bluuebunny/crossref_metadata_2025_split huggingface dataset:
Face Transplant: Current Update and First Canadian Experience
Authors: Govshievich Alexander , Saleh Eli , Boghossian Elie , Collette Suzon , Desy Delphine , Dufresne Simon , St-Jacques Helen , Chollet Andre , Tremblay Dominique , Guertin Charles , Tardif Michele , Poirier Jean , Ayad Tareck , Rahal Akram , Borsuk Daniel E. 
Published: April 2021

Summary:
Facial vascularized composite allotransplantation has emerged as a groundbreaking reconstructive solution for patients with severely disfiguring facial injuries. The authors report on the first Canadian face transplant. A 64-year-old man sustained a gunshot wound, which resulted in extensive midface bony and soft-tissue damage involving the lower two-thirds of the face. In May of 2018, he underwent a face transplant consisting of Le Fort III and bilateral sagittal split osteotomies in addition to skin from the lower two-thirds of the face and neck. Virtual surgical planning was used to fabricate osteotomy guides and stereolithographic models. Microsurgical anastomoses of the facial (three branches) and infraorbital nerves were performed bilaterally. At 18-month follow-up, the aesthetic outcome was excellent. Partial restoration of light touch sensation had been observed over the majority of the allograft. Although significantly affected, animation, speech, mastication, and deglutition were continuously improving with intensive therapy. Nevertheless, the patient was now tracheostomy and gastrostomy free. Despite these limitations, he reported a high degree of satisfaction with the procedure and had reintegrated into the community. Four grade I episodes of acute rejection with evidence of endotheliitis were successfully treated. Postoperative complications were mainly infectious, including mucormycosis of the left thigh, treated with surgical resection and antifungal therapy. Undoubtedly, immunosuppression represents the greatest obstacle in the field and limits the indications for facial vascularized composite allotransplantation. Continuous long-term follow-up is mandatory for surveillance of immunosuppression-related complications and functional assessment of the graft.
Outcomes of Furlow Double-Opposing Z-Plasty Palatoplasty for the Treatment of Symptomatic Overt and Occult Submucous Cleft Palate: A Comparison Study
Authors: Brooker Jack E. , Bykowski Michael , Cray James J. , Beiriger Justin , Roy Eva , Ford Matthew D. , Grunwaldt Lorelei , Davit Alexander , Goldstein Jesse A. , Jabbour Noel , Losee Joseph E. 
Published: April 2021

Background:
The submucous cleft palate can be overt or occult and may require surgical repair. The double-opposing Z-plasty (Furlow repair) is the authors’ center’s preferred approach. This study evaluated complication rates, differences in outcome between overt and occult types, and patient factors associated with surgical failure.

Methods:
This retrospective study reviewed documentation on all patients who underwent Furlow Z-plasty for submucous cleft palate at a single center between 2004 and 2018. Speech pathology was quantified using the Pittsburgh Weighted Speech Score.

Results:
A total of 351 patients were included (125 overt and 226 occult cases). Furlow Z-plasty was successful (postoperative Pittsburgh Weighted Speech Score <7 without recommendation for secondary speech surgery) in 291 patients (82.1 percent). Apart from those requiring secondary surgery, there were no documented complications. Occult-type patients were 7.5 years old at palatoplasty with a speech score of 14.1; overt-type patients were 6.5 years old with a score of 15.7. Postoperative speech scores were similar for both groups. Secondary speech surgery patients had a higher preoperative score (16.9 versus 14.2). Age at time of palatoplasty and submucous cleft palate type were not predictive of the need for secondary surgery. Syndromic patients had higher preoperative and postoperative speech scores (15.6 and 7.5, respectively) than nonsyndromic patients (14.3 and 4.3) and needed secondary surgery more often (24.4 percent versus 9.2 percent). V-shaped velar vaulting on preoperative assessment was present in 92 percent of occult-type patients.

Conclusions:
Furlow palatoplasty is a safe and effective means of repairing submucous cleft palate. Patients with the occult type presented later with a lower Pittsburgh Weighted Speech Score. High preoperative speech score and syndromic status were associated with the need for secondary speech surgery. V-shaped velar vaulting is a reliable sign of occult submucous cleft palate.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.
Complications During the Inpatient Rehabilitation Period in Neurological Subjects
Authors: Klaphajone Jakkrit , Wattanapan Pattra , Tunwattanapong Punjama , Wangno Wuttiganok , Kuptniratsaikul Vilai ,   the KPI Team for Rehabilitation Service Indicator
Published: April 2021

Objective
To explore common complications in people with neurological conditions during rehabilitation admission.

