bluuebunny/crossref_metadata_2025_split huggingface dataset:
Addressing Self-Injurious Behavior in the Medically Complex Child: Identifying the Root Cause vs Blocking Resulting Behavior
Authors: Low Kapalu Christina , Krasaelap Amornluck , Nyp Sarah S. 
Published: November 2022

CASE:
Gillian is a 7-year-old nonverbal, internationally adopted girl with significant visual impairment (sees shadows and objects with high contrast), moderate-severe hearing loss, autism spectrum disorder, profound intellectual disability, and a seizure disorder. She resided in an orphanage until age 4 years when she was adopted by her mother. She is referred to the multidisciplinary team in developmental-behavioral pediatrics by her gastroenterologist, who is managing her constipation, for evaluation and management of self-injurious behavior that occurs before bowel movements.
Gillian's adoptive mother reported that Gillian has a history of repetitive and self-injurious behavior including hitting her head with the palm of her hand and poking her eyes. The head-hitting behavior has resulted in consistent bruising to her forehead and nasal bridge. The eye poking is of significant concern because of the possibility of resultant injury including corneal abrasion or retinal detachment. Eye poking occurs exclusively during the hour before stooling, at home and school, and is accompanied by screaming, pacing, and increased aggression toward her mother/teachers. Mother typically responds by blocking the eye poking, redirecting Gillian to the toilet, providing prompts to use calming strategies (e.g., deep breathing), or providing sensory input by rubbing her arms/back. Teachers respond in a similar way at school. Gillian's mother has tried to place goggles over Gillian's eyes during eye poking, but this resulted in increased aggressive behaviors.
Gillian is not fully bowel trained but will sit on the toilet to urinate when prompted. She completes toilet-sits at home/school 5 to 7 times daily. Gillian passes small, soft bowel movements 2 to 4 times daily on a bowel management regimen consisting of polyethylene glycol 3350 17 grams twice daily and liquid senna 8.8 mg daily. Seizures are reportedly well controlled with an antiepileptic medication managed by her neurologist. Previous medical evaluation by otolaryngology, ophthalmology, neurology, and gastroenterology did not identify a source of pain or other cause for the eye poking. Physical examination reveals normal bowel sounds and a mildly distended abdomen but is otherwise unremarkable. What are your next steps for evaluation and treatment?
Evaluation of Chronic Constipation in Children With Autism Spectrum Disorder
Authors: Coe Alexander , Ciricillo Jacob , Mansi Sherief , El-Chammas Khalil , Santucci Neha , Bali Neetu , Lu Peter L. , Damrongmanee Alisara , Fei Lin , Liu Chunyan , Kaul Ajay , Williams Kent C. 
Published: November 2022

Objectives:
Chronic constipation occurs frequently in children with autism spectrum disorder (ASD). The primary objective was to determine whether chronic constipation is associated with a higher rate of abnormal colonic motor activity in ASD children than in non-ASD children. A secondary goal was to determine if clinical variables could identify children with ASD at risk for possessing abnormal colonic motility.

Methods:
A retrospective, propensity-matched, case-control study compared colonic manometry (CM) of an ASD cohort and non-ASD controls with chronic constipation. Clinical variables were evaluated as potential predictors for abnormal colonic motility.

Results:
Fifty-six patients with ASD and 123 controls without the diagnosis of ASD who underwent CM were included. Propensity score resulted in 35 matched cohorts of ASD and controls. The rate of abnormal CM findings between ASD and matched controls (24% vs 20%, P = 0.78) did not differ significantly. A prediction model of abnormal CM that included ASD diagnosis, duration of constipation, and soiling achieved a sensitivity of 0.94 and specificity of 0.65. The risk for abnormal colonic motility increased 11% for every 1-year increase in duration of constipation. Odds for abnormal motility were 30 times higher in ASD children with soiling than controls with soiling (P < 0.0001).

Conclusions:
Chronic constipation does not appear to be associated with a higher rate of abnormal colonic motility in children with ASD. Clinical information of disease duration and presence of soiling due to constipation show promise in identifying patients with ASD at a greater risk for abnormal colonic motility.
An Education Intervention to Raise Awareness Reduces Self-reported Opioid Overprescribing by Plastic Surgery Residents
Authors: Skladman Rachel , Keane Grace C. , Grant David , Mackinnon Susan E. 
Published: November 2022

Purpose
The aim of this study was to understand how opioid prescribing practices of plastic surgery residents changed after instituting opioid prescribing education (OPE) interventions.

