bluuebunny/crossref_metadata_2025_split huggingface dataset:
Scrub Typhus-Associated Hemophagocytic Lymphohistiocytosis: Not a Rare Entity in Pediatric Age Group
Authors: Basu Ankika , Chowdhoury Satyabrata Roy , Sarkar Mihir , Khemka Arpita , Mondal Rakesh , Datta Kalpana , Mondal Kalyanbrata 
Published: January 2021

Abstract

Background
Our goal was to study the demographic, clinical and laboratory profile and outcome of scrub typhus-associated hemophagocytic lymphohistiocytosis (HLH) in the pediatric age group.

Methods
We conducted a prospective observational study in a tertiary care teaching hospital over a period of 1 year. Children in the age group of 1 month to 12 years with IgM ELISA positive for scrub typhus were included in the study. HLH was diagnosed using HLH-2004 criteria. Demographic, clinical and laboratory profile, treatment and outcome of HLH patients were noted and also compared with non-HLH scrub typhus patients.

Results
Among 58 children with scrub typhus infection, 18 had HLH. The mean age of patients with HLH was 35.3 ± 44.8 months and 61% were male. Anemia, thrombocytopenia and hyperferritinemia were seen in all the patients. Hypertriglyceridemia, hypofibrinogenemia and coagulopathy were noted in 78%, 56% and 44%, respectively. All the patients were treated with intravenous doxycycline for an average duration of 9.5 days. Intravenous immunoglobulin and methylprednisolone were given in 33% and 22% cases, respectively. Complications like acute respiratory distress syndrome (ARDS) (p = 0.001) and MODS (p = 0.004) were significantly high in the HLH group. Younger age (&lt;3 years), fever &gt; 7 days, presence of convulsion, ARDS and MODS were the clinical predictors of scrub typhus-associated HLH.

Conclusion
HLH in scrub typhus infected children is being increasingly recognized. Younger age, prolonged fever, presence of convulsion, ARDS and MODS should alert clinicians of the risk of HLH. Treating the primary cause usually cures the disease and immunomodulator therapy need not be routinely administered.
Melanin production in coelomycetous agents of black grain eumycetoma
Authors: Lim Wilson , Parel Florianne , de Hoog Sybren , Verbon Annelies , van de Sande Wendy W J 
Published: January 2021

Abstract

Background
Eumycetoma is a fungal infection characterised by the formation of black grains by causative agents. The melanin biosynthetic pathways used by the most common causative agents of black-grain mycetoma are unknown and unravelling them could identify potential new therapeutic targets.

Method
Melanin biosynthetic pathways in the causative fungi were identified by the use of specific melanin inhibitors.

Results
In Trematosphaeria grisea and Falciformispora tompkinsii, 1,8-dihydroxynaphthalene (DHN)-melanin synthesis was inhibited, while DHN-, 3,4-dihydroxyphenylalanine (DOPA)- and pyo-melanin were inhibited in Medicopsis romeroi and Falciformispora senegalensis.

Conclusion
Our data suggest that Me. romeroi and F. senegalensis synthesise DHN-, DOPA- and pyo-melanin, while T. grisea and F. tompkinsii only synthesise DHN-melanin.
The Effectiveness of the SKINCARE Bundle in Preventing Medical-Device Related Pressure Injuries in Critical Care Units: A Clinical Trial
Authors: Tayyib Nahla , Asiri Mousa Yahya , Danic Sanja , Sahi Sharmaine L. , Lasafin Joem , Generale Leah Flor , Malubay Ana , Viloria Peter , Palmere Marie Grace , Parbo Angelica Rose , Aguilar Kethleen Eingie , Licuanan Patty Mae , Reyes Marinette 
Published: January 2021

ABSTRACT

OBJECTIVE
To examine the impact of a medical device-related pressure injury (MDRPI) prevention bundle/mnemonic on the incidence of acquired MDRPIs in critically ill patients.

METHODS
This study used a prospective, single-arm, open-label clinical design and was carried out from January to April 2020 in CCUs in a Saudi Arabian tertiary hospital. All participants received the SKINCARE bundle intervention, which is based on the best available evidence for MDRPI prevention in CCUs. The primary outcome was the development of MDRPI.

RESULTS
The MDRPI cumulative incidence was significantly lower after the implementation of the SKINCARE bundle (0.89%, 90% lower than historic incidence).

