bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unfallbedingte Notfälle bei Schwangerschaft – Fallbeispiel mit Beckenfraktur und Notsectio
Authors: Kilgus Sofia , Schäfer Frederik Maximilian , Stöckle Ulrich , Märdian Sven 
Published: July 2021

ZusammenfassungDie Versorgung von unfallbedingten Notfällen in der Schwangerschaft gehört selbst in überregionalen Traumazentren nicht zur täglichen Routine. Wir präsentieren den Fall einer 27 Jahre alten, nicht vorerkrankten Polytraumapatientin in der 30. Schwangerschaftswoche. Die führende Verletzung war eine Beckenfraktur mit spinopelviner Dissoziation und kreislaufrelevanter, intrapelviner Blutung. Durch ein konsequentes Polytraumamanagement, notfallmäßige Sectio, Ligatur der Corona mortis, Packing und operative Frakturstabilisierung des Beckens konnte das Leben der Mutter und des Kindes gerettet werden.
Development of Hormonal Intravaginal Rings: Technology and Challenges
Authors: Rafiei Fojan , Tabesh Hadi , Farzad Shayan , Farzaneh Farah , Rezaei Maryam , Hosseinzade Fateme , Mottaghy Khosrow 
Published: July 2021

AbstractIntravaginal rings (IVRs) are minimally invasive polymeric devices specifically designed to be used for the sustained and prolonged release of various type of drugs such as hormones. One of the benefits of using topical drug delivery systems (e.g., IVRs) is the fact that systemic drug delivery may cause drug resistance due to elevated drug levels. Topical drug delivery also provides higher concentrations of the drug to the target site and has fewer side effects. In addition, when a drug is administered vaginally, the hepatic first-pass effect is avoided, resulting in higher absorption. Contraception and treatments for specific diseases such as endometriosis and hormone deficiencies can be improved by the administration of hormones via an IVR. This article aims to classify and compare various designs of commercially available and non-commercial hormonal IVRs and to analyze their performance. Current challenges affecting the development of IVRs are investigated, and proposed solutions are discussed. A comprehensive search of publications in MEDLINE/PubMed and of commercial product data of IVRs was performed, and the materials, designs, performance, and applications (e.g., contraception, endometriosis, estrogen deficiency and urogenital atrophy) of hormonal IVRs were thoroughly evaluated. Most hormonal IVRs administer female sex hormones, i.e., estrogen and progestogens. In terms of material, IVRs are divided into 3 main groups: silicone, polyurethane, and polyethylene-co-vinyl acetate IVRs. As regards their design, there are 4 major designs for IVRs which strongly affect their performance and the timing and rate of hormone release. Important challenges include reducing the burst release and maintaining the bioavailability of hormones at their site of action over a prolonged period of administration as well as lowering production costs. Hormonal IVRs are a promising method which could be used to facilitate combination therapies by administering multiple drugs in a single IVR while eliminating the side effects of conventional drug administration methods. IVRs could considerably improve womenʼs quality of life all over the world within a short period of time.
Balanitis circumscripta plasmacellularis Zoon
Authors: Moll I. 
Published: July 2021

