bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chromatographic profile, in silico and in vivo study of the pharmacokinetic and toxicological properties of major constituent present in kefir, the kefiran
Authors: Barros Susy Érika de Lima , de Lima Henrique Barros , Gonçalves Leandra Karoline Alves , Correia Lenir Cabral , Brito Maiara de Fátima de Brito , Barcelos Mariana Pegrucci , Silva Guilherme Martins , da Silva Carlos Henrique Tomich de Paula , da Costa Rafael Garrett , Cruz Rodrigo Alves Soares , Carvalho José Carlos Tavares , da Silva Hage-Melim Lorane Izabel 
Published: May 2022

Abstract
Kefiran is a polysaccharide present in kefir grains that have been widely explored due to its potential health benefits. The objective of this work was to characterize and quantify the components present in the ethanolic extract of milk kefir grains; to study its pharmacokinetic and toxicological properties in silico and evaluate the acute toxicity of the kefiran in zebrafish. The prediction of pharmacokinetic properties was performed by QikProp software. In silico toxicity assessment was performed using the DEREK (deductive estimate of risk from existing knowledge) software. In the chromatographic, kefiran was identified as the major component. Results showed that the kefiran had low human oral absorption and intestinal absorption its due poor solubility profile; low logP value, indicating its lipophilicity and the low MDCK and Caco-2 cells permability, and unable to cross the blood–brain barrier. Kefiran did not present any structural warning for in silico toxicity. In zebrafish, the dose of 2,000 mg/kg of kefiran produced nonsignificant alterations in the analyzed organs. It can be said then that kefiran has an acceptable degree of safety for use in the development of drugs or functional foods. Further research such as in vivo testing to confirm its pharmacological potential is currently underway.
Do Smaller Local Governments Bring Citizens More? Evidence from Direct Elections in Indonesia
Authors: Singhania Deepak 
Published: May 2022

Abstract
Do smaller local governments provide more for their citizens, especially when they are also held accountable to their citizens? This paper extends the empirical literature on the size of local governments by explicitly exploring one of the key influencing factors – direct local elections, a proxy for local accountability. Using an Indonesian panel of village-level outcomes data, the paper shows that a reduction in local government size (due to district splitting) increases public good provision but that this effect is restricted to districts that had direct local elections. It also provides suggestive evidence to show that increased revenue was channeled into developmental expenditures only in those split districts that faced direct elections. The identification strategy relies on a surprise local election announced while the number of local governments in Indonesia was increasing, which also abruptly imposed a moratorium on the process of splitting.
Recognizing vestibular migraine
Authors: Kovalchick Jessica 
Published: May 2022

ABSTRACT
Vestibular migraine is a recently defined disorder that is underrecognized by clinicians across specialties. Acute attacks cause symptoms of migraine headaches as well as vestibular symptoms such as dizziness or vertigo. Further research is needed to determine the pathophysiology of vestibular migraine. No consensus treatment guidelines exist for this condition, and treatment is based on other migraine guidelines. Clinicians who are aware of vestibular migraine can speed diagnosis and treatment for patients and improve their quality of life.
Retrospective comparison of rates of aseptic loosening in fixed-bearing unicompartmental knee arthroplasty (UKA) implants
Authors: Boucher Henry R. , Hawken Jessica , Lee Ji Won , Mistretta Katherine , Gallagher Brian , Passano Brandon , Desale Sameer 
Published: May 2022

Background:
A prominent cause for failure and revision in unicompartmental knee arthroplasty (UKA) is aseptic implant loosening. This study compared the revision rates for aseptic loosening of a new UKA implant, Aesculap Univation X (B. Braun, Tuttlingen, Germany), versus a well-established standard design, Miller Galante (Zimmer, Warsaw, Indiana).

Methods:
Patient charts were retrospectively reviewed of medial UKAs performed using two different fixed-bearing UKA implants from different manufacturers between January 1, 2002, and November 6, 2020. Of 308 patients included in the study, 44 had the new implant (AUK) and 264 patients had a standard implant (ZUK). The revision rates for all-cause and aseptic loosening were compared. The Kaplan Meier curve for 5-year survival rate was calculated based on aseptic loosening as the cause of failure. Hazard ratios for failure were calculated with multivariable Cox regression analysis.

Results:
All-cause revision and revision from aseptic loosening were significantly higher for AUK versus ZUK (20% versus 5.30% and 18.18% versus 3.41%, respectively). The log-rank test showed significantly longer survival for ZUK versus AUK group (P<0.001). Multivariable Cox regression analysis found a hazard ratio of 21.62 (95% CI: 4.07, 114.72; P<0.001) for revision for the AUK versus ZUK group, controlling for sex, age, and body mass index.

