bluuebunny/crossref_metadata_2025_split huggingface dataset:
A surgical approach of an unusual variant of complete atrioventricular defect; A case report
Authors: Qabha Hamad , Alanazi Tariq , Khouqeer Mohamad , Dawary Mohannad , Khouqeer Fareed 
Published: December 2021

Abstract
Background
Complete atrioventricular canal is a congenital heart defect that is characterized by an atrial septal defect, ventricular septal defect, and a common atrioventricular valve. Standard surgical techniques for repairing complete atrioventricular canal defect mainly includes repairing the defect with a single patch, a double patch, or with the modified single patch technique.

Case presentation
This paper presents a novel surgical repair technique of an unusual anatomical presentation for a complete atrioventricular canal defect in a patient with Down syndrome.

Conclusions
Unusual anatomical variant for congenital heart defects occurs frequently, which gives surgeons real opportunities to innovate surgical approaches. This patient was an example of an unusual anatomical presentation for complete atrioventricular canal, and the surgical technique used for this patient was novel. Follow up for these patients is mandatory for long term results.
The Relation Between Mean Arterial Pressure and Cardiac Index in Major Abdominal Surgery Patients: A Prospective Observational Cohort Study
Authors: Kouz Karim , Bergholz Alina , Timmermann Lea M. , Brockmann Lennart , Flick Moritz , Hoppe Phillip , Briesenick Luisa , Schulte-Uentrop Leonie , Krause Linda , Maheshwari Kamal , Sessler Daniel I. , Saugel Bernd 
Published: December 2021

BACKGROUND:
Cardiac output is an important hemodynamic variable and determines oxygen delivery. In contrast to blood pressure, cardiac output is rarely measured even in high-risk surgical patients, suggesting that clinicians consider blood pressure to be a reasonable indicator of systemic blood flow. However, the relationship depends on constant vascular tone and volume, both of which routinely vary during anesthesia and surgery. We therefore tested the hypothesis that there is no clinically meaningful correlation between mean arterial pressure and cardiac index in major abdominal surgery patients.

METHODS:
In this prospective observational study, we assessed the relationship between mean arterial pressure and cardiac index in 100 patients having major abdominal surgery under general anesthesia.

RESULTS:
The pooled within-patient correlation coefficient calculated using meta-analysis methods was r = 0.34 (95% confidence interval, 0.28–0.40). Linear regression using a linear mixed effects model of cardiac index on mean arterial pressure revealed that cardiac index increases by 0.014 L·min−1·m−2 for each 1 mm Hg increase in mean arterial pressure. The 95% Wald confidence interval of this slope was 0.011 to 0.018 L·min−1·m−2·mm Hg−1 and thus within predefined equivalence margins of −0.03 and 0.03 L·min−1·m−2·mm Hg−1, thereby demonstrating lack of clinically meaningful association between mean arterial pressure and cardiac index.

CONCLUSIONS:
There is no clinically meaningful correlation between mean arterial pressure and cardiac index in patients having major abdominal surgery. Intraoperative blood pressure is thus a poor surrogate for cardiac index.
A draft genome sequence of the common, or spectacled caiman Caiman crocodilus
Authors: Okamoto Kenichi , Dopkins Nichole , Kinfu Elias 
Published: December 2021

The common, or spectacled, caiman Caiman crocodilus is an abundant, widely distributed Neotropical crocodilian exhibiting notable morphological and molecular diversification. The species also accounts by far for the largest share of crocodilian hides on the global market, with the C. crocodilus hide trade alone valued at about US$86.5 million per year. We obtained 239,911,946 paired-end reads comprising approximately 72 G bases using IlluminaTM sequencing of tissue sampled from a single Caiman crocodilus individual. These reads were de-novo assembled and progressively aligned against the genomes of increasingly related crocodilians; liftoff was used to annotate the draft C. crocodilus genome assembly based on an Alligator mississipiensis (a confamilial species) annotation. The draft assembly has been submitted to the National Center for Biotechnology Information and both assembly and annotation are currently available for review at doi.org/10.5281/zenodo.4755063
NaijaCovidAPI: an application programming interface for retrieval of COVID19 data from the Nigerian Center for Disease Control web platform
Authors: Mbaya Emmanuel Baldwin , Alao Babatunde , Ewejobi Philip , Nwokolo Innocent , Oguntosin Victoria , Adetiba Emmanuel 
Published: December 2021