Methods
Plastic surgery residents at a single academic institution completed a survey (fall 2017) assessing opioid prescribing following 8 common procedures. The Division then completed 3 multidisciplinary OPE interventions over 2.5 years, which provided passive learning to raise awareness without top-down prescribing guidelines. Residents were resurveyed at 2 time points after the interventions (fall 2018 and spring 2020). The primary outcome measure was self-reported morphine milligram equivalents prescribed.

Results
Survey response rates were 84% to 100%. Preintervention opioid prescriptions were characterized by high variability and absolute doses for all procedures. We observed statistically significant decreases in prescribed doses for most procedures at 9 months post intervention and further decreases at 2.5 years. In the most recently surveyed cohort, only 3 of 16 residents (18.8%) had OPE before residency, whereas 12 of 16 residents (75.0%) participated in OPE during residency. Eighty-eight percent of respondents “always” (8/16, 50%) or “usually” (6/16, 38%) considered the opioid epidemic when prescribing opioids, suggesting an improved prescribing culture. Barriers to better prescribing included duplicate prescriptions/accessing state-run prescription drug monitoring programs (75.0%), remote prescribing (75%), providing refills (56%), and prescribing opioids for patients on chronic opioid therapy (56%).

Conclusion
This prospective cohort study demonstrates that a simple multidisciplinary, didactic OPE intervention that aimed to increase residents' awareness has the potential to reduce self-reported opioid prescribing and sustain prescribing practices over many years. We identify persistent barriers facing our resident prescribers today, enabling more opioid educational interventions in the future.
Comparison of the Relapse Ratio and Osteogenesis Between 1-Piece and 2-Piece Fronto-Orbital Distraction Osteogenesis Among Patients With Bilateral Craniosynostosis in Early Childhood
Authors: Park Hojin , Choi Jong Woo , Ra Young Shin 
Published: November 2022

Background
Fronto-orbital distraction osteogenesis (FODO), used to correct bilateral coronal craniosynostosis (BCS), is grossly classified into 1-piece and 2-piece FODO. One-piece FODO osteomizes the frontal and supraorbital bones as one block by preserving the attachment between the dura mater and bone, whereas the 2-piece FODO detaches bone segments from the underlying dura mater and reshapes them. This study aimed to determine whether separating the bone-dura attachment would affect osteogenesis and the relapse of the deformity and to compare the surgical outcomes between 1-piece and 2-piece FODO.

Methods
Patients with BCS who underwent either 1-piece or 2-piece FODO between May 2008 and November 2016 were retrospectively reviewed. Patients older than 12 months who were diagnosed with syndromic or nonsyndromic craniosynostosis were included. The CT images were taken at initial presentation (T0), 1–3 years postoperatively (T1), and >4 years postoperatively (T2). These images were used to measure the frontal angle, anterior skull base ratio, and bone defect area.

Results
This study included 11 patients in the 1-piece group and 9 patients in the 2-piece group. The relapse ratios of the frontal angle were −2.3% ± 0.6% and −4.9% ± 2.1% in the 1-piece and 2-piece groups, respectively, showing that the 2-piece group had a significantly higher relapse ratio (P = 0.002). At the T2 period, the 1-piece group had a significantly higher anterior skull base ratio (0.80 ± 0.10) than that in the 2-piece group (0.69 ± 0.08, P = 0.046). In addition, the bone defect area was significantly lower in the 1-piece group (T1: 4.90 ± 2.32 cm2, T2: 2.55 ± 1.57 cm2) than in the 2-piece group (T1: 10.74 ± 5.89 cm2, T2: 5.35 ± 2.74 cm2) both at the T1 (P = 0.037) and T2 (P = 0.025) periods.

Conclusions
One-piece FODO can result in the preservation of the bone segments' vascularity and the enhancement of osteogenesis in the distraction gap. Moreover, 1-piece FODO is associated with lower rates of relapse of deformity and bone defects compared with 2-piece FODO. Lastly, 1-piece FODO can be performed to maximize the advantages of distraction osteogenesis and improve surgical outcomes, especially among early childhood patients with BCS.
High-Quality Lipoaspirate Following 1470-nm Radial Emitting Laser-Assisted Liposuction
Authors: Shapira Eyal , Plonski Lori , Menashe Shaked , Ofek Andre , Rosenthal Adaya , Brambilla Massimiliano , Goldenberg Gary , Haimowitz Sahar , Heller Lior 
Published: November 2022

Background
Laser-assisted liposuction (LAL) has been used to maximize viable adipocyte yields in lipoaspirates, although optimizing tissue processing methods is still a challenge. A high-quality lipoaspirate has been a key factor for extended graft longevity.

