bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tenon Patch Graft With Vascularized Conjunctival Flap for Management of Corneal Perforation
Authors: Shekhawat Nakul Singh , Kaur Bhavleen , Edalati Armand , Abousy Mya , Eghrari Allen Omid 
Published: October 2022

Purpose:
Traumatic paracentral corneal perforations may lead to irregular astigmatism and opacification from lamellar grafts. We present an alternative surgical technique using a Tenon patch graft and a conjunctival flap.

Methods:
A 42-year-old man presented with a 1-mm paracentral corneal perforation 6 weeks after penetrating trauma by a metallic foreign body. A region of Tenon fascia was excised and sutured to cover the perforation, and a conjunctival flap was then created and sutured over this Tenon graft. A bandage contact lens was placed postoperatively. Serial imaging was conducted to document healing including optical coherence tomography (OCT) and slit lamp photography.

Results:
At postoperative day 1, uncorrected distance visual acuity (UDVA) was hand motion, the anterior chamber was formed, and OCT revealed Tenon fascia and conjunctiva covering the defect. By postoperative week 2, the leak resolved and UDVA was 20/30. At postoperative week 4, UDVA improved to 20/20, the Tenon graft was noted to be undergoing contraction, and a single feeder vessel remained prominent in the conjunctival flap. By postoperative month 4, UDVA was 20/25 and only mild paracentral cornea clouding was noted. Initial, focal steepening and thickening normalized by month 4 leaving mild, normal astigmatism. OCT revealed integration of the Tenon graft into the corneal stroma.

Conclusions:
For paracentral corneal perforations, a Tenon patch graft in conjunction with a conjunctival flap may aid healing with favorable postoperative refractive outcomes.
The Role of Physical Therapy in Reducing the Recurrence of Clogged Milk Ducts and Subsequent Mastitis
Authors: McMeans Shana , Gantt Emily , Rhodes Stephanie , Wood Stacie , Divine Kate , McVey Lisa 
Published: October 2022

Background:
The World Health Organization supports and recognizes the benefits of breastfeeding, at least 6 months or more, for both a mother and her baby. A common cause for cessation of breastfeeding is the development of mastitis typically caused by a clogged milk duct. Literature is limited on physical therapy's role in reducing clogged milk ducts and subsequent mastitis.

Study Design:
A case report

Case Description:
This case describes a 33-year-old woman who was referred to physical therapy following unsuccessful treatment for breastfeeding complications that included daily bilateral clogged milk ducts and mastitis. The patient participated in a comprehensive physical therapy approach consisting of patient education, moist heat, therapeutic ultrasound, manual techniques, and cryotherapy.

Outcomes:
A retrospective review of 5 physical therapy visits over 3 weeks was completed. The patient reported no recurrence of mastitis and the ability to manage and decrease the recurrence of clogged milk ducts. The patient's number of daily clogged milk ducts and reported success with breastfeeding improved. At 6 months post-discharge, the patient reported she was able to continue breastfeeding and had no recurrence of mastitis.

Discussion:
Physical therapists may have a potential role in treating clogged milk ducts and subsequent mastitis in postpartum women where there is a lack of availability of lactation resources.
A video abstract is available (see Supplemental Digital Content 1, available at: http://links.lww.com/JWHPT/A84).
Use of anti-Müllerian hormone for understanding ovulatory dysfunction in polycystic ovarian syndrome
Authors: Aydogan Mathyk Begum , Cetin Esra , Yildiz Bulent O. 
Published: October 2022

Purpose of review
The aim of this review is to understand how anti-Müllerian hormone (AMH) contributes to ovulatory dysfunction in polycystic ovarian syndrome (PCOS).

Recent findings
In the last few years, new findings have emerged on AMH and its role on the central nervous system causing ovulatory dysfunction.

Summary
Anovulation is a prominent feature of PCOS. Women with anovulatory PCOS have higher AMH levels than in ovulatory PCOS. Higher levels of AMH may contribute to the pathophysiology of PCOS through central and peripheral actions. Once universal standardization is achieved to measure serum AMH, the benefits would be significant in diagnosing women with PCOS.
Endobariatrics: well past infancy and maturing rapidly
Authors: Shrestha Shreesh , Shrestha Esha , Shah Tilak 
Published: October 2022

Purpose of review
This review summarizes the key developments with regard to FDA-approved endoscopic bariatric metabolic therapies (EBMTs) in the last 2 years.

