bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Information Theory to Detect Rogue Taxa and Improve Consensus Trees
Authors: Smith Martin R 
Published: December 2021

Abstract“Rogue” taxa of uncertain affinity can confound attempts to summarize the results of phylogenetic analyses. Rogues reduce resolution and support values in consensus trees, potentially obscuring strong evidence for relationships between other taxa. Information theory provides a principled means of assessing the congruence between a set of trees and their consensus, allowing rogue taxa to be identified more effectively than when using ad hoc measures of tree quality. A basic implementation of this approach in R recovers reduced consensus trees that are better resolved, more accurate, and more informative than those generated by existing methods. [Consensus trees; information theory; phylogenetic software; Rogue taxa.]
Worrying levels of antimicrobial resistance in Gram-negative bacteria isolated from cell phones and uniforms of Peruvian intensive care unit workers
Authors: Ymaña Barbara , Luque Nestor , Ruiz Joaquim , Pons Maria J 
Published: December 2021

Abstract

Background
Healthcare worker (HCW) uniforms and cell phones are involved in pathogen transmission. This study aimed to characterize pathogenic microorganism isolates from HCW uniforms and cell phones.

Methods
Gram-negative microorganisms were recovered from HCW uniforms and cell phones. Antimicrobial susceptibility and the presence of extended-spectrum β-lactamases (ESBL) and carbapenemases were determined.

Results
Escherichia coli was the most prevalent microorganism. Overall, high levels of resistance to cephalosporins, quinolones, co-trimoxazole and colistin were found. ESBL were mainly related to blaCTX-M-15 and blaSHV- genes. Carbapenem-resistant isolates presented as blaKPC or blaNDM.

Conclusions
High levels of antimicrobial resistance, including colistin, were detected. Therefore, strategies are urgently needed to prevent bacterial dissemination.
Postural orthostatic tachycardia syndrome
Authors: Cline Holly M. , Einhardt Adam 
Published: December 2021

Abstract:
Postural orthostatic tachycardia syndrome is an underdiagnosed disorder of the autonomic nervous system. The median time to achieve correct diagnosis is 2 years and may take more than 10 years for some patients. Symptoms can be devastating to the daily life of patients and can result in long-term disability. Treatment availability is limited due to the need for further studies.
Associations of mid-childhood bisphenol A and bisphenol S exposure with mid-childhood and adolescent obesity
Authors: Gajjar Priya , Liu Yun , Li Nan , Buckley Jessie P. , Chen Aimin , Lanphear Bruce P. , Kalkwarf Heidi J. , Cecil Kim M. , Yolton Kimberly , Braun Joseph M. 
Published: December 2021

Background:
Bisphenol A (BPA) is a suspected obesogen that has been associated with adiposity in children. Bisphenol S (BPS), a structural analog of BPA, is used as a BPA substitute and may have similar health effects as BPA. However, few studies have examined whether BPS is associated with childhood adiposity.

Methods:
We quantified urinary BPA and BPS concentrations in 212 children age 8 years from the HOME Study, a prospective pregnancy and birth cohort study that enrolled pregnant women in Cincinnati, Ohio (2003–2006). We assessed children’s adiposity by bioelectric impedance at age 8 years (n = 212), and by anthropometry and dual-energy X-ray absorptiometry at age 12 years (n = 181). We measured serum adipocytokine concentrations at age 12 years (n = 155). Using multivariable linear regression, we estimated covariate-adjusted associations of BPA and BPS with adiposity measures at ages 8 and 12 years and adipocytokine concentrations at age 12 years.

Results:
Each 10-fold increase in urinary BPA concentrations were inversely associated with percent body fat at age 8 years [β = −1.2, 95% confidence interval (CI) = −3.4, 1.0] and 12 years (β = −1.6, 95% CI = −4.0, 0.9). In contrast, urinary BPS concentrations were positively associated with percent body fat at age 8 years (β = 1.1, 95% CI = −0.6, 2.7), but not at 12 years (β = 0.1, 95% CI = −1.7, 1.8). Urinary BPA and BPS concentrations were not associated with serum adiponectin or leptin concentrations.

