bluuebunny/crossref_metadata_2025_split huggingface dataset:
High Median Nerve Paralysis: Is the Hand of Benediction or Preacher’s Hand A Correct Sign?
Authors: Duraku Liron S. , Schreuders Ton A.R. , Power Dominic M. , Rajaratnam Vaikunthan , Chaudhry Tahseen , Hundepool Caroline A. , Zuidam Jelle M. 
Published: October 2022

Background:
High median nerve injuries are commonly presented in textbooks as adopting the typical posture of hand of benediction or preacher’s hand. This study aimed to show that the hand of benediction or preacher’s hand is incorrectly associated with a high median nerve paralysis.

Methods:
A retrospective review of four cases with a high median nerve injury is presented. Diagnosis of a high median nerve injury was performed by means of intraoperative findings, electrodiagnostic studies, or ultrasound imaging. None of the patients presented in this study had a hand of benediction on physical examination despite the presence of a high median nerve lesion.

Results:
All four patients with high median nerve injuries showed a similar hand posture when attempting to make a fist. Firstly, the index finger still flexed at the metacarpophalangeal joint because of the ulnar innervated interossei muscles. Secondly the thumb is completely abducted at the carpometocarpal joint and extended at the interphalangeal joint. Lastly, middle finger flexion is possible due to dual innervation of its flexor digitorum profundus by the ulnar nerve as well as due to the quadriga phenomenon.

Conclusions:
The clinical appearance of a high median nerve palsy is different from the classical hand of benediction or preacher’s hand posture pointing finger. We have shown that this incorrect association can result in delayed referral of patients with high median nerve injuries.
Efficacy of Müller’s Muscle-conjunctival Resection With or Without Suturing for the Correction of Ptosis
Authors: van Philips Iris O. R. , van Minderhout Helena M. , Stefanovic Maja , van Philips Lucien A. M. 
Published: October 2022

Purpose:
The purpose of this study was to compare the efficacy of Müller muscle-conjunctival resection (MMCR) with or without suturing for the correction of ptosis.

Methods:
A retrospective chart review was performed of 30 patients (56 eyelids) undergoing sutureless (sMMCR) (34 eyelids) or conventional MMCR (cMMCR) (22 eyelids). Primary outcome measures were the change in MRD1 and vertical eyelid height (VLH). Secondary outcome measures were the amount of resection of MMCR (rMMCR) and postoperative symmetry of 1 mm or less.

Results:
In total, 49 eyelids (87.5%) had involutional ptosis and 7 (12.5%) had contactlens induced ptosis. The age and follow up between the sMMCR and cMMCR groups was, respectively, 65.1 ± 11.0 versus 65.5 ± 11.0 years and 4.0 ± 2.5 versus 6.5 ± 2.1 months. Preoperatively there were no significant differences noted between the sMMCR and cMMCR groups. Postoperatively there was a statistically significant difference in change of MRD1 between the sMMCR and cMMCR groups, 2.74 ± 0.20 mm and 2.02 ± 0.25 mm (p = 0.026). The difference in change of VLH and rMMCR was not significant between the sMMCR and cMMCR groups, 2.28 ± 0.13 mm and 2.14 ± 0.15 mm (p = 0.49) and 9.29 ± 2.14 versus 9.46 ± 1.97 mm (p = 0.83). There were no significant differences in postoperative symmetry.

Conclusion:
The sMMCR and cMMCR techniques demonstrated equal effectiveness for the correction of ptosis. The rapid sMMCR could become the procedure of choice for the correction of involutional and contact lens induced ptosis.
Phlegmasia Cerulea Dolens
Authors: Placencia Mitzy , Wong Eugene 
Published: October 2022

ABSTRACTPhlegmasia cerulea dolens is a condition that results from severe venous obstruction of either the upper or, more commonly seen, lower extremities. This rare and life-threatening condition translates to “blue painful inflammation,” which highlights its most prominent presenting symptoms. A case of this condition is described here.
Molecular Evidence for Epithelial Origin of Mixed Ovarian Epithelial-Germ Cell Neoplasms: Report of 2 Cases and Review of Literature
Authors: Hall Katie C. , Post Miriam D. , Alldredge Jill , Aisner Dara L. , Berning Amber 
Published: October 2022

