bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dorsal Preservation Rhinoplasty in Asian Hump Noses
Authors: Jin Hong Ryul , Kim Yonjae , Jeon Yung Jin 
Published: March 2023

Summary:
Dorsal preservation rhinoplasty, which preserves the bony-cartilaginous junction and the keystone, has been gaining popularity in Western countries for hump nose correction. We aimed to report the feasibility, surgical outcome, and technical considerations of dorsal preservation rhinoplasty in Asian hump nose correction. A retrospective case series study was performed on nine patients who had undergone primary dorsal preservation rhinoplasty for hump nose correction. Rhinoplasty was performed by the senior author (HRJ) from March 2019 to December 2021. Clinical charts, graphic operation records, and standardized photographs of the patients were retrospectively reviewed and analyzed. Surgeries were performed through an open approach in all patients. Either the push-down (n = 3) or let-down technique (n = 6) was used for dorsal preservation. All patients underwent tip modification with or without radix graft together with DPR. Bony step-off camouflage at the transverse osteotomy site was required in three patients. After surgery, both the nasofacial and rhinion angles exhibited significant changes (p = 0.008). In all cases, hump reduction was successful without recurrence or saddle nose, and no major complications occurred. All patients were satisfied with the aesthetic and functional results. Dorsal preservation rhinoplasty seems to be a viable option for correcting Asian hump noses. Technical considerations include a preference for the open approach, camouflage of bony step-off deformity, and strategic management of the septal cartilage considering tip modification.
Impact of COVID-19 on HIV Adolescent Programming in 16 Countries With USAID-Supported PEPFAR Programs
Authors: Okegbe Tishina , Williams Jessica , Plourde Kate F. , Oliver Kelsey , Ddamulira Barbara , Caparrelli Kristina ,   USAID/PEPFAR Adolescent Group
Published: March 2023

Introduction:
The COVID-19 pandemic has disrupted access to critical health services, resulting in diminished gains in HIV epidemic control. This review assesses the magnitude of the impact that the COVID-19 pandemic has had on HIV services for adolescents.

Methods:
PEPFAR Monitoring, Evaluation, and Reporting programmatic data were analyzed from across 16 USAID-supported adolescent care and treatment programs for fiscal year 2020 (FY20; October 2019–September 2020). Descriptive statistics were used to calculate absolute number and percent change between the pre-COVID-19 (Quarters 1–2; October 2019–March 2020) and COVID-19 periods (Quarters 3–4; April 2020–September 2020) for clinical cascade indicators. All analyses were conducted in Microsoft Excel.

Results:
The number of HIV tests conducted during COVID-19 decreased by 21.4% compared with pre-COVID-19, with a subsequent 28% decrease in adolescents identified living with HIV. The rate of proxy linkage to antiretroviral therapy increased between periods, from 86.9% to 90.4%. There was a 25.9% decrease in treatment initiations among adolescents during COVID-19. During FY20, viral load coverage rates for adolescents dropped from 81.6% in FY20Q1 to 76.5% in FY20Q4, whereas the rates of viral load suppression for adolescents increased from 76.1% in FY20Q1 to 80.5% in FY20Q4.

Conclusion:
There was a substantial decrease in case-finding, treatment initiations, and viral load coverage rates for adolescents supported in USAID/PEPFAR programs during the COVID-19 pandemic. Additional health systems adaptations and strategies are required to ensure adolescents have continued access to HIV services during pandemic disruptions.
Standardization of the One-anastomosis Gastric Bypass Procedure for Morbid Obesity: Technical Aspects and Early Outcomes
Authors: Sakran Nasser , Haj Bassel , Pouwels Sjaak , Buchwald Jane N. , Abo Foul Salma , Parmar Chetan , Awad Ali , Arraf Jabra , Omari Abdallah , Hamoud Mohamad 
Published: March 2023

Background:
One-anastomosis gastric bypass (OAGB) has become an accepted metabolic/bariatric surgery procedure. This study aimed to describe our center’s standardized OAGB operative technique and report early (≤30 d) safety outcomes in patients with severe obesity.

Methods:
The medical records of patients who had undergone either primary (n=681, 88.0%) or revisional OAGB (n=93, 12.0%) were retrospectively evaluated. Patient demographics, operative time, length of hospital stay, readmissions, reoperations, and ≤30-day morbidity and mortality rates were analyzed.