Methods:
All neurological subjects, including those with stroke, spinal cord injury (SCI), and traumatic brain injury, who were admitted for intensive and less-intensive rehabilitation programs during January to December 2012 were recruited. Both avoidable and unavoidable complications and related factors were assessed.

Results:
Among 1146 subjects, 65% was male with a mean age of 54.5 years. Almost 90% were admitted for intensive rehabilitation. The common avoidable complications that occurred were urinary tract infection (UTI) (12.8%), musculoskeletal pain (7.0%), neuropathic pain (2.3%), pneumonia (1.5%), and pressure injury (1.2%). Spasticity, which is an unavoidable complication, occurred in 2.1% of subjects. Older age, male gender, diagnosis of SCI, and longer stay were important factors related to complications.

Conclusions:
Most of the common complications during rehabilitation were avoidable complications, especially UTI and pain. A heightened level of awareness and vigilance should be exercised in older male subjects, those with prolonged hospital stay, and those with a diagnosis of SCI.
Single dose of BNT162b2 mRNA vaccine against SARS-CoV2 induces neutralizing antibody and polyfunctional T-cell responses in patients with CML
Authors: Harrington Patrick , Doores Katie J. , Radia Deepti , O’Reilly Amy , Jeff Lam Ho Pui , Seow Jeffrey , Graham Carl , Lechmere Thomas , McLornan Donal , Dillon Richard , Shanmugharaj Yogita , Espehana Andreas , Woodley Claire , Saunders Jamie , Curto-Garcia Natalia , O’Sullivan Jennifer , Kordasti Shahram , Malim Michael H. , Harrison Claire , de Lavallade Hugues 
Published: April 2021

AbstractPatients receiving targeted cancer treatments such as tyrosine kinase inhibitors (TKIs) have been classified in the clinically extremely vulnerable group to develop severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including patients with Chronic Myeloid Leukaemia (CML) taking TKIs. In addition, concerns that immunocompromised individuals with solid and haematological malignancies may not mount an adequate immune response to a single dose of SARS-CoV-2 BNT162b2 (Pfizer-BioNTech) vaccine have been raised.We evaluated humoral and cellular immune responses after a first injection of BNT162b2 vaccine in 16 CML patients. Seroconversion and cellular immune response prior and after vaccination were assessed.By day 21 post-vaccination, anti-Spike IgG were detected in 14/16 (87.5%) of CML patients and all developed a neutralizing antibody response (ID50>50), including medium (ID50 of 200-500) or high (501-2000) neutralising antibodies titres in 9/16 (56.25%) patients. T cell response was seen in 14/15 (93.3%) evaluable patients, with polyfunctional responses seen in 12/15 (80%) patients (polyfunctional CD4+ response 9/15, polyfunctional CD8+ T cell response 9/15).These data demonstrate the immunogenicity of a single dose of SARS-CoV-2 BNT162b2 vaccine in most CML patients with both neutralizing antibodies and polyfunctional T-cell responses seen, in contrast to patients with solid tumour or lymphoid haematological malignancies.FundingKing’s Together Rapid COVID-19 Call awards to MHM, KJD; A Huo Family Foundation Award to MHM, KJD; Chronic Disease Research Foundation award CDRF-22/2020 to KJD, MHM; Wellcome Trust Investigator Award 106223/Z/14/Z to MHM; CG was supported by the MRC-KCL Doctoral Training Partnership in Biomedical Sciences (MR/N013700/1); Fondation Dormeur, Vaduz for funding equipment to KJD
Preexisting diabetes and COVID-associated hyperglycaemia in patients with COVID-19 pneumonia
Authors: Laurenzi Andrea , Caretto Amelia , Molinari Chiara , Bazzigaluppi Elena , Brigatti Cristina , Marzinotto Ilaria , Mercalli Alessia , Melzi Raffaella , Nano Rita , Tresoldi Cristina , Landoni Giovanni , Ciceri Fabio , Lampasona Vito , Scavini Marina , Piemonti Lorenzo 
Published: April 2021

