bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deep Learning in Predicting Preterm Birth: A Comparative Study of Machine Learning Algorithms
Authors: Zhang Fangchao , Tong Lingling , Shi Chen , Zuo Rui , Wang Liwei , Wang Yan 
Published: July 2024

Abstract

Objective
To determine whether deep learning algorithms are suitable for predicting preterm birth.

Methods
A retrospective study was conducted at Peking University Third Hospital from January 2018 to June 2023. Birth data were divided into two parts based on the date of delivery: the first part was used for model training and validation, while real world viability was evaluated using the second part. Four machine learning algorithms (logistic regression, random forest, support vector machine, and transformer) were employed to predict preterm birth. Receiver operating characteristic curves were plotted, and the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated.

Results
This research included data on 30,965 births, where 24,770 comprised the first part, and included 3164 (12.77%) in the preterm birth group, with 6195 in the second part, including 795 (12.83%) in the preterm birth group. Significant differences in various factors were observed between the preterm and full-term birth groups. The transformer model (AUC = 79.20%, sensitivity = 73.67%, specificity = 72.48%, PPV = 28.21%, NPV = 94.95%, and accuracy = 72.61% in the test dataset) demonstrated superior performance relative to logistic regression (AUC = 77.96% in the test dataset), support vector machine (AUC = 71.70% in the test dataset), and random forest (AUC = 75.09% in the test dataset) approaches.

Conclusion
This study highlights the promise of deep learning algorithms, specifically the transformer algorithm, for predicting preterm birth.
Hybrid Inferior Pedicle Reduction Mammaplasty with Free Nipple Grafts in a Patient with Gigantomastia
Authors: Melancon Devin M. , Schwartzberg Harel G. , Messa Genevieve E. , Boraski Jonathan C. 
Published: July 2024

Summary:
Gigantomastia presents a unique set of challenges for preservation of the nipple–areola complex in patients undergoing reduction mammaplasty. Historically an indication for breast amputation and free nipple graft (FNG), gigantomastia is now commonly treated using pedicle-based reconstruction. We present a case combining these two surgical techniques, using an inferior-pedicle reduction with an FNG in the management of extreme breast hypertrophy with 11,300 g in total resected. This case report shows that such a technique for gigantomastia reductions can combine the aesthetic benefits of a pedicled reduction with the reliability of FNGs. These benefits make the hybrid inferior pedicle reduction a useful option, which should be present in every plastic surgeon’s armamentarium when caring for these patients.
Analyzing Google Search Trends for Migraine Surgery and Nurtec in Response to Public Announcements
Authors: Bishay Anthony E. , Fijany Arman J. , Holan Cole , Mubang Ronnie N. , Montorfano Lisandro , Olsson Sofia E. , Troia Thomas , Bakian Arash , Kassis Salam Al , Tran Bill V. 
Published: July 2024

Background:
Nurtec, a versatile migraine medication, has gained popularity. However, the awareness of migraine surgery remains uncertain.

Methods:
Following a descriptive approach, this cross-sectional study used Google Trends data as of December 1, 2023, to analyze internet search patterns. Approval from Vanderbilt University’s institutional review board and adherence to Strengthening the Reporting of Observational Studies in Epidemiology guidelines were confirmed. Monthly relative search volume (RSV) data for “migraine surgery,” “Nurtec,” and “Rimegepant” were collected from January 1, 2004, to November 11, 2023, within the United States. Statistical analysis involved determining mean monthly RSV values and percentage changes for critical periods.

Results:
For “Nurtec,” a significant surge in RSV occurred from March 2020 to April 2020 (344%). Additional peaks were observed from June 2020 to July 2020 (66%), October 2020 to December 2020 (169%), May 2021 to June 2021 (33%), and May 2023 to June 2023 (14%). “Migraine surgery” exhibited a notable 400% increase in RSV, from March 2005 to May 2005. However, post-2006, RSV for “migraine surgery” consistently remained low without noticeable peaks.