Recent findings
The prevalence of obesity has increased during the coronavirus disease 2019 (COVID-19) pandemic, and obesity worsens COVID-19 related outcomes. Several studies have confirmed the safety and short-term efficacy of intragastric balloons (IGBs). In the short-term IGBs may improve steatosis and fibrosis in nonalcoholic fatty liver disease and improve quality of life and mental health. Unfortunately weight loss from these temporarily placed devices is not sustained long-term. Endoscopic sleeve gastroplasty (ESG) may be more effective and durable than IGBs, and result in fewer adverse events compared to bariatric surgery. The recently completed MERIT trial may catapult ESG as a first-line EBMT. Aspiration therapy meets safety and effectiveness thresholds for incorporation into routine practice, but overall acceptance has been lower than other FDA-approved EBMTs.

Summary
The field of endobariatrics is rapidly maturing. Significant knowledge gaps remain with regards to combining EBMTs with pharmacologic therapy to improve durability of weight loss. The rapid expansion in the literature supporting safety and long-term efficacy ESG may prompt revision of existing guidelines.
Probiotics for the Management of Pediatric Gastrointestinal Disorders: Position Paper of the ESPGHAN Special Interest Group on Gut Microbiota and Modifications
Authors: Szajewska Hania , Berni Canani Roberto , Domellöf Magnus , Guarino Alfredo , Hojsak Iva , Indrio Flavia , Lo Vecchio Andrea , Mihatsch Walter A. , Mosca Alexis , Orel Rok , Salvatore Silvia , Shamir Raanan , van den Akker Chris H. P. , van Goudoever Johannes B. , Vandenplas Yvan , Weizman Zvi ,   on behalf of the ESPGHAN Special Interest Group on Gut Microbiota and Modifications
Published: October 2022

Background:
Probiotics, defined as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host, are widely used despite uncertainty regarding their efficacy and discordant recommendations about their use. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Special Interest Group on Gut Microbiota and Modifications provides updated recommendations for the use of probiotics for the management of selected pediatric gastrointestinal disorders.

Methods:
All systematic reviews and/or meta-analyses, as well as subsequently published randomized controlled trials (RCTs) (until December 2021), that compared the use of probiotics in all delivery vehicles and formulations, at any dose, with no probiotic (ie, placebo or no treatment), were eligible for inclusion. The recommendations were formulated only if at least 2 RCTs on a similar well-defined probiotic strain were available. The modified Delphi process was used to establish consensus on the recommendations.

Results:
Recommendations for the use of specific probiotic strains were made for the management of acute gastroenteritis, prevention of antibiotic-associated diarrhea, nosocomial diarrhea and necrotizing enterocolitis, management of Helicobacter pylori infection, and management of functional abdominal pain disorders and infant colic.

Conclusions:
Despite evidence to support the use of specific probiotics in some clinical situations, further studies confirming the effect(s) and defining the type, dose, and timing of probiotics are still often required. The use of probiotics with no documented health benefits should be discouraged.
Atypical Presentation of Monkeypox Virus Infection in a Postvaccinated Altered Immunocompetent Patient—A Case-Report
Authors: Taleb Eyal , Zucker Roy , Wagner-Kolasko Gal , Raviv Yuval 
Published: October 2022

Abstract
We herein report a case of an altered immunocompetent patient with atypical monkeypox presentations after being vaccinated with JYNNOES vaccine. The initial presentation was of acute bacterial paronychia. This incident suggests the need for individuals at high-risk for monkeypox infection with altered immunity to receive 2 vaccination doses.
Restoration of Grasp after Single-Stage Free Functioning Gracilis Muscle Transfer In Traumatic Adult Pan Brachial Plexus Injury
Authors: Maldonado Andres A. , Poppler Louis , Kircher Michelle F. , Spinner Robert J. , Bishop Allen T. , Shin Alexander Y. 
Published: October 2022

Introduction:
A variety of approaches have been described to obtain rudimentary grasp following traumatic pan brachial plexus injury in the adult. The aim of this study is to evaluate hand prehension after a Gracilis Single-Stage Free Functioning Muscle Transfer (SSFFMT).

Materials and Methods:
Twenty-seven patients who underwent gracilis SSFFMT for elbow flexion and hand prehension following a pan-plexus injury were included. All patients presented with a minimum of 2 years of follow-up. Postoperative finger flexion, elbow flexion strength, preoperative and postoperative DASH scores, secondary hand procedures, complications as well as demographic characteristics were analyzed.

