bluuebunny/crossref_metadata_2025_split huggingface dataset:
Providing Breastfeeding Support During COVID-19: A Survey of Staff Experiences
Authors: Hoying Rachel , Badreldin Nevert , Shah Malika D. , Bolden Janelle R. , Cummings Peter , Robinson Daniel T. 
Published: September 2021

Background: The COVID-19 pandemic presents unique challenges to maternity settings. Its influence on providing in-hospital lactation support has not been well described. Research Aim: To describe the experiences of healthcare workers as they provided in-hospital lactation support during the pandemic. Methods: A prospective, cross-sectional, online survey evaluated healthcare providers working with postpartum women and newborns affected by COVID-19 at an academic center during March–June 2020. Providers were queried regarding the influence of COVID-19 and COVID-19-specific policies on providing lactation support. Questions assessed guidance received, perceived stress, difficulty providing care, and solicited qualitative responses. The constant comparative method was used to analyze qualitative data. Results: Of 108 providers, 70 (65%) completed the survey. Of 57 providing direct lactation support to women affected by COVID-19, most ( n = 39, 67%) reported increased stress. Participants reported lower stress scores when receiving guidance through shift meetings or email compared to those not receiving this guidance [stress score with shift meeting guidance ( M [ SD]): 3.10 (0.88); score without guidance: 3.83 (0.66); n = 39, p = .009; score with email guidance: 3.79 (0.58); score without guidance: 4.50 (0.58); n = 18, p = .045). Qualitative responses ( n = 67; 96%) identified three themes: visitor restrictions allowed less distraction during lactation support; physical separation disrupted maternal/infant bonding; workflow challenges resulted from policy changes and supply access. Conclusions: Most participating staff providing lactation support to participants affected by COVID-19 reported increased stress. Ensuring written or verbal guidance may reduce staff’s experiences of stress. Efforts to optimize lactation support during COVID-19 should consider reducing distractions, physical separation, and logistic challenges.
Human Milk Microbiome of Healthy Indian Mothers is Dominated by Genus Pseudomonas
Authors: Dutta Sourabh , Das Bhabatosh , Ghosh Tarini Shankar , Kumar Shakti , Kaushal Raj Kumari , Ray Pallab , Suri Vanita , Nair Gopinath Balakrish 
Published: September 2021

Background: The composition of the human milk microbiome is highly variable and multifactorial. Milk microbiota from various countries show striking differences. There is a paucity of data from healthy lactating Indian mothers. Research Aim: To describe the milk microbiota of healthy North Indian women, using a culture-independent, targeted metagenomic approach. Methods: We recruited exclusively breastfeeding mothers ( N = 22) who had vaginally delivered full-term singleton infants in a tertiary care hospital less than 1 week previously and had not recently consumed systemic antibiotics. Milk samples (5 ml) were collected aseptically, and microbial deoxyribonucleic acid was extracted. Microbial composition and diversity were determined using a 454-pyrosequencing platform. Core genera were identified, and their relative abundances ranked. Heatmaps showing the variation of the ranked abundances and Shannon index were obtained using R. Results: Participants (all exclusively vegetarian) had a mean ( SD) age of 27.2 (3.4) years, postnatal age of 3.9 (1.6) days and gestation 38 (1.2) weeks. The dominant phylum was Proteobacterium (relative abundance 84%) and dominant genus Pseudomonas (relative abundance 61.78%). Eleven species of Pseudomonas were identified, all generally considered nonpathogenic. Based on abundance patterns of the core genera, the milk samples could be grouped: (a) dominated by Pseudomonas with low diversity; (b) less Pseudomonas and high diversity; and (c) dominated by Pseudomonas but high diversity. All neonates were healthy and gaining weight well at 1 month of age. Conclusions: Healthy, lactating, vegetarian, North Indian women who deliver at term gestation and have no recent exposure to antibiotics, have a unique milk microbiome dominated by Pseudomonas.
Slowed-Down Rehabilitation Following Percutaneous Repair of Achilles Tendon Rupture
Authors: Maffulli Nicola , Gougoulias Nikolaos , Maffulli Gayle D. , Oliva Francesco , Migliorini Filippo 
Published: September 2021