AbstractAimThe aim of the current study was to compare clinical characteristics, laboratory findings and major outcomes of patients hospitalized for COVID-19 pneumonia with COVID-associated hyperglycaemia or preexisting diabetes.MethodsA cohort of 176 adult patients with a diagnosis of pre-existing diabetes (n=112) or COVID-associated hyperglycaemia (n=55) was studied. Clinical outcomes and laboratory findings were analysed according to the presence of the two conditions. The time to viral clearance was assessed during the follow-up after hospital discharge.ResultPatients with COVID-associated hyperglycaemia had lower BMI, significantly less comorbidities and higher levels of inflammatory markers and indicators of multi-organ injury than those with preexisting diabetes. No differences between preexisting diabetes and COVID-associated hyperglycaemia were evident for symptoms at admission, humoral response against SARS-CoV-2 or autoantibodies to glutamic acid decarboxylase or interferon alpha-4. COVID-associated hyperglycaemia was independently associated with the risk of adverse clinical outcome defined as ICU admission or death (HR 2.11, 95% CI 1.34-3.31; p=0.001), even after adjustment for age, sex and other selected variables associated with COVID-19 severity. Furthermore, we documented a negative association (HR 0.661, 95% CI 0.43-1.02; p=0.063) between COVID-associated hyperglycaemia and the time to swab negativization.ConclusionsThe recognition of hyperglycaemia as a specific clinical entity associated with COVID-19 pneumonia is relevant for early and appropriate patient management and close monitoring for the progression of disease severity.
Genetic Determinants of Blood Cell Traits Influence Susceptibility to Childhood Acute Lymphoblastic Leukemia
Authors: Kachuri Linda , Jeon Soyoung , DeWan Andrew T. , Metayer Catherine , Ma Xiaomei , Witte John S. , Chiang Charleston W. K. , Wiemels Joseph L. , de Smith Adam J. 
Published: April 2021

ABSTRACTAcute lymphoblastic leukemia (ALL) is the most common childhood cancer. Despite overlap between genetic risk loci for ALL and hematologic traits, the etiological relevance of dysregulated blood cell homeostasis remains unclear. We investigated this question in a genome-wide association study (GWAS) of ALL (2666 cases, 60,272 controls) and multi-trait GWAS of 9 blood cell indices in the UK Biobank. We identified 3000 blood cell trait-associated (P<5.0×10−8) variants, explaining 4.0% to 23.9% of trait variation, and including 115 loci associated with blood cell ratios (LMR: lymphocyte/monocyte, NLR: neutrophil/lymphocyte, PLR: platelet/lymphocyte). ALL susceptibility was genetically correlated with lymphocyte counts (rg=0.088, p=4.0×10−4) and PLR (rg= −0.072, p=0.0017). In Mendelian randomization analyses, genetically predicted increase in lymphocyte counts was associated with increased ALL risk (Odds ratio (OR)=1.16, p=0.031) and strengthened after accounting for other cell types (OR=1.48, p=8.8×10−4). We observed positive associations with increasing LMR (OR=1.22, p=0.0017) and inverse effects for NLR (OR=0.67, p=3.1×10−4) and PLR (OR=0.80, p=0.002). Our study shows that a genetically induced shift towards higher lymphocyte counts, overall and in relation to monocytes, neutrophils, and platelets, confers an increased susceptibility to childhood ALL.
Model-based evaluation of alternative reactive class closure strategies against COVID-19
Authors: Liu Quan-Hui , Zhang Juanjuan , Peng Cheng , Litvinova Maria , Huang Shudong , Poletti Piero , Trentini Filippo , Guzzetta Giorgio , Marziano Valentina , Zhou Tao , Viboud Cecile , Bento Ana I. , Lv Jiancheng , Vespignani Alessandro , Merler Stefano , Yu Hongjie , Ajelli Marco 
Published: April 2021

AbstractThere are contrasting results concerning the effect of reactive school closure on SARS-CoV-2 transmission. To shed light on this controversy, here we develop a data-driven computational model of SARS-CoV-2 transmission to investigate mechanistically the effect on COVID-19 outbreaks of school closure strategies based on syndromic surveillance and antigen screening of students. We found that by reactively closing classes based on syndromic surveillance, SARS-CoV-2 infections are reduced by no more than 13.1% (95%CI: 8.6%-20.2 %), due to the low probability of timely symptomatic case identification among the young population. We thus investigated an alternative triggering mechanism based on repeated screening of students using antigen tests. Should population-level social distancing measures unrelated to schools enable maintaining the reproduction number (R) at 1.3 or lower, an antigen-based screening strategy is estimated to fully prevent COVID-19 outbreaks in the general population. Depending on the contribution of schools to transmission, this strategy can either prevent COVID-19 outbreaks for R up to 1.9 or to at least greatly reduce outbreak size in very conservative scenarios about school contribution to transmission. Moving forward, the adoption of antigen-based screenings in schools could be instrumental to limit COVID-19 burden while vaccines continue to roll out through 2021, especially in light of possible continued emergence of SARS-CoV-2 variants.
Resolutive results with oral corticosteroids for patients with COVID-19 in pulmonary inflammatory phase. Successful outpatient experience during the collapse of Belém do Pará Health System - Brazil
Authors: Zeballos Roberto S. , Cruz Luciana N.L. , Brilhante Vânia C.R. , Adriana V. Lima , Martins Carlliane L.L.P. , Lima Karla N.A. , Leão Michele C.G.L. , Cruz Belinete L. , Dysarz Alessandra B. , Lobato Paulo C.B. , Almeida Erika S. , Costa Rute A.P. , Araújo Klevison C. , Almeida Augusto C.C. , Junior Leônidas B.D. , Harada Kathia O. , Araújo Rita H.V.S. , Prestes Elaine X. , Souza Ivete M.S. , Pereira Avany M.P. , Rocha Antônio B.M.A. , Estevão Iracema A. , Carvalho Fagnei I.C. , Melo Paulo M.P. 
Published: April 2021

