bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric immunotherapy and HIV control
Authors: Chinunga Tehillah T. , Chahroudi Ann , Ribeiro Susan P. 
Published: May 2024

Purpose of reviewHighlighting opportunities/potential for immunotherapy by understanding dynamics of HIV control during pediatric HIV infection with and without antiretroviral therapy (ART), as modeled in Simian immunodeficiency virus (SIV) and Simian-human immunodeficiency virus (SHIV)-infected rhesus macaques and observed in clinical trials. This review outlines mode of transmission, pathogenesis of pediatric HIV, unique aspects of the infant immune system, infant macaque models and immunotherapies.Recent findingsDuring the earliest stages of perinatal HIV infection, the infant immune system is characterized by a unique environment defined by immune tolerance and lack of HIV-specific T cell responses which contribute to disease progression. Moreover, primary lymphoid organs such as the thymus appear to play a distinct role in HIV pathogenesis in children living with HIV (CLWH). Key components of the immune system determine the degree of viral control, targets for strategies to induce viral control, and the response to immunotherapy. The pursuit of highly potent broadly neutralizing antibodies (bNAbs) and T cell vaccines has revolutionized the approach to HIV cure. Administration of HIV-1-specific bNAbs, targeting the highly variable envelope improves humoral immunity, and T cell vaccines induce or improve T cell responses such as the cytotoxic effects of HIV-1-specific CD8+T cells, both of which are promising options towards virologic control and ART-free remission as evidenced by completed and ongoing clinical trials.SummaryUnderstanding early events during HIV infection and disease progression in CLWH serves as a foundation for predicting or targeting later outcomes by harnessing the immune system's natural responses. The developing pediatric immune system offers multiple opportunities for specific long-term immunotherapies capable of improving quality of life during adolescence and adulthood.
Artificial Intelligence–Assisted Prescription Determination for Orthokeratology Lens Fitting: From Algorithm to Clinical Practice
Authors: Lan Wei-Zhong , Tang He , Wen Long-Bo , Chen Zhao , Zhou Yong-li , Dai Wei-wei , Wang Mao , Li Xiao-ning , Wang Wei-Jia , Tang Fan , Yang Zhi-kuan , Tang Yong 
Published: May 2024

Objectives:
To explore the potential of artificial intelligence (AI) to assist prescription determination for orthokeratology (OK) lenses.

Methods:
Artificial intelligence algorithm development followed by a real-world trial. A total of 11,502 OK lenses fitting records collected from seven clinical environments covering major brands. Records were randomly divided in a three-way data split. Cross-validation was used to identify the most accurate algorithm, followed by an evaluation using an independent test data set. An online AI-assisted system was implemented and assessed in a real-world trial involving four junior and three senior clinicians.

Results:
The primary outcome measure was the algorithm's accuracy (ACC). The ACC of the best performance of algorithms to predict the targeted reduction amplitude, lens diameter, and alignment curve of the prescription was 0.80, 0.82, and 0.83, respectively. With the assistance of the AI system, the number of trials required to determine the final prescription significantly decreased for six of the seven participating clinicians (all P<0.01). This reduction was more significant among junior clinicians compared with consultants (0.76±0.60 vs. 0.32±0.60, P<0.001). Junior clinicians achieved clinical outcomes comparable to their seniors, as 93.96% (140/149) and 94.44% (119/126), respectively, of the eyes fitted achieved unaided visual acuity no worse than 0.8 (P=0.864).

Conclusions:
AI can improve prescription efficiency and reduce discrepancies in clinical outcomes among clinicians with differing levels of experience. Embedment of AI in practice should ultimately help lessen the medical burden and improve service quality for myopia boom emerging worldwide.
Prevalence of Dry Eye Disease in Laser-Assisted In Situ Keratomileusis Candidates
Authors: Cartes Cristian , Aravena Camila , Monsalve Alejandro , Segovia Christian , Romero Cristobal , Quidel Daniela , Cid Fernanda , Monsalve Rudy , Navarro Luis , Araya Daniela , Araneda Daniela , Sepulveda Maylyn 
Published: May 2024

Objective:
To evaluate the prevalence of dry eye disease (DED) in laser-assisted in situ keratomileusis (LASIK) candidates.

Methods:
A chart review of consecutive LASIK candidates who underwent full ocular surface work-up was performed, including ocular surface disease index (OSDI), noninvasive tests (noninvasive tear breakup time [ni-TBUT], tear meniscus height, lipid layer thickness, and meibography), and invasive tests (Schirmer test I, fluorescein TBUT, corneal staining, and meibomian gland [MG] expressibility). The prevalence of DED was calculated according to the Dry Eye Workshop II (DEWS II), and Japanese and Asia Dry Eye Society (JDES/ADES) criteria.