Background: Following percutaneous repair of acute Achilles tendon (AT) ruptures, early postoperative weightbearing is advocated; however, it is debatable how aggressive rehabilitation should be. We compared the clinical and functional outcomes in 2 groups of patients who followed either our “traditional” or a “slowed down” rehabilitation after percutaneous surgical repair. Methods: Sixty patients were prospectively recruited to a slowed down (29 patients) or a traditional (31 patients) rehabilitation program. Both groups were allowed immediate weightbearing postoperatively; a removable brace with 5 heel wedges was applied at 2 weeks. In the slowed-down group, 1 wedge was removed after 4 weeks. Gradual removal of the boot took place after 4 wedges were kept for 4 weeks. In the traditional group, 1 wedge was removed every 2 weeks, with removal of the boot after 2 wedges had been kept for 2 weeks. The AT Resting Angle (ATRA) evaluated tendon elongation. Patient reported functional outcomes were assessed using the AT Rupture Score (ATRS). Calf circumference difference and the isometric plantarflexion strength of the gastro-soleus complex were evaluated. Results: At the 12-month follow-up, both ATRA and ATRS were more favorable in the slowed-down group. The isometric strength and the calf circumference were more similar to the contralateral leg in the slowed-down group than in the traditional one. Conclusion: Following percutaneous repair of acute Achilles tendon patients undergoing slowed down rehabilitation performed better than the traditional one. These conclusions must be considered within the limitations of the present study. Level of Evidence: Level II, prospective comparative study.
Experiences and Perspectives From Women Taking Investigational Therapy for Hepatitis C Virus During Pregnancy
Authors: Kislovskiy Yasaswi , Chappell Catherine , Flaherty Emily , Hamm Megan E , Cameron Flor de Abril , Krans Elizabeth E , Chang Judy C 
Published: September 2021

Objective: Describe the experiences and perspectives among pregnant people with chronic HCV infection receiving ledipasvir/sofosbuvir (LDV/SOF) therapy during pregnancy. Methods: We conducted semi-structured, in-depth interviews within an open-label, phase 1 study of LDV/SOF therapy among pregnant people with chronic HCV infection. Participants took 12 weeks of LDV/SOF and were interviewed at enrollment and again at the end of treatment. We transcribed the interviews verbatim and coded them with NVivo software for subsequent inductive thematic analysis. Results: Nine pregnant people completed the study, leading to 18 interview transcripts. All participants identified as women. Eight women acquired HCV through injection drug use, and 1 through perinatal transmission. We identified 3 themes. (1) Treatment for HCV during pregnancy with LDV/SOF was tolerable and convenient. (2) Women described that taking investigational LDV/SOF increased their self-esteem and sense of well-being due to possible cure from HCV, and they felt that the experience of working hard to achieve cure may potentially prevent return to drug abuse in the future. (3) Women appreciated researchers and providers that gave non-judgmental care and communicated honestly, and preferred person-centered care that acknowledges women’s individual needs. Conclusions: Women stated that cure from HCV would be “life-changing,” and described antepartum treatment for HCV with LDV/SOF as tolerable and desired, when provided by non-judgmental providers. Antepartum treatment was found to be acceptable by study participants and should be further evaluated to combat the increasing HCV epidemic among young persons, including pregnant people.
Axillary pullout syndrome: A novel approach to managing a devastating complication
Authors: Kugler Nathan W , Lewis Brian D , Malinowski Michael 
Published: September 2021

