bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Periareolar Approach: All Seasons Technique for Multiple Breast Conditions
Authors: Klinger Marco , Vinci Valeriano , Giannasi Silvia , Bandi Valeria , Veronesi Alessandra , Maione Luca , Catania Barbara , Lisa Andrea , Cornegliani Guido , Giaccone Micol , Siliprandi Mattia , Battistini Andrea , Barbera Federico , Tinterri Corrado , Testori Alberto , Caviggioli Fabio , Klinger Francesco 
Published: July 2021

Background:
The periareolar approach was first introduced by Hollander in 1924 and, since then, numerous contributions have been reported by different authors. Despite all the strengths associated with this versatile technique, the periareolar approach still poses three main problems: large areolar diameter with poor quality scar, flattening of the breast cone, and poor stability of the results. The purpose of this article is to show how this surgical technique, with a good patient selection, can be applied to different situations and obtain excellent results.

Methods:
We performed a retrospective study on 5028 consecutive procedures in 4198 female patients treated with a periareolar approach in two regional institutions between 2008 and 2018. We considered 853 pure mastopexies, 362 breast augmentations, 422 secondary breast augmentations, 402 corrections of stenotic breast, 2921 oncoplastic surgeries, and 68 breast reductions. Postoperative complication, as well as patient and surgeon satisfaction were assessed.

Result:
Patient and surgeon satisfaction 1 year after the procedure was excellent, and the complication rate was low.

Conclusions:
When the indication is set correctly, the periareolar approach can obtain excellent results. This versatile technique, initially introduced as a mastopexy technique, has expanded its applications and can now be used for multiple surgical situations.
Update on the Long-Term Outcomes Following the Management of Incomplete Punctal Canalization
Authors: Saini Pragya , Bothra Nandini , Ali Mohammad Javed 
Published: July 2021

Purpose:
To study the clinical profile, associated lacrimal disorders, and long-term outcomes following a membranotomy, in patients with incomplete punctal canalization (IPC).

Methods:
Retrospective interventional study was performed of all the patients diagnosed with IPC during the study period over 5 years from January 2015 to December 2020. The diagnosis of IPC was made based on the earlier published guidelines. A combination of rapid and slow taper Nettleship’s punctal dilators were used for an effective membranotomy, followed by further assessment of the lacrimal drainage passage. Appropriate interventions for associated lacrimal disorders were performed. Data collected on chart reviews include demographics, clinical presentation, laterality, type of IPC, associated lacrimal anomalies, management modalities, and long-term outcomes.

Results:
Ninety-eight puncta of 62 eyes of 46 patients with IPC were examined in the clinic. Incomplete punctal canalization-external membrane variant was seen in 62% (61/98) and internal membrane variant in 38% (37/98). Seventy-eight puncta (78/98, 79.5%) in 39 patients underwent membranotomy using Nettleship’s punctal dilator. Associated lacrimal drainage pathway deformities were seen in 31% of patients (12/39). Three puncta had mini-monoka insertion for associated canalicular stenosis and canalicular obstruction. Five patients with associated congenital nasolacrimal duct obstruction underwent probing, of which 3 patients needed dacryocystorhinostomy for complex congenital nasolacrimal duct obstruction. Associated punctal agenesis was noted in 3 patients involving the other punctum of the same eye. Canalicular wall hypoplasia involving 3 walls of the canaliculus was seen in 1 patient. At a mean follow up of 28 months, the anatomical and functional outcomes were noted in 100% and 97.4%, respectively.

Conclusions:
The long-term outcomes of membranotomy for IPC are excellent. Associated congenital lacrimal drainage anomalies are common with IPC.
Examination of the safety and effectiveness of low-concentration nitrous oxide anesthesia in cataract surgery
Authors: Noguchi Santaro , Nakakura Shunsuke , Noguchi Asuka , Nakama Sayuri , Aimi Miyuki , Kashima Tomoyuki , Tabuchi Hitoshi 
Published: July 2021

Purpose:
To investigate the effects in cataract surgery using local anesthesia along with a 30% low-concentration nitrous oxide (N2O) anesthesia compared with local anesthesia only.

Setting:
Saneikai Tsukazaki Hospital.