Ovarian germ cell tumors (GCT) account for 2% to 3% of malignant ovarian neoplasms in Western countries and typically occur within the first 2 decades. When presenting later in life, GCTs may be associated with epithelial malignancies. In these circumstances, it has been theorized that these tumors may originate from a somatic, rather than germ cell origin, especially in the postmenopausal setting; however, the true derivation is not fully understood. Our database was searched for primary ovarian GCTs associated with a malignant epithelial component in patients above 35 yr of age, from 2006 to 2021. Two cases were identified and in each case, slides were reviewed and targeted next-generation sequencing was utilized to identify and compare gene mutation variants in morphologically distinct components. Patient A is a 58-yr-old, with choriocarcinoma and minor component of mucinous adenocarcinoma, and patient B is a 43-yr-old, with yolk sac tumor and minor component of endometrioid adenocarcinoma. The morphologically distinct areas in each case showed disparate staining patterns; however, next-generation sequencing demonstrated identical mutation variants within both the germ cell and epithelial components. Variants in CDKN2A, PIK3CA, PIK3R1, and TP53 were present in patient A’s tumor, while patient B’s tumor showed CTNNB1, PIK3R1, and 2 PTEN variants. These mutational patterns are similar to those seen in pure epithelial counterparts, suggesting somatic derivation of the germ cell component. These rare tumors portend a poor prognosis and understanding their origin has clinical and therapeutic implications.
Urine tenofovir-monitoring predicts HIV viremia in patients treated with high genetic-barrier regimens
Authors: van Zyl Gert , Jennings Lauren , Kellermann Tracy , Nkantsu Zukisa , Cogill Dolphina , van Schalkwyk Marije , Spinelli Matthew , Decloedt Eric , Orrell Catherine , Gandhi Monica 
Published: October 2022

Objective:
Access to viral load measurements is constrained in resource-limited settings. A lateral flow urine tenofovir (TFV) rapid assay (UTRA) for patients whose regimens include TFV offers an affordable approach to frequent adherence monitoring.

Design:
We conducted a cross-sectional study of patients to assess the utility of UTRA to predict virologic failure, defined as a viral load greater than 400 copies/ml.

Methods:
We assessed urine TFV among 113 participants at increased risk of viral failure (who had previous viral failure on this regimen or had previously been ≥30 days out of care), comparing low genetic-barrier efavirenz (EFV) regimens (n = 60) to dolutegravir (DTG)-boosted or ritonavir-boosted protease inhibitor (PI/r)-based high genetic-barrier regimens (n = 53). Dried blood spots (DBS) for TFV-diphosphate and plasma for TFV concentrations were collected, with drug resistance assessed if viral failure present.

Results:
Among 113 participants, 17 of 53 received DTG or PI/r had viral failure at the cross-sectional visit, with 11 (64.7%) demonstrating an undetectable urine TFV; the negative-predictive value (NPV) of undetectable UTRA for viral failure was 85% (34/40); none of the 16 sequenced had dual class drug resistance. In those treated with EFV regimens the sensitivity was lower, as only 1 (4.8%) of 21 with viral failure had an undetectable UTRA (P < 0.001).

Conclusions:
Urine tenofovir-testing had a high negative-predictive value for viral failure in patients treated with DTG or ritonavir-boosted protease inhibitor regimens, where viral failure was largely explained by poor drug adherence. Frequent monitoring with inexpensive lateral flow urine TFV testing should be investigated prospectively in between viral load visits to improve viral load suppression on DTG-based first-line therapy in resource-limited settings.
Low-frequency pre-treatment HIV drug resistance: effects on 2-year outcome of first-line efavirenz-based antiretroviral therapy
Authors: Milne Ross S. , Beck Ingrid A. , Levine Molly , So Isaac , Andersen Nina , Deng Wenjie , Panpradist Nuttada , Kingoo James , Kiptinness Catherine , Yatich Nelly , Kiarie James N. , Sakr Samah R. , Chung Michael H. , Frenkel Lisa M. 
Published: October 2022

Objective(s):
Assess the impact of pre-treatment high-frequency and low-frequency drug-resistant HIV variants on long-term outcomes of first-line efavirenz-based antiretroviral therapy (ART).

Design:
Prospective observational study.

Methods:
Participants’ pre-treatment plasma RNA had two sections of HIV pol encoding reverse transcriptase sequenced (Illumina, MiSeq) using unique molecular identifiers to detect wild-type (pre-treatment drug-resistant variants less than 1% of viral quasispecies), low-frequency (1–9%) or high-frequency drug-resistant variants (10–100%). Associations between pre-treatment drug resistance and virologic outcomes over 24 months of efavirenz-based ART were assessed for the number and frequency of mutations by drug class and other resistance parameters.