Objectives Axillary pullout syndrome is a complex, potentially fatal complication following axillary-femoral bypass graft creation. The re-operative nature, in addition to ongoing hemorrhage, makes for a complicated and potentially morbid repair. Methods We present the case of a 57-year-old man with history of a previous left axillary-femoral-femoral bypass who presented with acute limb-threatening ischemia as a result of bypass thrombosis managed with a right axillary-femoral bypass for limb salvage. His postoperative course was complicated by an axillary anastomotic dehiscence while recovering in inpatient rehabilitation resulting in acute, life-threatening hemorrhage. He was managed utilizing a novel hybrid approach in which a retrograde stent graft was initially placed across the anastomotic dehiscence for control of hemorrhage. He then underwent exploration, decompression, and interposition graft repair utilizing the newly placed stent graft to reinforce the redo axillary anastomosis. Results and Conclusion Compared with a traditional operative approach, the hybrid endovascular and open approach limited ongoing hemorrhage while providing a more stable platform for repair and graft revascularization. A hybrid approach to the management of axillary pullout syndrome provides a safe, effective means to the management of axillary anastomotic dehiscence while minimizing the morbidity of ongoing hemorrhage.
Use and performance of machine learning models for type 2 diabetes prediction in clinical and community care settings: Protocol for a systematic review and meta-analysis of predictive modeling studies
Authors: De Silva Kushan , Enticott Joanne , Barton Christopher , Forbes Andrew , Saha Sajal , Nikam Rujuta 
Published: September 2021

Objective Machine learning involves the use of algorithms without explicit instructions. Of late, machine learning models have been widely applied for the prediction of type 2 diabetes. However, no evidence synthesis of the performance of these prediction models of type 2 diabetes is available. We aim to identify machine learning prediction models for type 2 diabetes in clinical and community care settings and determine their predictive performance. Methods The systematic review of English language machine learning predictive modeling studies in 12 databases will be conducted. Studies predicting type 2 diabetes in predefined clinical or community settings are eligible. Standard CHARMS and TRIPOD guidelines will guide data extraction. Methodological quality will be assessed using a predefined risk of bias assessment tool. The extent of validation will be categorized by Reilly–Evans levels. Primary outcomes include model performance metrics of discrimination ability, calibration, and classification accuracy. Secondary outcomes include candidate predictors, algorithms used, level of validation, and intended use of models. The random-effects meta-analysis of c-indices will be performed to evaluate discrimination abilities. The c-indices will be pooled per prediction model, per model type, and per algorithm. Publication bias will be assessed through funnel plots and regression tests. Sensitivity analysis will be conducted to estimate the effects of study quality and missing data on primary outcome. The sources of heterogeneity will be assessed through meta-regression. Subgroup analyses will be performed for primary outcomes. Ethics and dissemination No ethics approval is required, as no primary or personal data are collected. Findings will be disseminated through scientific sessions and peer-reviewed journals. PROSPERO registration number CRD42019130886
Return-to-Play Times and Player Performance After Medial Collateral Ligament Injury in Elite-Level European Soccer Players
Authors: Lavoie-Gagne Ophelie Z. , Retzky Julia , Diaz Connor C. , Mehta Nabil , Korrapati Avinaash , Forlenza Enrico M. , Knapik Derrick M. , Forsythe Brian 
Published: September 2021

Background: Participation in elite-level soccer predisposes athletes to injuries of the medial collateral ligament (MCL), resulting in variable durations of time lost from sport. Purpose: To (1) determine the rate of return to play (RTP) and timing after MCL injuries, (2) investigate MCL reinjury incidence after RTP, and (3) evaluate the long-term effects of MCL injury on future performance. Study Design: Descriptive epidemiology study. Methods: Using publicly available records, we identified athletes who had sustained MCL injury between 2000 and 2016 across the 5 major European soccer leagues (English Premier League, Bundesliga, La Liga, Ligue 1, and Serie A). Injured athletes were matched to controls using demographic characteristics and performance metrics from the season before injury. We recorded injury severity, RTP rate, reinjury incidence, player characteristics associated with RTP within 2 seasons of injury, player availability, field time, and performance metrics during the 4 seasons after injury. Results: A total of 59 athletes sustained 61 MCL injuries, with 86% (51/59) of injuries classified as moderate to severe and surgical intervention performed in 14% (8/59) of athletes. After injury, athletes missed a median of 33 days (range, 3-259 days) and 4 games (range, 1-30 games). Overall, 71% (42/59) of athletes returned successfully at the same level, with multivariable regression demonstrating no athlete characteristic predictive of RTP. MCL reinjury was reported in 3% (2/59) of athletes. Midfielders demonstrated decreased field time after RTP when compared with controls ( P < .05). No significant differences in player performance for any position were identified out to 4 seasons after injury. Injured athletes had a significantly higher rate of long-term retention ( P < .001). Conclusion: MCL injuries resulted in a median loss of 33 days in elite European soccer athletes, with the majority of injuries treated nonoperatively. RTP remained high, and few athletes experienced reinjury. While midfielders demonstrated a significant decrease in field time after RTP, player performance and long-term retention were not compromised. Future studies are warranted to better understand athlete-specific and external variables predictive of MCL injury and reinjury, while evaluating treatment and rehabilitation protocols to minimize time lost and to optimize athlete safety and health.
PEG10 amplification at 7q21.3 potentiates large-cell transformation in cutaneous T-cell lymphoma
Authors: Liu Fengjie , Gao Yumei , Xu Bufang , Xiong Shan , Yi Shengguo , Sun Jingru , Chen Zhuojing , Liu Xiangjun , Li Yingyi , Lin Yuchieh , Wen Yujie , Qin Yao , Yang Shuxia , Li Hang , Tejasvi Trilokraj , Tsoi Lam , Tu Ping , Ren Xianwen , Wang Yang 
Published: September 2021