ZusammenfassungDie Balanitis plasmacellularis Zoon (BPZ), zuerst beschrieben von J. J. Zoon, ist eine chronische entzündliche Dermatose, die histologisch definiert ist anhand eines subepithelialen, lymphohistiozytären Infiltrates mit vielen Plasmazellen. Dabei wurden ein Spektrum epithelialer Veränderungen und eine variable Zusammensetzung des Infiltrates beschrieben. Dadurch unterscheidet sie sich von der Erythroplasie Queyrat, obwohl beide klinisch sehr ähnlich sind. An der BPZ erkranken vorwiegend ältere, nicht zirkumzidierte, heterosexuelle Männer. Klinisch typisch sind scharf umschriebene, rötlich-glänzende Rundherde an der Dorsalseite der Glans mit Übergang auf den Sulcus und das innere Präputialblatt. Erosionen und flache Infiltrate können hinzukommen. Der Verlauf ist chronisch mit sehr geringen Beschwerden, etwas erhöhte Empfindlichkeit wird oft genannt. Die Pathogenese ist unklar. Barrierestörung und Infektionen, unterhalten durch Feuchtigkeit, Mangel an Hygiene, Traumata und Irritationen, werden diskutiert. Dafür spricht auch das spontane Abheilen nach Zirkumzision oder lokalen Therapien mit Mucipirocin oder Fusidinsäure. Lokale Steroide sind ebenfalls – wie in unserem Fall – effektiv. Eine proaktive Therapie mit Tacrolimus-Salbe scheint eine Option. Die plasmazelluläre Entzündung ist nicht auf das männliche Genitale beschränkt, auch eine Vulvitis plasmacellularis ist beschrieben sowie der Befall nahezu aller weiteren Schleimhäute.
The Athlete and Gut Microbiome: Short-chain Fatty Acids as Potential Ergogenic Aids for Exercise and Training
Authors: Bongiovanni Tindaro , Yin Marilyn Ong Li , Heaney Liam M. 
Published: July 2021

AbstractShort-chain fatty acids (SCFAs) are metabolites produced in the gut via microbial fermentation of dietary fibers referred to as microbiota-accessible carbohydrates (MACs). Acetate, propionate, and butyrate have been observed to regulate host dietary nutrient metabolism, energy balance, and local and systemic immune functions. In vitro and in vivo experiments have shown links between the presence of bacteria-derived SCFAs and host health through the blunting of inflammatory processes, as well as purported protection from the development of illness associated with respiratory infections. This bank of evidence suggests that SCFAs could be beneficial to enhance the athlete’s immunity, as well as act to improve exercise recovery via anti-inflammatory activity and to provide additional energy substrates for exercise performance. However, the mechanistic basis and applied evidence for these relationships in humans have yet to be fully established. In this narrative review, we explore the existing knowledge of SCFA synthesis and the functional importance of the gut microbiome composition to induce SCFA production. Further, changes in gut microbiota associated with exercise and various dietary MACs are described. Finally, we provide suggestions for future research and practical applications, including how these metabolites could be manipulated through dietary fiber intake to optimize immunity and energy metabolism.
Patterns of Thromboembolism in Patients with Advanced Pancreatic Cancer Undergoing First-Line Chemotherapy with FOLFIRINOX or Gemcitabine/nab-Paclitaxel
Authors: Riedl Jakob M. , Schwarzenbacher Esther , Moik Florian , Horvath Lena , Gantschnigg Antonia , Renneberg Felix , Posch Florian , Barth Dominik A. , Stotz Michael , Pichler Martin , Hatzl Stefan , Fandler-Höfler Simon , Gressenberger Paul , Gary Thomas , Jost Philipp J. , Greil Richard , Ay Cihan , Djanani Angela , Gerger Armin , Schlick Konstantin 
Published: July 2021