Design:
Retrospective, consecutive study.

Methods:
Patients who underwent bilateral cataract surgery were enrolled. 37 patients using room air inhalation (Air group) and 45 patients using 30% low-concentration N2O anesthesia (70% oxygen, total 6 L/min) at surgery start (N2O group) were retrospectively reviewed. Systolic blood pressure (BPs), diastolic blood pressure (BPd), and heart rate (HR) at surgery start and end, and mean intraoperative oxygen saturation (% SpO2) were examined. Immediately following surgery, a questionnaire using the Visual Analog Scale score was done to determine intraoperative pain, anxiety, memory, and nausea.

Results:
No systemic symptoms in all patients and ocular complications requiring treatment were observed. For the N2O and air groups, changes in BPs were −5.38 ± 11.07(P = .01) and 1.27 ± 13.61 mm Hg, and HR were −2.24 ± 6.76 and 0.89 ± 5.18 bpm (P = .001), respectively; intraoperative SpO2 was 99.05% ± 0.74% and 97.44% ± 1.31% (P < .001), intraoperative anxiety was 21.76 ± 23.2 and 37.17 ± 32.79 (P = .002), and intraoperative memory was 55.24 ± 36.8 and 68.91 ± 33.81 (P = .01), respectively. No patients experienced intraoperative nausea. There was no statistically difference in BPd (P = .47) and intraoperative pain (P = .62).

Conclusions:
Low-concentration N2O anesthesia may not cause respiratory depression, abnormal vital signs, or nausea in cataract surgery. It can suppress intraoperative anxiety and memory and decrease and stabilize vital signs.
Deep learning for abdominal ultrasound: A computer-aided diagnostic system for the severity of fatty liver
Authors: Chou Tsung-Hsien , Yeh Hsing-Jung , Chang Chun-Chao , Tang Jui-Hsiang , Kao Wei-Yu , Su I-Chia , Li Chien-Hung , Chang Wei-Hao , Huang Chun-Kai , Sufriyana Herdiantri , Su Emily Chia-Yu 
Published: July 2021

Background:
The prevalence of nonalcoholic fatty liver disease is increasing over time worldwide, with similar trends to those of diabetes and obesity. A liver biopsy, the gold standard of diagnosis, is not favored due to its invasiveness. Meanwhile, noninvasive evaluation methods of fatty liver are still either very expensive or demonstrate poor diagnostic performances, thus, limiting their applications. We developed neural network–based models to assess fatty liver and classify the severity using B-mode ultrasound (US) images.

Methods:
We followed standards for reporting of diagnostic accuracy guidelines to report this study. In this retrospective study, we utilized B-mode US images from a consecutive series of patients to develop four-class, two-class, and three-class diagnostic prediction models. The images were eligible if confirmed by at least two gastroenterologists. We compared pretrained convolutional neural network models, consisting of visual geometry group (VGG)19, ResNet-50 v2, MobileNet v2, Xception, and Inception v2. For validation, we utilized 20% of the dataset resulting in >100 images for each severity category.

Results:
There were 21,855 images from 2,070 patients classified as normal (N = 11,307), mild (N = 4,467), moderate (N = 3,155), or severe steatosis (N = 2,926). We used ResNet-50 v2 for the final model as the best ones. The areas under the receiver operating characteristic curves were 0.974 (mild steatosis vs others), 0.971 (moderate steatosis vs others), 0.981 (severe steatosis vs others), 0.985 (any severity vs normal), and 0.996 (moderate-to-severe steatosis/clinically abnormal vs normal-to-mild steatosis/clinically normal).

Conclusion:
Our deep learning models achieved comparable predictive performances to the most accurate, yet expensive, noninvasive diagnostic methods for fatty liver. Because of the discriminative ability, including for mild steatosis, significant impacts on clinical applications for fatty liver are expected. However, we need to overcome machine-dependent variation, motion artifacts, lacking of second confirmation from any other tools, and hospital-dependent regional bias.
Factors influencing locoregional recurrence and distant metastasis in Asian patients with cutaneous melanoma after surgery: A retrospective analysis in a tertiary hospital in Taiwan
Authors: Chu Po-Yu , Chen Yi-Fan , Li Cheng-Yuan , Yang Jai-Sing , King Yih-An , Chiu Yu-Jen , Ma Hsu 
Published: July 2021

Background:
The goal of this study was to investigate the prognostic factors for locoregional recurrence and metastasis in patients with cutaneous melanoma (CM) who underwent surgery, especially in the acral lentiginous melanoma (ALM) subtype.