AbstractMycosis fungoides (MF), the most common form of cutaneous T-cell lymphoma, undergo large-cell transformation (LCT) in the late stage, manifesting aggressive behavior, resistance to treatments, and poor prognosis, but the mechanisms involved remain unclear. To identify the molecular driver of LCT, we collected tumor samples from 133 MF patients and performed whole-transcriptome sequencing on 49 advanced-stage MF patients, followed by integrated copy number inference and genomic hybridization. Tumors with LCT showed unique transcriptional programs and enriched expressions of genes at chr7q. Paternally expressed gene 10 (PEG10), an imprinted gene at 7q21.3, was ectopically expressed in malignant T cells from LCT, driven by 7q21.3 amplification. Mechanistically, aberrant PEG10 expression increased cell size, promoted cell proliferation, and conferred treatment resistance by a PEG10/KLF2/NF-κB axis in in vitro and in vivo models. Pharmacologically targeting PEG10 reversed the phenotypes of proliferation and treatment resistance in LCT. Our findings reveal new molecular mechanisms underlying LCT and suggest that PEG10 inhibition may serve as a promising therapeutic approach in late-stage aggressive T-cell lymphoma.
American Society of Hematology 2021 guidelines for sickle cell disease: stem cell transplantation
Authors: Kanter Julie , Liem Robert I. , Bernaudin Françoise , Bolaños-Meade Javier , Fitzhugh Courtney D. , Hankins Jane S. , Murad M. Hassan , Panepinto Julie A. , Rondelli Damiano , Shenoy Shalini , Wagner John , Walters Mark C. , Woolford Teonna , Meerpohl Joerg J. , Tisdale John 
Published: September 2021

Abstract
Background: Sickle cell disease (SCD) is a life-limiting inherited hemoglobinopathy that results in significant complications and affects quality of life. Hematopoietic stem cell transplantation (HSCT) is currently the only curative intervention for SCD; however, guidelines are needed to inform how to apply HSCT in clinical practice.
Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and health professionals in their decisions about HSCT for SCD.
Methods: The multidisciplinary guideline panel formed by ASH included 2 patient representatives and was balanced to minimize potential bias from conflicts of interest. The Mayo Evidence-Based Practice Research Program supported the guideline development process, including performing systematic evidence reviews (through 2019). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment.
Results: The panel agreed on 8 recommendations to help patients and providers assess how individuals with SCD should consider the timing and type of HSCT.
Conclusions: The evidence review yielded no randomized controlled clinical trials for HSCT in SCD; therefore, all recommendations are based on very low certainty in the evidence. Key recommendations include considering HSCT for those with neurologic injury or recurrent acute chest syndrome at an early age and to improve nonmyeloablative regimens. Future research should include the development of a robust SCD registry to serve as a comparator for HSCT studies.
Peritransplantation ruxolitinib administration is safe and effective in patients with myelofibrosis: a pilot open-label study
Authors: Ali Haris , Tsai Ni-Chun , Synold Timothy , Mokhtari Sally , Tsia Weimin , Palmer Joycelynne , Stiller Tracey , Al Malki Monzr , Aldoss Ibrahim , Salhotra Amandeep , Rahmanuddin Syed , Pullarkat Vinod , Cai Ji-Lian , Stein Anthony , Forman Stephen J. , Marcucci Guido , Mei Matthew , Snyder David S. , Nakamura Ryotaro 
Published: September 2021