Abstract
Introduction Recent advances in prophylactic anticoagulation and antineoplastic treatment for advanced pancreatic cancer (aPC) warrant an updated reassessment of thromboembolic risk in this population. This multicenter retrospective cohort study aims to comprehensively characterize incidence, risk factors, and outcomes of venous (VTE) and arterial thromboembolism (ATE) in homogenously treated patients with aPC.
Methods Four hundred and fifty-five patients with aPC undergoing palliative first-line chemotherapy (Gemcitabine/nab-Paclitaxel (GN) or FOLIRINOX) were included. Primary outcomes were objectively confirmed VTE and/or ATE.
Results Over a median follow-up of 26 months, 86 VTE (cumulative incidence: 20.0%; 95% confidence interval [CI]: 16.3–24.0) and 11 ATE events (cumulative incidence: 2.8%; 95% CI: 1.5–4.9) were observed. VTE diagnosis was associated with increased mortality (transition hazard ratio [THR]: 1.59 [95% CI: 1.21–2.09]) and increased risk of cancer progression (THR: 1.47 [95% CI: 1.08–2.01]), while the impact of ATE on mortality was numerically but not statistically significant (THR: 1.85 [95% CI: 0.87–3.94]). The strongest predictor of increased VTE risk was history of cancer-associated VTE (subdistribution hazard ratio [SHR]: 3.29 [95% CI: 2.09–5.18]), while the Khorana score (SHR: 0.78 [0.57–1.06]) failed to predict VTE risk. A history of cerebrovascular disease was associated with markedly increased ATE risk (SHR: 22.05 [95% CI: 6.83–71.22], p < 0.001), especially ischemic stroke. Risk of VTE/ATE did not significantly differ according to type of first-line chemotherapy.
Conclusion Patients with aPC undergoing palliative first-line chemotherapy with FOLFIRINOX or GN face a high risk for VTE/ATE and its diagnosis is linked to worse clinical outcomes. VTE-risk prediction models have limited ability to sub-stratify thrombotic events in this high-risk scenario.
Nickel-Catalyzed Hydrodeoxygenation of Aryl Sulfamates with Alcohols as Mild Reducing Agents
Authors: Kuriyama Masami , Onomura Osamu , Matsuo Kasumi , Yamamoto Kosuke , Demizu Yosuke , Nishida Koyo 
Published: July 2021

AbstractThe nickel-catalyzed hydrodeoxygenation of aryl sulfamates has been developed with alcohols as mild reductants. A variety of functional groups and heterocycles were tolerated in this reaction system to give the desired products in high yields. In addition, the gram-scale process and stepwise cine-substitution were also achieved with high efficiency.
Antithrombin Resistance Rescues Clotting Defect of Homozygous Prothrombin-Y510N Dysprothrombinemia
Authors: Lu Yeling , Villoutreix Bruno O. , Biswas Indranil , Ding Qiulan , Wang Xuefeng , Rezaie Alireza R. 
Published: July 2021

AbstractA patient with hematuria in our clinic was diagnosed with urolithiasis. Analysis of the patient's plasma clotting time indicated that both activated partial thromboplastin time (52.6 seconds) and prothrombin time (19.4 seconds) are prolonged and prothrombin activity is reduced to 12.4% of normal, though the patient exhibited no abnormal bleeding phenotype and a prothrombin antigen level of 87.9%. Genetic analysis revealed the patient is homozygous for prothrombin Y510N mutation. We expressed and characterized the prothrombin-Y510N variant in appropriate coagulation assays and found that the specificity constant for activation of the mutant zymogen by factor Xa is impaired approximately fivefold. Thrombin generation assay using patient's plasma and prothrombin-deficient plasma supplemented with either wild-type or prothrombin-Y510N revealed that both peak height and time to peak for the prothrombin mutant are decreased; however, the endogenous thrombin generation potential is increased. Further analysis indicated that the thrombin mutant exhibits resistance to antithrombin and is inhibited by the serpin with approximately 12-fold slower rate constant. Protein C activation by thrombin-Y510N was also decreased by approximately 10-fold; however, thrombomodulin overcame the catalytic defect. The Na+-concentration-dependence of the amidolytic activities revealed that the dissociation constant for the interaction of Na+ with the mutant has been elevated approximately 20-fold. These results suggest that Y510 (Y184a in chymotrypsin numbering) belongs to network of residues involved in binding Na+. A normal protein C activation by thrombin-Y510N suggests that thrombomodulin modulates the conformation of the Na+-binding loop of thrombin. The clotting defect of thrombin-Y510N appears to be compensated by its markedly lower reactivity with antithrombin, explaining patient's normal hemostatic phenotype.
Pharmacokinetics of Direct Oral Anticoagulants in Emergency Situations: Results of the Prospective Observational RADOA-Registry
Authors: Lindhoff-Last Edelgard , Birschmann Ingvild , Kuhn Joachim , Lindau Simone , Konstantinides Stavros , Grottke Oliver , Nowak-Göttl Ulrike , Lucks Jessica , Zydek Barbara , von Heymann Christian , Sümnig Ariane , Beyer-Westendorf Jan , Schellong Sebastian , Meybohm Patrick , Greinacher Andreas , Herrmann Eva ,   On behalf of the RADOA-Registry Investigators (Reversal Agent use in patients treated with Direct Oral Anticoagulants or vitamin K antagonists Registry)
Published: July 2021

