bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multiple Sequential Free Flap Reconstructions of the Head and Neck: A Single-Center Experience
Authors: Moratin Julius , Horn Dominik , Heinemann Maleen , Metzger Karl , Mrosek Jan , Ristow Oliver , Engel Michael , Freudlsperger Christian , Freier Kolja , Hoffmann Jürgen 
Published: September 2021

Background:
Free flap reconstruction is the standard of care in extensive defects of the head and neck area, and although most patients may be treated sufficiently with one flap, recurrence of a malignant tumor or failure of a previous reconstruction may make the use of a second (or more) flap necessary. The aim of this study was to evaluate the indications and success rates of multiple consecutive reconstructive procedures in a large cohort of patients.

Methods:
Nine hundred ninety-six free flap reconstructions were retrospectively analyzed and cases of sequential reconstructions in the same patient were identified. Indications, success rates, perioperative procedures, and frequently used flaps were evaluated.

Results:
Two hundred twenty cases of sequential microvascular reconstructions were identified, ranging from two to six flaps per patient. The overall flap success rate was 89.1 percent. A history of diabetes was identified as a risk factor for flap failure (p = 0.029). There was no association of flap loss with the number of reconstructive procedures per patient.

Conclusions:
The use of several free flaps in the same patient is a feasible option for patients suffering from recurrent tumors or to improve quality of life by a secondary reconstruction. A salvage free flap transfer to replace a lost transplant exhibits good success rates.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Free Flap Coverage for Complex Primary and Revision Total Knee Arthroplasty
Authors: Athey Alexander G. , Wyles Cody C. , Carlsen Brian T. , Perry Kevin I. , Houdek Matthew T. , Moran Steven L. 
Published: September 2021

Background:
Free flap coverage in the setting of a total knee arthroplasty is rare. The purpose of the current study was to evaluate the outcome of patients who underwent a free flap to assist with soft-tissue coverage following a complex total knee arthroplasty.

Methods:
The authors used their institutional total joint registry to retrospectively review patients undergoing a free soft-tissue flap in the setting of complex primary and revision total knee arthroplasty. Among 29,069 primary and 6433 revision total knee arthroplasties from 1994 to 2017, eight (0.02 percent) required a free flap for wound coverage. This included three primary total knee arthroplasties (0.01 percent) for posttraumatic arthritis and five revision total knee arthroplasties (0.07 percent) in the setting of infection. Median follow-up was 4 years.

Results:
Free flaps included vertical rectus abdominis (n = 3), anterior lateral thigh (n = 2), latissimus (n = 2), and transverse rectus abdominis (n = 1). There were no total flap losses; however, one patient required additional skin grafting. Reoperation occurred in six patients, of which four were revisions of the total knee arthroplasty for infection (n = 2) and tibial component loosening (n = 2). One patient ultimately underwent transfemoral amputation for persistent infection. Following reconstruction, there was improvement in the median Knee Society Score (49 versus 82; p = 0.03) and total range of motion between preoperative and postoperative assessments (70 degrees versus 85 degrees; p = 0.14).

Conclusion:
Free flap coverage in the setting of total knee arthroplasty was associated with a high rate of reoperation; however, the limb was able to be preserved in the majority of patients, with a reasonable functional outcome.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Causes of death in HIV-infected and HIV-uninfected children aged under-five years in western Kenya
Authors: Onyango Dickens O. , Akelo Victor , van der Sande Marianne A.B. , Ridzon Renee , Were Joyce A. , Agaya Janet A. , Oele Elizabeth A. , Wandiga Steve , Igunza Aggrey K. , Young Peter W. , Blau Dianna M. , Joseph Rachael H. , Yuen Courtney M. , Zielinski-Gutierrez Emily , Tippett-Barr Beth A. 
Published: September 2021

Objectives:
Describe the causes of death among infants and children less than 5 years stratified by HIV status.

Design:
Cross-sectional analysis of causes of death ascertained through minimally invasive tissue sampling (MITS) in the Kenya Child Health and Mortality Prevention Surveillance site.

Methods:
We included decedents aged 28 days to less than 5 years, whose death was reported within 36 h, underwent MITS, and had HIV test results and causes of death determined. MITS specimens were tested using Taqman Array Cards, culture, cytology, histopathology and immunohistochemistry and HIV PCR. A panel evaluated epidemiologic, clinical, verbal autopsy and laboratory data to assign causes of death using ICD-10 guidelines. Causes of death and etiological agents were stratified by HIV status.