Background: In this work, a COVID19 Application Programming Interface (API) was built using the Representational State Transfer (REST) API architecture and it is designed to fetch data daily from the Nigerian Center for Disease Control (NCDC) website. Methods: The API is developed using ASP.NET Core Web API framework using C# programming language and Visual Studio 2019 as the Integrated Development Environment (IDE). The application has been deployed to Microsoft Azure as the cloud hosting platform and to successfully get new data from the NCDC website using Hangfire where a job has been scheduled to run every 12:30 pm (GMT + 1) and load the fetched data into our database. Various API Endpoints are defined to interact with the system and get data as needed, data can be fetched from a single state by name, all states on a particular day or over a range of days, etc. Results: The results from the data showed that Lagos and Abuja FCT in Nigeria were the hardest-hit states in terms of Total Confirmed cases while Lagos and Edo states had the highest death causalities with 465 and 186 as of August 2020. This analysis and many more can be easily made as a result of this API we have created that warehouses all COVID19 Data as presented by the NCDC since the first contracted case on February 29, 2020. This system was tested on the BlazeMeter platform, and it had an average of 11Hits/s with a response time of 2905milliseconds. Conclusions: The extension of NaijaCovidAPI over existing COVID19 APIs for Nigeria is the access and retrieval of previous data. Our contribution to the body of knowledge is the creation of a data hub for Nigeria's COVID-19 incidence from February 29, 2020, to date
Serial measurement of cytokines strongly predict COVID-19 outcome
Authors: Ozger Hasan Selcuk , Karakus Resul , Kuscu Elif Nazli , Bagriacik Umit Emin , Oruklu Nihan , Yaman Melek , Turkoglu Melda , Erbas Gonca , Atak Aysegul Yucel , Senol Esin 
Published: December 2021

Purpose
Cytokines are major mediators of COVID-19 pathogenesis and several of them are already being regarded as predictive markers for the clinical course and outcome of COVID-19 cases. A major pitfall of many COVID-19 cytokine studies is the lack of a benchmark sampling timing. Since cytokines and their relative change during an infectious disease course is quite dynamic, we evaluated the predictive value of serially measured cytokines for COVID-19 cases.

Methods
In this single-center, prospective study, a broad spectrum of cytokines were determined by multiplex ELISA assay in samples collected at admission and at the third day of hospitalization. Appropriateness of cytokine levels in predicting mortality were assessed by receiver-operating characteristic (ROC) analyses for both sampling times in paralel to conventional biomarkers.

Results
At both sampling points, higher levels of IL-6, IL-7, IL-10, IL-15, IL-27 IP-10, MCP-1, and GCSF were found to be more predictive for mortality (p<0.05). Some of these cytokines, such as IL-6, IL-10, IL-7 and GCSF, had higher sensitivity and specificity in predicting mortality. AUC values of IL-6, IL-10, IL-7 and GCSF were 0.85 (0.65 to 0.92), 0.88 (0.73 to 0.96), 0.80 (0.63 to 0.91) and 0.86 (0.70 to 0.95), respectively at hospital admission. Compared to hospital admission, on the 3rd day of hospitalization serum levels of IL-6 and, IL-10 decreased significantly in the survivor group, unlike the non-survivor group (IL-6, p = 0.015, and IL-10, p = 0.016).

Conclusion
Our study results suggest that single-sample-based cytokine analyzes can be misleading and that cytokine levels measured serially at different sampling times provide a more precise and accurate estimate for the outcome of COVID-19 patients.
Spatial and time domain analysis of eye-tracking data during screening of brain magnetic resonance images
Authors: Suman Abdulla Al , Russo Carlo , Carrigan Ann , Nalepka Patrick , Liquet-Weiland Benoit , Newport Robert Ahadizad , Kumari Poonam , Di Ieva Antonio 
Published: December 2021

Introduction
Eye-tracking research has been widely used in radiology applications. Prior studies exclusively analysed either temporal or spatial eye-tracking features, both of which alone do not completely characterise the spatiotemporal dynamics of radiologists’ gaze features.

Purpose
Our research aims to quantify human visual search dynamics in both domains during brain stimuli screening to explore the relationship between reader characteristics and stimuli complexity. The methodology can be used to discover strategies to aid trainee radiologists in identifying pathology, and to select regions of interest for machine vision applications.