Results:
A total of 774 consecutive patients with severe obesity (647 female, 83.6%) underwent OAGB between January 2016 and December 2021. Their mean age was 36.2±10.8 years (range: 18 to 70 y) and mean body mass index was 42.7±4.2 kg/m2 (range: 17.2 to 61 kg/m2). Mean operating time was 52.6±19.9 minutes (range: 25 to 295 min) and length of hospital stay was 1.6±0.9 days (range: 1 to 9 d). Early postoperative complications occurred in 16 cases (2.1%), including 2 leaks with an intra-abdominal abscess (0.3%), bleeding (n=3, 0.4%), acute kidney failure (n=1, 0.15%), urinary tract infection (n=2, 0.3%), and intensive care unit stay (n=4, 0.5%). Seventy patients (9.1%) were readmitted, and re-laparoscopy was performed in 1 patient (0.1%). There was no mortality.

Conclusions:
In the very early term, OAGB was a safe primary and revisional metabolic/bariatric surgery operation. Consistent performance of a standardized OAGB procedure contributed to low rates of morbidity and mortality in the hands of metabolic/bariatric surgeons with good laparoscopic skills at a high-volume center.
A Novel Robotic Approach for the Repair of Abdominal Wall Hernias With Concomitant Diastasis Recti: Outcomes and Long-term Follow-up
Authors: Aitken Gabriela , Gallego Eckstein Jeremy 
Published: March 2023

Background:
Diastasis recti (DR) is defined as the separation of the rectus muscles as a result of the linea alba thinning and stretching. The purpose of this study was to evaluate the long-term outcomes of a new technique, robotic rectus abdominis medialization (rRAM), for DR repair with a concomitant ventral hernia.

Methods:
Patients who underwent rRAM for repair of DR and a concomitant ventral hernia were identified between January 2015 and December 2020. The results are from a single surgeon at a single institution.

Results:
A total of 40 patients were identified, 29 of which were female. The mean age was 43 years, the mean body mass index was 27 kg/m2, and the mean inter-rectus distance was 6 cm based on available preoperative imaging. The median postoperative length of stay was 1 day, and the median follow-up time was 1 month. Within 30 postoperative days, 3 patients were re-admitted and 5 developed complications, of which 1 required operative re-intervention for seroma. Beyond 30 days, 3 patients required operative re-intervention most commonly for persistent pain from suture material. On the basis of computed tomography scans performed at a mean of 30 months after the date of service, the mean postoperative inter-rectus distance was 1 cm; 1 patient had DR recurrence, and 1 patient developed a new incisional hernia without DR recurrence. There was no hernia recurrence.

Conclusions:
rRAM is a safe and effective technique for DR repair with a concomitant ventral hernia. Further studies are needed to determine how outcomes from this robotic approach compare with those from different robotic, laparoscopic, and open techniques.
Death is overrated: the potential role of detection in driving virulence evolution
Authors: Kennedy David A. 
Published: March 2023

A common assumption in the evolution of virulence theory literature is that pathogens transmit better when they exploit their host more heavily, but by doing so, they impose a greater risk of killing their host, thus truncating infectious periods and reducing their own opportunities for transmission. Here, I derive an equation for the magnitude of this cost in terms of the infection fatality rate, and in doing so, I show that there are many cases where mortality costs are too small to plausibly constrain increases in host exploitation by pathogens. I propose that pathogen evolution may often be constrained by detection costs, whereby hosts alter their behaviour when infection is detectable, and thus reduce pathogen opportunities for onward transmission. I then derive an inequality to illustrate when mortality costs or detection costs impose stronger constraints on pathogen evolution, and I use empirical data from the literature to demonstrate that detection costs are frequently large in both human and animal populations. Finally, I give examples of how evolutionary predictions can change depending on whether costs of host exploitation are borne out through mortality or detection.
Computational Phenotypes for Patients with Opioid-Related Disorders Presenting to the Emergency Department
Authors: Taylor Richard Andrew , Gilson Aidan , Schulz Wade , Lopez Kevin , Young Patrick , Pandya Sameer , Coppi Andreas , Chartash David , Fiellin David , D’Onofria Gail 
Published: March 2023

