bluuebunny/crossref_metadata_2025_split huggingface dataset:
806 Scout post-PCI instantaneous wave-free ratio as a driver of functional complete
Authors: Calderone Dario , Mauro Maria Sara , Legnazzi Marco , Agnello Federica , Scalia Lorenzo , Greco Antonio , Capodanno Davide , Tamburino Corrado 
Published: December 2021

Abstract

Aims
Physiology assessment by means of instantaneous wave-free ratio (iFR) is non-inferior to fractional flow reserve for the assessment of intermediate coronary lesions that are candidates to percutaneous coronary intervention (PCI). However, in pivotal trials assessing iFR, tandem coronary lesions (i.e. two serial lesions located in the same coronary artery) were excluded. In addition, the role of iFR after PCI as a way to optimize its success is poorly understood, particularly in the context of ST-segment elevation myocardial infarction (STEMI) with multivessel disease and tandem stenoses. We describe an illustrative case of post-PCI iFR in a STEMI patient with multivessel disease that led to a significant change in the revascularization strategy.

Methods
A 71-year old man presented with infero-lateral STEMI and received PCI with 1 drug-eluting stent (DES) 2.25 × 18 mm on the distal right coronary artery. The left coronary artery presented a 30–40% stenosis of the proximal left circumflex (LCX) and a 90% bifurcation stenosis of the mid portion of the same artery. PCI of the distal lesion was performed with implantation of 1 DES 3.0 × 22 with flaring of the stent at the level of the side branch and proximal optimization technique. Post-PCI iFR of the LCX was performed to assess the success of the procedure, with a value of 0.74. To understand the relative contribution of the two tandem stenoses, a pullback of the iFR wire was performed, which showed an unexpectedly small jump of the pressure when the wire was between the two lesions (0.80).

Results
As such, the significant contribution of the proximal lesion was unravelled, which led to implantation of a second DES 4.0 × 26 mm, partially overlapping with the previously implanted DES. Post-PCI iFR confirmed the complete success of the procedure (1.00).

Conclusions
In the context of complete revascularization for STEMI presenting with non-infarct related artery tandem stenoses, post-PCI physiology contributes to unravel the relative contribution of low-grade angiographic stenoses corresponding to functionally significant atherosclerosis left untreated. This case example illustrates the emerging procedural value of post-PCI iFR in achieving the goal of complete functional revascularization.
807 Wellens syndrome: a rare entity not to underestimate
Authors: Calderone Dario , Mauro Maria Sara , Legnazzi Marco , Agnello Federica , Scalia Lorenzo , Greco Antonio , Capodanno Davide , Tamburino Corrado 
Published: December 2021

Abstract

Aims
Abrupt oppressive chest pain is a common reason of emergency department’s access. An accurate assessment of the clinical setting is needed to ensure the patient the correct management. This includes a good anamnesis, physical examination, electrocardiogram (ECG) and cardiac biomarkers evaluation. Wellens syndrome is a clinical entity characterized by acute chest pain, normal or minimal elevation of cardiac biomarker, specific ECG changes with no ST elevation or Q-waves. The ECG modifications contemplate: biphasic T waves in lead V2 and V3 (type A) initially positive and subsequent negative or deep and symmetrically inverted T waves in anterior leads (Type B, more often V1–V4). Recognizing these patterns can be so challenging for physician in emergency departments, especially in Type A, and failure in diagnosis can lead to deleterious outcomes. In fact, Wellens syndrome can be considered as a pre-infarction state that needs immediate intervention: if not treated appropriately, about 75% of patients can suffer anterior myocardial infarction due to a stenosis of left anterior descending (LAD) artery.

Methods
A 55-year-old male with hyperlipidaemia and a family history of cardiovascular disease, presented to emergency department with abrupt oppressive chest pain after mild physical effort. At presentation he presented a typical ECG of Wellens syndrome type A with negative cardiac biomarkers. His GRACE (Global Registry of Acute Coronary Events) score was 72 and his thrombolysis in myocardial infarction (TIMI) was 2. At second blood sample cardiac biomarkers was mildly higher than upper limit of normal.