Conclusions:
Among these patients, AUK had lower survivorship than the established implant, ZUK, due to significantly higher hazard of all-cause revision and revision from aseptic loosening. These findings suggest a need for caution with use of this new implant.

Level of Evidence:
Level III.
Clinically Detected Leg Length Discrepancy in Patients With Idiopathic Clubfoot Deformity: Prevalence and Outcomes
Authors: Addar Abdullah , Bouchard Maryse 
Published: May 2022

Background:
This study evaluates the prevalence and outcomes of patients with idiopathic clubfoot and clinically detected limb length discrepancy (LLD).

Methods:
This is a retrospective cohort study of idiopathic clubfoot patients in a Research Ethics Board–approved clubfoot registry. Patients with LLD ≥0.5 cm (LLD+) were compared with those with no or <0.5 cm LLD (LLD−). LLD was determined by documented clinical examination. Exclusion criteria included nonidiopathic clubfoot deformity, <2-year follow-up, and incomplete records.

Results:
Of the 300 patients included, 27 (9.0%) had an LLD, of whom 23 patients had a unilateral clubfoot deformity. The prevalence of LLD was 15.3% and 2.67% in unilateral and bilateral clubfoot patients, respectively. The mean LLD was 1.21 cm (0.5 to 3.5 cm, SD: 0.78 cm) in LLD+ patients, with a mean of 1.27 cm (SD: 0.79 cm) in unilateral clubfoot patients and 0.88 cm (SD: 0.75 cm) in bilateral patients. The total number of casts applied in LLD+ unilateral clubfoot patients was significantly higher than in LLD− unilateral patients (9.5 vs. 6.8 casts; P=0.015). The overall relapse rate in all patients was 30.3% and was significantly higher in the unilateral only LLD+ group [relative risk (RR)=2.89] and the total LLD+ patient cohort (RR=1.68). The risk of repeat casting for relapse was also higher in the unilateral LLD+ group (RR=2.45) and the total LLD+ group (RR=1.87). The risk of surgery for relapse was significantly higher in the unilateral LLD+ group for any surgery (P=0.046), and most specifically for open tendo-Achilles tenotomy (P=0.008) and tibialis anterior tendon transfer (P=0.019). There was no correlation between the severity of LLD and Pirani score at presentation.

Conclusions:
LLD was present in 9% of idiopathic clubfoot patients, and most were <2 cm. There is a significantly higher risk of relapse in patients with unilateral clubfoot and LLD. The risk of surgery overall was higher in all patients with a unilateral LLD. Assessment of LLD should be routinely performed in clubfoot patients.

Level of Evidence:
Level III.
Pitching Behaviors in Youth Fast-Pitched Softball: High Pitching Volumes With Unequal Pitch Counts Among Pitchers are Common
Authors: Greiner Justin J. , Trotter Cameron A. , McGuine Tim A. , Walczak Brian E. , Baer Geoffrey S. 
Published: May 2022

Background:
Softball is a popular sport among youth female athletes. While youth baseball has well-established, evidence-based pitching guidelines, youth softball pitching guidelines lack both evidence and enforcement. Adherence to pitch count limits in youth softball is infrequent and results in pitchers with exceedingly high pitching volumes.

Methods:
Pitch counts for youth fast-pitch softball teams competing for 1 consecutive year between January 2018 to December 2019 in age groups 8 and under (8U) to 14 and under (14U) were collected. Pitching volume was assessed based on individual games, single calendar days, and tournaments in which games are played on 2 or more consecutive days. Pitchers on teams were subdivided based on pitch count volumes and compared using a logarithmic transformation and geometric mean.

Results:
Data was collected for 10 teams from each age division resulting in analysis of 538 pitchers on 70 teams. The average pitcher threw 813 pitches per year and appeared in 20.0% of games while the average highest volume pitcher threw 2500 pitches per year and appeared in 54.5% of games. On average, the highest volume pitcher on each team threw 40% of all team pitches, while the 3 highest volume pitchers combined threw 82% of all team pitches. The average and high-volume pitcher threw pitches in 2 or more games on the same day in 37.5% and 48.6% of possible games while pitching 2 or more consecutive days in 64.0% and 79.6% of possible games, respectively.