Method
The study was performed using eye-tracking data 5 seconds in duration from 57 readers (15 Brain-experts, 11 Other-experts, 5 Registrars and 26 Naïves) for 40 neuroradiological images as stimuli (i.e., 20 normal and 20 pathological brain MRIs). The visual scanning patterns were analysed by calculating the fractal dimension (FD) and Hurst exponent (HE) using re-scaled range (R/S) and detrended fluctuation analysis (DFA) methods. The FD was used to measure the spatial geometrical complexity of the gaze patterns, and the HE analysis was used to measure participants’ focusing skill. The focusing skill is referred to persistence/anti-persistence of the participants’ gaze on the stimulus over time. Pathological and normal stimuli were analysed separately both at the “First Second” and full “Five Seconds” viewing duration.

Results
All experts were more focused and a had higher visual search complexity compared to Registrars and Naïves. This was seen in both the pathological and normal stimuli in the first and five second analyses. The Brain-experts subgroup was shown to achieve better focusing skill than Other-experts due to their domain specific expertise. Indeed, the FDs found when viewing pathological stimuli were higher than those in normal ones. Viewing normal stimuli resulted in an increase of FD found in five second data, unlike pathological stimuli, which did not change. In contrast to the FDs, the scanpath HEs of pathological and normal stimuli were similar. However, participants’ gaze was more focused for “Five Seconds” than “First Second” data.

Conclusions
The HE analysis of the scanpaths belonging to all experts showed that they have greater focus than Registrars and Naïves. This may be related to their higher visual search complexity than non-experts due to their training and expertise.
How do patients and physicians communicate about hereditary angioedema in the United States?
Authors: Jain Gagan , Walter Lauren , Reed Carolyn , O’Donnell Patricia , Troy Jeffrey 
Published: December 2021

Background
Hereditary angioedema (HAE) is a rare disease that manifests as recurrent and debilitating angioedema attacks, significantly impacting patients’ quality of life.

Objective
To assess communication dynamics between patients with HAE and treating physicians and the impact this has on the treatment of HAE in the United States.

Methods
This observational study used an institutional review board–approved protocol to collect four sources of patient–physician communication data from the period between January 2015 and May 2017: in-office conversations between patients aged ≥18 years with HAE and physicians, follow-up dictations with physicians, telephone interviews with patients and physicians, and publicly available social media posts from patients. Participant language was qualitatively assessed and key communication elements and communication gaps identified.

Results
Twenty-five in-office conversations, 14 follow-up physician dictations, and 17 telephone interviews were conducted with a total of 29 unique patients, 4 caregivers, and 14 physicians. In-office conversations were generally physician-driven and focused primarily on symptom frequency, location, and severity; lexicon from both parties centered on “episodes” and “swelling.” During visits, impact on quality of life was not routinely assessed by physicians nor discussed proactively by patients; however, during telephone interviews and online, patients frequently described the multifaceted burden of HAE. Patients highlighted the difficulties they experience by using repetition, emphasis, and metaphors; they also varied the descriptors used for attacks depending on the communication goal. Physicians used intensifiers to emphasize the necessity of rescue medication access, whereas prophylactic treatments were positioned as an option for frequent or laryngeal attacks.

Conclusion
Vocabulary differences suggest that the full impact of HAE is not consistently communicated by patients to physicians during clinical visits, indicating the potential for misaligned understanding of disease burden. A patient-driven, rather than physician-driven approach to the discussions may elicit valuable information that could help to optimize treatment approaches.
Determining propensity for sub-optimal low-density lipoprotein cholesterol response to statins and future risk of cardiovascular disease
Authors: Weng Stephen Franklin , Akyea Ralph Kwame , Man Kenneth KC , Lau Wallis C. Y. , Iyen Barbara , Blais Joseph Edgar , Chan Esther W. , Siu Chung Wah , Qureshi Nadeem , Wong Ian C. K. , Kai Joe 
Published: December 2021

Background
Variability in low-density lipoprotein cholesterol (LDL-C) response to statins is underappreciated. We characterised patients by their statin response (SR), baseline risk of cardiovascular disease (CVD) and 10-year CVD outcomes.

Methods and results
A multivariable model was developed using 183,213 United Kingdom (UK) patients without CVD to predict probability of sub-optimal SR, defined by guidelines as <40% reduction in LDL-C. We externally validated the model in a Hong Kong (HK) cohort (n = 170,904). Patients were stratified into four groups by predicted SR and 10-year CVD risk score: [SR1] optimal SR & low risk; [SR2] sub-optimal SR & low risk; [SR3] optimal SR & high risk; [SR4] sub-optimal SR & high risk; and 10-year hazard ratios (HR) determined for first major adverse cardiovascular event (MACE). Our SR model included 12 characteristics, with an area under the curve of 0.70 (95% confidence interval [CI] 0.70–0.71; UK) and 0.68 (95% CI 0.67–0.68; HK). HRs for MACE in predicted sub-optimal SR with low CVD risk groups (SR2 to SR1) were 1.39 (95% CI 1.35–1.43, p<0.001; UK) and 1.14 (95% CI 1.11–1.17, p<0.001; HK). In both cohorts, patients with predicted sub-optimal SR with high CVD risk (SR4 to SR3) had elevated risk of MACE (UK HR 1.36, 95% CI 1.32–1.40, p<0.001: HK HR 1.25, 95% CI 1.21–1.28, p<0.001).