Conclusions:
We did not observe evidence that urinary BPA or BPS concentrations during childhood were associated with greater child adiposity at ages 8 and 12 years in this cohort.
Technique to Fix the Stubborn Deviated Caudal Septum with an Internal Bone Graft Splint
Authors: Gelidan Adnan G. 
Published: December 2021

Background:
Septoplasty, especially of the caudal portion, during cosmetic rhinoplasty is a crucial step in achieving satisfactory straight outcomes for the bony cartilaginous infrastructure and the skin envelope. Many methods are available, which range from septal mucosal resection to internal splinting by bone in a batten fashion; a power tool is usually used. This study describes a simple technique using a nonpower tool to correct the stubborn deviated caudal septum, with a thin available bone.

Methods:
Patients who underwent cosmetic open septorhinoplasty for crooked nose deformity and did not respond to the traditional septoplasty techniques were included. Bony splint was harvested from the bony septum and fixed to the caudal septum using an 18-gauge needle to create holes to fix the bony splint to the caudal septum through horizontal matrix sutures to correct septal deviation.

Results:
Six rhinoplasty patients who had significant caudal septal deviation and did not respond to the traditional techniques of septoplasty were included in this study. The patients were successfully treated by using an internal bony batten splint to correct the deviation. No postoperative complications were noted, and none of the patients required a revision surgery.

Conclusions:
Bony batten graft is not a new concept. It involves correcting the resistant caudal septum deviation by splinting it internally by using power tools and drills to create the holes to fix the bony splint graft. Using an 18-gauge needle to drill the hole is a simple, quick, and effective technique to correct and straighten the septum for resistant cases.
Methods of Sentinel Lymph Node Identification in Auricular Melanoma
Authors: Noorbakhsh Seth , Papageorge Marianna , Maina Renee M. , Baumann Raymond , Moores Craig , Weiss Sarah A. , Pucar Darko , Ariyan Stephan , Olino Kelly , Clune James 
Published: December 2021

Background:
Sentinel lymph node biopsy is used to evaluate for micrometastasis in auricular melanoma. However, lymphatic drainage patterns of the ear are not well defined and predicting the location of sentinel nodes can be difficult. The goal of this study was to define the lymphatic drainage patterns of the ear and to compare multiple modalities of sentinel node identification.

Methods:
A retrospective review of a prospectively maintained database evaluated 80 patients with auricular melanoma who underwent sentinel lymph node biopsy by comparing preoperative imaging with intraoperative identification of sentinel nodes. Patients were placed into two cohorts, based on the modality of preoperative imaging: (1) planar lymphoscintigraphy only (n = 63) and (2) single-photon emission computerized tomography combined with computerized tomography (SPECT-CT) only (n = 17). Sites of preoperative mapping and sites of intraoperative identification were recorded as parotid/preauricular, mastoid/postauricular, and/or cervical.

Results:
In patients that underwent planar lymphoscintigraphy preoperatively (n = 63), significantly more sentinel nodes were identified intraoperatively than were mapped preoperatively in both the parotid/preauricular (P = 0.0017) and mastoid/postauricular (P = 0.0047) regions. Thirty-two nodes were identified intraoperatively that were not mapped preoperatively in the planar lymphoscintigraphy group (n = 63), two of which were positive for micrometastatic disease. In contrast, there were no discrepancies between preoperative mapping and intraoperative identification of sentinel nodes in the SPECT-CT group (n = 17).

Conclusions:
SPECT-CT is more accurate than planar lymphoscintigraphy for the preoperative identification of draining sentinel lymph nodes in auricular melanoma. If SPECT-CT is not available, planar lymphoscintigraphy can also be used safely, but careful intraoperative evaluation, even in basins not mapped by lymphoscintigraphy, must be performed to avoid missed sentinel nodes.
Short-term Efficacy and Safety of Biological Tear Substitutes and Topical Secretagogues for Dry Eye Disease: A Systematic Review and Network Meta-analysis
Authors: Jongkhajornpong Passara , Anothaisintawee Thunyarat , Lekhanont Kaevalin , Numthavaj Pawin , McKay Gareth , Attia John , Thakkinstian Ammarin 
Published: December 2021

Purpose:
The purpose of this study was to assess short-term efficacy and safety of tear promotion eye drops (biological tear substitutes and topical secretagogues) for treating dry eye disease.

Methods:
Randomized controlled trials comparing short-term effects of biological tear substitutes or topical secretagogues versus placebo or other topical dry eye treatments in adults with dry eye disease were identified from the MEDLINE, Embase, Scopus, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform databases. Pairwise meta-analysis and network meta-analysis were performed. Outcomes were ocular symptoms, ocular surface staining, tear break-up time, Schirmer test, and adverse events. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations approach.