Abstract
Background Direct oral anticoagulants (DOACs) are increasingly used worldwide. Little is known so far about their pharmacokinetics in emergency situations.
Methods A prospective, observational registry was performed to determine the clinical course in consecutive patients with major bleeding or urgent surgery treated with DOACs. In samples collected as part of routine care DOAC drug concentrations were measured using ultraperformance liquid chromatography-tandem mass spectrometry. Anticoagulant intensity at first presentation and drug half-life (t
1/2), tested in repeat samples, were evaluated.
Results A total of 140 patients were prospectively included. Pharmacokinetic data were available in 94% (132/140) of patients. Note that 67% (89/132) experienced life-threatening bleeding and 33% (43/132) needed an urgent surgery. For pharmacokinetic analysis a total of 605 blood samples was available. Median concentration on admission was 205 ng/mL for rivaroxaban and 108 ng/mL for apixaban. All treatment groups showed a high variation of drug concentrations at baseline. In rivaroxaban-treated patients t
½ was 17.3 hours (95% confidence interval [CI]: 15.4–19.7) without significant difference in both groups (major bleeding: t
½ 16.7 hours, 95% CI: 14.7–19.3; urgent surgery: t
½ 19.7 hours, 95% CI: 15.2–27.9; p = 0.292). In apixaban-treated patients t
½ was 25.0 hours (95% CI: 22.9–27.6) with a longer t
½ after urgent surgery (t
1/2: 30.8 hours; 95% CI: 26.9–36.4) compared with severe bleeding (t
1/2: 20.8 hours; 95% CI: 18.8–23.2; p < 0.001).
Conclusion Emergency patients under DOAC treatment show a high variation of anticoagulant concentrations at baseline. Compared with rivaroxaban, apixaban showed a lower median concentration on admission and a longer t
½.
Anorectal Malformation with Rectovestibular Fistula and Vaginal Agenesis: Usage of Rectovestibular Fistula as a Neovagina Followed by PSARP with Preservation of the Anal Sphincter
Authors: Dessanti Antonio , Louisma Osnel , Pierre Gabriel Steve , Liem Nguhien Thanh 
Published: July 2021

AbstractAnorectal malformation with rectovestibular fistula associated with vaginal agenesis is rare. We report on a child in whom this combination was diagnosed at the age of 1 year. After creation of a divided descending colostomy, we chose to leave the rectum-rectovestibular fistula to function as a neovagina, while the sigmoid colon was relocated via modified posterior sagittal anorectoplasty. The colostomy was closed 6 months after the main surgery. After a follow-up of 3 years, the patient is continent for stool and urine. The introitus of the neovagina appears wide and easy to explore. We conclude that our surgical approach may be a good option for these children.
Fibrin Network Porosity and Endo-/Exogenous Thrombin Cross-talk
Authors: He Shu , Wallén Håkan , Thålin Charlotte , Svensson Jan , Blombäck Margareta 
Published: July 2021