AbstractObjectiveWe aimed to discover computationally-derived phenotypes of opioid-related patient presentations to the emergency department (ED) via clinical notes and structured electronic health record (EHR) data.MethodsThis was a retrospective study of ED visits from 2013-2020 across ten sites within a regional healthcare network. We derived phenotypes from visits for patients 18 years of age with at least one prior or current documentation of an opioid-related diagnosis. Natural language processing was used to extract clinical entities from notes, which were combined with structured data within the EHR to create a set of features. We performed Latent Dirichlet allocation to identify topics within these features. Groups of patient presentations with similar attributes were identified by cluster analysis.ResultsIn total 82,577 ED visits met inclusion criteria. The 30 topics discovered ranged from those related to substance use disorder, chronic conditions, mental health, and medical management. Clustering on these topics identified nine unique cohorts with one-year survivals ranging from 84.2-96.8%, rates of one-year ED returns from 9-34%, rates of one-year opioid event 10-17%, rates of medications for opioid use disorder from 17-43%, and a median Carlson comorbidity index of 2-8. Two cohorts of phenotypes were identified related to chronic substance use disorder, or acute overdose.ConclusionsOur results indicate distinct phenotypic clusters with varying patient-oriented outcomes which provide future targets better allocation of resources and therapeutics. This highlights the heterogeneity of the overall population, and the need to develop targeted interventions for each population.
The impact of damaging epilepsy and cardiac genetic variant burden in sudden death in the young
Authors: Puckelwartz Megan J. , Pesce Lorenzo L. , Hernandez Edgar J. , Webster Gregory , Dellefave-Castillo Lisa M. , Russell Mark W. , Geisler Sarah S. , Kearns Samuel D. , Etheridge Felix K , Etheridge Susan P. , Monroe Tanner O. , Pottinger Tess D. , Kannankeril Prince J. , Shoemaker M. Benjamin , Fountain Darlene , Roden Dan M. , MacLeod Heather , Burns Kristin M. , Yandell Mark , Tristani-Firouzi Martin , George Alfred L. , McNally Elizabeth M. 
Published: March 2023

AbstractBackgroundSudden unexpected death in children is a tragic event. Understanding the genetics of sudden death in the young (SDY) enables family counseling and cascade screening. The objective of this study was to characterize genetic variation in an SDY cohort using whole genome sequencing.MethodsThe SDY Case Registry is a National Institutes of Health/Centers for Disease Control surveillance effort to discern the prevalence, causes, and risk factors for SDY. The SDY Case Registry prospectively collected clinical data and DNA biospecimens from SDY cases <20 years of age. SDY cases were collected from medical examiner and coroner offices spanning 13 US jurisdictions from 2015-2019. The cohort included 211 children (mean age 1 year; range 0-20 years), determined to have died suddenly and unexpectedly and in whom DNA biospecimens and next-of-kin consent were ascertained. A control cohort consisted of 211 randomly sampled, sex-and ancestry-matched individuals from the 1000 Genomes Project. Genetic variation was evaluated in epilepsy, cardiomyopathy and arrhythmia genes in the SDY and control cohorts. American College of Medical Genetics/Genomics guidelines were used to classify variants as pathogenic or likely pathogenic. Additionally, genetic variation predicted to be damaging was identified using a Bayesian-based artificial intelligence (AI) tool.ResultsThe SDY cohort was 42% European, 30% African, 17% Hispanic, and 11% with mixed ancestries, and 39% female. Six percent of the cohort was found to harbor a pathogenic or likely pathogenic genetic variant in an epilepsy, cardiomyopathy or arrhythmia gene. The genomes of SDY cases, but not controls, were enriched for rare, damaging variants in epilepsy, cardiomyopathy and arrhythmia-related genes. A greater number of rare epilepsy genetic variants correlated with younger age at death.ConclusionsWhile damaging cardiomyopathy and arrhythmia genes are recognized contributors to SDY, we also observed an enrichment in epilepsy-related genes in the SDY cohort, and a correlation between rare epilepsy variation and younger age at death. These findings emphasize the importance of considering epilepsy genes when evaluating SDY.
Kidney Failure Prediction: Multicenter External Validation of KFRE Model in Patients with CKD Stages 3-4 in Peru
Authors: Bravo-Zúñiga J , Chávez-Gómez R , Soto-Becerra P 
Published: March 2023