Conclusions:
The analysis of RSV trends for “Nurtec” and “migraine surgery” from 2004 to 2023 reveals the impact of pivotal events and marketing strategies on public interest. The distinct peaks in “Nurtec” RSV align with Food & Drug Administration approvals and marketing campaigns, highlighting the medication’s accessibility. Conversely, the consistently low RSV for “migraine surgery” indicates limited awareness, emphasizing the need for enhanced promotion and education regarding surgical interventions.
Research Letter: Characterizing Lifetime Mild TBI Exposure Among Female and Male Military Service Members and Veterans in the LIMBIC-CENC Study
Authors: Walton Samuel R. , Oldham Jessie R. , Remigio-Baker Rosemay A. , Brett Benjamin L. , Austin Tara A. , Cetin Olivia D. , Wilde Elisabeth A. , Lempke Landon B. , Ou Zhining , Kamineni Sreekanth , Martindale Sarah L. , O’Neil Maya E. , Pugh Mary J. , Swanson Randel L. , Pappadis Monique R. , Cifu David X. , Walker William C. 
Published: July 2024

Objective: To (1) characterize lifetime mild traumatic brain injury (TBI) exposures among male and female US military service members and Veterans (SMVs) and (2) evaluate sex-related differences in mild TBI exposures. Setting: Clinical research laboratory. Participants: Participants were enrolled in the ongoing Long-term Impact of Military-relevant Brain Injury Consortium—Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) Prospective Longitudinal Study. Design: Cross-sectional. Main Measures: Lifetime history of mild TBI was measured via structured interview. All mild TBI characteristics were collected as part of this interview, including total lifetime number; environment (deployment vs. non-deployment); timing of injury (relative to military service and age); and mechanism of injury (blast-related vs. non-blast). Results: Most participants (n = 2323; 87.5% male; 79.6% Veteran) reported ≥1 lifetime mild TBI (n = 1912; 82%), among whom, many reported ≥2 lifetime mild TBIs. Female SMVs reported fewer total lifetime mild TBIs than male participants (P < 0.001), including fewer deployment-related (P < 0.001) and non-deployment (P < 0.001) mild TBIs. There were significant sex differences for total number of mild TBIs sustained before (P = 0.005) and during (P < 0.001) military service but not after separation from military service (P = 0.99). Among participants with a lifetime history of mild TBI, female SMVs were less likely to report ≥2 mTBIs (P = 0.003); however, male SMVs were more likely to report a mild TBI during military service (P = 0.03), including combat-related mild TBI (P < 0.001) and mild TBI involving blast (P < 0.001). Conclusions: These findings inform clinical and research efforts related to mild TBI in US military SMVs. It may not be sufficient to simply measure the total number of mild TBIs when seeking to compare clinical outcomes related to mild TBI between sexes; rather, it is important to measure and account for the timing, environment, and mechanisms associated with mild TBIs sustained by female and male SMVs.
Influence of Opacity Depth on Big Bubble Formation During Deep Anterior Lamellar Keratoplasty in Corneal Stromal Scars
Authors: Lucchino Luca , Visioli Giacomo , Scarinci Fabio , Colabelli Gisoldi Rossella Anna Maria , Komaiha Chiara , Giovannetti Francesca , Marenco Marco , Pocobelli Giulio , Lambiase Alessandro , Pocobelli Augusto 
Published: July 2024

Purpose:
To identify the key preoperative predictors of big bubble (BB) formation during deep anterior lamellar keratoplasty in patients with corneal stromal scars (CSS).

Methods:
This retrospective cohort study included consecutive patients with CSS after infective keratitis who underwent BB-deep anterior lamellar keratoplasty between January 2021 and July 2023 at a tertiary referral center. Topographic and tomographic data were collected to compare the rates and types of BB formations. Anterior segment optical coherence tomography (AS-OCT) was employed to assess the maximum depth of opacity by dividing the stroma into 3 zones of equal thickness: anterior (stage A), mid (stage B), and posterior stroma (stage C). Multivariate logistic regression analysis was performed to identify the potential preoperative predictors of bubble formation.

Results:
Pneumatic dissection was achieved in 13 of 33 eyes (39.4%), with 11 BB type 1 eyes (33.3%) and 2 BB type 2 eyes (6.1%). According to AS-OCT grading, bubble formation was more frequent with CSS involving more superficial stromal layers (P <0.032). In the eyes with stage C, bubble formation failed 12 out of 14 times (85.7%, P <0.026). Spearman correlation showed that bubble formation was inversely associated with the AS-OCT grading (rho = −0.443, P = 0.001). After logistic regression analysis, AS-OCT grading was found to be the sole factor that predicted bubble formation (coeff. −1.58, confidence interval 95% −3.03 to −0.12, P = 0.034).