Results
Despite low grade on risk stratification he immediately underwent coronary angiography, who resulted in a subocclusive stenosis from ostium to the medium tract of LAD. PCI was subsequently taken with implantation of TWO drug eluting stent (DES). After 3 days he was discharged asymptomatic and in optical medical therapy.

Conclusions
Wellens syndrome is a rare clinical entity that must be considered as a pre- infarction state difficult to individuate. Conventional management in these patients utilizing typical risk stratification scores may not be appropriate. In this context an early diagnosis of ECG patterns it’s crucial, in order to provide an urgent percutaneous intervention. Failure in recognition of signs and symptoms of Wellens syndrome can lead to disastrous outcome due to a critical, vulnerable, stenosis on proxymal LAD and to a possible imminent large anterior myocardial infarction.
Effect of Test Portion Mass on Vitamin A Testing in Animal Feed Materials
Authors: Inerowicz H Dorota , Novotny Lawrence , Ramsey Charles A , Riter Ken L , Swarbrick Michele , Thiex Nancy 
Published: December 2021

Abstract

Background
Vitamin A test results have historically been notorious for poor repeatability and reproducibility. This problem has been discussed at length in Association of American Feed Control Officials Laboratory Methods and Services Committee meetings.

Objective
The objective of this work was to assess the effect of test portion mass on the repeatability of vitamin A test results.

Methods
The study was conducted in two parts. In Part I, fundamental sampling error (FSE) was determined experimentally through replicated (n = 16) vitamin A testing of three animal feed materials. The testing followed rigorous test portion selection for 10 g and 100 g test portions. In Part II, FSE calculations were made (1) using theoretical equations based on vitamin A as a liberated analyte and (2) on representing the particles in feed materials. Particle size characterization of vitamin A ingredients was estimated by microscopy and further evaluated by particle size analysis.

Results
RSDs, % for vitamin A determinations ranged from 10.5–24.7, and 2.26–10.7 for 10 g and 100 g test portions, respectively. FSE calculated for Ingredient A ranged from 18.3–101% and 5.79–32.0% for 10 g and 100 g test portions, respectively, and for Ingredient B, ranged from 10.2–56.2% and 3.21–17.8% for 10 g and 100 g test portions, respectively.

Conclusion
Test portion mass has a substantial impact on FSE and is an important factor in controlling the random error in vitamin A testing. FSE equations are useful to approximate minimum test portion mass.

Highlights
Vitamin A method development should use theoretical predictions and experimental verification to guide test portion mass. Strategies to deal with the larger test portion masses will be key to validating new methods.
Prenatal diagnosis of rapidly enlarging choledochal cyst with gastric outlet obstruction
Authors: Scalise P Nina , Yang Alex , Neumeyer Corinne , Perez-Atayde Antonio R , Robinson Jamie R , Kim Heung Bae , Cuenca Alex G 
Published: December 2021

Abstract
Choledochal cysts are congenital malformations of the biliary tract that involve aberrant configurations of the pancreaticobiliary ductal system. The pathology exists on a spectrum from fusiform dilation of the common bile duct to multiple dilations involving the intra- and extrahepatic bile ducts with potential risks of malignant transformation and hepatic fibrosis. Advancements in ultrasound technology have increased the incidence of prenatal diagnosis of choledochal cysts. Here, we present the case of a prenatally diagnosed initially asymptomatic Type I choledochal cyst with rapid progression in the neonatal period to a complete gastric outlet obstruction within the first month of life. We demonstrate the feasibility of cyst resection and reconstruction with Roux-en-Y hepaticojejunostomy in the neonatal age group. Finally, we discuss management of the case based on evolving imaging findings and laboratory evidence of impending liver dysfunction.
Contemporary Ashkenazic Hebrew: The Grammatical Profile of an Overlooked Twenty-First-Century Variety
Authors: Kahn Lily , Yampolskaya Sonya 
Published: December 2021

