bluuebunny/crossref_metadata_2025_split huggingface dataset:
Feasibility and Acceptability of Home-Collected Samples for Human Immunodeficiency Virus Preexposure Prophylaxis and Severe Acute Respiratory Syndrome Coronavirus 2 Laboratory Tests in San Francisco Primary Care Clinics
Authors: Saberi Parya , Ming Kristin , Shrestha Isha , Scott Hyman , Thorson Brad , Liu Albert 
Published: January 2022

Abstract

Background
Due to the difficulty of conducting laboratory testing during the pandemic shelter-in-place orders, the objective of this study was to examine the feasibility and acceptability of conducting home-collected samples for preexposure prophylaxis (PrEP) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) laboratory tests.

Methods
We conducted a pilot study among patients on PrEP in San Francisco primary care clinics. Individuals on PrEP provided home-collected laboratory samples using dried blood spot for fourth-generation human immunodeficiency virus antigen/antibody test, serum creatinine, syphilis antibody, and hepatitis C antibody, as needed; 3-site (oropharyngeal, rectal, and urine) swabbing for sexually transmitted infections; and nasopharyngeal swabbing for SARS-CoV-2 polymerase chain reaction. We examined feasibility and acceptability of collecting these laboratory samples using predefined benchmarks to determine feasibility or acceptability.

Results
Of 92 individuals who consented to participate, 73 (79.3%) mailed back their home-collected kit. Nearly 87.7% noted being extremely to moderately satisfied with the ability to complete the laboratory tests without having to come into a clinic. Approximately 49.3% of participants chose this home-collection method as their first choice for providing laboratory samples. Mean time from collection of samples by the participant to receipt of test results was reduced from the first quarter of the study (17 days) to the last quarter of the study (5 days).

Conclusions
We report high levels of feasibility and acceptability with the use of home-collected laboratory samples for patients on PrEP. Our results indicate that home-collected laboratory samples for patients on PrEP is a viable option that should be offered as an alternative to clinic-collected laboratory samples.
Contributions of Pubic Rami Fracture Morphology and Fixation to Pelvic Ring Stability in Type 1 Lateral Compression Injuries: A Biomechanical Cadaveric Study
Authors: Marenghi Natalie , Bang Katrina E. , Danelson Kerry , Hasty Eddie , Snoap Tyler , Taylor LaTarsha , Okundia Samantha , Kelly Erin , Teater Rachel , Halvorson Jason , Carroll Eben 
Published: January 2022

Background:
Treatment of lateral compression type 1 (LC-1) injuries has historically been nonoperative with immediate weight-bearing. However, management of these injuries remains controversial, with reports of displacement at follow-up for nonoperatively managed LC-1 fractures. The goal of our study was to determine the effect of superior pubic ramus fracture morphology and fixation construct on pelvic stability.

Methods:
Ten fresh-frozen cadaveric were transected into hemi-pelvises. Incomplete Denis type 1 sacral fractures were made. Hemi-pelvises were randomized to receive a transverse-type or oblique-type superior pubic ramus fracture with the contralateral hemi-pelvis receiving the opposing morphology. A lateral load to 135N was applied with an Instron materials testing machine and lateral displacement of the hemi-pelvis was recorded. Deflection and stiffness were calculated. Statistical analysis was conducted using a t test assuming unequal variances with an alpha = 0.05.

Results:
Oblique-type superior pubic ramus fractures allowed more deflection compared with transverse-type fractures in the absence of fixation (P = 0.018). The posterior-only and combined anterior and posterior fixation configurations on average reduced deflection more than no fixation or anterior fixation only. In all fixation configuration cases, the average deflection for transverse-type fractures was less than that of the oblique-type fractures.

Conclusions:
Our findings suggest that displacement of LC-1 pelvic injuries may be related to pubic rami fracture morphology. When looking at initial injury imaging, oblique-type pubic rami fractures may suggest an increased potential for displacement over time. In such cases, we recommend an examination under anesthesia to evaluate for underlying instability and consideration for fixation.

Level of Evidence:
Therapeutic Level V.
Functionality of Scarce Healthcare Resource Triage Teams During the COVID-19 Pandemic: A Multi-Institutional Simulation Study
Authors: Butler Catherine R. , Webster Laura B. , Sakata Vicki L. , Tonelli Mark R. , Diekema Douglas S. , Gray Megan M. 
Published: January 2022

Objectives:
Plans for allocating scarce healthcare resources during the COVID-19 pandemic commonly involve the activation of institutional triage teams. These teams would be responsible for selecting patients who are most likely to survive to be prioritized to receive scarce resources. However, there is little empirical support for this approach.