CONCLUSIONS
The SKINCARE bundle demonstrates significant improvement of skin care through decreased cumulative incidence of acquired MDRPI.
Insufficient Lactation Leading to Postpartum Diagnosis of Placenta Accreta Spectrum Disorder in a Primigravid Patient
Authors: Knill Courtney N. , Crandall R. Scott , Jurus Derek T. 
Published: January 2021

BACKGROUND:
Placenta accreta spectrum is most commonly diagnosed antenatally or at the time of delivery, but it may also present in the postpartum period.

CASE:
A 29-year-old primigravid patient without risk factors for placenta accreta spectrum had an uncomplicated vaginal birth with normal blood loss and delivery of an intact-appearing placenta. Five days postpartum, she was not lactating and uterine imaging to evaluate for retained products of conception was suspicious for placenta accreta spectrum. She began to develop bleeding in the following days and elected for definitive management. She underwent an uncomplicated hysterectomy on postpartum day 16 and began lactating on postoperative day 1.

CONCLUSION:
Retained placenta should be included in the differential diagnosis when lactation is insufficient.
Retrospective analysis of sentinel lymph node biopsy using methylene blue dye for early breast cancer
Authors: Yang Shan , Xiang Hong-Yu , Xin Ling , Zhang Hong , Zhang Shuang , Cheng Yuan-Jia , Liu Qian , Xu Ling , Li Ting , Duan Xue-Ning , Ye Jing-Ming , Liu Yin-Hua 
Published: January 2021

Abstract

Background
Methylene blue is the most commonly used tracer for sentinel lymph node (SLN) biopsy (SLNB) in China. This study aimed to investigate the feasibility of clinical application of SLNB using methylene blue dye (MBD) for early breast cancer and the prognosis of patients with different SLN and non-SLN statuses.

Methods
We retrospectively analyzed the clinicopathological data of patients with early breast cancer treated at the Peking University First Hospital between 2013 and 2018. We calculated the SLN identification rate (IR) in SLNB with MBD and the false-negative rate (FNR), and analyzed the prognosis of patients with different SLN and non-SLN statuses using Kaplan-Meier curves.

Results
Between January 2013 and December 2018, 1603 patients with early breast cancer underwent SLNB with MBD. The SLN IR was 95.8% (1536/1603). Two SLNs (median) were detected per patient. There were significant differences in FNR between patients with SLN micrometastasis and macrometastasis (19.0% vs. 4.5%, χ
2 = 12.771, P < 0.001). Chi-square test showed that there were significant differences in SLN successful detection rates among patients with different vascular tumor embolism status (96.3% vs. 90.8%, χ
2 = 9.013, P = 0.003) and tumor (T) stages (96.6% vs. 94.1%, χ
2 = 5.189, P = 0.023). Multivariate analysis showed that vascular tumor embolism was the only independent factor for SLN successful detection (odds ratio: 0.440, 95% confidence interval: 0.224−0.862, P = 0.017). Survival analysis showed a significant difference in disease-free survival (DFS) between patients with non-SLN metastasis and patients without non-SLN metastasis (P = 0.006).

Conclusion
Our single-center data show that, as a commonly used tracer in SLNB in China, MBD has an acceptable SLN IR and a low FNR in frozen sections. This finding is consistent with reports of dual tracer-guided SLNB. Positive SLNs with non-SLN metastasis are associated with DFS.
Factors associated with an increased risk of instrumental vaginal delivery in women with epidural analgesia for labour
Authors: Au-Yong Phui Sze , Tan Chin Wen , Tan Wee How , Tan Kah Heng , Goh Zhaohan , Sultana Rehena , Sng Ban Leong 
Published: January 2021

BACKGROUND
Epidural analgesia is the most effective form of labour analgesia, but is associated with an increased risk of instrumental delivery.

OBJECTIVE
To evaluate factors that are associated with an increased risk of instrumental delivery.

DESIGN
Retrospective cohort data study.

SETTING
Singapore's major public maternity institution.

PATIENTS
All obstetric patients who received labour epidural analgesia for vaginal delivery between January 2012 to December 2015.

INTERVENTION
None.

MAIN OUTCOME MEASURES
Our primary outcome was the incidence of instrumental delivery.