Conclusions
Patients with sub-optimal response to statins experienced significantly more MACE, regardless of baseline CVD risk. To enhance cholesterol management for primary prevention, statin response should be considered alongside risk assessment.
Association of air pollution and homocysteine with global DNA methylation: A population-based study from North India
Authors: Yadav Suniti , Longkumer Imnameren , Garg Priyanka Rani , Joshi Shipra , Rajkumari Sunanda , Devi Naorem Kiranmala , Saraswathy Kallur Nava 
Published: December 2021

BackgroundAnthropogenic air pollution has been implicated in aberrant changes of DNA methylation and homocysteine increase (>15μM/L). Folate (<3 ng/mL) and vitamin B12(<220 pg/mL) deficiencies also reduce global DNA methylation via homocysteine increase. Although B-vitamin supplements can attenuate epigenetic effects of air pollution but such understanding in population-specific studies are lacking. Hence, the present study aims to understand the role of air pollution, homocysteine, and nutritional deficiencies on methylation.MethodsWe examined cross-sectionally, homocysteine, folate, vitamin B12(chemiluminescence) and global DNA methylation (colorimetric ELISA Assay) among 274 and 270 individuals from low- and high- polluted areas, respectively, from a single Mendelian population. Global DNA methylation results were obtained on 254 and 258 samples from low- and high- polluted areas, respectively.ResultsSignificant decline in median global DNA methylation was seen as a result of air pollution [high-0.84 (0.37–1.97) vs. low-0.96 (0.45–2.75), p = 0.01]. High homocysteine in combination with air pollution significantly reduced global DNA methylation [high-0.71 (0.34–1.90) vs. low-0.93 (0.45–3.00), p = 0.003]. Folate deficient individuals in high polluted areas [high-0.70 (0.37–1.29) vs. low-1.21 (0.45–3.65)] showed significantly reduced global methylation levels (p = 0.007). In low polluted areas, despite folate deficiency, if normal vitamin B12levels were maintained, global DNA methylation levels improved significantly [2.03 (0.60–5.24), p = 0.007]. Conversely, in high polluted areas despite vitamin B12deficiency, if normal folate status was maintained, global DNA methylation status improved significantly [0.91 (0.36–1.63)] compared to vitamin B12normal individuals [0.54 (0.26–1.13), p = 0.04].ConclusionsHigh homocysteine may aggravate the effects of air pollution on DNA methylation. Vitamin B12in low-polluted and folate in high-polluted areas may be strong determinants for changes in DNA methylation levels. The effect of air pollution on methylation levels may be reduced through inclusion of dietary or supplemented B-vitamins. This may serve as public level approach in natural settings to prevent metabolic adversities at community level.
The impact of hypoglycemia on quality of life and related outcomes in children and adolescents with type 1 diabetes: A systematic review
Authors: Coolen Manon , Broadley Melanie , Hendrieckx Christel , Chatwin Hannah , Clowes Mark , Heller Simon , de Galan Bastiaan E. , Speight Jane , Pouwer Frans ,   for the Hypo-RESOLVE Consortium
Published: December 2021