ABSTRACTIn the face of new diseases, medicine needs to reinvent itself in order to contain and control epidemics, such as the one we have recently faced, COVID-19, a disease with a wide spectrum of clinical severity. A new moment has been established, since the application of well known, effective and safe medications for other diseases, has shown high success rates in the treatment of COVID-19. Thereunto, studies with early intervention are needed, which can change the unfavorable outcome of patients. In this article, we report the successful experience using an oral strategy during the collapse of Belém do Pará Health System, Brazil. Two hundred and ten patients were diagnosed with respiratory failure due to COVID-19, with no option of hospital treatment due to lack of beds and resources. These patients were then started on therapeutic regimen consisting of prednisolone, enoxaparin and macrolides associated and followed in outpatient facilities. Two hundred and eight patients had excellent therapeutic response and there were only two fatalities. These results push research boundaries, valuing outpatient treatment with early use of prednisolone in the initial pulmonary phase, preventing severe COVID-19 pneumonitis. Adoption of the proposed treatment intends to reduce the need for hospitalization, as well as lethality, with social robust benefits and incalculable economic savings since involves the use of accessible, safe and not expensive medications.
Multidimensional Sleep Health: Concepts, Advances, and Implications for Research and Intervention
Authors: Chung Joon , Goodman Matthew , Huang Tianyi , Bertisch Suzanne , Redline Susan 
Published: April 2021

AbstractThe new paradigm of multidimensional sleep health (‘sleep health’) offers both challenges and opportunities for sleep science. Buysse (2014) has described sleep health to be multidimensional, framed as positive attributes, operationalizable into composite measures of global sleep health, sensitive to upstream exposures, and consequential for downstream health. We highlight two paradigm-shifting effects of a multidimensional sleep health perspective. The first is the use of composite sleep metrics which i) enable quantification of population shifts in sleep health, ii) with possibly reduced measurement error, iii) greater statistical stability, and iv) reduced multiple-testing burdens. The second is that sleep dimensions do not occur in isolation, that is, they are commonly biologically or statistically dependent. These dependencies complicate hypothesis tests yet can be leveraged to inform scale construction, model interpretation, and inform targeted interventions. To illustrate these points, we i) extended Buysse’s Ru SATED model; ii) constructed a conceptual model of sleep health; and iii) showed exemplar analyses from the Multi-Ethnic Study of Atherosclerosis (n=735). Our findings support that sleep health is a distinctively useful paradigm to facilitate interpretation of a multitude of sleep dimensions. Nonetheless, the field of sleep health is still undergoing rapid development and is currently limited by: i) a lack of evidence-based cut-offs for defining optimal sleep health; ii) longitudinal data to define utility for predicting health outcomes; and iii) methodological research to inform how to best combine multiple dimensions for robust and reproducible composites.
B cells adapt their nuclear morphology to organize the immune synapse and help antigen extraction
Authors: Ulloa Romina , Corrales Oreste , Cabrera Fernanda , Jara-Wilde Jorge , José Saez Juan , Rivas Christopher , Lagos Jonathan , Härtel Steffen , Quiroga Clara , Gomes Edgar R , Yuseff María-Isabel , Muñoz Jheimmy Diaz 
Published: April 2021