RESULTS
Out of 17 227 pregnant women who received labour epidural analgesia, 12% (n = 2069) had instrumental delivery. Independent factors associated with an increased risk of instrumental delivery included maternal factors [nulliparity (adjusted odds ratio (aOR) 2.97, 95% CI 2.61 to 3.39, P < 0.0001] and advanced maternal age (aOR 1.04, 95% CI 1.03 to 1.05, P < 0.0001)). Greater maternal height (aOR 0.18, 95% CI 0.08 to 0.40), P < 0.0001) was associated with a reduced risk of instrumental delivery. Significant labour-related factors increasing the risk of an instrumental delivery were the use of prostin (aOR 1.19, 95% CI 1.07 to 1.32, P = 0.0014), pre-epidural analgesia (aOR 1.16, 95% CI 1.05 to 1.28, P = 0.0040), a longer second stage of labour (aOR 1.23, 95% CI 1.20 to 1.26, P < 0.0001), higher infant birth weight (aOR 1.27, 95% CI 1.12 to 1.43, P = 0.0002) and an epidural performed by a senior anaesthetist (aOR 1.94, 95% CI 1.72 to 2.18, P < 0.0001). Labour epidural-related factors for an increased risk of instrumental delivery were the occurrence of breakthrough pain (aOR 1.55, 95% CI 1.37 to 1.76, P < 0.0001), a more dense motor block (aOR 1.14, 95% CI 1.03 to 1.25, P = 0.0097) and having an epidural infusion stopped at full cervical dilatation (aOR 1.18, 95% CI 1.05 to 1.32, P = 0.0048) [receiver operating characteristic (ROC) = 0.75].

CONCLUSIONS
The multivariate model generated would help identify women at higher risk of instrumental delivery, which can help clinicians to address potentially modifiable factors and improve clinical care.
Breast Reconstruction Using the Lateral Thoracic, Thoracodorsal, and Intercostal Arteries Perforator Flaps
Authors: Mangialardi Maria Lucia , Baldelli Ilaria , Salgarello Marzia , Raposio Edoardo 
Published: January 2021

Background:
Breast-conserving surgery followed by radiotherapy represents the standard of care for early-stage breast cancer. The aim of this article was to provide a review of the literature about the use of the lateral thoracic artery perforator (LTAP) flap, the lateral thoracodorsal (LTD) flap, and the lateral intercostal artery perforator (LICAP) flap in lateral partial breast defect.

Methods:
A literature search was performed via PubMed, Medline, and Cochrane. Patient’s characteristics, topography and size of breast defect, flap size and design, number of perforators, and operative time were analyzed. Aesthetic and patient-reported outcomes, postoperative complications, and donor site morbidity were also registered.

Results:
Thirteen articles fulfilled inclusion criteria, and 432 patients were included. Different flap designs and flap combinations were described. Satisfactory outcomes were reported for between 78% and 100% of cases. Patient satisfaction ranged from 75.8% to 92.5% of cases. The overall complication rate was 9.25%, and donor site morbidity was very low (3.7%).

Conclusions:
A distinct advantage of LTAP, LTD, and LICAP flap reconstruction is that the thoracodorsal pedicle is not sacrificed, not compromising eventual delayed breast reconstruction with TDAP or latissimus dorsi flaps. This staged approach to partial breast reconstruction is especially useful in cases where the oncological margins are uncertain and wider resections (or mastectomies) are secondly required.
POSITIVE RESULTS BIAS AND IMPACT FACTOR IN RETINA CLINICAL TRIALS 2016 to 2019
Authors: Parikh Ankur , Markle Jonathan , Venincasa Michael , Kuriyan Ajay E. , Gupta Mrinali , Sridhar Jayanth 
Published: January 2021

Purpose:
To assess for a positive results bias in recently published randomized controlled trials in the field of vitreoretinal disease.

Methods:
A bibliometric analysis was conducted examining randomized controlled trials published in the field of retina between January 1, 2016, and December 31, 2019. Studies were classified as positive result or negative result based on the statistical significance of their primary outcome. Publication date and sample size were documented. These variables were compared against Journal Citation Reports Impact Factor in the year of publication.

Results:
Two hundred and eighty-eight randomized controlled trials from 64 unique journals were included and analyzed. One hundred and eighty-five (64.2%) studies were classified as positive result, and 103 (35.8%) studies were classified as negative result. There was no association between impact factor and positive result. Studies classified as positive result had larger sample sizes, and higher sample size was associated with higher impact factor.