Abstract
Ashkenazic Hebrew is a unique language variety with a centuries-long history of written use among Central and Eastern European Jews. It has distinct phonological and grammatical features attested in texts composed by Ashkenazic Jews (e.g. adherents of the Hasidic and Maskilic movements) in Europe prior to the twentieth century. While Ashkenazic Hebrew is commonly believed to have been replaced by Israeli Hebrew in the twentieth century, this traditional written variety of the language actually continues to thrive in contemporary Diaspora Haredi (strictly Orthodox) communities, chiefly the Hasidic centres of New York, London, Montreal and Antwerp. This fascinating and understudied form of Hebrew is used widely and productively in the composition of a rich variety of original documents for a Hasidic audience (about e.g. Covid transmission, United States educational stipulations, Zoom schooling, lockdown rules, etc.). In this article we demonstrate that contemporary Ashkenazic Hebrew has many shared orthographic, phonological, grammatical and lexical features with its Eastern European antecedent. These include: orthography of loanwords based on Yiddish conventions (e.g. חולי הקאראנא xóylay ha-koróna ‘those ill with coronavirus’); morphology of plural loan nouns (בקאלידזשעס be-kóleǧes‘in colleges’, הפראגראמע״ן haprográmen ‘the programmes’); retention of the definite article with inseparable prepositions (בהשכונה be-ha-šxíne‘in the neighbourhood’);
Differentiating Negligent Standards of Care in Diagnosis
Authors: Liddell Kathleen , Skopek Jeffrey M , Le Gallez Isabelle , Fritz Zoë 
Published: December 2021

Abstract
Diagnosis lies at the heart of the medical encounter, yet it has received much less attention than treatment. It is widely assumed that negligent diagnosis claims should be governed by the Bolam test, but we demonstrate that this is not always the case. First, we disaggregate the diagnostic process into three different acts: forming the diagnosis, communicating it to the patient, and recording it. Second, we consider alternatives to Bolam for defining negligence, including less deferential profession-led standards, patient-led standards, and even a reasonable person standard. Third, bringing together these distinctions—within the diagnostic process, and between standards of care—we reveal the unappreciated complexity of negligent diagnosis. Analysing the standard of care that might apply to the three different acts in the diagnostic process, we identify reasons to think that Montgomery should apply to the communication of a diagnosis. We also argue that even in areas where the law is well-established, such as the application of Bolam to the formation of a diagnosis, challenging questions arise that require further attention. Throughout, the framework and analysis that we develop have significant implications for a set of negligence cases, as well as for medical education, clinical guidelines, and patient care.
Bipartite interaction sites differentially modulate RNA-binding affinity of a protein complex essential for germline stem cell self-renewal
Authors: Qiu Chen , Wine Robert N , Campbell Zachary T , Hall Traci M Tanaka 
Published: December 2021

Abstract
In C. elegans, PUF proteins promote germline stem cell self-renewal. Their functions hinge on partnerships with two proteins that are redundantly required for stem cell maintenance. Here we focus on understanding how the essential partner protein, LST-1, modulates mRNA regulation by the PUF protein, FBF-2. LST-1 contains two nonidentical sites of interaction with FBF-2, LST-1 A and B. Our crystal structures of complexes of FBF-2, LST-1 A, and RNA visualize how FBF-2 associates with LST-1 A versus LST-1 B. One commonality is that FBF-2 contacts the conserved lysine and leucine side chains in the KxxL motifs in LST-1 A and B. A key difference is that FBF-2 forms unique contacts with regions N- and C-terminal to the KxxL motif. Consequently, LST-1 A does not modulate the RNA-binding affinity of FBF-2, whereas LST-1 B decreases RNA-binding affinity of FBF-2. The N-terminal region of LST-1 B, which binds near the 5′ end of RNA elements, is essential to modulate FBF-2 RNA-binding affinity, while the C-terminal residues of LST-1 B contribute strong binding affinity to FBF-2. We conclude that LST-1 has the potential to impact which mRNAs are regulated depending on the precise nature of engagement through its functionally distinct FBF binding sites.
Patients’ Experiences With Staphylococcus aureus and Gram-Negative Bacterial Bloodstream Infections: Results From Cognitive Interviews to Inform Assessment of Health-Related Quality of Life
Authors: King Heather A , Doernberg Sarah B , Grover Kiran , Miller Julie , Oakes Megan , Wang Tsai-Wei , McFatrich Molly , Ruffin Felicia , Staman Karen , Lane Hannah G , Rader Abigail , Sund Zoë , Bosworth Hayden B , Reeve Bryce B , Fowler Vance G , Holland Thomas L 
Published: December 2021

