bluuebunny/crossref_metadata_2025_split huggingface dataset:
A phylogenetic assessment of HIV-1 transmission trends among people who inject drugs from Coastal and Nairobi, Kenya
Authors: Kingston Hanley , Nduva George , Chohan Bhavna H , Mbogo Loice , Monroe-Wise Aliza , Sambai Betsy , Guthrie Brandon L , Wilkinson Eduan , Giandhari Jennifer , Masyuko Sarah , Sinkele William , de Oliveria Tulio , Bukusi David , Scott John , Farquhar Carey , Herbeck Joshua T 
Published: November 2024

Abstract
Although recent modeling suggests that needle–syringe programs (NSPs) have reduced parenteral HIV transmission among people who inject drugs (PWID) in Kenya, the prevalence in this population remains high (∼14–20%, compared to ∼4% in the larger population). Reducing transmission or acquisition requires understanding historic and modern transmission trends, but the relationship between the PWID HIV-1 sub-epidemic and the general epidemic in Kenya is not well understood. We incorporated 303 new (2018–21) HIV-1 pol sequences from PWID and their sexual and injecting partners with 2666 previously published Kenyan HIV-1 sequences to quantify relative rates and direction of HIV-1 transmissions involving PWID from the coast and Nairobi regions of Kenya. We used genetic similarity cluster analysis (thresholds: patristic distance &lt;0.045 and &lt;0.015) and maximum likelihood and Bayesian ancestral state reconstruction to estimate transmission histories at the population group (female sex workers, men who have sex with men, PWID, or general population) and regional (coast or Nairobi) levels. Of 1081 participants living with HIV-1, 274 (25%) were not virally suppressed and 303 (28%) had sequences available. Of new sequences from PWID, 58% were in phylogenetic clusters at distance threshold &lt;0.045. Only 21% of clusters containing sequences from PWID included a second PWID sequence. Sequences from PWID were similarly likely to cluster with sequences from female sex workers, men who have sex with men, and the general population. Ancestral state reconstruction suggested that transmission to PWID from other populations was more common than from PWID to other populations. This study expands our understanding of the HIV-1 sub-epidemic among PWID in Kenya by incorporating four times more HIV-1 sequences from this population than prior studies. Despite recruiting many PWID from local sexual and injecting networks, we found low levels of linked transmission in this population. This may suggest lower relative levels of parenteral transmission in recent years and supports maintaining NSPs among PWID, while also strengthening interventions to reduce HIV-1 sexual acquisition and transmission for this population.
Tibial Malalignment Is an Independent Predictor of Nonunion After Intramedullary Nailing of Tibial Shaft Fractures
Authors: Goch Abraham , Healey Kathleen , Zingas Nicolas , Raffetto Michael , McKibben Natasha , Benzel Caroline , Stockton David J. , O'Hara Nathan N. , Slobogean Gerard P. , Nascone Jason W. , O'Toole Robert V. 
Published: November 2024

OBJECTIVES:
This study aimed to assess the relationship between postoperative alignment and nonunion in patients with tibial shaft fractures treated with intramedullary nailing.

METHODS:

Design:
Retrospective case–control study.

Setting:
Single academic trauma center.

Patients Selection Criteria:
Adult patients with closed or open tibial shaft fractures (42A-C) treated with intramedullary nailing from 2007 to 2018.

Outcomes Measures and Comparisons:
Case patients with nonunion were compared with control patients with radiographic evidence of healing in terms of the postoperative tibial alignment measured in the coronal and sagittal planes.

RESULTS:
Of the 192 included patients (median age, 38 years; 76% male), 51 patients had a nonunion, and 141 patients had united fractures and served as the control group. A strong association between postoperative tibial malalignment in 1 plane and nonunion (odds ratio, 3.0; 95% confidence interval, 1.1–8.3; P = 0.03) was demonstrated. This association was even greater for malalignment in both coronal and sagittal planes (odds ratio, 5.7; 95% confidence interval, 2.1–16.1; P < 0.001) after controlling for confounders.

CONCLUSIONS:
After controlling for confounding factors, postoperative malalignment in the coronal or sagittal plane was associated with significantly increased odds of tibial shaft nonunion after intramedullary nailing.