Methods:
This study was a retrospective review of patients who underwent surgery for CM at Taipei Veterans General Hospital between 2000 and 2018. We investigated the risk factors for locoregional and distant metastases. The association between clinicopathological factors and locoregional recurrence and distant metastasis of the CM and ALM subtypes was analyzed. In addition, the outcomes between the ALM and non-ALM groups were compared.

Results:
A total of 161 patients were included in the analysis. The most common histological subtype was ALM. The overall locoregional recurrence rate of CM was 13.0% and the distant metastasis rate was 42.9%, whereas that of the ALM subtype was 12.5% and 45.5%, respectively. In patients with CM, male sex, tumor with lymphovascular invasion, and positive lymph node status were the prognostic factors for both locoregional recurrence and distant metastasis. Among the patients with ALM, positive lymph node status was significantly associated with both locoregional recurrence and distant metastasis.

Conclusion:
In this cohort, factors influencing locoregional recurrence and distant metastasis were similar between the ALM and non-ALM groups. The above-recommended surgical margin did not show any benefit in either the CM or the ALM subtype. ALM can be handled using the same surgical strategy as CM in the Asian population.
Loop Electrosurgical Excision Procedure in Managing Persistent Low-Grade Abnormality or Human Papillomavirus Positivity
Authors: Leung Shuk On Annie , Vitonis Allison F. , Feldman Sarah 
Published: July 2021

Objectives
The aims of the study were to estimate the rate and to identify predictors of high-grade abnormalities among women with persistent low-grade abnormalities or high-risk human papillomavirus (hrHPV) positivity for at least 2 years stratified by presence (high risk) or absence (low risk) of previous high-grade results or HPV 16/18.

Materials and Methods
A retrospective cohort study of patients who underwent a loop electrosurgical excision procedure (LEEP) for persistent low-grade or hrHPV positivity was performed. Patients were stratified based on whether they had a history of high-grade and/or HPV 16/18 positivity. Rates of high-grade or worse abnormalities on LEEP were compared using Fisher exact tests. Logistic regression was used to evaluate the associations between patient characteristics and high-grade results on the LEEP.

Results
Three hundred eleven LEEPs were performed for persistent low-grade or hrHPV positivity. The rates of occult high grade were 12% and 22% among the low- and high-risk groups, respectively. Compared with those 45 years and older, the adjusted odds of high grade was 3.79 (95% CI = 1.19–12.1) for women aged 25–29 years. The odds of high grade was higher among current versus never smokers (6.40; 95% CI = 2.01–20.4) and those with a history of high-grade abnormality (2.23; 95% CI = 1.12–4.43). At 2 years, approximately half had an abnormal cytology and/or hrHPV positivity result independent of whether high grade was identified on their LEEP specimen.

Conclusions
Patients with persistent low-grade abnormalities or persistent hrHPV should be counseled on the risks and benefits of a LEEP given that 12%–22% have a risk of occult high grade, especially if they have a history of high-grade dysplasia.
A Retrospective Cross-sectional Study on the Risk Factors of Recurrent Falls Among Inpatients
Authors: Chang Wen-Pei , Jen Hsiu-Ju , Huang Tsai-Wei 
Published: July 2021

Background:
Recurrent falls are more likely to cause injuries and disabilities than single falls.

Purpose:
This study investigated the incidence and risk factors of recurrent falls among inpatients.

Methods:
We analyzed inpatient fall data from the anomaly event notification database and electronic medical records of a hospital. We collected data regarding 1059 inpatients who had fallen during their hospital stay. Among these inpatients, 390 (36.83%) had fallen within the previous year.

Results:
Inpatients in the orthopedics and neurology wards were at a higher risk of recurrent falls than those in surgical wards; inpatients who were physically dependent were at a higher risk of recurrent falls than those who were physically independent; inpatients with poor vision were at a lower risk of recurrent falls than those without this issue; and inpatients who were using antidepressants were at a higher risk of recurrent falls than those who were not using antidepressants.