Conclusion:
These results do not support the presence of a recent positive results bias in retina randomized controlled trials. This is reassuring, although several factors could be contributing to this finding including studies that were conducted but never submitted and selective reporting of outcomes. Thus, it will be important to remain cognizant of potential publication biases moving forward.
NEGATIVE VESSEL REMODELING IN STARGARDT DISEASE QUANTIFIED WITH VOLUME-RENDERED OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Reich Michael , Dreesbach Michelle , Boehringer Daniel , Schottenhamml Julia , Gehring Esteban , Scholl Hendrik P. N. , Inglin Nadja , Agostini Hansjuergen , Reinhard Thomas , Lagrèze Wolf A. , Spaide Richard F. , Lange Clemens , Maloca Peter M. 
Published: January 2021

Purpose:
To quantify retinal vasculature changes in Stargardt disease1 (STGD1) with volume-rendered optical coherence tomography angiography.

Methods:
Optical coherence tomography angiography volumes from healthy subjects and two subgroups of patients with STGD1 with the presence/absence of definitely decreased autofluorescence areas were compared. Optical coherence tomography angiography vessel surface area and vessel volume were measured in central zones (Z) of 1-, 2-, and 3-mm diameter.

Results:
Twenty nine eyes of 15 patients with STGD1 (20/9 eyes with/without definitely decreased autofluorescence) and 30 eyes of 15 controls contributed data. An enlarged foveal avascular zone was found in patients with STGD1 without and even more with definitely decreased autofluorescence associated with a vessel rarefication in central and also paracentral zones with unnoticeable autofluorescence. Vessel surface area and vessel volume were reduced in both STGD1 subgroups for all zones (P < 0.0001). Stargardt disease 1 eyes when compared to without definitely decreased autofluorescence showed reduced vessel surface area and vessel volume in Z2+3 (both P < 0.05).

Conclusion:
Volume rendering of optical coherence tomography angiography in STGD1 shows a reduced retinal flow in the central macula. This is most likely secondary to loss of neurosensory tissue with disease progression and therefore not likely be favorably influenced by gene transfer and retinal pigment epithelial transplantation. Retinal blood flow assessed by 3D volume-rendered optical coherence tomography angiography could serve as surrogate marker for vascular changes of the central retina.
Advances in perimetry for glaucoma
Authors: Prager Alisa J. , Kang J. Minjy , Tanna Angelo P. 
Published: January 2021

Purpose of review
Perimetry remains important for the diagnosis and management of glaucoma despite advances in imaging technology. The purpose of this review is to describe advances in the acquisition and analysis of visual field data and highlight novel techniques for performing perimetry.

Recent findings
Studies have focused on improving the detection of patients at highest risk of severe vision loss and the development of innovative testing strategies that allow for more frequent testing. Artificial intelligence has been utilized in research settings to improve detection and characterization of glaucomatous field damage. Furthermore, tablet-based strategies and virtual reality headsets show promise for glaucoma screening and remote monitoring of patients with glaucoma.

Summary
New testing strategies and research findings have improved our ability to identify patients with both paracentral and mid-peripheral visual field progression. New strategies have the potential to make visual field testing more efficient, reliable and accessible for patients with glaucoma.
Long-term inflammatory pain does not impact exploratory behavior and stress coping strategies in mice
Authors: Burek Dominika J. , Massaly Nicolas , Doering Michelle , Zec Azra , Gaelen Jordan , Morón Jose A. 
Published: January 2021