LEVEL OF EVIDENCE:
Prognostic, Level III. See Instructions for Authors for a complete description of levels of evidence.
Co-administration of dexmedetomidine with total intravenous anaesthesia in carotid endarterectomy reduces requirements for propofol and improves haemodynamic stability
Authors: Vetter Christian , Meyer Eva R. , Seidel Kathleen , Bervini David , Huber Markus , Krejci Vladimir 
Published: November 2024

BACKGROUND
Total intravenous anaesthesia guided by electroencephalography and neurophysiological monitoring may be used for carotid endarterectomy. Reduction of brain metabolic demand during cross-clamping of the internal carotid artery with propofol titrated to burst suppression requires effect-site concentrations that may delay emergence and interfere with intraoperative neurophysiological monitoring.

OBJECTIVE
To test the hypothesis that dexmedetomidine decreases the effect-site concentration of propofol required for burst-suppression in patients undergoing carotid endarterectomy.

DESIGN
Randomised controlled trial.

PARTICIPANTS
Patients undergoing carotid endarterectomy.

SETTING
University Hospital of Berne, Switzerland, from October 2018 to September 2024

INTERVENTIONS
Patients were randomised into a control (n = 23) and a dexmedetomidine groups (n = 22). Total intravenous anaesthesia was administered to both groups. Patients in the dexmedetomidine group received an intravenous bolus of dexmedetomidine (0.4 μg kg−1 over 10 min) before induction, followed by a continuous intravenous infusion (0.4 μg kg−1 h−1). The effect-site concentrations of propofol were titrated against frontal electroencephalography parameters. Burst suppression was induced with propofol during cross-clamping of the internal carotid artery.

OUTCOME MEASURES
The primary outcome was the effect-site concentration of propofol required for burst-suppression. The secondary outcomes were the requirement for vasoactive substances, neurophysiological monitoring parameters, and postoperative delirium.

RESULTS
The effect-site concentration of propofol required for burst suppression was 4.0 μg ml−1 [3.50 to 4.90] (median [interquartile range]) in the dexmedetomidine group compared with 6.0 μg ml−1 [5.5 to 7.3] in the control group (P < 0.001). Less norepinephrine was required in the dexmedetomidine group (total 454 μg [246 to 818] compared with 1000 μg [444 to 1326] (P = 0.015) in the control group). Dexmedetomidine did not affect intraoperative neurophysiological monitoring.

CONCLUSION
Co-administration of dexmedetomidine to total intravenous anaesthesia for carotid endarterectomy decreased the effect-site concentrations of propofol required for burst suppression by 33%. The propofol-sparing effect and peripheral alpha-agonism of dexmedetomidine may explain the reduced requirement for vasopressors.

TRIAL REGISTRATION
Clinicaltrials.gov identifier: NCT04662177.
A Guide to the Implementation and Design of Ex Vivo Perfusion Machines for Vascularized Composite Allotransplantation
Authors: Muss Tessa E. , Loftin Amanda H. , Zamore Zachary H. , Drivas Eleni M. , Guo Yi-Nan , Zhang Yichuan , Brassil John , Oh Byoung Chol , Brandacher Gerald 
Published: November 2024

Background:
Ex vivo machine perfusion (EVMP) is a versatile platform utilized in vascularized composite allotransplantation (VCA) to prolong preservation, salvage tissue, and evaluate graft viability. However, there is no consensus on best practices for VCA. This article discusses the common components, modifications, and considerations necessary for a successful VCA perfusion.

Methods:
A systematic literature review was performed in several databases (PubMed, Scopus, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov) to identify articles published on VCA EVMP (face, limb, abdominal wall, uterus, penis, and free flaps) before August 2022. Graft type and animal model, general perfusion parameters, core components of the circuit, and optional components for enhanced monitoring were extracted from the articles.

Results:
A total of 1370 articles were screened, and 46 articles met inclusion criteria. Most articles (84.8%) were published in the last 10 years. Pigs were the main model used, but 10 protocols used human grafts. Free flaps were the most common graft type (41.3%), then upper extremities/forelimbs (28.3%), uteruses (17.4%), and hindlimbs (13.0%). Postperfusion replantation occurred in 15.2% of studies. Normothermic perfusion predominated (54.1%), followed by hypothermic (24.3%), and subnormothermic (21.6%). The majority of studies (87.0%) oxygenated their systems, most commonly with carbogen.