ObjectiveTo conduct a systematic review to examine associations between hypoglycemia and quality of life (QoL) in children and adolescents with type 1 diabetes.MethodsFour databases (Medline, Cochrane Library, CINAHL, PsycINFO) were searched systematically in November 2019 and searches were updated in September 2021. Studies were eligible if they included children and/or adolescents with type 1 diabetes, reported on the association between hypoglycemia and QoL (or related outcomes), had a quantitative design, and were published in a peer-reviewed journal after 2000. A protocol was registered the International Prospective Register of Systematic Reviews (PROSPERO; CRD42020154023). Studies were evaluated using the Joanna Briggs Institute’s critical appraisal tool. A narrative synthesis was conducted by outcome and hypoglycemia severity.ResultsIn total, 27 studies met inclusion criteria. No hypoglycemia-specific measures of QoL were identified. Evidence for an association between SH and (domains) of generic and diabetes-specific QoL was too limited to draw conclusions, due to heterogenous definitions and operationalizations of hypoglycemia and outcomes across studies. SH was associated with greater worry about hypoglycemia, but was not clearly associated with diabetes distress, depression, anxiety, disordered eating or posttraumatic stress disorder. Although limited, some evidence suggests that more recent, more frequent, or more severe episodes of hypoglycemia may be associated with adverse outcomes and that the context in which hypoglycemia takes places might be important in relation to its impact.ConclusionsThere is insufficient evidence regarding the impact of hypoglycemia on QoL in children and adolescents with type 1 diabetes at this stage. There is a need for further research to examine this relationship, ideally using hypoglycemia-specific QoL measures.
The Alaska Native/American Indian experience of hepatitis C treatment with sofosbuvir-based direct-acting antivirals
Authors: Townshend-Bulson Lisa , Roik Elena , Barbour Youssef , Bruden Dana J. T. , Homan Chriss E. , Espera Hannah G. F. , Stevenson Timothy J. , Hewitt Annette M. , Rhodes Wileina , Gove James E. , Plotnik Julia N. , Snowball Mary M. , McGilvray John , Simons Brenna C. , Johnston Janet M. , McMahon Brian J. 
Published: December 2021

Background
Direct-acting antiviral (DAA) drugs have been effective in the treatment of chronic hepatitis C virus (HCV) infection. Limited data are available on safety, tolerability, and efficacy in American Indian or Alaska Native people. We aim to evaluate the treatment outcomes of sofosbuvir- based regimens for treatment of HCV in a real life setting in Alaska Native/American Indian (AN/AI) people.

Methods
AN/AI patients within the Alaska Tribal Health System with confirmed positive anti-HCV and HCV RNA, who were 18 years of age and older were included in the study. Pretreatment baseline patient characteristics, treatment efficacy based on sustained virologic response (SVR) 12 weeks after treatment completion, and adverse effects were assessed. The following treatments were given according to the American Association for the Study of Liver Diseases/Infectious Disease Society of America (AASLD/IDSA) HCV Guidance: ledipasvir/sofosbuvir, sofosbuvir plus weight-based ribavirin, and sofosbuvir/velpatasvir.

Results
We included 501 patients with a mean age of 54.3 (range 21.3–78.3) in the study. Overall SVR was achieved in 95.2% of patients who received one of the three DAA regimens. For those with cirrhosis, overall SVR was 92.8% and for those with genotype 3 91.1% achieved SVR. The most common symptom experienced during treatment was headache. Joint pain was found to decrease during treatment. One person discontinued sofosbuvir plus ribavirin due to myocardial infarction and one discontinued sofosbuvir/velpatasvir due to urticaria.

Conclusions
In the real-world setting, sofosbuvir-based treatment is safe, effective, and well tolerated in AN/AI patients. Sustained virologic response was high regardless of HCV genotype or cirrhosis status.
Management of a patient in the state of total occlusion of aorta due to Takayasu arteritis in preconceptional and pregnancy period
Authors: Günakan Emre , Akay Tankut , Esin Sertaç 
Published: December 2021

Abstract

Objectives
Total aortic occlusion is a severe complication of Takayasu arteritis (TAK). Pregnancy follow-up in the state of total aortic occlusion due to TAK has not been reported before.

Case presentation
A 35 year-old nulliparous woman with total aortic occlusion in the distal aorta due to TAK, admitted with pregnancy desire. She had developed a collateral vessel system which has maintained the lower body circulation. She was informed about the potential risks after an evaluation and she admitted to our clinic at the seventh week of pregnancy, and acetylsalicylic acid was prescribed. At 20th gestational week anomaly screening was in normal limits although the uterine artery Doppler had lower S/D, PI and RI values. She was followed-up regularly in every two weeks. Vascular examination was performed by using an ankle brachial index (ABI) by duplex ultrasound. At 20th gestational week ankle brachial index score was 0.8–0.9 which indicates mild disease. Around 28th gestational week her claudication got worse again and ABI was in moderate level (0.5–0.8) and low molecular weight heparin was started. Until 37th gestational week her disease was stable, ABI was above 0.5, her blood pressure was in normal limits, no vascular complication occurred and the baby’s growth percentile was at 25th centile. At 37th gestational week a 2,640 g baby was delivered. Patient was discharged without any complications at third post-operative day.

Conclusions
Complicated TAK patients may have good obstetric outcomes with a multidisciplinary approach in experienced tertiary centers.