ABSTRACTBackgroundTo externally validate the 4-variable Kidney Failure Risk Equation (KFRE) in the Peruvian population for predicting kidney failure at 2 and 5 years.MethodsWe included patients from 17 primary care centers from the Health’s Social Security of Peru. Patients older than 18 years, diagnosed with chronic kidney disease (CKD) stage 3a-3b-4 and 3b-4, between January 2013 and December 2017. Patients were followed until they developed kidney failure, died, were lost, or ended the study (December 31, 2019), whichever came first. Performance of the KFRE model was assessed based on discrimination and calibration measures considering the competing risk of death.ResultsWe included 7519 patients in stages 3a-4 and 2,798 patients in stages 3b-4. KFRE discrimination at 2 and 5 years was high, with Time-Dependent Area Under the Curve (AUC-td) and C-index > 0.8 for all populations. Regarding calibration in-the-large, the Observed-to-Expected (O/E) ratio and the calibration intercept indicated that KFRE underestimates the overall risk at two years and overestimates it at 5-years in all populations.ConclusionsThe 4-variable KFRE models have good discrimination but poor calibration in the Peruvian population. The model underestimates the risk of kidney failure in the short term and overestimates it in the long term.SIGNIFICANCE STATEMENTThe Kidney Failure Risk Equation (KFRE) is a widely used prediction model for kidney failure risk assessment in patients with chronic kidney disease (CKD). However, its performance in Latin American populations remains unclear, particularly in primary care settings. This study externally validated the KFRE in Peruvian CKD patients, demonstrating high discrimination but revealing miscalibration that could lead to adverse patient outcomes resulting from over- or under-estimation of risk. These results underscore the need for model updating and further research to optimize the KFRE’s use in clinical practice in Latin America, provide valuable insights for applying the KFRE in Latin American settings, and highlight the importance of continuous evaluation and refinement of prediction models in diverse populations.
Safety and Feasibility of a “Fast-Track” Monitoring Protocol for Patients Treated with Intravenous Thrombolytic Therapy
Authors: Fukuda Keiko A , Shah Kavit , Kenmuir Cynthia , Barnagian Derrick , Nawash Baraa , Nelson Mackenzie , Desai Shashvat , Rocha Marcelo , Starr Matthew , Roach Eileen , Henry Stephanie , Molyneaux Bradley J , Jadhav Ashutosh P 
Published: March 2023

AbstractIntroductionOur health care systems continue to face significant strain due to chronically taxed intensive care resources. A subgroup of post-thrombolytic stroke patients may not require prolonged intensive monitoring, alleviating some burden. Here we describe the safety, feasibility, and utility of a Fast-Track Protocol (FTP) for early de-escalation of high-acuity monitoring.MethodsWe compared a prospective cohort of FTP patients at our stroke centers from April 2020 – February 2022 to a similar retrospective cohort. Those on presentation with NIHSS < 10 and without large vessel occlusion or flow-limiting stenosis, intravenous anti-hypertensive use, and any hemodynamic or respiratory concerns were eligible. Primary outcomes included early neurologic deterioration, defined as worsening of NIHSS ≥ 4-points at 24 hours, parenchymal hemorrhage, and symptomatic intracranial hemorrhage.ResultsOf 574 thrombolysis patients, 119 (21%) were eligible for FTP. One hundred (88%) were included for analysis. The median ± IQR hospitalization was 2.0 ± 1.6 days. None of the four patients with early neurologic deterioration were due to hemorrhage. No symptomatic intracranial hemorrhages occurred, and no FTP patients were transferred back to the ICU. Median ± IQR 90-day modified Rankin scale was 1 ± 1.DiscussionFTP is a safe and feasible strategy to triage ICU patients and decrease unnecessary ICU monitoring. This is important in a post-pandemic era as ICU resources continue to fluctuate. Future studies are needed to establish the optimal level of monitoring in post thrombolytic patients.
Axial segmentation by iterative mechanical signaling
Authors: Wopat Susan , Adhyapok Priyom , Daga Bijoy , Crawford Janice M. , Peskin Brianna , Norman James , Bagwell Jennifer , Fogerson Stephanie M. , Di Talia Stefano , Kiehart Daniel P. , Charbonneau Patrick , Bagnat Michel 
Published: March 2023