Results:
Thirty-nine randomized controlled trials (3693 patients) were eligible. Using artificial tears as a reference, autologous platelet lysate was the most effective treatment for lowering ocular surface disease index (unstandardized mean difference [USMD] −31.85; 95% confidence interval [CI]: −43.19 to −20.51) and platelet rich plasma showed the most reduction in corneal fluorescein staining scores (standardized mean difference −2.52; 95% CI: −3.23 to −1.82). Cord blood serum was the most effective treatment for increasing tear break-up time (USMD 2.67; 95% CI: 0.53–4.82), and eledoisin was superior to others in improving Schirmer scores (USMD 2.28; 95% CI: 0.14–4.42). Most interventions did not significantly increase ocular adverse events compared with artificial tears.

Conclusions:
Biological tear substitutes, including autologous serum, autologous platelet lysate, platelet rich plasma, and cord blood serum, might be the most effective treatment among tear promotion eye drops in relieving dry eye symptoms without increasing adverse events. However, there remains uncertainty around these findings because of low/very low certainty of evidence.
Can We Reduce Overtreatment of Cervical High-Grade Squamous Intraepithelial Lesions?
Authors: Bradbury Melissa , Rabasa Jordi , Murcia Maria Teresa , Dinarès Maria Carme , Sainz Alex , Castellet Cristina , Pérez-Benavente Assumpció , Gil-Moreno Antonio , Centeno Cristina 
Published: December 2021

Objective
The aim was to evaluate the cytology, colposcopic, and pathological factors associated with the absence of high-grade squamous intraepithelial lesion (HSIL)/cervical intraepithelial neoplasia (CIN) 2–3 lesion on loop electrosurgical excision procedure (LEEP) specimens in women with high-grade cytology and/or HSIL/CIN 2–3 biopsy and the risk of disease persistence/recurrence.

Materials and Methods
Two-center retrospective study of women undergoing LEEP for high-grade cervical disease between January 2014 and December 2019. Clinical, cytology, colposcopy, and pathology results were evaluated to identify independent predictive factors associated with CIN 1/negative LEEP results. Univariate and multivariate logistic regression models were performed. Follow-up data was evaluated to assess the risk of HSIL/CIN 2–3 persistence/recurrence.

Results
Six hundred thirty-nine of 801 women (79.8%) had high-grade cytology and 631 (78.8%) HSIL/CIN 2–3 biopsy. High-risk human papillomavirus test was positive in 98% of women. Loop electrosurgical excision procedure specimen showing CIN 1 or less was found in 27%–31%. Normal/low-grade colposcopy (odds ratio [OR] = 2.17, CI = 1.39–3.39, p = .001) and CIN 1/negative biopsy (OR = 3.25, CI = 2.12–4.99, p < .001) were predictors of negative/CIN 1 LEEP result in women with high-grade cytology. Normal/low-grade cytology (OR = 1.77, CI = 1.19–2.64, p = .005), normal/low-grade colposcopy (OR = 1.66, CI = 1.11–2.49, p = .013), and CIN 2 biopsy (OR = 2.75, CI = 1.73–4.39, p < .001) were predictors in women with HSIL/CIN 2–3 biopsy. Women with a negative/CIN 1 LEEP had lower recurrence/persistence than those with confirmed HSIL/CIN 2–3(1 vs 31, p = .002). Positive endocervical margin (OR = 2.85, CI = 1.10–7.36, p = .03) and high-risk human papillomavirus persistence (OR = 41.3, CI = 16–106.7, p < .01) were predictors of HSIL/CIN 2–3 persistence/recurrence.

Conclusions
A CIN 1/negative LEEP specimen in women with high-grade cytology and/or HSIL/CIN 2–3 biopsy is associated with negative/low-grade cytology, normal/low-grade colposcopic findings and CIN 2 biopsy result before treatment. The HSIL/CIN 2–3 disease persistence/recurrence is low when LEEP specimen does not confirm HSIL/CIN 2–3.
Desquamative Inflammatory Vaginitis and Plasma Cell Vulvitis Represent a Spectrum of Hemorrhagic Vestibulovaginitis
Authors: Song Myriarm , Day Tania , Kliman Len , Otton Geoff , Yap Desiree , Pagano Ross , Tan Yasmin , Scurry James 
Published: December 2021

Objective
The aim of the study was to identify whether desquamative inflammatory vaginitis (DIV) and plasma cell vulvitis (PCV) are distinct clinicopathologic entities.