Abstract
Pain puts patients at risk for developing psychiatric conditions such as anxiety and depression. Preclinical mouse models of pain-induced affective behavior vary widely in methodology and results, impairing progress towards improved therapeutics. To systematically investigate the effect of long-term inflammatory pain on exploratory behavior and stress coping strategy, we assessed male C57BL/6J mice in the forced swim test (FST), elevated zero maze, and open field test at 4 and 6 weeks postinjection of Complete Freund's Adjuvant, while controlling for testing order and combination. Inflammatory pain did not induce a passive stress coping strategy in the FST and did not reduce exploratory behavior in the elevated zero maze or the open field test. Using systematic correlational analysis and composite behavioral scores, we found no consistent association among measures for mice with or without inflammatory pain. A meta-analysis of similar studies indicated a modest, significant effect of Complete Freund's Adjuvant on exploratory behavior, but not immobility in the FST, and high heterogeneity among effect sizes in all 3 paradigms. Given the urgency for understanding the mechanisms of pain comorbidities and identifying novel therapies, these findings support the reallocation of our limited resources away from such unreliable assays and toward motivated and naturalistic behaviors. Future studies in pain and psychiatric translational research may benefit by considering outcomes beyond binary categorization, quantifying the associations between multiple measured behaviors, and agnostically identifying subtle yet meaningful patterns in behaviors.
Conditioned open-label placebo for opioid reduction after spine surgery: a randomized controlled trial
Authors: Flowers Kelsey M. , Patton Megan E. , Hruschak Valerie J. , Fields Kara G. , Schwartz Emily , Zeballos Jose , Kang James D. , Edwards Rob R. , Kaptchuk Ted J. , Schreiber Kristin L. 
Published: January 2021

Abstract
Placebo effects have traditionally involved concealment or deception. However, recent evidence suggests that placebo effects can also be elicited when prescribed transparently as “open-label placebos” (OLPs), and that the pairing of an unconditioned stimulus (eg, opioid analgesic) with a conditioned stimulus (eg, placebo pill) can lead to the conditioned stimulus alone reducing pain. In this randomized control trial, we investigated whether combining conditioning with an OLP (COLP) in the immediate postoperative period could reduce daily opioid use and postsurgical pain among patients recovering from spine surgery. Patients were randomized to COLP or treatment as usual, with both groups receiving unrestricted access to a typical opioid-based postoperative analgesic regimen. The generalized estimating equations method was used to assess the treatment effect of COLP on daily opioid consumption and pain during postoperative period from postoperative day (POD) 1 to POD 17. Patients in the COLP group consumed approximately 30% less daily morphine milligram equivalents compared with patients in the treatment as usual group during POD 1 to 17 (−14.5 daily morphine milligram equivalents; 95% CI: [−26.8, −2.2]). Daily worst pain scores were also lower in the COLP group (−1.0 point on the 10-point scale; 95% CI: [−2.0, −0.1]), although a significant difference was not detected in average daily pain between the groups (−0.8 point; 95% CI: [−1.7, 0.2]). These findings suggest that COLP may serve as a potential adjuvant analgesic therapy to decrease opioid consumption in the early postoperative period, without increasing pain.
Effect of anodal high-definition transcranial direct current stimulation on the pain sensitivity in a healthy population: a double-blind, sham-controlled study
Authors: Kold Sebastian , Graven-Nielsen Thomas 
Published: January 2021

Abstract
High-definition transcranial direct current stimulation (HD-tDCS) of brain areas related to pain processing may provide analgesic effects evident in the sensory detection and pain thresholds. The somatosensory sensitivity was assessed after HD-tDCS targeting the primary motor cortex (M1) and/or the dorsolateral prefrontal cortex (DLPFC). Eighty-one (40 females) subjects were randomly assigned to 1 of 4 anodal HD-tDCS protocols (20 minutes) applied on 3 consecutive days: Sham-tDCS, DLPFC-tDCS, M1-tDCS, and DLPFC&M1-tDCS (simultaneous transcranial direct current stimulation [tDCS] of DLPFC and M1). Subjects and experimenter were blinded to the tDCS protocols. The somatosensory sensitivity were assessed each day, before and after each tDCS by detection and pain thresholds to thermal and mechanical skin stimulation, vibration detection thresholds, and pressure pain thresholds. Subjects were effectively blinded to the protocol, with no significant difference in rates of whether they received real or placebo tDCS between the 4 groups. Compared with the Sham-tDCS, none of the active HD-tDCS protocols caused significant changes in detection or pain thresholds. Independent of tDCS protocols, pain and detection thresholds except vibration detection were increased immediately after the first tDCS protocol compared with baseline (P < 0.05). Overall, the active stimulation protocols were not able to induce significant modulation of the somatosensory thresholds in this healthy population compared with sham-tDCS. Unrelated to the HD-tDCS protocol, a decreased sensitivity was found after the first intervention, indicating a placebo effect or possible habituation to the quantitative sensory testing assessments. These findings add to the increasing literature of null findings in the modulatory effects of HD-tDCS on the healthy somatosensory system.