SummaryIn bony fishes, formation of the vertebral column, or spine, is guided by a metameric blueprint established in the epithelial sheath of the notochord. Generation of the notochord template begins days after somitogenesis and even occurs in the absence of somite segmentation. However, patterning defects in the somites lead to imprecise notochord segmentation, suggesting these processes are linked. Here, we reveal that spatial coordination between the notochord and the axial musculature is necessary to ensure segmentation of the zebrafish spine both in time and space. We find that the connective tissues that anchor the axial skeletal musculature, known as the myosepta in zebrafish, transmit spatial patterning cues necessary to initiate notochord segment formation, a critical pre-patterning step in spine morphogenesis. When an irregular pattern of muscle segments and myosepta interact with the notochord sheath, segments form non-sequentially, initiate at atypical locations, and eventually display altered morphology later in development. We determine that locations of myoseptum-notochord connections are hubs for mechanical signal transmission, which are characterized by localized sites of deformation of the extracellular matrix (ECM) layer encasing the notochord. The notochord sheath responds to the external mechanical changes by locally augmenting focal adhesion machinery to define the initiation site for segmentation. Using a coarse-grained mathematical model that captures the spatial patterns of myoseptum-notochord interactions, we find that a fixed-length scale of external cues is critical for driving sequential segment patterning in the notochord. Together, this work identifies a robust segmentation mechanism that hinges upon mechanical coupling of adjacent tissues to control patterning dynamics.
De novoassembly of the black flounder genome. Why do pleuronectiformes have such a small genome size?
Authors: Villarreal Fernando , Burguener Germán F. , Sosa Ezequiel J. , Stocchi Nicolas , Somoza Gustavo M. , Turjanski Adrián , Blanco Andrés , Viñas Jordi , Mechaly Alejandro S. 
Published: March 2023

ABSTRACTBlack flounder (Paralichthys orbignyanus) is an economically important ma-rine fish with aquaculture potential in Argentina due to its market value. In this study, we sequenced the whole genome using an Illumina sequencing technology. We started with two independent libraries (from one female and one pool of females; each with 150 bp paired-end reads, a mean insert length of 350 bp, and >35 X-fold coverage). Each library was assembled separately using SOAPdenovo2 and the resulting contigs were scaffolded with SSPACE3 before gaps were filled with GapCloser. In vertebrates, including teleosts, the number of transposable elements (TEs) is related to genome size, but it remains unclear whether the size of introns and exons also plays a role. Therefore, the main objective of the present study was to test whether the small genome size of Pleuronectiformes is related to the size of their introns and exons. The assemblies re-sulted in a genome size of ∼538 Mbp (41.35% GC content, 0.11% undetermined bases). Analysis of the assemblies at the core genes level (subset of the 458 universally ex-pressed KOG families) revealed that more than 98% of core genes are present, with more than 78% of them having more than 50% coverage. This indicates a fairly complete and accurate genome at the coding sequence level. Prediction of genes based on statistical predictors (geneid) and sequence-based predictors (Exonerate, using a closely related species,Paralichthys olivaceus, as a reference) was performed. This revealed 25,231 protein-coding genes, 445 tRNAs, 3 rRNAs, and more than 1,500 non-coding RNAs of other types (including a complete set of spliceosomes and several types of snoRNA and miRNA). As a result, this study concluded that the reduced genome size of flounders is related to a reduction in transcript size, mainly through a reduction in exon number, but also through a reduction in large introns. Thus, both components seem to be involved in the strategy of genome reduction in Pleuronectiformes.
Massively Parallel Profiling of RNA-targeting CRISPR-Cas13d
Authors: Kuo Hung-Che , Prupes Joshua , Chou Chia-Wei , Finkelstein Ilya J. 
Published: March 2023

ABSTRACTType VI CRISPR enzymes cleave target RNAs and are widely used for gene regulation, RNA tracking, and diagnostics. However, a systematic understanding of their RNA binding specificity and cleavage activation is lacking. Here, we describeRNAchip-hybridizedassociation-mappingplatform (RNA-CHAMP), a massively parallel platform that repurposes next-generation DNA sequencing chips to measure the binding affinity for over 10,000 RNA targets containing structural perturbations, mismatches, insertions, and deletions relative to the CRISPR RNA (crRNA). Deep profiling of Cas13d, a compact and widely used RNA nuclease, reveals that it does not require a protospacer flanking sequence (PFS) but is exquisitely sensitive to secondary structure within the target RNA. Cas13d binding is strongly penalized by mismatches, insertions, and deletions in the distal crRNA-target RNA regions, while alterations in the proximal region inhibit nuclease activity without affecting binding. A biophysical model built from these data reveals that target recognition begins at the distal end of unstructured target RNAs and proceeds to the proximal end. Using this model, we designed a series of partially mismatched guide RNAs that modulate nuclease activity to detect single nucleotide polymorphisms (SNPs) in circulating SARS-CoV-2 variants. This work describes the key determinants of RNA targeting by a type VI CRISPR enzyme to improve CRISPR diagnostics andin vivoRNA editing. More broadly, RNA-CHAMP provides a quantitative platform for systematically measuring protein-RNA interactions.