Objective
To assess the viability and potency of stromal vascular fraction (SVF) cells and adipose-derived stem cells (ASCs) in fat samples from lipoaspirates harvested with a novel 1470-nm diode, radial emitting LAL platform. Two processing methods, enzymatic and nonenzymatic, were compared.

Methods
Laser-assisted liposuction lipoaspirates harvested from 10 subjects were examined for cell viability after processing by enzymatic or nonenzymatic methods. Isolated SVF cells were cultured with an ASC-permissive medium to assess their viability and proliferation capacity by cell proliferation assay. Flow cytometric analysis with ASC-specific markers, gene expression levels, and immunofluorescence for ASC transcription factors were also conducted.

Results
Lipoaspirates showed high SVF cell viability of 97% ± 0.02% and 98% ± 0.01%, averaged SVF cell count of 8.7 × 106 ± 3.9 × 106 and 9.4 × 106 ± 4.2 × 106 cells per mL, and averaged ASC count of 1 × 106 ± 2.2 × 105 and 1.2 × 106 ± 5 × 105 cells per mL in nonenzymatic and enzymatic methods, respectively. The ASC-specific markers, gene expression levels, and immunofluorescence for ASC transcription factors confirmed the adipose origin of the cells.

Conclusions
The laser lipoaspirates provide a high yield of viable and potent SVF cells and ASCs through both nonenzymatic and enzymatic processes. Improved purity of the harvested lipoaspirate and high ASC content are expected to result in extended graft longevity. Furthermore, eliminating enzymatic digestion may provide advantages, such as reducing process time, cost, and regulatory constraints.
Comparison of Human, Porcine, and Bovine Acellular Dermal Matrix in Prepectoral Breast Reconstruction
Authors: Pires Giovanna R. , Moss Whitney D. , Hosein Ray C. , Overschmidt Bo T. , Magno-Padron David A. , Agarwal Jayant P. , McFarland Mary M. , Casucci Tallie , Kwok Alvin C. 
Published: November 2022

Objective
The aim of the study is to determine rates of overall complications and failure of prepectoral breast reconstruction between various types of acellular dermal matrices (ADMs).

Background
Implant-based breast reconstruction is the most common reconstructive technique after mastectomy in the United States. Traditionally, the reconstruction has been performed in the subpectoral plane; however, there has been an emerging interest in prepectoral reconstruction using ADM. Human (hADM), porcine (pADM), and bovine (bADM) ADMs are available for use, but little is known about the benefits and complication profiles of each for prepectoral breast reconstruction.

Methods
Studies examining complications after the use of ADM for prepectoral breast reconstruction were identified using MEDLINE, Embase, the Cochrane Library, LILACS, and the Web of Science from January 2010 to August 2021. Titles and abstracts of 1838 studies were screened, followed by full-text screening of 355 articles. Thirty-three studies were found to meet inclusion criteria.

Results
From the 33 studies, 6046 prepectoral reconstructions were examined. Implant loss was comparable across the different types of ADM (pADM, 4.0%; hADM, 4.0%; bADM, 3.7%). Bovine ADM had the highest rate of capsular contracture (6.1%), infection (9.0%), skin flap necrosis (8.3%), dehiscence (5.4%), and hematoma (6.1%) when compared with both hADM and pADM. Human ADM had the highest rate of postoperative seroma (5.3%), followed by pADM (4.6%) and bADM (4.5%).

Conclusions
Among the prepectoral breast reconstruction studies using hADM, pADM, or bADM included in our analysis, complication profiles were similar. Bovine ADM had the highest proportion of breast complications in the following categories: capsular contracture, infection rate, skin flap necrosis, dehiscence, and hematoma. Implant loss was comparable across the cohorts. Overall, prepectoral breast reconstruction using ADM leads to relatively low complication rates with the highest rates within the bADM cohort.
Risk Factors Associated With Pressure Injuries in Surgical Patients
Authors: Kim Jung Yoon , Lee Hyun Hee 
Published: November 2022

PURPOSE:
This study aimed to identify predictive risk factors for pressure injury (PI) occurring during surgery.