Materials and Methods
The pathology database identified biopsies described as “vaginitis” or “vulvitis” occurring in nonkeratinized epithelium or mucocutaneous junction. Exclusions were age less than 18 years, unavailable slides or records, concurrent neoplasia, or histopathology consistent with other entities. Clinical data included demographics, symptoms, examination, microbiology, treatment, and response. Histopathologic review documented site, epithelial thickness and characteristics, infiltrate, and vascular abnormalities. Cases were analyzed according to histopathologic impression of DIV or PCV based on previous pathologic descriptions.

Results
There were 36 specimens classified as DIV and 18 as PCV from 51 women with mean age of 51 years; 3 (6%) had concurrent biopsies with both. Pain was more common in PCV, but rates of discharge, itch, and bleeding were comparable. Rates of petechiae or erythema were similar and vaginal examination was abnormal in 72% of PCV cases. All DIV and 33% of PCV occurred in squamous mucosa; the remaining PCV cases were from mucocutaneous junction. Mean epithelial thickness, rete ridge appearance, exocytosis, and spongiosis were similar in DIV and PCV. Epithelial erosion, wide-diameter lesions, plasma cells, and stromal hemosiderin occurred in both but were more common in PCV. Lymphocyte-obscured basal layer, narrow-diameter lesions, hemorrhage, and vascular congestion were seen in both, but more common and marked in DIV.

Conclusions
Desquamative inflammatory vaginitis and PCV have overlapping symptoms, signs, and histopathologic features. They may represent a single condition of hemorrhagic vestibulovaginitis with varying manifestations according to location and severity.
Thermal Ablation of High-Grade Premalignant Disease of the Cervix—Standing the Test of Time: A Retrospective Study
Authors: Ragupathy Kalpana , Jayasinghe Thummini , McMullen Wendy 
Published: December 2021

Objective
Analyze long-term (20 years) cytology and histology outcomes after treatment of high-grade cervical intraepithelial neoplasia (HGCIN) with thermal ablation (TA).

Methods
All women having TA for HGCIN between January 1996 and December 1998 (36 months; N = 885) were identified; data were collected on age of patients, symptoms, colposcopy findings, and biopsy reports. Local and national (cytology and colposcopy) databases and colposcopy records were used to collect long-term follow-up data. Probability of CIN recurrence was assessed using Kaplan-Meier “survival” curve.

Results
Follow-up data (available for 796) was collected in 2018 capturing 20 years of follow-up data. Two hundred eighty-one women were treated for CIN 2 and 515 women for CIN 3. Seven hundred ninety-one of 796 (>99%) were treated at first visit. Two hundred sixty two of 796 (33%) had evidence of crypt involvement on pretreatment biopsy. Probability of having consistently normal cytological follow-up was 92%, 89%, 86%, and 83% at 5, 10, 15, and 20 years, respectively. Cumulative probability of having recurrent HGCIN was 0.5% at 5 years, 1% at 10 years, 1.9% at 15 years, and 3% at 18 years. There was 1 invasive squamous cell cancer at 11 years after treatment.

Conclusions
Thermal ablation is a safe and effective treatment for HGCIN, which is now shown to have stood the test of time. We advise more widespread adoption in the United Kingdom and globally so long as agreed criteria are met.
Long-Term Multilevel Intervention Impact on Human Papillomavirus Vaccination Rates Spanning the COVID-19 Pandemic
Authors: Casey Sharon M. , Jansen Emily , Drainoni Mari-Lynn , Schuch Thomas J. , Leschly Karin S. , Perkins Rebecca B. 
Published: December 2021

Objective
The aim of the study was to evaluate the long-term sustainability of a multilevel intervention and the COVID-19 pandemic impact on adolescent human papillomavirus (HPV) vaccination coverage.

Materials and Methods
In 2016, a pediatric and family medicine practice within a federally qualified health center completed a multilevel intervention, Development of Systems and Education for Human Papillomavirus Vaccination. We examined the intervention impact on HPV vaccine initiation and completion rates among adolescents 10–18 years between March 2016 and October 2020. We determined the total number of HPV vaccine doses administered monthly. Data were plotted on statistical process control charts.

Results
Vaccine initiation increased from an average of 14% to an average of 42% for 10-year-old patients and from an average of 72% to an average of 92% for 11- to 12-year-old patients between March 2016 and January 2017 and remained stable through March 2020. Complete vaccination by age 13 years increased from 62% to 88% through October 2020.