Results:
Twenty patients (74%) demonstrated active finger pull-through. Only 6 (25%) patients considered their hand function as useful for daily activities. DASH score improved by 13.1 ± 13.7 (p-value < 0.005). All patients were expected to require one secondary procedure: combined wrist, thumb CMC and thumb IP fusions, as no extensor reconstruction was performed. These were actually performed in 89%, 78% and 74% of patients, respectively. Four postoperative complications included hematoma, seroma, wound dehiscence and skin paddle loss. No flap loss occurred.

Conclusion:
In pan-plexus injuries, the use of a gracilis SSFFMT is an alternative to the Doi double FFMT procedure and cC7 transfer, especially for patients that cannot afford (economically or mentally) two to three important surgeries in a short period of time. Further research and studies are required to improve hand function in these patients.
Acute Flaccid Myelitis: Review of Clinical Features, Diagnosis, and Management with Nerve Transfers
Authors: Kozlowski Julia , Linzey Joseph R. , Muhlestein Whitney E. , Smith Brandon W. , Chang Kate Wan-Chu , Yang Lynda J.-S. 
Published: October 2022

OBJECTIVEAcute flaccid myelitis (AFM) is a devastating neurological condition in children manifesting as acute limb weakness, paralysis, or both. Despite increased awareness of AFM following the initiation of U.S. surveillance in 2014, no consensus exists for its treatment. The purpose of this systematic review is to summarize the most current knowledge regarding AFM epidemiology, etiology, clinical features, diagnosis, and supportive and operative management, focusing on the promise of nerve transfers for this disease.METHODSThe authors systematically reviewed the literature based on PRISMA guidelines using multiple databases to search the keywords (“acute flaccid myelitis”), (‘acute flaccid myelitis’/exp OR ‘acute flaccid myelitis’), and (Acute AND flaccid AND myelitis). Original articles were included if the studies reported on (1) the diagnosis of AFM and (2) patient-specific data regarding epidemiology, etiology, clinical features, diagnostic features, or management of AFM.RESULTSOf 843 articles initially identified, 99 were included in this review. The precise etiology and pathophysiologic mechanism of AFM is yet to be definitively determined, but AFM is strongly associated with non-polio enterovirus infections. Clinical presentation typically comprises preceding viral prodrome, pleocytosis, spinal cord lesions on T2 MRI, and acute onset of flaccid weakness/paralysis with hyporeflexia in at least one extremity. Supportive care includes medical therapy and rehabilitation, though patients treated conservatively often have persistent neurological deficits. Early studies of nerve transfer for AFM have shown favorable outcomes for patients with persistent weakness.CONCLUSIONSSupportive care and physical therapy are the foundation of a multi-disciplinary approach to managing AFM. However, for patients with persistent limb weakness, nerve transfer has shown promise for improving function, particularly in distal muscle groups. When evaluating a patient for nerve transfer, surgeons must consider potential spontaneous recovery, patient selection, donor nerve availability, recipient nerve appropriateness, and procedure timing.
Modeling the Risk of HIV Transfusion Transmission
Authors: Belov Artur , Yang Hong , Forshee Richard A. , Whitaker Barbee I. , Eder Anne F. , Chancey Caren , Anderson Steven A. 
Published: October 2022

Background:
Blood donations are routinely screened for HIV to prevent an infectious unit from being released to the blood supply. Despite improvements to blood screening assays, donations from infected donors remain undetectable during the window period (WP), when the virus has not yet replicated above the lower limit of detection (LOD) of a screening assay. To aid in the quantitative risk assessments of WP donations, a dose–response model describing the probability of transfusion-transmission of HIV over a range of viral RNA copies was developed.

Methods:
An exponential model was chosen based on data fit and parsimony. A data set from a HIV challenge study using a nonhuman primate model and another data set from reported human blood transfusions associated with HIV infected donors were separately fit to the model to generate parameter estimates. A Bayesian framework using No-U-Turn Sampling (NUTS) and Monte Carlo simulations was performed to generate posterior distributions quantifying uncertainty in parameter estimation and model predictions.

Results:
The parameters of the exponential model for both nonhuman primate and human data were estimated with a mean (95% credible intervals) of 2.70 × 10−2 (7.74 × 10−3, 6.06 × 10−2) and 7.56 × 10−4 (3.68 × 10−4, 1.31 × 10−3), respectively. The predicted ID50 for the animal and human models was 26 (12, 90) and 918 (529, 1886) RNA copies transfused, respectively.