AbstractUpon interaction with immobilized antigens B cells form an immune synapse, where actin remodeling and re-positioning of the microtubule-organizing center (MTOC) together with lysosomes can facilitate antigen extraction. B cells have restricted cytoplasmic space, mainly occupied by a large nucleus, yet the role of nuclear morphology in the formation of the immune synapse has not been addressed. Here we show that, upon activation, B cells re-orientate and adapt the size of their nuclear groove facing the immune synapse, where the MTOC sits and lysosomes accumulate. Silencing nuclear envelope proteins, Nesprin-1 and Sun-1, impairs nuclear reorientation towards the synapse and leads to defects in actin organization at this level. Consequently, B cells are unable to internalize the BCR after antigen activation. Nesprin-1 and Sun-1-silenced B cells also fail to accumulate the tethering factor Exo70 at the center of the synaptic membrane and display defective lysosome positioning, impairing efficient antigen extraction at the immune synapse. Thus, changes in nuclear morphology and positioning emerge as critical regulatory steps to coordinate B cell activation.
Clinical Trends Among U.S. Adults Hospitalized with COVID-19, March-December 2020
Authors: Garg Shikha , Patel Kadam , Pham Huong , Kirley Pam D. , Kawasaki Breanna , Yousey-Hindes Kimberly , Anderson Evan J. , Weigel Andrew , Ryan Patricia A. , Reeg Libby , Como-Sabetti Kathryn , Davis Sarah Shrum , Muse Alison , Bennett Nancy M. , Billing Laurie , Sutton Melissa , Talbot H. Keipp , Hill Mary , Wortham Jonathan , Kim Lindsay , Havers Fiona ,   COVID-NET Surveillance Team
Published: April 2021

AbstractBackgroundThe COVID-19 pandemic has caused substantial morbidity and mortality.ObjectivesTo describe monthly demographic and clinical trends among adults hospitalized with COVID-19.DesignPooled cross-sectional.Setting99 counties within 14 states participating in the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET).PatientsU.S. adults (aged ≥18 years) hospitalized with laboratory-confirmed COVID-19 during March 1-December 31, 2020.MeasurementsMonthly trends in weighted percentages of interventions and outcomes including length of stay (LOS), intensive care unit admissions (ICU), invasive mechanical ventilation (IMV), vasopressor use and in-hospital death (death). Monthly hospitalization, ICU and death rates per 100,000 population.ResultsAmong 116,743 hospitalized adults, median age was 62 years. Among 18,508 sampled adults, median LOS decreased from 6.4 (March) to 4.6 days (December). Remdesivir and systemic corticosteroid use increased from 1.7% and 18.9% (March) to 53.8% and 74.2% (December), respectively. Frequency of ICU decreased from 37.8% (March) to 20.5% (December). IMV (27.8% to 8.7%), vasopressors (22.7% to 8.8%) and deaths (13.9% to 8.7%) decreased from March to October; however, percentages of these interventions and outcomes remained stable or increased in November and December. Percentage of deaths significantly decreased over time for non-Hispanic White patients (p-value <0.01) but not non-Hispanic Black or Hispanic patients. Rates of hospitalization (105.3 per 100,000), ICU (20.2) and death (11.7) were highest during December.LimitationsCOVID-NET covers approximately 10% of the U.S. population; findings may not be generalizable to the entire country.ConclusionsAfter initial improvement during April-October 2020, trends in interventions and outcomes worsened during November-December, corresponding with the 3rd peak of the U.S. pandemic. These data provide a longitudinal assessment of trends in COVID-19-associated outcomes prior to widespread COVID-19 vaccine implementation.
Tonic interferon restricts pathogenic IL-17-driven inflammatory disease via balancing the microbiome
Authors: Marié Isabelle J. , Brambilla Lara , Azzouz Doua , Chen Ze , Baracho Gisele , Arnett Azlann , Li Haiyan S. , Liu Weiguo , Cimmino Luisa , Chattopadhyay Pratip , Silverman Gregg , Watowich Stephanie S. , Khor Bernard , Levy David E. 
Published: April 2021

AbstractMaintenance of immune homeostasis involves a synergistic relationship between the host and the microbiome. Canonical interferon (IFN) signaling controls responses to acute microbial infection, through engagement of the STAT1 transcription factor. However, the contribution of tonic levels of IFN to immune homeostasis in absence of acute infection remains largely unexplored. We report that STAT1 KO mice spontaneously developed an inflammatory disease marked by myeloid hyperplasia and splenic accumulation of hematopoietic stem cells. Moreover, these animals developed inflammatory bowel disease. Profiling gut bacteria revealed a profound dysbiosis in absence of tonic IFN signaling, which triggered expansion of TH17 cells and loss of splenic Tregcells. Resolution of dysbiosis by antibiotic treatment averted the TH17 bias, and blocking IL17 signaling prevented myeloid expansion and splenic stem cell accumulation. Thus, tonic IFNs regulate gut microbial ecology, which is crucial for maintaining physiologic immune homeostasis and preventing inflammation.