Abstract

Background
We previously conducted a concept elicitation study on the impact of Staphylococcus aureus and gram-negative bacterial bloodstream infections (SAB/GNB) on health-related quality of life (HRQoL) from the patient’s perspective and found significant impacts on HRQoL, particularly in the physical and functional domains. Using this information and following guidance on the development of patient-reported outcome (PRO) measures, we determined which combination of measures and items (ie, specific questions) would be most appropriate in a survey assessing HRQoL in bloodstream infections.

Methods
We selected a variety of measures/items from the Patient-Reported Outcomes Measurement Information System (PROMIS) representing different domains. We purposefully sampled patients ~6–12 weeks post-SAB/GNB and conducted 2 rounds of cognitive interviews to refine the survey by exploring patients’ understanding of items and answer selection as well as relevance for capturing HRQoL.

Results
We interviewed 17 SAB/GNB patients. Based on the first round of cognitive interviews (n = 10), we revised the survey. After round 2 of cognitive interviewing (n = 7), we finalized the survey to include 10 different PROMIS short forms/measures of the most salient HRQoL domains and 2 adapted questions (41 items total) that were found to adequately capture HRQoL.

Conclusions
We developed a survey from well-established PRO measures that captures what matters most to SAB/GNB patients as they recover. This survey, uniquely tailored to bloodstream infections, can be used to assess these meaningful, important HRQoL outcomes in clinical trials and in patient care. Engaging patients is crucial to developing treatments for bloodstream infections.
The Senior Medical Resident’s New Role in Assessment in Internal Medicine
Authors: Rassos James , Ginsburg Shiphra , Stalmeijer Renée E. , Melvin Lindsay J. 
Published: December 2021

Purpose
With the introduction of competency-based medical education, senior residents have taken on a new, formalized role of completing assessments of their junior colleagues. However, no prior studies have explored the role of near-peer assessment within the context of entrustable professional activities (EPAs) and competency-based medical education. This study explored internal medicine residents’ perceptions of near-peer feedback and assessment in the context of EPAs.

Method
Semistructured interviews were conducted from September 2019 to March 2020 with 16 internal medicine residents (8 first-year residents and 8 second- and third-year residents) at the University of Toronto, Toronto, Ontario, Canada. Interviews were conducted and coded iteratively within a constructivist grounded theory approach until sufficiency was reached.

Results
Senior residents noted a tension in their dual roles of coach and assessor when completing EPAs. Senior residents managed the relationship with junior residents to not upset the learner and potentially harm the team dynamic, leading to the documentation of often inflated EPA ratings. Junior residents found senior residents to be credible providers of feedback; however, they were reticent to find senior residents credible as assessors.

Conclusions
Although EPAs have formalized moments of feedback, senior residents struggled to include constructive feedback comments, all while knowing the assessment decisions may inform the overall summative decision of their peers. As a result, EPA ratings were often inflated. The utility of having senior residents serve as assessors needs to be reexamined because there is concern that this new role has taken away the benefits of having a senior resident act solely as a coach.
Understanding Health Care Graduates’ Conceptualizations of Transitions: A Longitudinal Qualitative Research Study
Authors: Rees Charlotte E. , Ottrey Ella , Kemp Caitlin , Brock Tina P. , Leech Michelle , Lyons Kayley , Monrouxe Lynn V. , Morphet Julia , Palermo Claire 
Published: December 2021

Purpose
Although transitions have been defined in various ways in the higher education literature (e.g., inculcation, development, becoming), little research exists exploring health care learners’ conceptualizations of transitions across their transition from final year to new graduate. How they understand transitions is important because such conceptualizations will shape how they navigate their transitions and vice versa.

Method
The authors conducted a 3-month longitudinal qualitative research study with 35 health care learners from 4 disciplines (medicine, dietetics, nursing, and pharmacy) across their final year to new graduate transition to explore how they conceptualized transitions. Data collection occurred between July 2019 and April 2020 at Monash University in Victoria, Australia. The authors employed framework analysis to interrogate the interview and longitudinal audio diary data cross-sectionally and longitudinally.