Conclusions:
Depth of opacity in CSS was the key determinant for predicting the success of pneumatic dissection, as advanced AS-OCT stages are strongly associated with BB failure.
Pancreatic Stone Protein in the Diagnosis of Sepsis in Children Admitted to High-Dependency Care: A Single-Center Prospective Cohort Study
Authors: Bottari Gabriella , Paionni Emanuel , Fegatelli Danilo Alunni , Murciano Manuel , Rosati Francesco , Ferrigno Federica , Pisani Mara , Cristaldi Sebastian , Musolino Annamaria , Borrelli Giorgia , Bochicchio Chiara , Romani Lorenza , De Luca Maia , Agosta Marilena , Lancella Laura , Villani Alberto , Vestri Annarita , Atti Marta Ciofi Degli , Perno Carlo F. , Porzio Ottavia , Raponi Massimiliano , Cecchetti Corrado 
Published: July 2024

OBJECTIVES:
Blood level of pancreatic stone protein (PSP) is a promising biomarker of sepsis both in adults and children. The aim of our study was to investigate the diagnostic accuracy of PSP in children with suspected sepsis and to compare diagnostic performance with other sepsis biomarkers approved for clinical use, that is, procalcitonin (PCT) and C-reactive protein (CRP).

DESIGN:
Prospective study.

SETTING:
PICU and pediatric emergency department.

INTERVENTION:
Blood levels of PSP were measured using a nanofluidic point-of-care immunoassay (abioSCOPE, Abionic SA, Switzerland) within 24 hours of admission.

MEASUREMENTS AND MAIN RESULTS:
We studied 99 children aged between older than 1 month and younger than 18 years with signs and symptoms of systemic inflammatory response syndrome (irrespective of associated organ dysfunction). The prevalence of sepsis was 35 of 99 (35.4%). Patients with sepsis had higher PSP levels (p < 0.001) than patients with systemic inflammation of noninfectious cause. In this analysis, the optimal cutoff for the diagnosis of sepsis using PSP was 123 ng/mL, which resulted in a sensitivity of 0.63 (95% CI, 0.43–0.80), specificity of 0.89 (95% CI, 0.77–0.95). The PSP test area under the receiver operating characteristic curve (AUROC) was 0.82 (95% CI, 0.73–0.91) and, by comparison, procalcitonin and CRP AUROC were 0.70 (95% CI, 0.58–0.82) and 0.72 (95% CI, 0.60–0.84), respectively. Overall, the pretest to posttest probability of sepsis with a positive test changed from 0.35 to 0.73.

CONCLUSIONS:
In this single-center prospective pediatric cohort, admitted to the high intensive care and to the PICU, our findings suggested the potential use of PSP as a sepsis biomarker. However, because of the clinical diagnostic uncertainty with a positive result, further investigation is needed particularly in combination with other biomarkers.
Harnessing Mobility: A Medically Complex Child’s Home Program Utilizing an In-Home Body Weight Support System
Authors: Sabet Andrina , Galloway James Cole 
Published: July 2024

Purpose:
To describe a home program for a child with medical complexity using an over-ground body weight support (BWS) system.

Summary of Key Points:
Children with medical complexity often use home programs due to challenges with regular therapy attendance. In this case, effective home program components including child centered design, family leadership, and best practice principles were prioritized around the PUMA (portable mobility aid for children). This BWS system was to be used for 1 hour per day to support mobility and active play.

Statement of Conclusions:
The CMC and family demonstrated high adherence, using over-ground BWS 87% of the 135 days it was accessible with an average daily usage of 59 min spread across 1-3 bouts per day. The average daily fun index during usage was 7/10.

Recommendations for Clinical Practice:
This home program demonstrated over-ground BWS technology as a feasible, fun platform for functional mobility and socialization in a child with significant medical and physical limitations.
Risk Factors for Step-Off Deformity of the Donor Site following Abdominal Flap–Based Breast Reconstruction
Authors: Kim Jisu , Son Sumin , Mun Goo-Hyun 
Published: July 2024

Background:
Step-off deformity is a suboptimal aesthetic outcome at the donor site following abdominal flap harvesting for breast reconstruction. This study assessed the prevalence of step-off deformities after autologous breast reconstruction and explored the associated risk factors.

Methods:
This retrospective study evaluated step-off deformities among consecutive patients who had undergone autologous abdominal flap–based breast reconstruction between January of 2019 and December of 2022. The postoperative evaluation used medical records and photographs, defining step-off deformity as a thickness discrepancy in the upper and lower abdominal tissue with reference to the scar line and angles less than 165 degrees. Moreover, the study explored potential risk factors, including abdominal subcutaneous tissue thickness based on computed tomography.

Results:
In total, 187 patients underwent abdominal flap-based breast reconstruction; 38 exhibited step-off deformity. The case group exhibited significantly higher body mass index (BMI) and greater subcutaneous layer thickness in both the upper and lower abdomen compared with those of the control group. The groups did not differ significantly in postoperative complications, including abdominal bulging or hernia. Multivariable analysis revealed notable risk factors for step-off deformity development: BMI (P = 0.026), presence of preoperative abdominal fold (P = 0.028), and thickness differences between the upper and lower abdomen (P = 0.011). The cut-off values were 26.1 kg/m2 for BMI and 9.5 mm for thickness differences.