Results:
Of 176 included decedents, 14% (n = 25) were HIV-infected, median viral load was 112 205 copies/ml [interquartile range (IQR) = 9349–2 670 143). HIV-disease (96%; n = 24) and malnutrition (23%; n = 34) were the leading underlying causes of death in HIV-infected and HIV-uninfected decedents, respectively. Malnutrition was more frequent in the causal chain of HIV-infected (56%; n = 14) than HIV-uninfected decedents (31%; n = 49) (P value = 0.03). Viral pneumonia was twice as common in HIV-infected (50%; n = 9) than HIV-uninfected decedents (22%; n = 7) (P value = 0.04).

Conclusion:
Nearly all HIV-infected decedents’ underlying cause of death was HIV disease, which was associated with malnutrition. Our findings underscore the need for strengthening early identification and management of HIV-infected children. Prevention, early diagnosis and treatment of malnutrition could be instrumental in improving the survival of HIV-infected and HIV-uninfected children.
Evaluation of HIV-1 reservoir size and broadly neutralizing antibody susceptibility in acute antiretroviral therapy-treated individuals
Authors: Moldt Brian , Günthard Huldrych F. , Workowski Kimberly A. , Little Susan J. , Eron Joseph J. , Overton Edgar T. , Lehmann Clara , Rokx Casper , Kozal Michael J. , Gandhi Rajesh T. , Braun Dominique L. , Parvangada Aiyappa , Li Jiani , Martin Ross , Selzer Lisa , Cox Stephanie , Margot Nicolas , Liu Hui , Slamowitz Debbie , Makadzange Tariro , Collins Sean E. , Geleziunas Romas , Callebaut Christian 
Published: September 2021

Objective:
Persistence of the viral reservoir is the main barrier to curing HIV. Initiation of ART during acute HIV infection can limit the size and diversity of the reservoir. In depth characterization of the reservoir in individuals who initiate ART during acute infection will be critical for clinical trial design and cure strategies.

Methods:
Four cohorts with participants who initiated ART during acute infection or during chronic infection were enrolled in a cross-sectional, noninterventional study. Viral reservoir was evaluated by the Intact Proviral DNA Assay (IPDA), the Total HIV DNA Assay (THDA) and the Quantitative Viral Outgrowth Assay (QVOA). Viral diversity and susceptibility to V3-glycan bNAbs were determined by genotyping of the viral envelope gene.

Results:
Participants who initiated ART during the acute Fiebig I–IV stages had lower level of total HIV DNA than participants who initiated ART during chronic infection whereas no difference was observed in intact HIV DNA or outgrowth virus. Participants who initiated ART during Fiebig I–IV also had lower viral diversity and appeared to have higher susceptibility to bNAbs than participants initiating ART during chronic infection.

Conclusion:
Individuals initiating ART during Fiebig I–IV had small viral reservoirs, low viral diversity, and high susceptibility to bNAbs, and would be an optimal target population for proof-of-concept HIV cure trials.
Synergy between low BMI and hyperglycemia at baseline increases tuberculosis incidence among people living with HIV
Authors: Kyaw Nang T.T. , Kumar Ajay M.V. , Harries Anthony D. , Satyanarayana Srinath , Oo Nay L. , Hayat Matthew J. , Castro Kenneth G. , Magee Matthew J. 
Published: September 2021

Objectives:
Low BMI and hyperglycemia are each important risk factors for tuberculosis (TB). However, the contribution of synergy between low BMI and hyperglycemia to risk of TB among people living with HIV (PWH) is unexplored. We compared TB incidence among PWH with different exposure profiles to low BMI (BMI < 18.5 kg/m2) and hyperglycemia (random blood glucose ≥140 mg/dl).

Design and methods:
We conducted a cohort study using data of PWH (≥15 years) who enrolled in Myanmar's Integrated HIV Care Program between 2011 and 2017. We used their follow-up data until 2018 to determine TB incidence.

Results:
Among 20 865 PWH included in this study, 7610 (36%) had low BMI only, 1324 (6%) had hyperglycemia only, and 465 (2%) patients had concurrent low BMI and hyperglycemia (joint exposure) at baseline. During a median follow-up of 2.2 years (interquartile range: 0.5, 4.2), 3628 (17%) developed TB [6.7, 95% confidence interval (CI): 6.5,7.0 cases per 100 person-years (PY)]. TB incidence among PWH with joint exposure was 21.0 (95% CI: 18.0, 24.7), with low BMI only was 10.9 (95% CI: 10.4, 11.4), with hyperglycemia only was 5.2 (95% CI: 4.4, 6.3) and with no exposure was 4.6 (95% CI: 4.4, 4.9) cases per 100 PY. The attributable proportion of incident TB due to synergy between low BMI and hyperglycemia was 0.23 (95% CI: 0.06, 0.36).