Conclusions:
EVMP is a rapidly growing area of research. Leveraging EVMP in VCA can optimize VCA procedures and allow for expansion into replantation, flap salvage, and other areas of plastic surgery. Currently, VCA EVMP is achieved through a variety of approaches, but standardization is necessary to advance this technology and attain clinical translation.
Cutaneous Metastasis of Breast Carcinoma in the Distal Phalanx of the Left Little Finger: A Case Report
Authors: Albalawi Ibrahim Abdullah S. , Nukaly Houriah Y. , Said May Ibrahim , Moharram Laila , Elgazzar Khaled 
Published: November 2024

Summary:
With breast cancer cases escalating globally, the risk of uncommon sequelae like cutaneous metastatic carcinoma also rises. The identification of such metastases is essential in posttreatment surveillance. A 73-year-old woman with a history of hypertension and diabetes initially presented with postmenopausal bleeding, leading to the discovery and treatment of endometrial carcinoma via hysterosalpingo-oophorectomy. Nearly a decade later, she developed bilateral breast carcinoma, confirmed via radiology and biopsies, necessitating a bilateral-modified radical mastectomy. Her postoperative phase was complicated by the development of sternum bone metastasis and a peculiar metastatic lesion on the left little finger, presenting as a fungating swelling on the distal phalanx. This lesion was later identified as metastatic metaplastic carcinoma from the breast, a rarity for cutaneous metastases. An amputation of the distal phalanx was performed, but her overall condition worsened. Ten months posttreatment, she was hospitalized with a severely deteriorated condition and died shortly after. This case highlights the insidious nature of cutaneous metastases in breast cancer and the potential for unusual presentations, such as the rare involvement of the distal phalanx. It emphasizes the importance of continuous vigilance in the follow-up of breast cancer patients, particularly when unusual symptoms arise, and underscores the value of a multidisciplinary approach in managing complex metastatic diseases to potentially improve survival outcomes.
Association Between Follow-Up Visit Timing After A Concussion and Subsequent Care Seeking in Children and Youth: A Population-Based Study in British Columbia
Authors: Ramsay Scott , Dahinten V. Susan , Ranger Manon , Babul Shelina , Saewyc Elizabeth 
Published: November 2024

Objective:
To assess the relationship between follow-up visit timing and occurrence of the first subsequent health care seeking visit.

Setting:
The province of British Columbia, Canada.

Participants:
A total of 21 029 children and youth who were diagnosed with an initial concussion from January 1, 2016, to December 31, 2017. These data were obtained from Population Data BC.

Design:
A retrospective, descriptive correlational study.

Main Measures:
Follow-up timing was measured categorically as timely (4 weeks), delayed (1–3 months), or no follow-up; the occurrence of a subsequent health care visit beyond 3 months postinjury was measured up to 12 months at 3-month intervals (ie, 4-6, 7-9, and 10-12 months). These variables were measured using diagnostic codes for concussion, post-concussion syndrome, and the 17 concussion symptoms.

Results:
After controlling for sociodemographic characteristics, having a delayed follow-up, relative to timely follow-up, was associated with higher odds of a subsequent health care seeking visit at 4 to 6 months (odds ratio [OR] = 2.68; confidence interval [CI], 2.08-3.47), 7 to 9 months (OR = 1.71; CI, 1.21-2.40), and 10 to 12 months (OR = 1.67; CI, 1.13-2.48). In contrast to having a delayed follow-up, having no follow-up, relative to timely follow-up, was associated with not having a subsequent health care seeking visit at 4 to 6 months (OR = 0.57; CI, 0.48-0.67) and 7 to 9 months (OR = 0.79; CI, 0.66-0.96), respectively.

Conclusions:
Follow-up visit timing after a concussion in children and youth is associated with subsequent health care seeking. Greater efforts are needed to investigate the importance of initial follow-up visit timing, as they may play an integral role in injury prevention and symptom management following injury.
REAL-WORLD LONG-TERM OUTCOMES OF INTRAVITREAL FARICIMAB IN PREVIOUSLY TREATED CHRONIC NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Ambati Naveen R. , Leone Adam , Brill Daniel , Sisk Robert A. 
Published: November 2024

Purpose:
To study the real-world outcomes of intravitreal faricimab (IVF) in long-standing neovascular age-related macular degeneration (nAMD) over a 1-year study period.

Methods:
Retrospective single-center cohort study of patients with previously treated nAMD receiving IVF with at least 12 months of follow-up. Main outcome measures include injection intervals, visual acuity (VA), and optical coherence tomography features.

Results:
A total of 263 eyes from 217 patients received 6.4 ± 2.3 IVF injections over 1 year. Injection interval increased after switching to IVF (5.9 ± 1.8 vs. 7.6 ± 2.4 weeks) (P < 0.01). There was no improvement in VA after switching to IVF at any time period (P > 0.15). Average CST decreased after the first IVF injection and was sustained for 1 year (313.7 ± 96.0 vs. 288.2 ± 80.6 µm) (P < 0.01). There was a statistically significant resolution of subretinal fluid but not IRF at all time points (40.8%–50.4%; P < 0.01). Persistent fluid after the first IVF injection was resolved in 34.4% (n = 45) by 1 year. IVF was discontinued in 31 eyes (11.8%), four (1.6%) that experienced intraocular inflammation.