Results
The authors found 10 different conceptualizations of transitions broadly categorized as time bound and linear (one-off events, systems, linear, adaptation, linked to identities), ongoing and complex (ongoing processes, multifaceted, complex), or related to transition shock (labor, linked to emotions). The adaptation conceptualization increased in dominance over time, the linear conceptualization was more apparent in the interviews (time points 1 and 3), and the multifaceted and emotion-linked conceptualizations were more dominant in the longitudinal audio diaries (time point 2).

Conclusions
This novel study illustrates conceptualizations of transitions as broadly consistent with existing higher education literature but extends this research considerably by identifying differences in conceptualizations across time. The authors encourage health care learners, educators, and policy makers to develop expanded and more sophisticated understandings of transitions to ensure that health care learners can better navigate often challenging graduate transitions. Further research should explore stakeholders’ transition conceptualizations over lengthier durations beyond the new graduate transition.
Dysbiosis of Ocular Surface Microbiota in Patients With Refractive Allergic Conjunctival Diseases
Authors: Inada Noriko , Shoji Jun , Harata Gaku , Miyazawa Kenji , He Fang , Tomioka Akiko , Hirota Akira , Tonozuka Yukiko , Yamagami Satoru 
Published: December 2021

Purpose:
We investigated ocular surface microbiota dysbiosis in patients with refractory allergic conjunctival diseases (ACDs; stratified into mild and severe groups) treated with topical tacrolimus.

Methods:
Patients (n = 21) with refractory ACDs (including vernal and atopic keratoconjunctivitis) actively treated with topical tacrolimus and 6 healthy controls were evaluated. Based on clinical scores and expression of specific cytokines on the ocular surface, patients with ACDs were divided into mild and severe groups using cluster analysis. The microbial composition of tear specimens collected from patients with mild and severe ACD and control subjects using the Schirmer test paper was determined through next-generation 16S rRNA sequencing analysis.

Results:
Compared with healthy controls, patients with ACDs exhibited significantly decreased ocular surface microbiota α-diversity. Ocular surface microbiota mainly comprised members of the phyla Actinobacteria, Bacteroidetes, Firmicutes, and Proteobacteria in all groups. The relative abundance of ocular surface microbiota in patients with ACDs was increased for phylum Firmicutes and decreased for phylum Proteobacteria (compared with control subjects). The genera Blautia (vs. mild ACD group) and Morganella (vs. control group) exhibited significantly increased abundance only in the severe ACD group.

Conclusions:
The ocular surface microbiota in patients with severe ACD exhibited decreased diversity and exacerbation of dysbiosis compared with that in patients with mild ACD and control subjects. Patients with mild refractory ACD also exhibited decreased diversity of these microbiota. These alterations in microbiota indicated a change in the ocular surface of patients with refractory ACD (be it because of disease pathogenesis or topical immunomodulatory treatment).
Occupational Heat Exposure as a Risk Factor for End-Stage Kidney Disease
Authors: Doueihy Celina , Chelala Dania , Ossaili Hadi , Hachem Gebrael El , Zeidan Sandy , Ghoul Balsam El , Aoun Mabel 
Published: December 2021

Objective:
More patients are reaching end-stage kidney disease without evident cause. This study aims to explore occupational risk factors associated with hemodialysis.

Methods:
A multicenter matched case–control study included dialysis patients and age, sex, and diabetes-matched controls (normal kidney function). Conditional logistic regression analysis assessed occupational factors associated with dialysis.

Results:
Two hundred thirty eight hemodialysis patients and 238 controls were included. History of occupational heat exposure (odds ratio [OR] = 1.93; 95% confidence interval [CI]: 1.24 to 3.00), working as a cook (OR = 12; 95% CI: 1.56 to 92.29), as construction worker (OR = 10; 95% CI: 1.28 to 78.12) were associated with higher risk of dialysis. These results were significant in men and in those with kidney disease of unknown etiology.

Conclusions:
Occupational heat exposure was found to be associated with hemodialysis. This is an important step for future development of preventive strategies in high-risk professions.