Design:
High-fidelity triage-team simulation study.

Setting:
Healthcare institutions in Washington state.

SUBJECTS:
Triage teams, consisting of at least two senior clinicians and a bioethicist.

INTERVENTIONS:
Participants reviewed a limited amount of deidentified information for a diverse sample of critically ill patients. Teams then assigned each patient to one of five prioritization categories defined by likelihood of survival to hospital discharge. The process was refined based on observation and participant feedback after which a second phase of simulations was conducted.

MEASUREMENTS AND MAIN RESULTS:
Feasibility was assessed by the time required for teams to perform their task. Prognostic accuracy was assessed by comparing teams’ prediction about likelihood of survival to hospital discharge with real-world discharge outcomes. Agreement between the teams on prognostic categorization was evaluated using kappa statistics. Eleven triage team simulations (eight in phase 1 and three in phase 2) were conducted from December 2020 to February 2021. Overall, teams reviewed a median of 23 patient cases in each session (interquartile range [IQR], 17–29) and spent a median of 102 seconds (IQR, 50–268) per case. The concordance between expected survival and real-world survival to discharge was 71% (IQR, 64–76%). The overall agreement between teams for placement of patients into prognostic categories was moderate (weighted kappa = 0.53).

Conclusions:
These findings support the potential feasibility, accuracy, and effectiveness of institutional triage teams informed by a limited set of patient information items as part of a strategy for allocating scarce resources in healthcare emergencies. Additional work is needed to refine the process and adapt it to local contexts.
Autologous Mandible Reconstruction in a Hypercoagulable Patient following Multiple Failed Free Flaps
Authors: Maier Mark A. , Guidry Richard F. , Palines Patrick A. , Stalder Mark W. 
Published: January 2022

Summary:
Coagulopathies affect 3% of free flap patients and are among the leading causes of free flap failure. This report describes the case of a head and neck cancer patient that experienced two remote free flap failures before successful autologous mandibular reconstruction. Following identification of an unrecognized thrombophilic state, a focused anticoagulation strategy was executed, including an intraoperative heparin drip, stringent postoperative maintenance of Factor Xa levels between 0.3 and 0.5 IU per mL, and transition to an outpatient enoxaparin regimen of 1 mg per kg twice daily for 1.5 months following surgery. Here, we demonstrate that free tissue transfer following multiple previous failed attempts in the setting of hypercoagulability remains a viable reconstructive option with close interdisciplinary collaboration, close clinical monitoring, and patient-specific antithrombotic protocols.
The association between socioeconomic status and prevalence, awareness, treatment and control of hypertension in different ethnic groups: the Healthy Life in an Urban Setting study
Authors: Blok Sebastiaan , Haggenburg Sabine , Collard Didier , Van Der Linden Eva L. , Galenkamp Henrike , Moll van Charante Eric P. , Agyemang Charles , Van Den Born Bert-Jan H. 
Published: January 2022

Background:
Socioeconomic status (SES) and ethnicity are both important determinants of hypertension prevalence and control rates but their separate contribution is unknown. We assessed the association of SES with hypertension prevalence, awareness, treatment and control, and whether this differs between ethnic groups.

Methods:
We used baseline data from the Healthy Life in an Urban Setting (HELIUS) study, a multiethnic population-based cohort study, including 18 106 participants (84% of the total cohort) of Dutch (n = 4262), African Surinamese (n = 3732), Moroccan (n = 2902), Turkish (n = 2694), South-Asian Surinamese (n = 2664) and Ghanaian (n = 1947) descent with data on SES and hypertension status.

Results:
Regardless of ethnicity, lower SES was associated with higher hypertension prevalence, especially in participants with no education compared with those with higher levels of education [OR 2.29 (2.05–2.56)]. There was an inverse association between SES and hypertension treatment with the strongest association for lower compared with higher educated participants [OR 1.63 (1.39–1.90)]. In addition, lower SES was associated with lower hypertension control with the strongest association for participants with the lowest compared with the highest occupational level [OR 0.76 (0.60–0.95)]. The association between educational level and treatment but not the other SES- or hypertension-indicators, was influenced by ethnicity, with lower educated Dutch and African Surinamese having higher ORs for hypertensive treatment [Dutch OR 1.98 (1.43–2.76); African Surinamese OR 1.44 (1.10–1.89)].