Conclusions:
Softball pitchers throw high volumes of pitches while also pitching multiple days consecutively. A disparity among pitchers on softball teams exists as 40% of team pitches are thrown by 1 player and over 80% of team pitches are thrown by the top 3 pitchers. These high-volume pitchers may be engaging in unsustainable pitching practices that could predispose to injury.

Level of Evidence:
Level IV—cross-sectional.
Post-Intensive Care COVID Survivorship Clinic: A Single-Center Experience
Authors: Gilmartin Michael , Collins Jack , Mason Sabina , Horgan Anna , Cuadrado Elena , Ryberg Melanie , McDermott Garret , Baily-Scanlan Maria , Hevey David , Donnelly Maria , O’Doherty Veronica , Kelly Yvelynne P. 
Published: May 2022

OBJECTIVES:
Patients discharged from the ICU post-COVID-19 pneumonitis may experience long-term morbidity related to their critical illness, the treatment for this and the ICU environment. The aim of this study was to characterize the cognitive, psychologic, and physical consequences of COVID-19 in patients admitted to the ICU and discharged alive.

DESIGN:
Prospective cohort study.

SETTING:
Post-intensive care syndrome (PICS) follow-up clinic at Tallaght University Hospital, a tertiary referral center with a 16-bed mixed medical-surgical ICU, including critical care physicians, a psychologist, a physiotherapist, and a research nurse.

PATIENTS:
Patients who had been admitted to the ICU in our tertiary referral center with COVID-19 pneumonitis 6 months earlier.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
A total of 22 patients attended the 6-month PICS follow-up clinic following admission to ICU with COVID-19 pneumonitis. Mean grip strength was low at the 6-month follow-up at 24.1 pounds (sd 9.8) with a minimally active median metabolic equivalent (MET) of 970 METs/wk (interquartile range, 0–7,794 METs/wk). Only 59% of patients were independent with regard to their activities of daily living. Eight of 14 patients (57%) had returned to work by 6 months post-ICU discharge. Their mean Intensive Care Psychological Assessment Tool (IPAT) score was 6.6 (sd 4.6) with a Post-Traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders-5th Edition (PCL-5) score of 21.1 (sd 17.5) and a mean Montreal Cognitive Assessment (MoCA) score of 24 (sd 8.4); suggestive of mild cognitive impairment. In a multivariable regression model, only Acute Physiology and Chronic Health Evaluation II score was significantly independently associated with MoCA score as a cognitive PICS outcome (beta-coefficient, –1.6; se, 0.6; p = 0.04). None of the predictor variables were significantly independently associated with IPAT and PCL-5 as psychologic outcomes, nor with International Physical Activity Questionnaire-Short Form as a physical PICS outcome.

CONCLUSIONS:
In this single-center prospective cohort study, we found that patients have a high burden of physical and psychologic impairment at 6 months following ICU discharge post-COVID-19 pneumonitis; in many cases requiring specialist referrals for long-term input. We advocate for increased resources for this much needed follow-up multidisciplinary intervention for an ever-growing population of patients.
Does temporomandibular disorder correlate with menopausal symptoms?
Authors: Galhardo Alessandra Pucci Mantelli , Mukai Marcia Katsuyoshi , Baracat Maria Cândida P. , da Fonseca Angela Maggio , Roa Cristiane Lima , Sorpreso Isabel Cristina Espósito , Baracat Edmund Chada , Soares Jose Maria 
Published: May 2022

Abstract

Objective:
To assess the correlation between menopausal symptoms and pain caused by temporomandibular disorder (TMD) and the impact of sociodemographic factors on the association.

Methods:
In this cross-sectional study, a total of 74 women with TMD symptoms were enrolled and divided into three groups according to the Stages of Reproductive Aging Workshop + 10 (STRAW + 10) criteria: G1 (n = 25, late menopausal transition), G2 (n = 30, early postmenopause), and G3 (n = 19, late postmenopause). Sociodemographic data were collected, along with data on menopausal symptoms (Blatt-Kupperman menopausal index) and TMD-induced pain (craniomandibular index). Statistical analysis was performed using a chi-squared test and linear correlation tests (Spearman and Pearson).

Results:
Analysis of the three groups showed that TMD-induced pain was more intense in G1 than in G3 (P = 0.0426, r
= 0.2364, r
2 = 0.05589), and menopausal symptoms correlated with the intensity of TMD-induced pain (P = 0.0004, r
= 0.4020). This correlation was more significant during the late menopausal transition (G1: P
= 0.0267, r
= 0.4427, r
2 = 0.1960). In G2, women with fewer than 4 years of schooling had a higher total Blatt- Kupperman menopausal index score (17.0 ± 85.0) and craniomandibular index (0.29 ± 0.23) than women with more than 4 years of schooling (P
= 0.02 for both indices).