Conclusion:
This dose–response model can be used in a quantitative framework to estimate the probability of transfusion-transmission of HIV through WP donations. These models can be especially informative when assessing risk from blood components with low viral load.
Development and Validation of a Deep Learning System for the Diagnosis of Pediatric Diseases: A Large-Scale Real-World Data Study in Shanghai
Authors: Ge Xiaoling , Wang Yi , Xie Li , Shang Yujuan , Zhai Yihui , Huang Zhiheng , Huang Jianfeng , Ye Chengjie , Ma Ao , Li Wanting , Zhang Xiaobo , Xu Hong 
Published: October 2022

AbstractBackgroundArtificial intelligence (AI)-assisted diagnosis is considered to be the future direction of improving the efficiency and accuracy of pediatric diseases diagnosis, while the existing research based on AI are far from sufficient because of limited data amount, inadequate coverage of disease types, or high construction costs, and have not been applied on a large scale. We aimed to develop an accurate deep learning model trained on millions of real-world data to verify the feasibility of the technology, and build the whole process of outpatient auxiliary diagnosis.Methods and findingsWe applied a Chinese Natural Language Processing (NLP) and an end-to-end deep neural network classifier to the outpatient’s electronic medical records (EMRs) in a single child care center in Shanghai, China, to unstructured text processing and construct an auxiliary diagnostic model, all patients were aged from 0 to 18 years. A training cohort with millions of records and an independent validation cohort with tens of thousands of records were intake separately and calculate diagnosis concordance rate (DCR) of model in each diseases group. The records with inconsistent diagnoses between human and AI were evaluated by clinical experts’ group, and calculate the relative correct rate (RCR) to evaluate the diagnostic performance of the model. A total of 5,271,347 medical records were intake in model training covering sixteen categories of diseases according to disease coding, reaching a DCR of 95· 49% (95· 48∼95· 51). For validation, 91,880 records were obtained from validation dataset, which reached a DCR of 93· 51% (93· 35∼93· 67) and FDCR of 72.04% (71· 75∼72· 33). It was confirmed that the accuracy of the model was still higher than that of human with most RCR>1 in validation dataset.ConclusionsThe deep learning system could support diagnosis of pediatric diseases, which has high diagnostic performance, comprehensive disease coverage, feasible technology, and can be promoted in multiple sites in the future.FundingThe Authors received no specific funding for this work.
Integrated analysis of cell-free DNA for the early detection of cancer in people with Li-Fraumeni Syndrome
Authors: Wong Derek , Luo Ping , Oldfield Leslie , Gong Haifan , Brunga Ledia , Rabinowicz Ron , Subasri Vallijah , Chan Clarissa , Downs Tiana , Farncombe Kirsten M , Luu Beatrice , Norman Maia , Eagles Jenna , Pederson Stephenie , Wellum Johanna , Danesh Arnavaz , Prokopec Stephenie , Zhao Eric , Znassi Nadia , Lam Bernard , Marsh Kayla , Sundaravadanam Yogi , Torti Dax , Malkin David , Kim Raymond H , Pugh Trevor J 
Published: October 2022

SummaryDespite advances in cancer therapeutics, early detection is often the best prognostic indicator for survival (1). People with Li-Fraumeni syndrome harbor a germline pathogenic variant in the tumor suppressor geneTP53(2) and face a near 100% lifetime risk of developing a wide spectrum of, often multiple, cancers (3).TP53mutation carriers routinely undergo intensive surveillance protocols which, although associated with significantly improved survival, are burdensome to both the patient and the health care system (4). Liquid biopsy, the analysis of cell-free DNA fragments in bodily fluids, has become an attractive tool for a range of clinical applications, including early cancer detection, because of its ability to provide real-time holistic insight into the cellular milieu (5). Here, we assess the efficacy of a multi-modal liquid biopsy assay that integrates a targeted gene panel, shallow whole genome, and cell-free methylated DNA immunoprecipitation sequencing for the early detection of cancer in a cohort of Li-Fraumeni syndrome patients: 196 blood samples from 89 patients, of which 26 were pediatric and 63 were adults. Our integrated analysis was able to detect a cancer-associated signal in 79.4% of samples from patients with active cancer, a 37.5% – 58.8% improvement over each individual analysis. Through analysis of patient plasma at cancer negative timepoints, we were able to detect cancer-associated signals up to 16 months prior to occurrence of cancer as detected by conventional clinical modalities in 17.6% ofTP53mutation carriers. This study provides a framework for the integration of liquid biopsy into current surveillance methods for patients with Li-Fraumeni syndrome.
Gut microbial disruption in critically ill patients with COVID-19 associated pulmonary aspergillosis
Authors: Maurer H. Carlo , Schult David , Koyumdzhieva Plamena , Reitmeier Sandra , Middelhoff Moritz , Rasch Sebastian , List Markus , Janssen Klaus-Peter , Steiger Katja , Protzer Ulrike , Schmid Roland M. , Neuhaus Klaus , Haller Dirk , Quante Michael , Lahmer Tobias 
Published: October 2022