Conclusion:
Synergy between low BMI and hyperglycemia was associated with increased excess TB incidence in PWH. TB preventive treatment, nutritional support, and hyperglycemia management should be evaluated as interventions to reduce TB risk in PWH with joint exposure.
Prevalence of SARS-CoV-2: An age-stratified, population-based, sero-epidemiological survey in Islamabad, Pakistan
Authors: Baig Mirza Amir , Ansari Jamil Ahmed , Ikram Aamer , Khan Mumtaz Ali , Salman Muhammad , Hussain Zakir , Baig Mirza Zeeshan Iqbal , Chaudhry Ambreen , Malik Muhammad Wasif , Akram Khurram Shahzad , Saeed Asim , Ranjha Muazzam Abbas , Sultan Faisal , Sabir Sohail 
Published: September 2021

AbstractIntroductionSerological surveys are valuable tools to evaluate the extent of disease transmission, measuring preventive effectiveness and proportion of asymptomatic individuals. This age-stratified, serological survey was aimed to measure the COVID-19 distribution and determinants in district Islamabad of Pakistan.MethodologyThree-stage cluster sampling, using population proportionate to size technique, starting with a random number was used. A structured, pretested questionnaire was used after taking informed written consent, to gather demographic, risk factor information.ResultsSeroprevalence was found 16.5% (AR: 16.5%/100,000). The mean age was 35 (±16 Years). The majority were male (64%), self-employed (29%), and had primary level education (33%). The highest seroprevalence was found in the 21-30 years age group (24.8%) while the 41-50 years age group showed the highest attack rate (112.9/100,000 population). The proportion of the population tested that were asymptomatic was 69% (n=711) while the most frequently reported sign/symptom was cough (99%) followed by fever (20%). No known co-morbidity was reported in 86% (n=884) of respondents while hypertension remained the most reported condition (8%). High seroprevalence was observed in urban areas (12.3%) compared to rural union councils (6.4%). Visiting a house where COVID-19 case was isolated (OR 2, CI 1.38-2.84, P< 0.001), history of contact with a known case of COVID-19 (OR 1.42, CI 1.11-1.82, P=0.005), and attending a mass gathering (OR 1.21, CI: 1.02-1.42, p=0.02) were significant risk factors associated with contracting an infection. A Chi-Square test of independence showed significant protection while using regular hand hygiene practices (6.5; p<0.05) and regular usage of face masks (8.6; p<0.05).ConclusionSeroprevalence gives a direct estimation of population groups exposed to the virus. A remarkable difference in prevalence is found in urban and rural areas, extreme age groups, and socioeconomic statuses, suggesting targeted public health interventions. Sero-studies are affordable counterparts of molecular testing where quick estimation, prevention effectiveness, and data-driven public health policies are priorities.
Physical Injuries and Burns among Refugees in Lebanon: Implications for Programs and Policies
Authors: Al-Hajj Samar , Moustafa Moustafa , Hechi Majed El , Chahrour Mohamad A. , Nasrallah Ali A. , Kaafarani Haytham 
Published: September 2021

AbstractBackgroundRefugees are prone to injury due to often austere living conditions, social and economic disadvantages, and limited access to health care services in host countries. This study systematically quantified the prevalence of physical injuries and burns among the refugee community in Western Lebanon and examined injury characteristics, risk factors and outcomes.MethodWe conducted a cluster-based population survey across 21 camps in the Bekaa region of Lebanon from February to April 2019. A modified version of the ‘Surgeons Overseas Assessment of Surgical Need (SOSAS)’ tool v 3.0 was administered to the head of the refugee household and documented all injuries sustained by family members over the last 12 months. Descriptive and univariate regression analyses were performed to understand the association between variables.Results750 heads of household were surveyed. 112 (14.9%) household sustained injuries in the past 12 months, 39 of which (34.9%) reported disabling injuries that affected their work and daily living. Most injuries occurred inside the tent (29.9%). A burn was sustained by at least one household member in 136 (18.1%) households. The majority (63.7%) of burns affected children under 5 years and were mainly due to boiling liquid (50%). Significantly more burns were reported in households where caregivers have the inability to lockout children while cooking (25.6% vs 14.9%, p-value=0.001). Similarly, households with unemployed head significantly had more reported burns (19.7% vs 13.3%, p-value=0.05). Nearly 16.1% of injured refugees were unable to seek health care due to lack of health insurance coverage and financial liability.ConclusionRefugees suffer injuries and burns with substantial human and economic repercussions on individuals, their families and the host healthcare system. Resources should be allocated to designing safe camps and implementing educational and awareness programs with special focus on heating and cooking methods.
Population-scale analysis of common and rare genetic variation associated with hearing loss in adults
Authors: Praveen Kavita , Dobbyn Lee , Gurski Lauren , Ayer Ariane H. , Staples Jeffrey , Mishra Shawn , Bai Yu , Kaufman Alexandra , Moscati Arden , Benner Christian , Chen Esteban , Chen Siying , Popov Alexander , Smith Janell ,   GHS-REGN DiscovEHR collaboration,   Regeneron Genetics Center,   Decibel-REGN collaboration, Melander Olle , Jones Marcus , Marchini Jonathan , Balasubramanian Suganthi , Zambrowicz Brian , Drummond Meghan , Baras Aris , Abecasis Goncalo R. , Ferreira Manuel A. , Stahl Eli A. , Coppola Giovanni 
Published: September 2021