Results:
In total, 135 patients (270 eyes) were evaluated. The mean age was 32.6±8.3 years, and 62.9% were women (n=85); 19 patients (15.4%) wore contact lenses, and 31 patients (23.8%) used artificial tears. The mean OSDI was 18.2±16.9, which was abnormal in 54.1% (n=62). Inferior lid MG dropout was the sign with the highest percentage of abnormal results (61.5%; n=83). There were no differences between men and women in any test except for ni-TBUT (6.3±0.3 and 7.2±0.2, respectively; P=0.002). Dry eye disease prevalence was 25.9% and 53.3%, according to JDES/ADES and DEWS II criteria, respectively. The only significant risk factor for DED was artificial tear use for both DEWS II (odds ratio [OR]=3.5, confidence interval [CI] [1.35–9.39]) and JDES/ADES (OR=2.58, CI [1.03–6.48]).

Conclusions:
This study found a high prevalence of DED and abnormalities in LASIK candidates and highlights the importance of ocular surface evaluation before photorefractive surgery.
Investigating the topographic effect of epithelium in myopic eyes with subtle topographic preoperative abnormalities
Authors: Salah-Mabed Imene , Saad Alain , Gatinel Damien 
Published: May 2024

Purpose:
To explore the topographic effect of the epithelium in keratoconus suspected (KCS) and in normal Placido classified corneas.

Setting:
Rothschild Foundation, Paris, France.

Design:
Prospective interventional case series.

Methods:
Anterior corneal specular Placido topography using OPD-Scan II was performed in 97 eyes of 67 patients undergoing photorefractive keratectomy for myopia, before and after epithelium removal. The differences in axial keratometry, asphericity, and astigmatism were computed.

Results:
After epithelial peeling, some Placido-normal classified corneas became KCS. Therefore, we have subdivided this group into 2 groups: one of normal classified corneas which stayed normal after epithelium removal (Group NN) and another of corneas that became KCS classified (Group NK). The mean difference in axial mean keratometry in the third central millimeter rings was +0.50 ± 0.24 diopters (D), 0.69 ± 0.31 D, and 0.49 ± 0.35 D and the mean difference in the magnitude of epithelial-induced astigmatism in the first central millimeter ring was 0.37 D × 89 degrees (positive cylinder), 0.54 D 86 degrees, and 0.52 D 86 degrees, respectively, in Group NN, NK, and KK (KCS corneas that stayed KCS). These differences were significant (P < .0001). Preoperative keratometry was the only predictive factor differentiating Group NN from NK (P < .001).

Conclusions:
The epithelial layer tended to reduce the magnitude of the Bowman layer's astigmatism, prolateness, and keratometry, more importantly in Group NK. In the KK group, we found a similar trend as in normal eyes (Group NN). The epithelium would be able to mask Bowman layer's irregularities until a certain degree of severity.
The CLABSI Playbook: Design and Implementation of a Multipronged Approach to Decrease CLABSIs
Authors: Bohan Christian O. , Mlinarich Joseph , Hahn Donna , Shelly Mark , Dang Navneet 
Published: May 2024

ABSTRACT
Central line–associated blood stream infections (CLABSIs) are a quality marker for the critical care environment. They have become an area of particular interest because they cost the healthcare system close to a billion dollars per year and have a significant impact on patient safety. Through a preliminary analysis of our system's CLABSI rates, we found significantly higher rates than the national average, prompting further investigation. We decreased our CLABSI rate by over 40% from 2021 (1.6 per 1,000 line days) to the fourth quarter of 2022 (0.91) and kept the rate below or around the national rate (0.86) for the last three quarters of 2022. Through looking at current outcome data, identifying key stakeholders, developing dedicated committees, conducting root cause analyses, monitoring progress, adjusting procedures, scaling to the system, and continuously monitoring and reporting results, we have shown the efficacy of this kind of quality improvement structure and strive to reduce our hospital system's impact on avoidable healthcare-associated patient harm.
A Scoping Review of Complementary and Alternative Medicine for Human Papillomavirus Infections and Cervical Dysplasia
Authors: Walsh Caroline J. , Friedman Julie C. , Piper Christi , Conageski Christine 
Published: May 2024

Objective
The goal of this scoping review is to synthesize clinically relevant scientific literature on current complementary and alternative medications that address human papillomavirus (HPV) infections and cervical dysplasia.