Conclusions:
Higher BMI, presence of abdominal fold, and significant upper-lower abdomen tissue thickness differences may be associated with an increased risk of donor step-off deformity after abdominal flap harvest. These findings may inform patient counseling and warrant attention when closing donor wounds in high-risk individuals.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Normothermic Machine Perfusion and Normothermic Regional Perfusion of DCD Kidneys Before Transplantation: A Systematic Review
Authors: Klein Nulend Rowan , Hameed Ahmer , Singla Animesh , Yuen Lawrence , Lee Taina , Yoon Peter , Nahm Chris , Wong Germaine , Laurence Jerome , Lim Wai H. , Hawthorne Wayne J. , Pleass Henry 
Published: July 2024

Background.
To overcome organ shortages, donation after circulatory death (DCD) kidneys are being increasingly used for transplantation. Prior research suggests that DCD kidneys have inferior outcomes compared with kidneys donated after brain death. Normothermic machine perfusion (NMP) and normothermic regional perfusion (NRP) may enhance the preservation of DCD kidneys and improve transplant outcomes. This study aimed to review the evidence surrounding NMP and NRP in DCD kidney transplantation.

Methods.
Two independent reviewers conducted searches for all publications reporting outcomes for NMP and NRP-controlled DCD kidneys, focusing on delayed graft function, primary nonfunction, graft function, graft survival, and graft utilization. Weighted means were calculated for all relevant outcomes and controls. Formal meta-analyses could not be conducted because of significant heterogeneity.

Results.
Twenty studies were included for review (6 NMP studies and 14 NRP studies). Delayed graft function rates seemed to be lower for NRP kidneys (24.6%) compared with NMP kidneys (54.3%). Both modalities yielded similar outcomes with respect to primary nonfunction (NMP 3.3% and NRP 5.6%), graft function (12-mo creatinine 149.3 μmol/L for NMP and 129.9 μmol/L for NRP), and graft utilization (NMP 83.3% and NRP 89%). Although no direct comparisons exist, our evidence suggests that both modalities have good short- and medium-term graft outcomes and high graft survival rates.

Conclusions.
Current literature demonstrates that both NMP and NRP are feasible strategies that may increase donor organ utilization while maintaining acceptable transplant outcomes and likely improved outcomes compared with cold-stored DCD kidneys. Further research is needed to directly compare NRP and NMP outcomes.
Benchmarking of Germline Copy Number Variant Callers from Whole Genome Sequencing Data for Clinical Applications
Authors: De La Vega Francisco M. , Irvine Sean A. , Anur Pavana , Potts Kelly , Kraft Lewis , Torres Raul , Kang Peter , Truong Sean , Lee Yeonghun , Han Shunhua , Onuchic Vitor , Han James 
Published: July 2024

AbstractWhole-genome sequencing (WGS) is increasingly favored over other genomic sequencing methods for clinical applications due to its comprehensive coverage and declining costs. WGS is particularly useful for the detection of copy number variants (CNVs), presumed to be more accurate than targeted sequencing assays such as WES or gene panels, because it can identify breakpoints in addition to changes in coverage depth. Recent advancements in bioinformatics tools, including those employing hardware acceleration and machine learning, have enhanced CNV detection. Although numerous benchmarking studies have been published, primarily focusing on open-source tools for short-read WGS CNV calling, systematic evaluations that encompass commercially available tools that meet the rigorous demands of clinical testing are still necessary. In clinical settings, where the confirmation of reported CNVs is often required, there is a higher priority on sensitivity over specificity/precision compared to research applications. Moreover, clinical gene panel reporting primarily concerns whether a CNV affects coding regions or, in some cases, promoters, rather than the precise detection of breakpoints. This study aims to benchmark the performance of various CNV detection tools tailored for clinical reporting from WGS using reference cell lines, providing insights critical for optimizing clinical diagnostics. Our results indicate that while different tools exhibit strengths in either sensitivity or precision and are better suited for certain classes and lengths of variants, few can deliver the balanced performance essential for clinical testing, where high sensitivity is imperative. Generally, callers demonstrate better performance for deletions than duplications, with the latter being poorly detected in events shorter than 5kb. We demonstrate that the DRAGEN™ v4.2 CNV caller, particularly with custom filters on its high sensitivity mode, offers a superior balance of sensitivity and precision compared to other available tools.
Human gut microbiota interactions shape the long-term growth dynamics and evolutionary adaptations ofClostridioides difficile
Authors: Sulaiman Jordy Evan , Thompson Jaron , Cheung Pak Lun Kevin , Qian Yili , Mill Jericha , James Isabella , Vivas Eugenio I. , Simcox Judith , Venturelli Ophelia 
Published: July 2024