DESIGN:
Retrospective case-control study.

SUBJECTS AND SETTING:
Data on records of 6070 patients hospitalized for surgery at Seoul National University Bundang Hospital located in Seoul Korea. Data were collected between May 2013 and December 2014.

METHODS:
Anonymized data from patients were accessed via electronic health records, nursing records, direct patient assessment, surgical, clinical laboratory, and anesthesia records, preanesthesia status evaluations, and PI incident reports, and transfusion and extracorporeal circulation reports. Descriptive and logistic regression analyses were conducted.

RESULTS:
Three hundred eighty-one of the 6070 patients (6.3%) developed within 24 hours a PI that was associated with surgery. The most common locations for the PIs were the coccyx (15.1%; n = 75) and trunk (chest or abdomen; 15.1%; n = 75). All PIs were classified as stage 1 (66.6%; n = 331) or 2 (33.4%; n = 166). Based on logistic regression results, we found that the risk factors that were independently predictive of surgery-related PIs were patient position during surgery, admission to an intensive care unit after surgery, required blood transfusion during surgery, and duration of surgery.

CONCLUSIONS:
This retrospective study identified several risk factors associated with a higher incidence of perioperative PIs in surgical patients. A PI prevention program accounting for these factors could potentially help prevent PIs and their costly complications.
Exome-wide benchmark of difficult-to-sequence regions using short-read next-generation DNA sequencing
Authors: Hijikata Atsushi , Suyama Mikita , Kikugawa Shingo , Matoba Ryo , Naruto Takuya , Enomoto Yumi , Kurosawa Kenji , Harada Naoki , Yanagi Kumiko , Kaname Tadashi , Miyako Keisuke , Takazawa Masaki , Sasai Hideo , Hosokawa Junichi , Itoga Sakae , Yamaguchi Tomomi , Kosho Tomoki , Matsubara Keiko , Kuroki Yoko , Fukami Maki , Adachi Kaori , Nanba Eiji , Tsuchida Naomi , Uchiyama Yuri , Matsumoto Naomichi , Nishimura Kunihiro , Ohara Osamu 
Published: November 2022

AbstractNext-generation DNA sequencing (NGS) in short-read mode has been recently used for genetic testing in various clinical settings. NGS data accuracy is crucial in clinical settings, and several reports regarding quality control of NGS data, focusing mostly on establishing NGS sequence read accuracy, have been published thus far. Variant calling is another critical source of NGS errors that remains mostly unexplored despite its established significance. In this study, we used a machine-learning-based method to establish an exome-wide benchmark of difficult-to-sequence regions using 10 genome sequence features on the basis of real-world NGS data accumulated in The Genome Aggregation Database (gnomAD) of the human reference genome sequence (GRCh38/hg38). We used the obtained metrics, designated “UNMET score,” along with other lines of structural information of the human genome to identify difficult-to-sequence genomic regions using conventional NGS. Thus, the UNMET score could provide appropriate caveats to address potential sequential errors in protein-coding exons of the human reference genome sequence GRCh38/hg38 in clinical sequencing.
Repurposing the mammalian RNA-binding protein Musashi-1 as an allosteric translation repressor in bacteria
Authors: Dolcemascolo Roswitha , Heras-Hernández María , Goiriz Lucas , Montagud-Martínez Roser , Requena-Menéndez Alejandro , Ruiz Raúl , Pérez-Ràfols Anna , Higuera-Rodríguez R. Anahí , Pérez-Ropero Guillermo , Vranken Wim F. , Martelli Tommaso , Kaiser Wolfgang , Buijs Jos , Rodrigo Guillermo 
Published: November 2022

