered as a feature of congenital cardiac anomalies.
A cross-sectional study of breast pain in a diverse population of breast cancer patients
Authors: Fukui Jami , Bantum Erin , Meister Madison , Lim Shannon , Marumoto Ashley Davidson , Pagano Ian 
Published: July 2021

Abstract

Background:
Breast cancer is the most common cancer in women, and postoperative breast pain has been reported to be anywhere from 25% to 60%. However, there is sparse data regarding racial/ethnic differences in breast pain among breast cancer patients.

Methods:
We performed a cross-sectional anonymous survey of breast cancer patients from the Hawaii Cancer Consortium over a 6-week period between 2019 and 2020. The 237 breast cancer participants were ages 29 to 98, 74% Asian, and mainly from outpatient oncology clinics. We evaluated the prevalence of breast pain in a diverse group of breast cancer patients and characterized the pain using a modified short-form McGill pain questionnaire (sfMPQ).

Results:
Eighty-four respondents (35.4%) reported breast pain. On univariable analysis, we found significant racial/ethnic differences in the amount of breast pain, where Chinese and Japanese participants reported significantly less pain compared to White participants on a 10-point pain scale. We found differences in breast pain according to age and endocrine therapy use as well as survey location, however, no differences were seen according to chemotherapy, radiation, or breast surgery. Based on the sfMPQ, the most common descriptors of breast pain were sensory (throbbing, shooting, and stabbing) compared to affective (tiring-exhausting, sickening, fearful, and punishing-cruel) characteristics. Although they were described as mild and intermittent, in women with breast pain, 33.4% reported the breast pain affected their sleep, 16.7% their work, and 15.4% their sexual activity.

Conclusions:
Breast pain is a significant problem in our breast cancer community. This survey assessment has informed our understanding of breast pain in our diverse population. In turn, we are developing culturally appropriate pain management strategies to treat this challenging symptom common in breast cancer survivors.
Cost-effectiveness of Multidisciplinary Care in Plastic Surgery
Authors: Raj Sarth , Williams Elizabeth M. , Davis Matthew J. , Abu-Ghname Amjed , Luu Bryan C. , Buchanan Edward P. 
Published: July 2021

Background
Multidisciplinary care has been previously shown to improve outcomes for patients and providers alike, fostering interprofessional collaboration and communication. Many studies have demonstrated the beneficial health care outcomes of interdisciplinary care. However, there has been minimal focus on the cost-effectiveness of such care, particularly in the realm of plastic surgery. This is the first systematic review to examine cost savings attributable to plastic surgery involvement in multidisciplinary care.

Methods
A comprehensive literature review of articles published on cost outcomes associated with multidisciplinary teams including a plastic surgeon was performed. Included articles reported on cost outcomes directly or indirectly attributable to a collaborative intervention. Explicitly reported cost savings were totaled on a per-patient basis. Each article was also reviewed to determine whether the authors ultimately recommended the team-based intervention described.

Results
A total of 604 articles were identified in the initial query, of which 8 met the inclusion criteria. Three studies reported explicit cost savings from multidisciplinary care, with cost savings ranging from $707 to $26,098 per patient, and 5 studies reported changes in secondary factors such as complication rates and length of stay. All studies ultimately recommended multidisciplinary care, regardless of whether cost savings were achieved.

Conclusions
This systematic review of the cost-effectiveness of multidisciplinary plastic surgery care examined both primary cost savings and associated quality outcomes, such as length of stay, complication rate, and resource consumption. Our findings indicate that the inclusion of plastic surgery in team-based care provides both direct and indirect cost savings to all involved parties.
Critical care ultrasound in geriatric trauma resuscitation leads to decreased fluid administration and ventilator days
Authors: Cleveland Elaine Marie , Warren Yancy Everett , Shenoy Rathna , Lewis Margaret Ruffin , Cunningham Kyle William , Wang Huaping , Huynh Toan T. , Brintzenhoff Rita Anne 
Published: July 2021

BACKGROUND
Geriatric trauma populations respond differently than younger trauma populations. Critical care ultrasound (CCUS) can guide resuscitation, and it has been shown to decrease intravenous fluid (IVF), lower time until operation, and lower mortality in trauma. Critical care ultrasound–guided resuscitation has not yet been studied in geriatric trauma. We hypothesized that incorporation of CCUS would decrease amount of IVF administered, decrease time to initiation of vasopressors, and decrease end organ dysfunction.