ABSTRACTClostridioides difficilecan transiently or persistently colonize the human gut, posing a risk factor for infections. This colonization is influenced by complex molecular and ecological interactions with human gut microbiota. By investigatingC. difficiledynamics in human gut communities over hundreds of generations, we show patterns of stable coexistence, instability, or competitive exclusion. Lowering carbohydrate concentration shifted a community containingC. difficileand the prevalent human gut symbiontPhocaeicola vulgatusfrom competitive exclusion to coexistence, facilitated by increased cross-feeding. In this environment,C. difficileadapted via single-point mutations in key metabolic genes, altering its metabolic niche from proline to glucose utilization. These metabolic changes substantially impacted inter-species interactions and reduced disease severity in the mammalian gut. In sum, human gut microbiota interactions are crucial in shaping the long-term growth dynamics and evolutionary adaptations ofC. difficile, offering key insights for developing anti-C. difficilestrategies.
Virological characteristics of the SARS-CoV-2 KP.3.1.1 variant
Authors: Kaku Yu , Uriu Keiya , Okumura Kaho , Ito Jumpei , Sato Kei ,   The Genotype to Phenotype Japan (G2P-Japan) Consortium
Published: July 2024

AbstractThe SARS-CoV-2 JN.1 variant (BA.2.86.1.1), arising from BA.2.86.1 with spike protein (S) substitution S:L455S, outcompeted the previously predominant XBB lineages by the beginning of 2024. Subsequently, JN.1 subvariants including KP.2 (JN.1.11.1.2) and KP.3 (JN.1.11.1.3), which acquired additional S substitutions e.g., S:R346T, S:F456L, and S:Q493E, have emerged concurrently. Thereafter, JN.1 subvariants, such as LB.1 (JN.1.9.2.1), KP.2.3 (JN.1.11.1.2.3), and KP.3.1.1 (JN.1.11.1.3.1.1), which convergently acquired a deletion of Serine at the 31st position in S (S:S31del) in addition to the above substitutions, have emerged and spread as of June 2024. We recently reported the virological features of JN.1 subvariants including KP.2, KP.3, LB.1, and KP.2.3.2,3 Here, we investigated the virological properties of KP.3.1.1. First, we estimated the relative effective reproduction number (Re) of KP.3.1.1 using a Bayesian multinomial logistic model4 based on genome surveillance data from Spain, the USA, France, Canada, and the UK, where this variant has spread as of June 2024. In Spain, the Re of KP.3.1.1 is over 1.2-fold higher than that of JN.1 and even higher than those of KP.2, KP.3, LB.1, and KP.2.3. Additionally, the other countries under investigation herein show higher Re for KP.3.1.1. However, it must be noted there is the possibility of overestimation in these countries due to more limited KP.3.1.1 sequence numbers. These results suggest that KP.3.1.1 will spread worldwide along with other JN.1 sublineages. We then assessed the virological properties of KP.3.1.1 using pseudoviruses. The pseudovirus of KP.3.1.1 had significantly higher infectivity than that of KP.3. Neutralization of KP.3.1.1 was tested using i) convalescent sera after breakthrough infection (BTI) with XBB.1.5 or EG.5, ii) convalescent sera after the infection with HK.3 or JN.1, and iii) sera after monovalent XBB.1.5 vaccination. The 50% neutralization titer (NT50) against KP.3.1.1 was significantly lower than KP.3 (1.4–1.6-fold) in all four groups of convalescent sera tested. KP.3.1.1 also showed a 1.3-fold lower NT50 against XBB.1.5 vaccine sera than KP.3. Moreover, KP.3.1.1 showed stronger resistance with a 1.3-fold lower NT50 with statistical significances to the convalescent sera infected with EG.5 and HK.3 than KP.2.3. Altogether, KP.3.1.1 exhibited a higher Re, higher pseudovirus infectivity, and higher neutralization evasion than KP.3. These results align with our recent report that the JN.1 subvariants with S:S31del (e.g., KP.2.3 and LB.1) exhibited enhanced Re and immune evasion compared to the other JN.1 subvariants without S:S31del (e.g., JN.1, KP.2, and KP.3), highlighting the evolutionary significance of S:S31del in the JN.1 lineages.