Materials and Methods
A systematic search of published studies was performed December 2021 for the following concepts: human papilloma virus, cervical dysplasia, and complementary and alternative medicine (CAM). Relevant publications were identified by searching Ovid MEDLINE ALL, Embase, Cochrane Library, AMED, and MEDLINE databases, in addition to clinical trial databases. Data were extracted based on specific study selection criteria and analyzed by 3 authors independently using Covidence software.

Results
A total of 2324 studies were identified of which 56 met inclusion criteria. Treatment outcomes measured regression of HPV, improvement of cervical cytology, and/or regression of histopathology with varied definitions of success across all studies. The CAM therapies found to have the most clinical benefit and best supporting data via randomized control trials were topical mushroom (Coriolus versicolor) gel, oral and topical selenium therapies, and oral indol-3-carbinol. Adverse events were reported in only 28/56 (50%) of included studies.

Conclusions
The evidence for treating HPV and cervical dysplasia with CAM is of low quality because of lack of standardized, clinically relevant treatment outcomes, lack of standardization of products, and minimal reporting on adverse and long-term effects. Future large, randomized control trials are needed to further assess efficacy and safety of CAM therapies to address HPV and cervical dysplasia.
Time Differences From Abnormal Cervical Cancer Screening to Colposcopy Between Insurance Statuses
Authors: Khurana Sonia , Smolar Isaiah , Warren Leslie , Velasquez Jessica , Kaplowitz Elianna , Rios Jeanette , Pero Adriana , Roberts Harley , Mitchell Mackenzie , Oner Ceyda , Abraham Cynthia 
Published: May 2024

Objective
Screening and diagnostic follow-up to prevent cervical cancer are influenced by socioeconomic and systemic factors. This study sought to characterize intervals from abnormal cervical cancer screening to colposcopy between practices differing by insurance status at a large, urban academic center.

Materials and Methods
This retrospective cohort study included patients aged 21–65 who presented for colposcopy between January 1, 2021, and January 1, 2022, at the resident and faculty gynecology practices of a single large urban academic medical center. Patient characteristics were compared using t tests or Wilcoxon rank sum tests for continuous measures and χ2 or Fisher exact tests for categorical measures. Intervals from abnormal cervical cancer screening to colposcopy were compared using the Wilcoxon rank sum test and linear regression analysis with multivariable models adjusted for age, cervical cytology result, human papillomavirus result, and HIV status.

Results
Resident practice patients were publicly insured and more likely to be Black or Hispanic (p < .0001); rates of high-risk human papillomavirus and smoking were similar. Resident practice patients had longer intervals from abnormal cervical cancer screening to colposcopy compared with faculty practice patients (median 79.5 vs 34 d, p < .0001). On adjusted analysis, resident practice patients faced a 95% longer interval (p < .0001).

Conclusions
Publicly insured patients of a resident-based practice faced significantly longer intervals from abnormal cervical cancer screening to colposcopy than faculty practice patients at a single urban academic center. Effort to address these differences may be an area of focus in improving health disparities.
Psychosocial Factors Associated With Vulvodynia
Authors: Queiroz Janice F. , Aquino Antonio C.Q. , Sarmento Ayane C.A. , Siqueira Beatriz B. , Medeiros Heitor D. , Falsetta Megan L. , Maurer Tracey , Gonçalves Ana Katherine 
Published: May 2024

Objectives
We set out to identify the psychosocial factors associated with vulvodynia and the effects on sexuality, mental health, and quality of life.

Materials and Methods
PubMed, LILACS, Embase, CINAHL, Web of Science, Scopus, and PsycINFO were searched in August 2023. Two authors selected and extracted the data independently. The risk of bias was assessed using the Newcastle-Ottawa Scale for Observational Studies. To rank the strength of evidence, the Grading of Recommendations Assessment, Development and Evaluation Working Group (GRADE) approach was utilized.

Results
A total of 3,182 articles were identified. Twenty-two observational studies (8 cohorts and 14 case-controls) met the eligibility criteria and were included, comprising 2,624 patients. Vulvodynia has been associated with psychological factors (anxiety and depression) and social factors (childhood exposure to physical and sexual abuse, posttraumatic stress, and domestic abuse). Concerning sexual function, the most frequent outcomes were dyspareunia and sexual dysfunction. Only one study assessed quality of life, which showed that women with chronic vulvar pain had greater difficulty performing physical activities and experienced negative moods and feelings. The assessment of the risk of bias showed that the average quality of studies was good to excellent. However, the studies failed to select the nonexposed cohort or control group to describe the results, and often, the study population was rather small, which made it impossible to carry out a meta-analysis.