METHODS
A PRE-CCUS geriatric trauma group between January 2015 and October 2016 was resuscitated per standard practice. A POST-CCUS group between January 2017 and December 2018 was resuscitated based on CCUS performed by trained intensivist upon admission to the intensive care unit and 6 hours after initial ultrasound. The PRE-CCUS and POST-CCUS groups underwent propensity score matching, yielding 60 enrollees in each arm. Retrospective review was conducted for demographics, clinical outcomes, and primary endpoints, including amount of IVF in the first 48 hours, duration to initiation of vasopressor use, and end organ dysfunction. Wilcoxon two-sample, χ2 tests, and κ statistics were performed to check associations between groups.

RESULTS
There was no statistical difference between PRE-CCUS and POST-CCUS demographics and Injury Severity Scores. Intravenous fluid within 48 hours decreased from median [interquartile range] of 4941 mL [4019 mL] in the PRE-CCUS to 2633 mL [3671 mL] in the POST-CCUS (p = 0.0003). There was no significant difference between the two groups in time to initiation of vasopressors, vasopressor duration, lactate clearance, intensive care unit length of stay, or hospital length of stay. There was a significant decrease in ventilator days, with 26.7% PRE-CCUS with ventilation longer than 2 days, and only 6.7% POST-CCUS requiring ventilation longer than 2 days (p = 0.0033).

CONCLUSION
Critical care ultrasound can be a useful addition to geriatric resuscitation. The POST-CCUS received less IV fluid and had decreased ventilator days. While mortality, lactate clearance, complications, and hospital stay were not statistically different, there was a perception that CCUS was a useful adjunct for assessing volume status and cardiac function.

LEVEL OF EVIDENCE
Therapeutic, level II.
Outcome measures used in clinical research evaluating prehospital blood component transfusion in traumatically injured bleeding patients: A systematic review
Authors: Tucker Harriet , Avery Pascale , Brohi Karim , Davenport Ross , Griggs Joanne , Weaver Anne , Green Laura 
Published: July 2021

BACKGROUND
Trial outcomes should be relevant to all stakeholders and allow assessment of interventions’ efficacy and safety at appropriate timeframes. There is no consensus regarding outcome measures in the growing field of prehospital trauma transfusion research. Harmonization of future clinical outcome reporting is key to facilitate interstudy comparisons and generate cohesive, robust evidence to guide practice. The objective of this study was to evaluate outcome measures reported in prehospital trauma transfusion trials.

METHODS
Data Sources, Eligibility Criteria, Participants, and Interventions
We conducted a scoping systematic review to identify the type, number, and definitions of outcomes reported in randomized controlled trials, and prospective and retrospective observational cohort studies investigating prehospital blood component transfusion in adult and pediatric patients with traumatic hemorrhage. Electronic database searching of PubMed, Embase, Web of Science, Cochrane, OVID, clinical trials.gov, and the Transfusion Evidence Library was completed in accordance with Preferred Reporting Items for Meta-analyses guidelines.
Study Appraisal and Synthesis Methods
Two review authors independently extracted outcome data. Unique lists of salutogenic (patient-reported health and wellbeing outcomes) and nonsalutogenic focused outcomes were established.

RESULTS
A total of 3,471 records were identified. Thirty-four studies fulfilled the inclusion criteria: 4 military (n = 1,566 patients) and 30 civilian (n = 14,398 patients), all between 2000 and 2020. Two hundred twelve individual non–patient-reported outcomes were identified, which collapsed into 20 outcome domains with varied definitions and timings. All primary outcomes measured effectiveness, rather than safety or complications. Sixty-nine percent reported mortality, with 11 different definitions. No salutogenic outcomes were reported.

CONCLUSION
There is heterogeneity in outcome reporting and definitions, an absence of patient-reported outcome, and an emphasis on clinical effectiveness rather than safety or adverse events in prehospital trauma transfusion trials. We recommend stakeholder consultation and a Delphi process to develop a clearly defined minimum core outcome set for prehospital trauma transfusion trials.

LEVEL OF EVIDENCE
Scoping systematic review, level III.
PathML: A unified framework for whole-slide image analysis with deep learning
Authors: Berman Adam G. , Orchard William R. , Gehrung Marcel , Markowetz Florian 
Published: July 2021