Conclusions:
Our results suggest that TMD-induced pain and menopausal symptoms are correlated, and more strongly so in the late menopausal transition. Additionally, sociodemographic factors, such as schooling, have a major influence on symptoms in early postmenopause. Performing the TMD evaluation during the climacteric period may be important.
Standardized Perioperative Protocol and Routine Ketorolac Use for Head and Neck Free Flap Reconstruction
Authors: Luthringer Margaret M. , Kim Kevin G. , Mukherjee Thayer J. , Van Kouwenberg Emily A. , Agag Richard L. , Sinkin Jeremy C. 
Published: May 2022

Background:
No consensus exists on ideal perioperative management or anticoagulation regimen for free flap reconstruction of the head and neck. Perceived benefits from antiplatelet therapy need to be balanced against potential complications. Ketorolac, a platelet aggregation inhibitor and a parenteral analgesic, was introduced as part of a standardized perioperative protocol at our institution. In this study, we aimed to examine the impact of implementation of this protocol as well as complications associated with the routine use of perioperative ketorolac in a diverse group of patients who underwent head and neck free flap reconstruction.

Methods:
A single institution retrospective review was performed, including all patients who underwent head and neck free flap reconstruction between October 2016 and November 2019. Patients were divided into two cohorts: those who received ketorolac as part of a standardized protocol, and those who did not.

Results:
Twenty-four consecutive patients with 24 head and neck free flaps were evaluated. Eighteen patients were in the standard protocol, and six were not. There were no microvascular thromboses, flap failures, or hematomas in either group. Intensive care unit length of stay and opiate use were significantly reduced in the standardized protocol group.

Conclusions:
A standardized perioperative protocol for head and neck free flap reconstruction can reduce hospital and intensive care unit length of stay. No statistically significant differences in complication rates were identified when comparing ketorolac use and perioperative regimens among patients undergoing a diverse set of microsurgical head and neck free flap reconstructions.
KeratoScreen: Early Keratoconus Classification With Zernike Polynomial Using Deep Learning
Authors: Gao He-Bei , Pan Zhi-Geng , Shen Mei-Xiao , Lu Fan , Li Hong , Zhang Xiao-Qin 
Published: May 2022

Purpose:
We aimed to investigate the usefulness of Zernike coefficients (ZCs) for distinguishing subclinical keratoconus (KC) from normal corneas and to evaluate the goodness of detection of the entire corneal topography and tomography characteristics with ZCs as a screening feature input set of artificial neural networks.

Methods:
This retrospective study was conducted at the Affiliated Eye Hospital of Wenzhou Medical University, China. A total of 208 patients (1040 corneal topography images) were evaluated. Data were collected between 2012 and 2018 using the Pentacam system and analyzed from February 2019 to December 2021. An artificial neural network (KeratoScreen) was trained using a data set of ZCs generated from corneal topography and tomography. Each image was previously assigned to 3 groups: normal (70 eyes; average age, 28.7 ± 2.6 years), subclinical KC (48 eyes; average age, 24.6 ± 5.7 years), and KC (90 eyes; average age, 25.9 ± 5.4 years). The data set was randomly split into 70% for training and 30% for testing. We evaluated the precision of screening symptoms and examined the discriminative capability of several combinations of the input set and nodes.

Results:
The best results were achieved using ZCs generated from corneal thickness as an input parameter, determining the 3 categories of clinical classification for each subject. The sensitivity and precision rates were 93.9% and 96.1% in subclinical KC cases and 97.6% and 95.1% in KC cases, respectively.

Conclusions:
Deep learning algorithms based on ZCs could be used to screen for early KC and for other corneal ectasia during preoperative screening for corneal refractive surgery.
Visual recovery after immediate sequential bilateral cataract surgery at a veterans' hospital
Authors: Kwedar Kathleen , Arnold Joseph , Hesemann Nathan 
Published: May 2022

Purpose:
To answer patient questions about the expected timeline for recovery, the objective postoperative visual acuities were reviewed for patients undergoing immediate sequential bilateral cataract surgery (ISBCS).

Setting:
Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri.

Design:
Retrospective chart review.

Methods:
All patients who underwent ISBCS in 2019 were evaluated. A total of 116 patients (232 eyes) were studied. Uncorrected distance visual acuity (UDVA) for postoperative day 0 or 1 (POD0/1), postoperative week 1 (POW1), and postoperative month 1 (POM1) were required for study inclusion. Patients with ocular comorbidities were not excluded, although all patients passed an initial screening to qualify for ISBCS. The outcome measures included POD0/1, POW1, and POM1 UDVA.