ABSTRACTThe RNA recognition motif (RRM) is the most common RNA-binding protein domain identified in nature. However, RRM-containing proteins are only prevalent in eukaryotic phyla, in which they play central regulatory roles. Here, we engineered an orthogonal post-transcriptional control system of gene expression in the bacteriumEscherichia coliwith the mammalian RNA-binding protein Musashi-1, which is a stem cell marker with neurodevelopmental role that contains two canonical RRMs. In the circuit, Musashi-1 is regulated transcriptionally and works as an allosteric translation repressor thanks to a specific interaction with the N-terminal coding region of a messenger RNA and its structural plasticity to respond to fatty acids. We fully characterized the genetic system at the population and single-cell levels showing a significant fold change in reporter expression, and the underlying molecular mechanism by assessing thein vitrobinding kinetics andin vivofunctionality of a series of RNA mutants. The dynamic response of the system was well recapitulated by a bottom-up mathematical model. Moreover, we applied the post-transcriptional mechanism engineered with Musashi-1 to specifically regulate a gene within an operon, to implement combinatorial regulation, and to reduce protein expression noise. This work illustrates how RRM-based regulation can be adapted to simple organisms, thereby adding a new regulatory layer in prokaryotes for translation control.
Measures to assess quality of postnatal care: a scoping review
Authors: Galle Anna , Moran Allisyn C , Bonet Mercedes , Graham Katriona , Muzigaba Moise , Portela Anayda , Day Louise Tina , Tuabu Godwin Kwaku , De Sá é Silva Bianca , Moller Ann-Beth 
Published: November 2022

AbstractHigh quality postnatal care is key for the health and wellbeing of women after childbirth and their newborns. In 2022, the World Health Organization (WHO) published global recommendations on maternal and newborn care for a positive postnatal care experience. Evidence regarding appropriate measures to monitor implementation of postnatal care (PNC) according to the WHO recommendations is lacking. This scoping review aims to document the measures used to assess the quality of postnatal care and their validity. The review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Five electronic bibliographic databases were searched together with a grey literature search. Two reviewers independently screened and appraised identified articles. All data on PNC measures were extracted and mapped to the postnatal care guideline according to three categories: i) maternal care, ii) newborn care, iii) health system and health promotion interventions. We identified 62 resources providing measures aligning with the WHO PNC recommendations. For most PNC recommendations there were measures available and the highest number of recommendations were found for breastfeeding and the assessment of the newborn. No measures were found for recommendations related to sedentary behavior, criteria to be assessed before discharge, retention of staff in rural areas and use of digital communication. Measure validity assessment was described in 24 articles (39%), but methods were not standardized. Our study highlights a gap in existing PNC measures for several recommendations in the WHO PNC guideline. Assessment of the validity of measurement of PNC indicators was limited. Consensus on how the quality of PNC should be measured is needed, involving a selection of priority measures and the development of new measures as appropriate.
Predictors of long-term progression to chronic kidney disease in HIV infection in Ghana from 2003-2018
Authors: Chadwick David R , Barker Fred , Smith Colette , Perditer Okyere , Hardy Yasmine , Owusu Dorcas , Villa Giovanni , Sarfo Fred Stephen , Geretti Anna-Maria , Phillips Richard 
Published: November 2022

AbstractAimHIV is associated with an increased risk of progression to chronic kidney disease (CKD), and this risk is higher in people of West African descent than many other ethnicities. Our study aimed to assess the rates of progression to CKD and predictors of rapid progression in patients receiving antiretroviral therapy (ART) in central Ghana between 2003 and 2018.MethodsThis single-centre retrospective study enrolled people with HIV (PWH) initiating ART in Ghana between 2003-2018. Demographics, hepatitis B (HBsAg) status, ART regimens and eGFR measurements were recorded, and multi-level model linear regression was performed to determine predictors of greater levels of eGFR decline.Results659 participants were included in the study with a median follow-up time of 6 years (IQR 3.6-8.9). 149 participants (22.6%) also had confirmed HBV co-infection. Tenofovir was associated with the highest mean rate of eGFR decline of all Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs), representing a statistically significant annual decline -1.08 mL/min/1.73m2/year (CI: -0.24, -1.92) faster than those taking zidovudine. Regarding other ARTs, both nevirapine (-0.78mL /min/173m2/year; CI: -0.17, -1.39) and protease inhibitors (-1.55mL/mil/173m2/year; CI: - 0.41, -2.68) were associated with slower eGFR declines compared with efavirenz. Negative HbsAg status was associated with greater eGFR decline compared with positive HBsAg status (-1.25mL/mil/173m2; CI 0.29. 2.20).ConclusionIncreased rates of eGFR decline amongst PWH in Ghana were associated with tenofovir, nevirapine, and protease inhibitor use as well as negative HBsAg status. Further higher-quality research is needed to explore long-term predictors of eGFR decline in African populations.