Results:
Virologic failure was detected in 30 of 352 (9%) and pre-treatment drug-resistant variants were detected in the viral quasispecies of 31 of 352 (9%) participants prescribed efavirenz-based ART. Survival analyses revealed statistically significant associations between pre-treatment drug resistance at low (P < 0.0001) and high (P < 0.001) frequencies, at oligonucleotide ligation assay (OLA) (P < 0.00001) and non-OLA (P < 0.01) codons, to a single-antiretroviral class (P < 0.00001), and a shorter time to virologic failure of efavirenz-based ART. Regression analyses detected independent effects across resistance categories, including both low-frequency (P < 0.01) and high-frequency (P < 0.001) drug-resistant variants.

Conclusion:
We observed that pre-treatment HIV drug resistance detected at low frequencies increased the risk of virologic failure over 24 months of efavirenz-based ART, but that most failures, regardless of drug-resistant variants’ frequencies, were detected within a year of ART initiation. These observations suggest that when efavirenz-based ART is prescribed, screening for pre-treatment drug resistance by an assay capable of detecting low-frequency variants, including OLA, may guide clinicians to prescribe more effective ART.
HIV transmission among acutely infected participants of a Dutch cohort study 2015–2021 is not associated with large, clustered outbreaks
Authors: Prins Henrieke A.B. , Rokx Casper , Verbon Annelies , van Sighem Ard , de Bree Godelieve J. , Dijkstra Maartje , Prins Jan M. , Reiss Peter , van Kampen Jeroen J.A. , van de Vijver David A.M.C. 
Published: October 2022

Objective:
Timely identification of acute or early HIV infection (AEHI) is important to help prevent onward transmission, and understanding the number of secondary infections resulting from individuals with AEHI is key to planning HIV prevention services and case finding.

Design:
We performed a phylogenetic investigation of a dense sample of individuals with AEHI who took part in the Netherlands Cohort Study on Acute HIV infection (NOVA) in the Netherlands during 2015-2021.

Methods:
Transmission clusters were identified using phylogenetic analyses based on HIV pol sequences. The Tamura-Nei model was used to estimate genetic distance. A number of 1000 bootstraps was used to check the reliability of clustering using maximum likelihood. A cluster was defined as having a bootstrap value of at least 95% and a genetic distance of at most 1.5%. Sensitivity analyses using different values for the bootstrap and genetic distance were performed to study the reproducibility of the clustering.

Results:
Of the 156 participants included in NOVA between July 2015 and April 2021, 134 individuals for whom baseline characteristics and genotypic resistance data at baseline were available could be included. We identified 10 clusters, but the majority of persons (111/134) were not part of a cluster, suggesting mainly independent transmission events.

Conclusion:
Mainly independent transmission events among a study population consisting predominantly of MSM in a low-incidence high-resource setting is likely the result of active AEHI case finding and direct start of treatment, and the roll-out over recent years of preventive measures such as preexposure prophylaxis.
Estimating the effectiveness of shielding during pregnancy against SARS-CoV-2 in New York City during the first year of the COVID-19 pandemic
Authors: Chen Siyu , Murphy Elisabeth A , Pendergrass Angeline G , Sukhu Ashley C , Eng Dorothy , Jurkiewicz Magdalena , Mohammed Iman , Rand Sophie , White Lisa J , Hupert Nathaniel , Yang Yawei J 
Published: October 2022

AbstractPregnant patients have increased morbidity and mortality in the setting of SARS-CoV-2 infection. The exposure of pregnant patients in New York City to SARS-CoV-2 is not well understood due to early lack of access to testing and the presence of asymptomatic COVID-19 infections. Before the availability of vaccinations, preventative (shielding) measures, including but not limited to wearing a mask and quarantining at home to limit contact, were recommended for pregnant patients. Using universal testing data from 2196 patients who gave birth from April through December 2020 from one institution in New York City, and in comparison, with infection data of the general population in New York City, we estimated the exposure and real-world effectiveness of shielding in pregnant patients. Our Bayesian model shows that patients already pregnant at the onset of the pandemic had a 50% decrease in exposure compared to those who became pregnant after the onset of the pandemic and to the general population.
Deep reinforcement learning framework for controlling infectious disease outbreaks in the context of multi-jurisdictions
Authors: Khatami Seyedeh Nazanin , Gopalappa Chaitra 
Published: October 2022