Conclusions
The certainty of evidence for the associations between anxiety and depression, vulvodynia, and sexual functioning suggests that combating these factors could improve overall quality of life in vulvodynia patients.
Aryl Hydrocarbon Receptor Knockout Accelerates PanIN Formation and Fibro-Inflammation in a Mutant Kras-Driven Pancreatic Cancer Model
Authors: Walcheck Morgan T. , Schwartz Patrick B. , Carrillo Noah D. , Matkowskyj Kristina A. , Nukaya Manabu , Bradfield Christopher A. , Ronnekleiv-Kelly Sean M. 
Published: May 2024

Objectives
The pathogenesis of pancreas cancer (PDAC) remains poorly understood, hindering efforts to develop a more effective therapy for PDAC. Recent discoveries show the aryl hydrocarbon receptor (AHR) plays a crucial role in the development of several cancers and can be targeted for therapeutic effect. However, its involvement in the pathogenesis of PDAC remains unclear. To address this gap, we evaluated the role of AHR in the development of PDAC precancerous lesions in vivo.

Materials and Methods
We created a global AHR-null, mutant Kras-driven PDAC mouse model (A−/−KC) and evaluated the changes in PDAC precursor lesion formation (PanIN‐1, 2, and 3) and associated fibro-inflammation between KC and A−/−KC at 5 months of age. We then examined the changes in the immune microenvironment followed by single-cell RNA-sequencing analysis to evaluate concomitant transcriptomic changes.

Results
We identified a significant increase in PanIN-1 lesion formation and PanIN-1 associated fibro-inflammatory infiltrate in A−/−KC versus KC mice. This was associated with significant changes in the adaptive immune system, particularly a decrease in the CD4+/CD8+ T-cell ratio, as well as a decrease in the T-regulatory/Th17 T-cell ratio suggesting unregulated inflammation.

Conclusions
These findings show the loss of AHR results in heightened Kras-induced PanIN formation, through modulation of immune cells within the pancreatic tumor microenvironment.
Dynamic Prediction of Mortality Using Longitudinally Measured Pediatric Sequential Organ Failure Assessment Scores: A Joint Modeling Approach*
Authors: Akhondi-Asl Alireza , Geva Alon , Burns Jeffrey P. , Mehta Nilesh M. 
Published: May 2024

OBJECTIVES:
The pediatric Sequential Organ Failure Assessment (pSOFA) score was designed to track illness severity and predict mortality in critically ill children. Most commonly, pSOFA at a point in time is used to assess a static patient condition. However, this approach has a significant drawback because it fails to consider any changes in a patients’ condition during their PICU stay and, especially, their response to initial critical care treatment. We aimed to evaluate the performance of longitudinal pSOFA scores for predicting mortality.

DESIGN:
Single-center, retrospective cohort study.

SETTING:
Quaternary 40-bed PICU.

PATIENTS:
All patients admitted to the PICU between 2015 and 2021 with at least 24 hours of ICU stay.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
We calculated daily pSOFA scores up to 30 days, or until death or discharge from the PICU, if earlier. We used the joint longitudinal and time-to-event data model for the dynamic prediction of 30-day in-hospital mortality. The dataset, which included 9146 patients with a 30-day in-hospital mortality of 2.6%, was divided randomly into training (75%) and validation (25%) subsets, and subjected to 40 repeated stratified cross-validations. We used dynamic area under the curve (AUC) to evaluate the discriminative performance of the model. Compared with the admission-day pSOFA score, AUC for predicting mortality between days 5 and 30 was improved on average by 6.4% (95% CI, 6.3–6.6%) using longitudinal pSOFA scores from the first 3 days and 9.2% (95% CI, 9.0–9.5%) using scores from the first 5 days.

CONCLUSIONS:
Compared with admission-day pSOFA score, longitudinal pSOFA scores improved the accuracy of mortality prediction in PICU patients at a single center. The pSOFA score has the potential to be used dynamically for the evaluation of patient conditions.
Measuring Physical Function in the PICU: Development and Testing of a Children’s Version (Age 2–18 yr) of the Chelsea Critical Care Physical Assessment Tool
Authors: Ferguson Alexandra H. , Stockton Kellie A. , Wright Sarah E. , George Joanne M. , Fulton Tessa J. , Stocker Christian , Long Debbie A. 
Published: May 2024

OBJECTIVES:
To adapt and develop a reliable and easily administered outcome measure of physical and respiratory function in critically ill children in the PICU.