AbstractThe inspection of stained tissue slides by pathologists is essential for the early detection, diagnosis and monitoring of disease. Recently, deep learning methods for the analysis of whole-slide images (WSIs) have shown excellent performance on these tasks, and have the potential to substantially reduce the workload of pathologists. However, successful implementation of deep learning for WSI analysis is complex and requires careful consideration of model hyperparameters, slide and image artefacts, and data augmentation. Here we introduce PathML, a Python library for performing preand post-processing of WSIs, which has been designed to interact with the most widely used deep learning libraries, PyTorch and TensorFlow, thus allowing seamless integration into deep learning workflows. We present the current best practices in deep learning for WSI analysis, and give a step-by-step guide using the PathML framework: from annotating and pre-processing of slides, to implementing neural network architectures, to training and post-processing. PathML provides a unified framework in which deep learning methods for WSI analysis can be developed and applied, thus increasing the accessibility of an important new application of deep learning.
Genotoxicity evaluation of levonorgestrel-releasing intrauterine system (LNG-IUS) in exfoliated cervical cells using the micronucleus (MN) test
Authors: Zamani Ayse Gul , Karatayli Rengin , Kazim Gezginc , Acar Aynur , Yildirim Mahmut Selman 
Published: July 2021

AbstractPurposeThis study aimed to determine whether any relationships exist between the levonorgestrel-releasing intrauterine system (LNG-IUS) and micronuclei or other nuclear anomalies, including condensed chromatin, karyorrhexis, and karyolysis, on the cervical epithelium in young women.MethodsA prospective observational study was conducted. The study population comprised healthy women aged ≤40 years who were referred for birth control. Cervical smears that were obtained from 18 women before and three months after LNG-IUS insertion were tested for micronuclei and other nuclear anomaliesusing the micronucleus test.ResultsThe results revealed no statistically significant difference (P>0.05) in the frequency of micronucleated exfoliated cervical mucosa cells after LNG-IUS exposure. However, LNG-IUS was able to increase other nuclear alterations closely related to cytotoxicity.ConclusionsData indicated that exposure to LNG-IUS may not be a factor in inducing chromosomal damage, but it can promote cytotoxicity.
Humoral immune response in inactivated SARS-CoV-2 vaccine: When should a booster dose be administered?
Authors: Kara Ertan , Tanir Ferdi , Demirhindi Hakan , Mete Burak , Kibar Filiz , Cetiner Salih , Candevir Aslihan , Inaltekin Ayşe 
Published: July 2021

AbstractBackgroundFor a sustained and essential protective antibody response, it is important to understand how long the humoral immune response induced by the SARS-CoV-2 inactivated vaccine persists.AimsThis study aimed to detect the first and third-month concentrations and seroconversion rates of the antibodies induced by the inactivated vaccine.Study DesignThis is a vaccine efficacy study.MethodsThe study included 272 health workers who were vaccinated at days 0 and 28 by the inactivated SARS-CoV-2 vaccine (3μg/0.5ml). Anti-S-RBD-IgG and total anti-spike/anti- nucleocapsid-IgG antibody concentrations and seroconversion rates were examined in vaccinated health workers at the 1st and 3rd months after the vaccination. The test method used for the qualitative detection and differentiation of IgG antibodies (indirect method) to SARS-CoV-2 is a chemiluminescence reaction (CLIA).ResultsThe mean age of the health workers was 38.93±10.59 (min:21-max:64). A total of 45(16.5%) participants declared to have had COVID-19 before the first dose of the inactivated vaccine. The participants were found to be reactive for anti-S-RBD-IgG antibodies by 98.2% and 97.8% at the first and third months, respectively, after the administration of the second dose. The decrease in the mean plasma concentrations of anti-S-RBD IgG was observed as 56.7% in the cohort with only two doses of the vaccine (1st month:42.4AU/ml versus 3rd month: 18.2AU/ml). In the cohort with a history of COVID-19 prior to the vaccination, the decrease was observed as 25.1% (1st month:58.29 versus 3rd month:43.64 AU/ml) and at a mean of 57.4 (0-90) days prior to vaccination, the decrease was of 43.1% (1st month:55.05 AU/ml versus 3rd month:31.28 AU/ml), keeping more stable in participants infected at a mean of 183.1 (91-330) days prior to vaccination (a decrease of 5.2%; with 62.34 AU/ml at 1st and 59.08 AU/ml at 3rd months). Anti-S-RBD concentrations were observed to increase 10-fold (30.44 AU/ml at 1st and 310.64 AU/ml at 3rd months) in participants infected after the vaccination and to decrease among people aged 50 years and older.ConclusionAntibody concentrations at the 1st and 3rd months after the vaccination with two doses of the inactivated SARS-CoV-2 vaccine were found to be decreased, but still detectable (except in one participant). As participants who had COVID-19 at a mean of 181 (90-330) days before the vaccination presented with a more stable antibody level, it can be concluded that a booster at months 6-12, resulting in a schedule of 0-1-6 months, is recommended for the inactive SARS-CoV-2 vaccination.