AbstractIn the absence of pharmaceutical interventions, social distancing and lockdown have been key options for controlling new or reemerging respiratory infectious disease outbreaks. The timely implementation of these interventions is vital for effectively controlling and safeguarding the economy.Motivated by the COVID-19 pandemic, we evaluated whether, when, and to what level lockdowns are necessary to minimize epidemic and economic burdens of new disease outbreaks. We formulated the question as a sequential decision-making Markov Decision Process and solved it using deep Q-network algorithm. We evaluated the question under two objective functions: a 2-objective function to minimize economic burden and hospital capacity violations, suitable for diseases with severe health risks but with minimal death, and a 3-objective function that additionally minimizes the number of deaths, suitable for diseases that have high risk of mortality. A key feature of the model is that we evaluated the above questions in the context of two-geographical jurisdictions that interact through travel but make autonomous and independent decisions, evaluating under cross-jurisdictional cooperation and non-cooperation.In the 2-objective function under cross-jurisdictional cooperation, the optimal policy was to aim for shutdowns at 50% and 25% per day. Though this policy avoided hospital capacity violations, the shutdowns extended until a large proportion of the population reached herd immunity. Delays in initiating this optimal policy or non-cooperation from an outside jurisdiction required shutdowns at a higher level of 75% per day, thus adding to economic burdens. In the 3-objective function, the optimal policy under cross-jurisdictional cooperation was to aim for shutdowns of up to 75% per day to prevent deaths by reducing infected cases. This optimal policy continued for the entire duration of the simulation, suggesting that, until pharmaceutical interventions such as treatment or vaccines become available, contact reductions through physical distancing would be necessary to minimize deaths. Deviating from this policy increased the number of shutdowns and led to several deaths.In summary, we present a decision-analytic methodology for identifying optimal lockdown strategy under the context of interactions between jurisdictions that make autonomous and independent decisions. The numerical analysis outcomes are intuitive and, as expected, serve as proof of the feasibility of such a model.
Waist circumference and glycaemia are strong predictors of progression to diabetes in individuals with prediabetes in sub-Saharan Africa: 4-year prospective cohort study in Malawi
Authors: Nakanga Wisdom P. , Crampin Amelia C. , Mkandawire Joseph , Banda Louis , Andrews Rob C. , Hattersley Andrew T. , Nyirenda Moffat J. , Rodgers Lauren R. 
Published: October 2022

ABSTRACTIntroductionSub-Saharan Africa is projected to have the highest increase in the number of people with diabetes worldwide. However, the drivers of diabetes in this region have not been clearly elucidated. The aim of this study was to evaluate the incidence of diabetes and the predictors of progression in a population-based cohort with impaired fasting glucose (IFG) in Malawi.MethodsWe used data from an extensive rural and urban non-communicable disease survey. One hundred seventy-five, of 389 individuals with impaired fasting glucose (IFG) at baseline, age 48 ±15 years and body mass index 27.5 ±5.9 kg/m2 were followed up for a median of 4.2 years (714 person-years). Incidence rates were calculated, and predictors of progression to diabetes were analysed using multivariable logistic regression models, with overall performance determined using receiver operator characteristics (ROC) curves.ResultsThe median follow-up was 4.2 (IQR 3.4 – 4.7) years. Forty-five out of 175 (26%) progressed to diabetes. Incidence rates of diabetes were 62.9 per 1000 person-years 95% CI, 47.0-84.3. The predictors of progression were higher; age (odds ratio [OR] 1.48, 95% CI 1.01-2.19, P=0.046), BMI (OR 1.98, 95% CI 1.34-2.94,P=0.001), waist circumference (OR 2.50, 95% CI 1.60-3.91,P<0.001), waist-hip ratio (OR 1.40, 95%CI 0.98-2.01,P=0.03), systolic blood pressure (OR 1.56, 95% CI 1.10-2.21,P=0.01), fasting plasma glucose (OR 1.53, 95%CI 1.08-2.16,P=0.01), cholesterol (OR 1.44, 95% CI 1.00-2.08,P=0.05) and low-density lipoprotein cholesterol (OR 1.80, 95% 1.23-2.64,P=0.002). A simple model combining fasting plasma glucose and waist circumference was predictive of progression to diabetes (ROC area under the curve=0.79)ConclusionThe incidence of diabetes in people with IFG in Malawi is higher than those seen in Europe (35.0 per 1,000 person-years) but similar to those seen in India (61.0 per 1,000 person-years). Predictors of progression are like those seen in other populations. A simple chart with probabilities of progression to diabetes based on waist circumference and fasting plasma glucose could be used to identify those at risk of progression in clinical settings in sub-Saharan Africa.
Nonlinear relationship between systolic blood pressure and diabetic retinopathy in type 2 diabetic patients in southern China: a single-center observational study
Authors: Luo Yisheng , Zhang Chen , Zhou Chaochao , Yan Zhisong , Ouyang Zezhong , Zhu Wenbin 
Published: October 2022