AbstractThe earliest assessment of fibrin network porosity used a liquid permeation system and confocal 3D microscopy, which was later replaced by scanning electron microscopy. Although the methods have extensively been applied in studies of health or disease, there remains debate on the choice of a proper clotting trigger. In this review, we assess published data and convey our opinions with regard to several issues. First, when the coagulation process is initiated by recombinant tissue factor (rTF) and phospholipids, the fibrin network porosity is regulated by the endogenous thrombin based on enzymatic activations of multiple coagulants. If purified thrombin (1.0 IU/mL) is employed as the clotting trigger, fibrin network porosity may be affected by exogenous thrombin, which directly polymerizes fibrinogen in plasma, and additionally by endogenous thrombin stemming from a “positive feedback loop” action of the added thrombin. Second, with use of either endogenous or exogenous thrombin, the concentration and clotting property of available fibrinogen both influence the fibrin network porosity. Third, in the assay systems in vitro, exogenous thrombin but not rTF-induced endogenous thrombin seems to be functional enough to activate factor XIII, which then contributes to a decrease in the fibrin network porosity. Fourth, fibrin network porosity determines the transport of fibrinolytic components into/through the clots and therefore serves as an indicator of the fibrinolysis potential in plasma.
The Value of Duodenal Biopsies in the Evaluation of Megaloblastic Anemia
Authors: Nasrin Nisha N. , Shanmugasundaram Sakthisankari , Kartikayan R. K. 
Published: July 2021

Abstract
Introduction Megaloblastic anemia is one of the common causes of anemia in India. Duodenal biopsies are routinely performed in the investigation of megaloblastic anemia. The present study was undertaken to analyze the value of duodenal biopsy in megaloblastic anemia and to correlate endoscopic findings with biopsy. As a secondary aim, the study has also analyzed the hematological profile and vitamin B12 and folate status of these patients.
Materials and Methods All the cases of megaloblastic anemia with bone marrow studies diagnosed at PSG Institute of Medical Sciences and Research during the two year period from January 2016 to December 2017 were retrieved. Clinical and laboratory findings (serum vitamin B12 and folate levels) and endoscopic findings were retrieved from hospital records of the patients. Duodenal biopsies of these patients reported in the histopathology department were retrieved and reviewed. Statistical analysis was done using SPSS software 20.0.
Results There were 93 cases of megaloblastic anemia diagnosed on bone marrow biopsies. Tropical sprue was diagnosed in 49.5% of cases, followed by intraepithelial lymphocytosis (17.2%), peptic duodenitis (17.2%), and no significant pathology in 16% of cases. Pancytopenia was present in 54.8% of cases. Isolated vitamin B12 deficiency including low levels was present in 48.38% and folate deficiency was seen in 4.3% cases; 34.48% cases had both vitamin B12 and folate deficiency.
Conclusion The incidence of tropical sprue in megaloblastic anemia is 49.5% in the study. Duodenal biopsy is valuable in the work up of megaloblastic anemia, irrespective of the endoscopic changes in identifying the etiology.
Modified Graner's Technique with\without Vascularized Capitate Lengthening for Kienböck Disease Stage IIIb—A Pilot Study
Authors: Atiyya Ahmed Naeem , Eldiasty Abdelrahman , Koriem Islam , Nabil Amr 
Published: July 2021

Abstract
Background Intercarpal fusions are used to treat stage IIIb Kienböck disease. They increase force transfer across the radioscaphoid articulation with predisposition to arthritis.
Description of Technique This technique is excision of lunate followed by proximal transfer of capitate, with scaphocapitate and triquetrocapitate fusion to increase area of load transfer mimicking wrist hemiarthroplasty. Our purpose is to evaluate mid-term results of this technique.
Patients and Methods A prospective case series study was conducted on 11 patients with stage IIIb and IIIc. In seven cases, transfer of the capitate was performed by osteotomizing the capitate just distal to its waist, proximal migration to replace the excised lunate then bone grafting. In four cases, proximal transfer of vascularized pedicled capitate was done. Clinical outcome measures included pain (visual analog scale), grip strength, range of motion, and functional evaluation by modified Mayo wrist score and scoring system of Evans. Radiological outcome measures included healing of fusion mass, progression of the disease, and occurrence of avascular necrosis to the capitate.
Results Follow-up period averaged 54 months. Scaphocapitate fusion healing averaged 11 weeks. Union of the lengthened capitate occurred in 10 patients only. There was postoperative improvement in pain scores, grip, Evans, and modified Mayo wrist score. There was postoperative decrease in wrist flexion and extension. One patient showed resorption of the capitate head with progressive radioscaphoid arthritis-necessitated wrist fusion.
Conclusion The mid-term results of this technique may be satisfactory due to low incidence of degenerative arthritis in the radioscaphoid joint. However, longer follow-up with recruiting larger number of patients is needed.
Childhood Stroke: Long-Term Outcomes and Health-Related Quality of Life with a Special Focus on the Development of Epilepsy
Authors: von Stülpnagel C. , Kutschker Sebastian , Sperl Wolfgang , Berweck Steffen , Staudt Martin , Berndt Markus , Kluger G. 
Published: July 2021