Conclusion:
SES, in particular education, impacts hypertension treatment in the Netherlands, whereas the association of specific SES parameters with hypertension indicators differ across ethnic groups. Further exploration is needed on how sociocultural beliefs and behaviours may differentially affect blood pressure control across ethnic minority populations.
Analysis of symptomatic recurrences of common bile ducts stones after endoscopic removal
Authors: Han Soo Jeong , Chang Jae Hyuck , Gweon Tae-Geun , Kim Tae Ho , Kim Hyung-Keun , Kim Chang Whan 
Published: January 2022

Abstract
Early or multiple recurrences of symptomatic common bile duct (CBD) stones are troublesome late complications after endoscopic stone removal. We aimed to determine the factors related to early or multiple recurrences of CBD stones.
We retrospectively analyzed patients who underwent endoscopic CBD stone extraction in a single institute between January 2006 and December 2015. Patients were divided into 2 groups according to the number and interval of CBD stone recurrences: single versus multiple (≥2) and early (<1.5 years) versus late (≥1.5 years) recurrence.
After exclusion, 78 patients were enrolled and followed up for a median of 1974 (IQR: 938–3239) days. Twenty-seven (34.6%) patients experienced multiple recurrences (≥2 times), and 26 (33.3%) patients experienced early first recurrence (<1.5 years). In the multivariate analysis, CBD angulation was independently related to multiple CBD stone recurrence (OR: 4.689, P = .016), and endoscopic papillary large balloon dilation was independently related to late first CBD stone recurrence (OR: 3.783, P = .025). The mean CBD angles were more angulated with increasing instances of recurrence (0, 1, 2, 3, and ≥4 times) with corresponding values of 150.3°, 148.2°, 143.6°, 142.2°, and 126.7°, respectively (P = .011). The period between the initial treatment and first recurrence was significantly longer than the period between the first and second recurrence (P = .048).
In conclusion, greater CBD angulation is associated with the increased number of CBD stone recurrence, and EPLBD delays the recurrence of CBD stones after endoscopic CBD stone removal.
Combined Central and Peripheral Demyelination in a Case With Sjogren Syndrome
Authors: Sokmen Okan , Gocmen Rahsan , Nurlu Gulay , Karabudak Rana 
Published: January 2022

Introduction:
Combined central and peripheral demyelination (CCPD) is a rare entity in which central and peripheral nervous system demyelination coexist. Herein, we present a patient with coexistence of Sjögren syndrome (SS) and CCPD.

Case Report:
A 58-year-old female patient was admitted to our neurology clinic with paraparesis, difficulty walking, imbalance, and paresthesia. Neurological examination showed paraparesis, absence of lower extremity deep tendon reflex, sensory deficit at the T8 level, loss of deep sensory position, and vibration. Spinal magnetic resonance imaging revealed multiple focal T2-hyperintense and contrast-enhancing cord lesions. Fat-suppressed imaging disclosed T2 hyperintensity in lumbar nerve roots, diffuse linear enhancement of the cauda equina, and diffuse increased enhancement in lumbar nerve roots. Electrodiagnostic findings fulfilled the diagnostic criteria for chronic inflammatory demyelinating polyneuropathy. Extensive laboratory workup excluded all possible pathologies. The Schirmer test detected positive in both eyes and minor salivary gland biopsy resulted in grade 3. These results were consistent with SS. The patient received intravenous methylprednisolone, azathioprine hydroxychloroquine. Approximately 2 years later, her complaints had completely disappeared, except for mild sensory complaints.

Conclusion:
It is unclear whether the association of central nervous system and peripheral nervous system demyelination and SS is a coincidence or a consequence. Our patient shows that patients with SS can have CCPD, and a significant clinical response can be obtained with early treatment. We hope that this unique case sheds light on the pathophysiology of CCPD.
Clinical Review of Smartphone Applications in Parkinson’s Disease
Authors: Tripathi Susmit , Malhotra Ashwin , Qazi Murtaza , Chou Jingyuan , Wang Fei , Barkan Samantha , Hellmers Natalie , Henchcliffe Claire , Sarva Harini 
Published: January 2022

Background:
Parkinson’s disease (PD) is the second leading neurodegenerative disease worldwide. Important advances in monitoring and treatment have been made in recent years. This article reviews literature on utility of smartphone applications in monitoring PD symptoms that may ultimately facilitate improved patient care, and on movement modulation as a potential therapeutic.