ABSTRACTUnderstanding the genetic underpinnings of disabling hearing loss, which affects ∼466 million people worldwide, can provide avenues for new therapeutic target development. We performed a genome-wide association meta-analysis of hearing loss with 125,749 cases and 469,497 controls across five cohorts, including UK Biobank, Geisinger DiscovEHR, the Malmö Diet and Cancer Study, Mount Sinai’s BioMe Personalized Medicine Cohort, and FinnGen. We identified 53 loci affecting hearing loss risk, 15 of which are novel, including common coding variants in COL9A3 and TMPRSS3. Through exome-sequencing of 108,415 cases and 329,581 controls from the same cohorts, we identified hearing loss associations with burden of rare coding variants in FSCN2 (odds ratio [OR] = 1.14, P = 1.9 × 10−15) and burden of predicted loss-of-function variants in KLHDC7B (OR = 2.14, P = 5.2 × 10−30). We also observed single-variant and gene-burden associations with 11 genes known to cause Mendelian forms of hearing loss, including an increased risk in heterozygous carriers of mutations in the autosomal recessive hearing loss genes GJB2 (Gly12fs; OR = 1.21, P = 4.2 × 10−11) and SLC26A5 (gene burden; OR = 1.96, P = 2.8 × 10−17). Our results suggest that loss of KLHDC7B function increases risk for hearing loss, and show that Mendelian hearing loss genes contribute to the burden of hearing loss in the adult population, suggesting a shared etiology between common and rare forms of hearing loss. This work illustrates the potential of large-scale exome sequencing to elucidate the genetic architecture of common traits in which risk is modulated by both common and rare variation.
Lexical and acoustic speech features relating to Alzheimer’s disease pathology
Authors: Cho Sunghye , Cousins Katheryn A.Q. , Shellikeri Sanjana , Ash Sharon , Irwin David J. , Liberman Mark , Grossman Murray , Nevler Naomi 
Published: September 2021

AbstractINTRODUCTIONIn this study, we compared digital speech features of AD and lvPPA patients in a biologically confirmed cohort and related them to specific neuropsychiatric test scores and CSF proteins.METHODSWe extracted language variables with automated lexical and acoustic pipelines from oral picture descriptions of 44 AD and 21 lvPPA patients with autopsy or CSF confirmation of AD pathology. We correlated distinct speech features with MMSE and BNT test scores and CSF p-tau levels.RESULTSLvPPA patients produced fewer verbs, adjectives, and more fillers with lower lexical diversity and higher pause rate than AD. Both groups showed some shared language impairments compared with normal speakers.DISCUSSIONOur speech measures captured differences in speech between the two phenotypes. Also, shared speech markers were linked to the common underlying pathology. This work demonstrates the potential of natural speech analysis in detecting underlying AD pathology.
The Effect of Conflict on Healthcare Workers in Syria: Results of a Qualitative Survey
Authors: Abdelrahman Sarah , Haar Rohini J. 
Published: September 2021