Results:
Postoperative UDVA was stable or improved compared with preoperative corrected distance visual acuity (CDVA) for 48% (66/138) of eyes on POD0, 79% (74/94) of eyes on POD1, and 90% (209/232) of eyes on POW1. 83% of patients at POD1 and 90% of patients at POW1 had stable or improved visual acuity in at least 1 eye. 92% (214/232) of eyes had a POW1 UDVA of 20/40 or better. Of the 18 eyes with a postoperative POW1 UDVA of 20/50 or worse, 5 (28%) were known preoperatively to have limited visual potential. 99% (115/116) of patients had at least 1 eye 20/40 or better.

Conclusions:
Most of the patients who underwent ISBCS demonstrated meaningful improvement in UDVA compared with preoperative CDVA as early as POD1. These results serve to guide discussion of postoperative expectations with patients interested in ISBCS.
Age-related appearance of lamellar structures in lens capsule of cataractous eyes and its pathological significance
Authors: Hirata Akira , Mine Keiko , Hayashi Ken 
Published: May 2022

Abstract

Purpose:
To determine morphological changes in the lens capsule with aging.

Design:
Cross-sectional study.

Setting:
Hayashi Eye Hospital, Fukuoka, Japan.

Methods:
Twenty-five eyes from the older patient group (aged ≥ 80 years) and 25 eyes from the younger patient group (aged ≤ 65 years) who were diagnosed with cataract and indicated for surgery were included in the study. After continuous curvilinear capsulorhexis (CCC), the anterior lens capsule was collected, immediately fixed, and processed for electron microscopy analysis. Backscattered electron images of the cross-section of the anterior lens capsule were observed under a scanning electron microscope. The ultrastructure of the anterior lens capsule was observed and compared between groups. Factors associated with the occurrence of the lamellar structure were also identified. The presence or absence of a lamellar structure was an objective variable, and preoperative clinical characteristics were the explanatory variables.

Results:
Fifty eyes of 50 patients were included. In the younger patient group, 20 (80%) eyes had a homogeneous lens capsule, whereas 5 eyes had a lamellar structure. By contrast, in the older patient group, 5 eyes had homogeneous structures, while the remaining 20 (80%) eyes had lamellar structures. One eye showed capsular delamination. The only significant factor for the occurrence of lamellar structures was age group (p<0.01, nominal logistic regression analysis).

Conclusions:
Lamellar structures appear in the anterior capsule during aging. The appearance of lamellar structures indicates fragility of the lens capsule, which may, in turn, lead to capsular delamination or lens dislocation in some cases.
Grpr expression defines a population of superficial dorsal horn vertical cells that have a role in both itch and pain
Authors: Polgár Erika , Dickie Allen C. , Gutierrez-Mecinas Maria , Bell Andrew M. , Boyle Kieran A. , Quillet Raphaëlle , Ab Rashid Elisha , Clark Ross A. , German Morgan T. , Watanabe Masahiko , Riddell John S. , Todd Andrew J. 
Published: May 2022

Abstract
Neurons in the superficial dorsal horn that express the gastrin-releasing peptide receptor (GRPR) are strongly implicated in spinal itch pathways. However, a recent study reported that many of these correspond to vertical cells, a population of interneurons that are believed to transmit nociceptive information. In this study, we have used a GRPRCreERT2 mouse line to identify and target cells that possess Grpr mRNA. We find that the GRPR cells are highly concentrated in lamina I and the outer part of lamina II, that they are all glutamatergic, and that they account for ∼15% of the excitatory neurons in the superficial dorsal horn. We had previously identified 6 neurochemically distinct excitatory interneuron populations in this region based on neuropeptide expression and the GRPR cells are largely separate from these, although they show some overlap with cells that express substance P. Anatomical analysis revealed that the GRPR neurons are indeed vertical cells, and that their axons target each other, as well as arborising in regions that contain projection neurons: lamina I, the lateral spinal nucleus, and the lateral part of lamina V. Surprisingly, given the proposed role of GRPR cells in itch, we found that most of the cells received monosynaptic input from Trpv1-expressing (nociceptive) afferents, that the majority responded to noxious and pruritic stimuli, and that chemogenetically activating them resulted in pain-related and itch-related behaviours. Together, these findings suggest that the GRPR cells are involved in spinal cord circuits that underlie both pain and itch.