Conclusion:
The risk of recurrent falls is highly correlated with ward type, physical independence, self-perceived good vision, and use of antidepressants.
Validation of PROMIS-29 domain scores among adult burn survivors: A National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System Study
Authors: McMullen Kara , Bamer Alyssa , Ryan Colleen M. , Schneider Jeffrey C. , Gibran Nicole , Stewart Barclay T. , Mroz Tracy , Wolf Steven , Amtmann Dagmar 
Published: July 2021

BACKGROUND
Patient-reported outcomes are important for understanding recovery after burn injury, benchmarking service delivery and measuring the impact of interventions. Patient-Reported Outcomes Measurement Information System (PROMIS)-29 domains have been validated for use among diverse populations though not among burn survivors. The purpose of this study was to examine validity and reliability of PROMIS-29 scores in this population.

METHODS
The PROMIS-29 scores of physical function, anxiety, depression, fatigue, sleep disturbance, ability to participate in social roles, and pain interference were evaluated for validity and reliability in adult burn survivors. Unidimensionality, floor and ceiling effects, internal consistency, and reliability were examined. Differential item functioning was used to examine bias with respect to demographic and injury characteristics. Correlations with measures of related constructs (Community Integration Questionnaire, Satisfaction with Life Scale, Post-Traumatic Stress Checklist-Civilian, and Veteran’s Rand-12) and known-group differences were examined.

RESULTS
Eight hundred and seventy-six burn survivors with moderate to severe injury from 6 months to 20 years postburn provided responses on PROMIS-29 domains. Participants’ ages ranged from 18 years to 93 years at time of assessment; mean years since injury was 3.4. All PROMIS domain scores showed high internal consistency (Cronbach’s α = 0.87–0.97). There was a large ceiling effect on ability to participate in social roles (39.7%) and physical function (43.3%). One-factor confirmatory factor analyses supported unidimensionality (all comparative fit indices >0.95). We found no statistically significant bias (differential item functioning). Reliability was high (>0.9) across trait levels for all domains except sleep, which reached moderate reliability (>0.85). All known-group differences by demographic and clinical characteristics were in the hypothesized direction and magnitude except burn size categories.

CONCLUSION
The results provide strong evidence for reliability and validity of PROMIS-29 domain scores among adult burn survivors. Reliability of the extreme scores could be increased and the ceiling effects reduced by administering PROMIS-43, which includes six items per domain, or by administering by computerized adaptive testing.

LEVEL OF EVIDENCE
Diagnostic Test or Criteria, level III.
Breaching the curation bottleneck with human-machine reading symbiosis
Authors: Wong Cliff , Rao Rajesh , Yin Taofei , Statz Cara , Mockus Susan , Patterson Sara , Poon Hoifung 
Published: July 2021

AbstractPurposeThe explosion of molecular biomarker and treatment information in the precision medicine era drastically exacerbated difficulty in identifying patient-relevant knowledge for clinical researchers and practitioners. Curated knowledgebases, such as the JAX Clinical Knowledgebase (CKB) are tools to organize and display knowledge in a readily accessible format; however, curators face the same challenges in comprehensively identifying clinically relevant information for curation. Natural language processing (NLP) has emerged as a promising direction for accelerating manual curation, but prior applications were often conceived as stand-alone efforts to automate curation, and the scope is often limited to simple entity and relation extraction. In this paper, we study the alternative paradigm of assisted curation and identify key desiderata to scale up knowledge curation with human-computer symbiosis.MethodsWe chose precision oncology for a case study and introduced self-supervised machine reading, which can automatically generate noisy training examples from unlabeled text. We developed a curation user interface (UI) for precision oncology and through iterative “curathons” (curation hackathons), conducted retrospective and prospective user studies for head-to-head comparison between manual and machine-assisted curation.ResultsContrary to the prevailing assumption, we showed that high recall is more important for end-to-end assisted curation. In extensive user studies, we showed that assisted curation can double the curation speed and increase the number of findings by an order of magnitude for previously scarcely curated drugs.ConclusionWe demonstrated that an iterative and thoughtful collaboration between professional curators and NLP researchers can facilitate rapid advances in assisted curation for precision medicine. Human-machine reading symbiosis can potentially be applicable to clinical care and research scenarios where curation is a major bottleneck.
Cooperative DNA base and shape recognition by the CCAAT-binding complex and its bZIP transcription factor HapX
Authors: Huber Eva M. , Hortschansky Peter , Scheven Mareike T. , Misslinger Matthias , Haas Hubertus , Brakhage Axel A. , Groll Michael 
Published: July 2021