DESIGN:
Modified Delphi study to adapt the Chelsea Critical Care Physical Assessment (CPAx) tool for use in children 2–18 years old, with subsequent prospective testing in a single-center cohort.

SETTING:
Single-center tertiary PICU.

SUBJECTS:
Delphi process in 27 panelists (including physiotherapists, occupational therapists, and pediatric intensivists from seven countries from January 2018 to March 2018). Cohort study in 54 patients admitted to PICU for greater than 24 hours over a 3-month period (April 2018 to June 2018), with median age 5.5 years (interquartile range [IQR], 3–12.75 yr), 33 of 54 male, and 38 of 54 invasively ventilated.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Three Delphi iterations were required to reach greater than or equal to 80% consensus in all the children’s CPAx (cCPAx) items. In the subsequent cohort study, six physiotherapists used the cCPAx tool and scored 54 participants, with a total 106 observations. The median cCPAx tool score was 14.50 (IQR, 3–25) out of a possible total of 50. Inter-rater reliability for 30 randomly selected participants was excellent (intraclass correlation coefficient, 0.998). Completion rate of cCPAx in the 54 patients occurred in 78 of 106 occasions (74%).

CONCLUSIONS:
The cCPAx tool content that was developed using Delphi methodology provided a feasible and clinically relevant tool for use in assessing physical morbidity in PICU patients 2–18 years old. Overall, the cCPAx scores were low, demonstrating low levels of physical function and high levels of immobility during PICU care.
Pre–Coronary Artery Bypass Grafting Computed Tomography–Based Fractional Flow Reserve Predicts Graft Failure: Implications for Planning Invasive Treatment of Coronary Artery Disease
Authors: Wardziak Łukasz , Kruk Mariusz , Demkow Marcin , Kępka Cezary 
Published: May 2024

Objective
The aim of the study is to evaluate whether a pre–coronary artery bypass grafting (CABG) coronary computed tomography-based fractional flow reserve (FFR-CT) result at the site of a future anastomosis would predict the graft failure in patients undergoing CABG.

Methods
In 43 patients who had coronary computed tomography angiography (CCTA) prior to the CABG, follow-up CCTA were acquired >12 months post-CABG procedure. The FFR-CT values were simulated on the basis of the pre-CABG CCTA. Based on follow-up CCTA, the anastomosis sites and the graft patency were determined. The graft failure was defined as either its stenosis >50% or occlusion.

Results
Ninety eight (44 saphenous, 54 left or right internal mammary artery) grafts were assessed. Eighteen grafts from 16 patients were dysfunctional on follow-up CCTA. The FFR-CT values at the location of future anastomosis were higher in dysfunctional than in normal grafts (0.77 [0.71–0.81] vs 0.60 [0.56–0.66], respectively, P = 0.0007). Pre-CABG FFR-CT (hazard ratio = 1.1; 95% CI: 1.012–1.1, P = 0.0230), and bypass graft to right coronary artery (hazard ratio = 3.7; 95% CI: 1.4–9.3 vs left anterior descending artery) were independent predictors of graft dysfunction during follow-up. The optimal threshold of FFR-CT to predict graft failure was >0.68 (sensitivity 88.9% (95% CI: 65.3–98.6), specificity 63.7% (95% CI: 52.2–74.2), positive predictive value 35.6% (95% CI: 28.3%–43.5%), negative predictive value 96.2% (95% CI: 87.2%–99.0%)).

Conclusions
Pre-CABG functional FFR-CT predicts future coronary bypass graft failure. This shows utility of FFR-CT for guiding coronary revascularization and also suggests significance of physiological assessment prior to CABG.
Hepatic PSMA-Avid Postradiation Inflammation
Authors: Silveira Patrick , Razmaria Aria , Yeh Randy 
Published: May 2024

Abstract
A 62-year-old man with de novo large volume metastatic prostate cancer to the bone, liver, and nodes status post multiple lines of therapy including external beam radiation to T12–L2 approximately 13 months prior underwent 68Ga-PSMA PET/CT to determine eligibility for 177Lu-PSMA therapy. 68Ga-PSMA PET/CT demonstrated tracer-avid osseous and nodal lesions consistent with metastases. In addition, regional geographic tracer avidity was seen in the midline left hepatic lobe associated with capsular retraction and demonstrated no FDG avidity on subsequent imaging, probably inflammatory related to prior radiation to T12–L2.