Conclusions
This intervention led to continued improvement for on-time HPV vaccination coverage 4 years after intervention completion.
Clinical Trial Registration: This trial has been registered at http://www.clinicaltrials.gov (identifier NCT02812732).
Lower Genital Tract Microbiome—A Work in Progress
Authors: Sobel Jack D. 
Published: December 2021

Abstract
The lower genital tract microbiome is composed of millions upon millions of microbes colonizing this unique anatomical niche reflecting the influence of genetic, biologic, and behavioral factors. Over the last decade, as a result of ever advancing technology and research investment, our knowledge of this complex microbiome ecosystem has grown enormously. All too often such progress remains invisible to practitioners. In this special issue, clinical scientists, in a unique contribution, have bridged the ever-increasing distance between vaginal microbiota science and clinical disease. Approaching a myriad of pathologic entities, authors describe the clinical application of recent molecular laboratory findings encouraging diagnostic, prognostic, and therapeutic advances. Nevertheless, challenges are recognized and the authors outline vulvovaginal disease management opportunities. Above all, exposing the dynamism of vaginal microbiota affords a better understanding of pathogenesis of lower genital tract disease.
Case Report: Bilateral Valsalva Retinopathy in an Acutely Anemic Patient
Authors: Castillo Alvaro Jose 
Published: December 2021

SIGNIFICANCE
The Valsalva maneuver is known to cause pre-retinal hemorrhages, which have a predilection to affect the macula. Certain conditions may increase the risk of developing Valsalva retinopathy including anemia. Knowing these associations can aid in uncovering underlying systemic conditions for which a patient may not otherwise be aware.

PURPOSE
This case report reviews the presentation of Valsalva retinopathy and the impacts of acute anemia on retinal findings. Recommendations for management are also reviewed and reported.

CASE REPORT
A 30-year-old Hispanic man presented to the emergency department for progressing weakness over the previous month. He had a history of polysubstance abuse and had not been eating for the previous month except for water intake. He was diagnosed with unconjugated hyperbilirubinemia, anemia, thrombocytopenia, hypercoagulable state, hypokalemia, and hypomagnesia and admitted to the intensive care unit for treatment and observation. He was referred to the eye clinic to be examined for Kayser-Fleischer rings because of concern for Wilson disease. On ophthalmological examination, the patient had reduced vision in both eyes attributed to bilateral subinternal limiting membrane macular hemorrhages likely due to Valsalva, with acute anemia and thrombocytopenia as contributing factors. The patient was referred to a retinal specialist, and observation was recommended with follow-up in 3 months. The patient, unfortunately, never followed up despite multiple attempts to reschedule.

CONCLUSIONS
Patient history and the common location of retinal hemorrhages aid in diagnosing Valsalva retinopathy. In this case, the patient had a known history of acute anemia and thrombocytopenia with a recent history of straining. Anemia, among other systemic conditions, can increase the risk of developing retinopathy after a Valsalva maneuver. Although Valsalva retinopathy can occur in healthy patients without underlying conditions, it is important to rule out other conditions that might present with retinal hemorrhage or that may increase the risk of Valsalva retinopathy.
Effects of anesthesia on ozone-induced lung and systemic inflammation
Authors: Wilson Miranda L. , Thysell Jarl A. , Baumann Kristen K. , Quaranta Danny V. , Liang W. Sandy , Erickson Michelle A. 
Published: December 2021

AbstractAnesthetics are required for procedures that deliver drugs/biologics, infectious/inflammatory agents, and toxicants directly to the lungs. However, the possible confounding effects of anesthesia on lung inflammation and injury are underreported. Here, we tested the effects of brief isoflurane (Iso) or ketamine/xylazine/atipamezole (K/X/A) anesthesia prior to ozone exposure (4 hours, 3ppm) on lung inflammatory responses in mice. Anesthesia regimens modeled those used for non-surgical intratracheal instillations, and were administered 1-2 hours or 24 hours prior to initiating ozone exposure. We found that Iso given 1-2 hours prior to ozone inhibited inflammatory responses in the lung, and this effect was absent when Iso was given 23-24 hours prior to ozone. In contrast, K/X/A given 1-2 hours prior to ozone increased lung and systemic inflammation. Our results highlight the need to comprehensively evaluate anesthesia as an experimental variable in the assessment of lung inflammation in response to ozone and other inflammatory stimuli.