Conclusion:
Long-standing nAMD eyes switched to IVF experienced a significant extension in injection interval, stable visual acuity, improvement in CST, and resolution of fluid on OCT in many patients over 1 year.
Dupilumab-Associated Bilateral Conjunctival Papillomas and Corneal Perforation
Authors: Dewhurst Nicholas , Larney Conor , Jobson Dale , Nofal Nour , Chong Alvin , Chan Elsie 
Published: November 2024

Purpose:
We report a unique case of significant human papillomavirus–associated conjunctival papillomas and severe corneal ulceration leading to corneal perforation in a patient treated with dupilumab for atopic dermatitis.

Methods:
This study is a case report and literature review of severe corneal side effects related to dupilumab.

Results:
A 27-year-old man with severe atopic dermatitis and no ocular history was administered dupilumab 300 mg via subcutaneous injections every 2 weeks with an excellent response. Following the onset of treatment, the patient developed conjunctivitis, conjunctival papillomas, and dry eyes, which were initially treated with lubricating eye drops. Fourteen months after commencing dupilumab, he had a rapid onset of painful visual loss in the OD accompanied by severe bilateral conjunctival injection and was found to have a central corneal ulcer and diffuse papillomas on the palpebral and bulbar conjunctiva. Despite management with intravenous methylprednisolone and topical dexamethasone, the patient's corneal ulcer progressed to a corneal melt, resulting in perforation 2 months after diagnosis, which necessitated a corneal graft.

Conclusions:
We present the third reported case of dupilumab-associated corneal perforation and the first case to our knowledge of dupilumab-associated conjunctival papillomas. As dupilumab usage increases, awareness of these potential complications among prescribers is essential.
Sex and Sexual Orientation as Potential Risk Factors for Coinfection With Sexually Transmitted Infections in Surabaya, Indonesia: A Single-Center Cross-Sectional Study
Authors: Dewi Arifiana Wungu Kartika , Hidayati Afif Nurul ,   Sawitri, Listiawan M. Yulianto , Ervianti Evy , Astari Linda , Utomo Budi 
Published: November 2024

Objective:
Sexually transmitted diseases are infections transmitted from an infected person to an uninfected person through sexual contact. We conducted this study to evaluate the prevalence and the risk factors of coinfection because there has been few research that thoroughly demonstrates its occurrence in Indonesia, particularly in Surabaya.

Methods:
This research is a retrospective analytical study at Dr Soetomo General Academic Hospital in a period of 2019 to 2021, and primarily aimed to assess risk factors associated with coinfection events in patients with sexually transmitted infections. Patient’s data included sex, age, occupation, marital status, comorbid factors, number of sexual partners, sexual orientation, and patient’s nonsexual behavior were taken from the medical records for analysis. The chi-square test was used to analyze the correlations between variables.

Results:
There were 416 sexually transmitted infection patients between 2019 and 2021. Among them, 187 patients were proved to have coinfections, of which 184 patients had 2 coinfections and 3 patients had 3 coinfections. There was a statistically significant difference in the presence of coinfections according to sex and sexual orientation (both P < 0.001), however, there was no statistically significant association of age, patient’s occupation, marital status, comorbidity, and sexual partner with coinfection of patients with sexually transmitted infections.

Conclusion:
The incidence of coinfection is significantly associated with both sex and sexual orientation in Surabaya, Indonesia. The identified risk factors of coinfection should be considered in the development of local public health strategies to prevent and control sexually transmitted diseases.
Outcomes of Community-Acquired Acute Kidney Injury
Authors: Wang Virginia , Zepel Lindsay , Smith Valerie A. , Brookhart Maurice A. , Bowling Christopher B. , Maciejewski Matthew L. , Diamantidis Clarissa J. 
Published: November 2024

Background:
Community-acquired acute kidney injury (CA-AKI) occurs outside of the hospital and is the most common form of AKI. CA-AKI is not well understood, which hinders efforts to prevent, identify, and manage CA-AKI.

Objective:
Examine 30-day outcomes following CA-AKI using national administrative and lab data from the Veterans Health Administration (VA).

Research Design:
Retrospective cohort study.

Subjects:
VA primary care patients with recorded outpatient serum creatinine (SCr) with observed CA-AKI (cases) and a standardized mortality ratio propensity-weighted 5% comparator sample without observed CA-AKI in 2013–2017.