Review Summary:
Novel mobile phone applications can provide one-time and/or continuous data to monitor PD motor symptoms in person or remotely, that may support precise therapeutic adjustments and management decisions. Apps have also been developed for medication management and treatment.

Conclusions:
Smartphone applications provide a wide array of platforms allowing for meaningful short-term and long-term data collection and are also being tested for intervention. However, the variability of the applications and the need to translate complicated sensor data may hinder immediate clinical applicability. Future studies should involve stake-holders early in the design process to promote usability and streamline the interface between patients, clinicians, and PD apps.
Posterior Circulation Alberta Stroke Program Early Computed Tomography Score (pc-ASPECT) for the Evaluation of Cerebellar Infarcts
Authors: Altiparmak Taylan , Nazliel Bijen , Batur Caglayan Hale , Tokgoz Nil , Akyol Gurses Asli , Ucar Murat 
Published: January 2022

Background:
Patients with cerebellar ischemic stroke may be misdiagnosed and may exhibit a delayed time to acute stroke treatment compared with patients with anterior circulation ischemic stroke. The posterior circulation Alberta stroke program early computed tomography score (pc-ASPECT) score has been used to evaluate hyperacute stroke, much as the ASPECT in anterior circulation stroke recently. Our main objective was to evaluate the associations of the clinical and etiological characteristics of ischemic cerebellar infarction patients on admission with their pc-ASPECT scores, as well as the correlations of the pc-ASPECT score with morbidity and mortality rates.

Materials and Methods:
We include 114 patients with cerebellar infarction who underwent 1 year of follow-up into the study.

Results:
Patients with a pc-ASPECT score <7 were more likely to present with impaired consciousness (P<0.001), multiple posterior circulation infarcts (P<0.001), hydrocephalus (P<0.001), lesions of the vermis (P=0.028), and peduncle (P=0.024), perfusion deficits in the total of posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery (P<0.05), and basilar artery stenosis (P=0.005), ischemia in additional anatomical structures in the posterior circulation (P<0.001) compared with those with a score ≥7.

Conclusions:
Although the pc-ASPECT score alone is insufficient in some cases like vertebral artery dissection, using it together with the National Institutes of Health Stroke Scale (NIHSS) score and clinical findings may be beneficial during the hyperacute period of cerebellar ischemia. Presentation with impaired consciousness, basilar artery pathologies, vermian ischemia, and ischemia in additional anatomical structures in the posterior circulation other than the cerebellum appeared as important clinical and radiologic parameters predicting long-term prognosis.
Topical Review: An Update of Diagnostic and Management Algorithms for Acquired Blepharoptosis
Authors: Nichols Kelly K. , Malloy Kelly A. , Karpecki Paul M. , Bacharach Jason , Douglas Raymond S. , Foster Shane , Gromacki Susan J. , Whitley Walter O. 
Published: January 2022

SIGNIFICANCE
Acquired ptosis is a condition of the upper eyelid that has negative cosmetic and functional effects but is likely underdiagnosed and undertreated. Given the evolving understanding of the condition and expanding therapeutic options, this review reappraised published evidence and clinical experience regarding diagnosis and treatment of acquired ptosis.
The authors met over two structured virtual working sessions to review current evidence and develop timely recommendations for acquired ptosis identification, differential diagnosis, characterization, and treatment selection. Diagnostic algorithms, plus management and referral guidelines, are presented. Eyelid evaluation and, when needed, ptosis diagnostic workup are essential in the comprehensive eye examination. Acquired ptosis can be efficiently identified via patient questionnaire, history, and photograph review combined with assessment of eyelid position and symmetry using established methods. When ptosis is present, it is essential to evaluate onset, symptoms, pupil diameter, and extraocular muscle function to identify or rule out serious underlying conditions. If signs of serious underlying etiology are present, immediate referral/follow-up testing is required. After ruling out serious underlying causes, masquerade conditions, and pseudoptosis, pharmacologic or surgical treatment should be selected based on the clinical evidence. Effectively managing acquired ptosis requires practice-wide commitment to thorough eyelid evaluation, accurate diagnosis, and adoption of new treatment modalities. Aided by evolving pharmacologic therapeutic options, shifting from a “detect and refer” to a “diagnose and manage” approach can support identification and treatment of more patients with acquired ptosis, particularly mild-to-moderate cases.
Pediatric Carbon Monoxide Poisoning
Authors: Bağci Zafer , Arslan Abdullah , Neşelioğlu Salim 
Published: January 2022