AbstractBackground Childhood stroke is rare and can predispose to post-stroke epilepsy. The purpose of this study was to evaluate long-term quality of life (QoL) in patients with childhood stroke, focusing on epileptic aspects.Method This involves a retrospective study of 98 patients with childhood stroke (pre- and neonatal strokes excluded), who had been inpatients between 1986 and 2003 for early rehabilitation. Data were obtained via interviews using a standardized questionnaire: QoL evaluation with KINDL, functional outcome with Barthel Index, and motor handicaps-assessment with modified Rankin Score.Results Forty-nine of 98 patients (31 males, mean follow-up 16 years, range 8–25 years) were included. Six patients passed away (three of sudden unexpected death in epilepsy). At least one epileptic seizure occurred in 27/49 patients (occurrence: 2 days–13 years.; mean 3.3 years.). Epilepsy manifested in 19/49 patients. No correlation was found between the development of epilepsy and the location or etiology of the stroke. The presence of functional independence was significantly higher in seizure-free patients and in patients without epilepsy. For the external assessment (filled in for the patient by the parent/caregiver), there was no significant difference in QoL in patients with and without epilepsy; however, in the in-person KINDL questionnaire a significantly lower QoL was noted in epilepsy patients compared with patients without epilepsy.Conclusion One important finding in our study is that in the long-term course 39% of patients developed epilepsy after a childhood stroke. It occurred as late as 13 years after the acute episode and affected the QoL especially in cognitively less handicapped patients.
Prevalence of Macroprolactinemia in People Detected to Have Hyperprolactinemia
Authors: Sharma Lokesh Kumar , Dutta Deep , Sharma Neera , Kulshreshtha Bindu , Lal Sandhya , Sethi Ritika 
Published: July 2021

AbstractBackground Macroprolactinemia is an analytic laboma encountered as a part of prolactin assay. No data are available on the burden of macroprolactinemia in Indians. This study aimed to determine the prevalence and predictors of macroprolactinemia among people with hyperprolactinemia.Methods Consecutive patients detected to have serum prolactin > 18 ng/mL as per the upper reference limit were further screened for macroprolactin by post-polyethylene-glycol (PEG)-precipitation test. Macroprolactinemia was defined as post-PEG recovery of prolactin < 40%.Results The four most common underlying etiologies for the testing of hyperprolactinemia were polycystic ovary syndrome (n = 402; 32.71%), pituitary adenomas (n = 318; 25.87%), drug-induced hyperprolactinemia (n = 224; 18.23%), and infertility (n = 126; 10.25%). A total of 1,229 patients (male:female = 191:1038) having mean age 30.46 ± 10.14 years had hyperprolactinemia, of which 168 (13.7%) were diagnosed to have macroprolactinemia. Macroprolactinemia was significantly higher in females than males (15.03 vs. 6.28%; p < 0.001). Age quartile-based analysis revealed no difference in occurrence of macroprolactinemia. Only 34 patients (2.76%) with macroprolactinemia (< 40% recovery of prolactin post-PEG precipitation) had raised prolactin levels after recovery. These patients primarily had underlying pituitary pathology.Conclusion Macroprolactinemia is not uncommon in people being tested for hyperprolactinemia. We should not hesitate to screen for macroprolactinemia in patients who have incidentally been detected to have hyperprolactinemia.