ABSTRACTThe heterotrimeric CCAAT-binding complex (CBC) is a master regulator of transcription. It specifically recognizes the CCAAT-box, a fundamental eukaryotic promoter element. Certain fungi, likeAspergilli, encode a fourth CBC-subunit, HapX, to fine-tune expression of genes involved in iron metabolism. Although being a basic region leucine zipper with its own DNA recognition motif, HapX function strictly relies on the CBC. We here report two crystal structures of the CBC-HapX complex bound to DNA duplexes with distinct sequence and position of HapX sites. In either structure, a HapX dimer targets the nucleic acid downstream of the CCAAT-box and the leash-like N-terminus of the distal HapX subunit interacts with CBC and DNA.In vitroandin vivoanalyses of HapX mutants support the structures, highlight the complex as an exceptional major and minor groove DNA binder, and enrich our understanding of the functional as well as structural plasticity of related complexes across species.
SnoRNA guide activities – real and ambiguous
Authors: Deryusheva Svetlana , Talross Gaëlle J.S. , Gall Joseph G. 
Published: July 2021

ABSTRACTIn eukaryotes, rRNAs and spliceosomal snRNAs are heavily modified posttranscriptionally. Pseudouridylation and 2’-O-methylation are the most abundant types of RNA modifications. They are mediated by modification guide RNAs, also known as small nucleolar (sno)RNAs and small Cajal body-specific (sca)RNAs. We used yeast and vertebrate cells to test guide activities predicted for a number of snoRNAs, based on their regions of complementarity with rRNAs. We showed that human SNORA24 is a genuine guide RNA for 18S-Ψ609, despite some non-canonical base-pairing with its target. At the same time, we found quite a few snoRNAs that have the ability to base-pair with rRNAs and can induce predicted modifications in artificial substrate RNAs, but do not modify the same target sequence within endogenous rRNA molecules. Furthermore, certain fragments of rRNAs can be modified by the endogenous yeast modification machinery when inserted into an artificial backbone RNA, even though the same sequences are not modified in endogenous yeast rRNAs. In Xenopus cells a guide RNA generated from scaRNA, but not from snoRNA, could induce an additional pseudouridylation of U2 snRNA at position 60; both guide RNAs were equally active on a U2 snRNA-specific substrate in yeast cells. Thus, posttranscriptional modification of functionally important RNAs, such as rRNAs and snRNAs, is highly regulated and more complex than simply strong base-pairing between a guide RNA and substrate RNA. We discuss possible regulatory roles for these unexpected modifications.
Repetition effects in action planning reflect effector- but not hemisphere-specific coding
Authors: Seegelke Christian , Schonard Carolin , Heed Tobias 
Published: July 2021

AbstractAction choices are influenced by future and recent past action states. For example, when performing two actions in succession, response times (RT) to initiate the second action are reduced when the same hand is used. These findings suggest the existence of effector-specific processing for action planning. However, given that each hand is primarily controlled by the contralateral hemisphere, the RT benefit might actually reflect effector-independent, hemisphere-specific rather than effector-specific repetition effects. Here, participants performed two consecutive movements, each with a hand or a foot, in one of two directions. Direction was specified in an egocentric reference frame (inward, outward) or in an allocentric reference frame (left, right). Successive actions were initiated faster when the same limb (e.g., left hand - left hand), but not when the other limb of the same body side (e.g., left foot - left hand) executed the second action. The same-limb advantage was evident even when the two movements involved different directions, whether specified egocentrically or allocentrically. Corroborating evidence from computational modeling lends support to the claim that repetition effects in action planning reflect persistent changes in baseline activity within neural populations that encode effector-specific action plans.