Abstract
We report results of our prospective pilot trial evaluating safety/feasibility of peritransplantation ruxolitinib for myelofibrosis treatment. Primary objectives were to determine safety and maximum tolerated dose (MTD) of ruxolitinib. Ruxolitinib was administered at 2 dose levels (DLs) of 5 and 10 mg twice daily, with fludarabine/melphalan conditioning regimen and tacrolimus/sirolimus graft-versus-host disease (GVHD) prophylaxis. We enrolled 6 and 12 patients at DL1 and DL2, respectively. Median age at transplantation was 65 years (range, 25-73). Per Dynamic International Prognostic Scoring System, 4 patients were high and 14 intermediate risk. Peripheral blood stem cells were graft source from matched sibling (n = 5) or unrelated (n = 13) donor. At each DL, 1 patient developed dose-limiting toxicities (DLTs): grade 3 cardiac and gastrointestinal with grade 4 pulmonary DLTs in DL1, and grade 3 kidney injury in DL2. All patients achieved engraftment. Grade 2 to 4 and 3 to 4 acute GVHD cumulative incidence was 17% (95% confidence interval [CI], 6-47) and 11% (95% CI, 3-41), respectively. Cumulative incidence of 1-year chronic GVHD was 42% (95% CI, 24-74). With 22.6-month (range, 6.2-25.8) median follow-up in surviving patients, 1-year overall and progression-free survival were 77% (95% CI, 50-91) and 71% (95% CI, 44-87), respectively. Causes of death (n = 4) were cardiac arrest, GVHD, respiratory failure, and refractory GVHD of liver. Our results show peritransplantation ruxolitinib is safe and well tolerated at MTD of 10 mg twice daily and associated with dose-dependent pharmacokinetic and cytokine profile. Early efficacy data are highly promising in high-risk older patients with myelofibrosis. This trial was registered at www.clinicaltrials.gov as #NCT02917096.
Bilineal evolution of a U2AF1-mutated clone associated with acquisition of distinct secondary mutations
Authors: Montgomery Nathan D. , Galeotti Jonathan , Johnson Steven M. , Commander Leah , Weimer Eric T. , Chandra Pranil K. , Nazir Tariq , Alexander Thomas B. , Zeidner Joshua F. , Foster Matthew C. 
Published: September 2021

Abstract
Rare hematologic malignancies display evidence of both myeloid and lymphoid differentiation. Here, we describe such a novel bilineal event discovered in an adult woman with B-lymphoblastic leukemia (BLL). At the time of BLL diagnosis, the patient had a normal karyotype and a bulk sequencing panel identified pathogenic variants in BCOR, EZH2, RUNX1, and U2AF1, a genotype more typical of myeloid neoplasia. Additionally, the patient was noted to have 3-year history of cytopenias, and morphologic dyspoiesis was noted on post-treatment samples, raising the possibility of an antecedent hematologic disorder. To investigate the clonal architecture of her disease, we performed targeted sequencing on fractionated samples enriched for either B-lymphoblasts or circulating granulocytes. These studies revealed a truncal founder mutation in the spliceosome gene U2AF1 in both fractions, while distinct secondary mutations were present only in B-lymphoblasts (BCOR, NRAS) or myeloid cells (ASXL1, EZH2, RUNX1). These results indicate that both processes evolved from a common U2AF1-mutated precursor, which then acquired additional mutations during a process of divergent evolution and bilineal differentiation. Our findings highlight an atypical mechanism of BLL leukemogenesis and demonstrate the potential utility of fractionated sequencing in the characterization of acute leukemia.