Measures:
CA-AKI was defined as a ≥1.5-fold relative increase in outpatient SCr or inpatient SCr (≤24 h from admission) from a reference outpatient SCr ≤12 months prior. Outcomes were 30-day mortality and hospitalization and were assessed in separate weighted Cox regression models.

Results:
Among 220,777 CA-AKI events and 492,539 comparators without observed CA-AKI, CA-AKI was associated with a higher risk of 30-day all-cause mortality [hazard ratio (HR)=4.17, 95% CI: 3.74, 4.63] and hospitalization (HR=1.82, 95% CI: 1.74, 1.90) versus comparator. Risks increased with severity (mortality HR=3.02, 7.67, and 12.22 for AKI stages 1–3, respectively). Outpatient CA-AKI was associated with a high risk of mortality (HR=2.04, 95% CI: 1.83, 2.28) and even higher for inpatient CA-AKI, present [≤24 h from admission (HR=11.32, 95% CI: 10.16, 12.61)].

Conclusions:
In a national cohort of Veterans, CA-AKI was associated with a 2-fold increased risk of hospitalization and a 3–11-fold risk of mortality. Improving identification and management is critical to mitigate adverse outcomes of CA-AKI.
Assessment of Antibody Levels and Vaccine-induced Serologic Responses After Completion of Cancer Treatment in Pediatric Patients: A 6-Year Experience in Turkey on HAV, HBV, VZV, and MMR Vaccinations
Authors: Gundesli Sebiha S. , Celik Melda , Yalcin Siddika Songul , Aydin Guzide B. , Kurucu Nilgun , Yalcin Bilgehan , Varan Ali , Kutluk Tezer M. 
Published: November 2024

Objective:
Childhood cancer treatment disrupts vaccination schedules and weakens or eliminates vaccine-induced immunity. In addition, post-treatment vaccine responses vary. This study aimed to assess post-treatment serum antibody levels and vaccine responses in children.

Methods:
Pediatric patients treated at Hacettepe University between years 2015 and 2020, achieved remission after chemotherapy for lymphoma and solid tumors were included. Post-treatment vaccination status, serum antibody levels for hepatitis A (HAV), hepatitis B (HBV), varicella-zoster (VZV), measles-mumps-rubella (MMR), and changes in vaccine responses were retrospectively analyzed.

Results:
The study included 533 patients. Post-treatment seronegativity rates were: measles (83.5%), HAV (64%), rubella (60.1%), HBV (48.5%), VZV (43.3%), and mumps (28%). Post-treatment antibody loss was observed for measles (47.1%), HAV (31.9%), HBV (31.4%), mumps (28.6%), VZV (21.7%), and rubella (11.4%). Seropositivity after 1 vaccine dose was seen with HAV (83.6%), rubella (82.9%), HBV (81.4%), VZV (63.5%), mumps (45.4%), and measles (33.3%). Seropositivity after 2 vaccine doses was achieved with HAV (98.8%), VZV (84.6%), rubella (80%), HBV (80%), measles (32.2%), and mumps (36.2%).

Conclusion:
Post-treatment serological vaccine responses in children were lower than anticipated despite multiple doses. Given the potential need for periodic serological assessments and booster vaccinations, long-term follow-ups are planned.
Summary of the best evidence for vocal rehabilitation training in adults with unilateral vocal fold paralysis
Authors: Tang Caihong , Zhang Xinxin , He Hong , Jing Lingling , Tuo Wangyang , Shi Yulan 
Published: November 2024

Purpose:
To search, evaluate, and summarize the relevant evidence of voice rehabilitation training in adults with unilateral vocal fold paralysis (UVFP).

Methods:
Using the ‘6S’ model, the database of UpToDate, BMJ Best Practice, domestic and foreign guidelines, and voice rehabilitation training for adults with UVFP were systematically searched. The search includes clinical decisions, guidelines, systematic reviews, randomized controlled trials, and expert consensus. Data search since the establishment of the database to 27 November 2023. The quality evaluation of the literature methodology and the extraction and integration of evidence were carried out independently by two researchers.

Results:
A total of 12 literature were included, including 2 systematic reviews, 2 expert consensus, 4 guidelines, 2 clinical decisions, and 2 randomized controlled trials. Four categories of 16 pieces of evidence were summarized: evaluation of vocal cord paralysis, voice rehabilitation training, health education, joint decision-making, and multidisciplinary cooperation.

Conclusion:
This study summarized the best evidence of voice rehabilitation training for adults with UVFP and provided evidence-based summary for clinical staff to carry out relevant interventions.