Objectives
Carbon monoxide (CO) poisoning remains the foremost cause of poisoning worldwide. This study aimed to investigate the effects of hyperbaric oxygen therapy (HBOT) and normobaric oxygen therapy (NBOT) on thiol/disulfide homeostasis in children with CO intoxication.

Methods
Eighty-one children aged 0 to 18 years with CO intoxication were included in this cross-sectional study. No changes were made in the routine clinical evaluation and treatment practices of the patients. Thirty-two children who received HBOT and 49 children who received NBOT were compared for serum native thiol, disulfide, and total thiol levels, as well as for the changes in disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol ratios before and after treatment.

Results
Antioxidant levels, such as native thiol and total thiol, were significantly decreased in patients who received HBOT and increased in those who received NBOT (P = 0.02 and P = 0.01, respectively). There was no statistically significant difference between the 2 groups concerning the change of native thiol/total thiol ratios (P = 0.07). In addition, there was no significant difference regarding changes in disulfide, disulfide/native thiol, and disulfide/total thiol levels before and after treatment (P = 0.39, P = 0.07, and P = 0.07, respectively).

Conclusions
Although thiol-disulfide balance is maintained in patients treated with HBOT, antioxidant levels decrease significantly compared with NBOT. Despite efficiency of HBOT in CO intoxication, oxidative stress and reperfusion injury due to hyperoxygenation should be considered in the treatment of HBOT.
How We Incorporate Venetoclax in Treatment Regimens for Acute Myeloid Leukemia
Authors: Maiti Abhishek , Konopleva Marina Y. 
Published: January 2022

Abstract
Venetoclax has transformed the therapeutic landscape of acute myeloid leukemia (AML). Hypomethylating agents with venetoclax (HMA-VEN) have significantly improved outcomes and have become the standard therapy for older/unfit patients with newly diagnosed AML and are comparable to intensive chemotherapy in salvage setting. Venetoclax with intensive chemotherapy have shown high response rates in both frontline and salvage setting in younger patients, and triplet combinations with HMA-VEN and FLT3 inhibitors have shown encouraging results in FLT3
mut AML. While patients with NPM1
mut, IDH1/2
mut experience favorable outcomes, those with TP53
mut and secondary AML may experience minimal benefit from the addition of venetoclax. Despite improved outcomes, severe cytopenias and infectious complications are common with venetoclax-based regimens. Early response evaluation, dose reductions, venetoclax interruptions, use of growth factors, and prophylactic antimicrobials may minimize such myelosuppression and risk of infections. Outcomes after failure of frontline HMA-VEN are dismal, and novel approaches are needed to abrogate primary and acquired resistance.
What Are the Prospects for Treating TP53 Mutated Myelodysplastic Syndromes and Acute Myeloid Leukemia?
Authors: Wang Chen , Sallman David A. 
Published: January 2022

Abstract

TP53 is a key tumor suppressor gene involved in fundamental biological processes of genomic stability and is recurrently mutated in a subgroup of myelodysplastic syndromes and acute myeloid leukemia. These patients have unique clinical and molecular features resulting in dismal outcomes despite standard cytotoxic chemotherapy, and long-term survival is seldom achieved with allogeneic stem cell transplant. Upfront use of hypomethylating agents with or without venetoclax has resulted in a favorable initial response over intensive cytotoxic chemotherapy, albeit responses are nondurable, and the median overall survival is typically less than 6 to 8 months. In this review, we examine the evidence of conventional treatments and focus on the emerging novel therapeutic options, including targeted molecular and immunotherapies for this challenging molecular subgroup. Together, there are still significant unmet needs to improve outcomes of patients with TP53 mutated myelodysplastic syndromes and acute myeloid leukemia, and enrollment in clinical trials should be highly favored whenever they are available.