ABSTRACTObjectivesCOVID-19 disease can be exacerbated byAspergillussuperinfection (CAPA). The causes of CAPA are not yet fully understood. Recently, alterations in the gut microbiome have been associated with a complicating course and increasing severity of COVID-19 disease, most likely via immunological mechanisms. Aim of this study was to investigate a potential association between severe CAPA and alterations in the gut and bronchial microbiota.MethodsWe performed 16S rRNA gene amplicon sequencing of stool and bronchial samples from a total of 16 COVID-19 patients with CAPA and 26 patients without CAPA. All patients were admitted to the intensive care unit. Results were carefully tested for potential influences on the microbiome during hospitalization.ResultsWe found that late in COVID-19 disease, CAPA patients exhibited a trend towards reduced gut microbial diversity. Furthermore, late stage CAPA disease showed an increased presence ofStaphylococcus epidermidisin the gut. This is not found in late non-CAPA cases or early disease. The analysis of bronchial samples did not show significant results.ConclusionsThis is the first study showing alterations in the gut microbiome accompany severe CAPA and possibly influence the host’s immunological response. In particular, an increase ofStaphylococcus epidermidisin the intestine could be of importance.SummaryThe composition of intestinal bacteria in severe CAPA disease is altered with an increase in Staphylococcus epidermidis in the gut. Alterations in the composition of intestinal bacteria in severe CAPA may indicate immunologic involvement of the gut in the disease.
LINC01184 is highly expressed and functions as a tumor-promotive factor in hepatocellular carcinoma
Authors: Zhang Qiangnu , Yan Lesen , Chen Jiaojuan , Liu Liping 
Published: October 2022

AbstractThe expression and function of LINC01184 in hepatocellular carcinoma are unknown. We analyzed the changes in LINC01184 expression in hepatocellular carcinoma using public data, and also analyzed the relationship between LINC01184 and patient prognosis. In vitro, we investigated the effect of LINC01184 on HCC cell growth using cell activity analysis, clone formation analysis, and regulatory death analysis. We also explored the effect of LINC01184 on HCC cell migration using transwell analysis and scratch assay. We found that LINC01184 was significantly highly expressed in hepatocellular carcinoma tissues. Patients with high LINC01184 levels had poorer overall survival and disease-free survival. knockdown of LINC01184 in HUH7 and PLC/PRF/5 cells inhibited cell proliferation and induced regulatory death. Down-regulation of LINC01184 also leads to a reduction in the migratory capacity of cells. In conclusion, LINC01184 may become a biomarker or a new therapeutic target for HCC.
Assessing the epidemic impact of protests during the COVID-19 pandemic
Authors: Hong Inho , Ferreira Leonardo N. , Rutherford Alex , Cebrian Manuel 
Published: October 2022

ABSTRACTProtests during the COVID-19 pandemic present a complex trade-off between democratic rights of freedom of assembly and an epidemic risk, and have created a need for careful assessment of protest-driven infections. Here, we build a coupled disease transmission model and assess the impact of protests on the COVID-19 spread in the continental US using a dataset of 4,121 protests and 1.66 million protesters between April and June of 2020. We find that protests in 2020 had limited effects, creating tens of additional daily cases country-wide, due to their small size. However, a simple scaling relation of protest-driven infections derived from our simulations reveals that very large protests with over millions of participants can significantly boost outbreaks and impact the healthcare system. In the worst-case scenario, very large protests can add over 20,000 daily cases and over 7,000 ICU admissions over the continental US. We hope our model can aid the policy rationale to maintain freedom of assembly in the current and future pandemics, while providing estimates for preparations for a healthcare surge in the worst-case setting.