AbstractThe purpose of this study is to understand how the conflict in Syria, having devasted the healthcare system, has affected Syrian healthcare workers (Joseph et al. 2016). We provide a secondary analysis of a summer 2019 survey Physicians for Human Rights (PHR) conducted with 82 Syrian healthcare workers living in neighbouring countries as well as in northeast and northwest Syria. Our descriptive analysis found that 48 participants reported an average of 16.52 hours of work per day, and 40 participants reported caring for an average of 43 patients per day while working in Syria during the conflict. Sixty-eight participants reported facing barriers to perform their work, and 59 participants reported facing risks as a medical professional. Seventy-one participants experienced traumatic events during their work as a medical professional, and 70 participants experienced stress in the month prior to being interviewed.This analysis illustrates the negative effect an armed conflict has on healthcare workers through disruptions in their workload, training and resources, barriers and risks faced, and mental health and security issues. The study indicates that these factors require long-term consideration in order to protect healthcare workers and improve the health system.
Epidemiological and Clinical Features, Treatment Status, and Economic Burden of Traumatic Spinal Cord Injury in China
Authors: Zhou Hengxing , Lou Yongfu , Chen Lingxiao , Kang Yi , Liu Lu , Cai Zhiwei , Anderson David B , Wang Wei , Zhang Chi , Wang Jinghua , Ning Guangzhi , Gao Yanzheng , He Baorong , Ding Wenyuan , Wang Yisheng , Mei Wei , Song Yueming , Zhou Yue , Xia Maosheng , Wang Huan , Zhao Jie , Yin Guoyong , Zhang Tao , Jing Feng , Zhu Rusen , Meng Bin , Duan Li , Deng Zhongliang , Zhang Zhongmin , Wu Desheng , Liu Yajun , Cai Zhengdong , Huang Lin , Yin Zhanhai , Li Kainan , Lu Shibao , Cao Xu , Feng Shiqing 
Published: September 2021

AbstractBackgroundChina has the largest population of traumatic spinal cord injury (TSCI), but has not yet performed a national-level study on its epidemiological and clinical features, treatment status, and economic burden.MethodsA total of 14 754 patients were recruited between January 2013 and December 2018 from 37 hospitals in 11 provinces and municipalities, which represented all geographical divisions of China. The percentage of TSCI in hospitalized patients and the percentage of TSCI in hospitalized patients through the orthopaedic departments were calculated. The treatment status, total and daily costs were collected.ResultsThe percentage of TSCI in hospitalized patients and the percentage of TSCI in hospitalized patients through the orthopaedic departments did not change significantly overall (APC= -0.5%, 95% CI: -3.0 to 2.1 and -1.6%, -4.9 to 1.8, respectively). A total of 10 918 (74.0%) patients received surgery after TSCI. However, only 3.0% of patients underwent surgery received surgery less than 24 hours after injury. A total of 2 084 (14.1%) patients were treated with methylprednisolone sodium succinate/methylprednisolone (MPSS/MP) at a high dose (≥500 mg) and 641 (4.3%) patients receiving it within 8 hours. The total costs for acute TSCI decreased (-4.8%, -6.2 to -3.4), while the daily costs did not change significantly (0.5%, -1.2 to 2.2).ConclusionsThis study revealed epidemiological and clinical features, treatment status, and economic burden of TSCI that occurred in China from 2013 to 2018.FundingNational Key Research and Development Project of Stem Cell and Transformation Research (2019YFA0112100).
Monoclonal antibodies against SARS-CoV-2: potential game-changer still underused
Authors: Gentile Ivan , Maraolo Alberto Enrico , Buonomo Antonio Riccardo , Nobile Mariano , Piscitelli Prisco , Miani Alessandro , Moriello Nicola Schiano 
Published: September 2021

AbstractEven several months after the start of a massive vaccination campaign against COVID-19, mortality and hospital admission are still in considerable numbers in many nations. Monoclonal antibodies are the ideal complement to vaccination in high-risk subjects who have been infected by SARS-CoV-2 and are at high risk of developing severe disease. Combining data provided by clinal trials and demographics of SARS-CoV-2 infections, this analysis tries to predict the benefits of an extensive use of monoclonal antibodies to reduce hospital admissions, deaths, and costs.
TSABL: Trait Specific Annotation Based Locus Predictor
Authors: Lorenz Kimberly , Thom Christopher S. , Adurty Sanjana , Voight Benjamin F. 
Published: September 2021

AbstractThe majority of GWAS loci fall in the non-coding genome, making causal variants difficult to identify and study. We hypothesized that the regulatory features underlying causal variants are biologically specific, identifiable from data, and that the regulatory architecture that influences one trait is distinct compared to biologically unrelated traits. To better characterize and identify these variants, we used publicly available GWAS loci and genomic annotations to build 17 Trait Specific Annotation Based Locus (TSABL) predictors to identify differences between GWAS loci associated with different phenotypic trait groups. We used a penalized binomial logistic regression model to select trait relevant annotations and tested all models on a holdout set of loci not used for training in any trait. We were able to successfully build models for autoimmune, electrocardiogram, lipid, platelet, red blood cell, and white blood cell trait groups. We used these models both to prioritize variants in existing loci and to identify new genomic regions of interest. We found that TSABL models identified biologically relevant regulatory features, and anticipate their future use to enhance the design and interpretation of genetic studies.