AbstractBackgroundBlood pressure (BP) control has been shown in clinical trials to reduce the risk of diabetic retinopathy (DR). To some extent, systolic blood pressure (SBP) has been shown to have a positive correlation with DR. However, there are no studies that have standardized SBP thresholds for DR prevention. Our goal was to use threshold analysis to further investigate the relationship between SBP and DR, identifying safe levels of SBP that contribute to DR preventionMethodsWe analyzed data from a cross-sectional study (December 2017-November 2018, n = 426, mean age 59.15±13.68) of patients with type 2 diabetes mellitus in the endocrinology department of Guangdong Provincial People’s Hospital, which is publicly available in the Dryad database. DR severity was assessed by retinal photographs. The International Clinical Diabetic Retinopathy and Diabetic Macular Edema Disease Severity Scale was used to classify DR severity and divide it into two groups: with DR and without DR. SBP was analyzed as a continuous variable. Multivariate logistic regression models, smoothed curve fitting, threshold analysis, and interaction tests were used to assess the relationship between SBP and DR.ResultsPrevalence of DR in the study population was 39.20%. After adjusting for age, sex, DM duration, HbA1c, BUN, HDL, LDL, TRIG, CHOL, TP, DBP, PP, eGFR, and CKD stage, the association between SBP and DR appears as a threshold effect, with a inflection point of 132 mm Hg. The risk of DR did not change significantly when SBP ≤132 mm Hg (OR: 0.86; 95% CI: 0.63 to 1.17, p=0.3400). When SBP ≥132 mm Hg, each 10 mm Hg increase in SBP raise the risk of developing DR by 28% (OR:1.28; 95% CI:1.07 to 1.54, P=0.0081). In addition, a stronger association of SBP with DR in patients with TP≤60g/L (OR=1.58, 95% CI: 1.19-2.08, P=0.001) compared to those with TP>60g/L (OR=1.15, 95% CI: 1.03, 1.27, P=0.012) was discovered, with a P value for interaction=0.023.ConclusionIn Chinese patients with type 2 diabetes, SBP was significantly associated with DR when SBP ≥132 mm Hg. Further longitudinal studies are needed to confirm our findings, especially in patients with TP≤60g/L.
Establishing attributes and corresponding levels for a discrete choice experiment on nurses’ job preferences in Iran
Authors: Emamgholipour Sara , Shahraki Mahdi , Haddadfar Amir Mohammad 
Published: October 2022

AbstractBackgroundDCE is a widely used technique in healthcare to elicit non-market-stated preferences. This study was conducted primarily to identify the most important factors affecting the job preferences of nurses through a scoping review of literature review and qualitative methods, and finally to help select attributes and attribute levels.MethodsThis study was conducted in four stages based on Helter and Boehler’s proposed framework. The first stage was raw data collection to identify the factors influencing nurses’ job preferences. For this reason, a scoping review was performed to identify relevant attributes and their levels. In addition, 7 nurses and experts in the field of nursing were interviewed (in-depth interviews) to identify related characteristics according to the Iranian nursing workplace. Then, 19 nurses were asked to rate the attributes and levels. At this stage, all possible attributes from different sources were gathered. In the third stage, inappropriate attributes were deleted based on acquired qualitative data, and the research team decided which attributes to include in the final design. Attribute wording was done in the final stage. JMP Pro 16 was used to construct the final design. A utility-neutral design was generated and blocked into 3 versions, each consisting of 6 scenarios (choice sets). Finally, a pilot study involving 24 nurses was undertaken in April 2022.ResultsBy using scoping review and qualitative methods such as semi-structured interviews, 23 potential job-related factors that affect nurses’ career choices were identified. Salary, type of employment contract, workload, type of health facility, workplace facilities, work schedule, and Expected time spent on the assigned job for promotion to a higher position were 7 attributes considered in the final design of the scenarios. Internal and face validity, intelligibility, and acceptability of the questionnaire were tested in the pilot study, and minor modifications were made. It was revealed that the respondents in the pilot study were able to understand and answer all of the choice sets with ease.ConclusionSome of the most significant financial and non-financial factors that affect Iranian nurses’ job preferences are mentioned in this study. This indicates that policymakers have a wide range of interventions available that can significantly improve the working conditions of nurses. Additionally, the full description of the attribute development and level selection processes makes this study valuable to the literature on DCE.