bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction of Severe Esophageal Varices in Patients With Cirrhosis Based on Levitt’s CO Breath Test
Authors: Feng Chu-Wu , Kang Ling-Ling , Zhang Hou-De 
Published: October 2022

Goals:
This study investigated the feasibility of using erythrocyte (RBC) lifespan determined by Levitt’s CO breath test (LCOBT) to predict esophageal varices needing treatment (VNT) in patients with cirrhosis.

Background:
Esophageal varix bleeding is a common fatal complication of cirrhosis and portal hypertension. The gold standard for identifying VNT is esophagogastroduodenoscopy (EGD), an invasive procedure with low patient compliance. VNT screening based on Baveno VI criteria has mediocre specificity.

Study:
RBC lifespan was determined by LCOBT in 53 cirrhotic patients (13 without varices, 11 mild/moderate varices, and 29 severe varices). Correlation of varix severity with RBC lifespan and other variables was analyzed. Rates of shortened RBC lifespan and thrombocytopenia (Baveno VI criteria) were compared.

Results:
RBC lifespan correlated inversely with severity of varices (r=−0.793, P<0.001). Mean RBC lifespans were 129±31, 96±21, and 59±21 days for Nonvarix, Mild/Moderate, and Severe groups. Shortened RBC lifespan (<75 d) was observed in 79.3% (23/29) of patients with severe varices, a frequency similar or identical to thrombocytopenia rates [original Baveno VI criteria, 86.2% (25/29), P=0.487; expanded criteria, 79.3% (23/29), P>0.999]. Among 24 patients without severe varices, shortened RBC lifespan was observed in 1 patient whereas thrombocytopenia was detected in 13 and 8 patients based on the original (P<0.001) and expanded criteria (P=0.010), respectively.

Conclusions:
RBC lifespan correlates inversely with varix severity in patients with cirrhosis. LCOBT may enable specific screening for VNT.
Eating Habits and Eating Disorder Associated Behavior in Bipolar Disorder
Authors: Hirte Teresa S. , Fellendorf Frederike T. , Unterrainer Human-Friedrich , Dalkner Nina , Bengesser Susanne A. , Birner Armin , Platzer Martina , Queissner Robert , Holasek Sandra , Schwerdtfeger Andreas , Reininghaus Eva Z. 
Published: October 2022

Abstract
A relevant comorbidity of bipolar disorder (BD) is eating disorders (EDs). Crossed vulnerability factors as eating disorder–specific symptoms (EDSSs) may trigger the onset of both disorders in either direction. The Structured Inventory for Anorexic and Bulimic Eating Disorders for Self-Report was used to examine the occurrence of EDs in euthymic/subsyndromal individuals with BD (n = 86) and healthy controls (n = 86) matched for age and sex. Furthermore, we explored EDSSs with the subscales “general psychopathology and social integration,” “bulimic symptoms,” “body image and slimness ideal,” “sexuality and body weight,” “counteract,” and “atypical binge.” Higher rates of all EDSSs were reported in BD. Younger individuals with BD showed higher expression in “bulimic symptoms,” “body image and slimness ideal,” and “atypical binge” subscales. No participants fulfilled ED diagnosis. The findings show a link between EDSS and BD. Clinicians should pay attention to a multimodal intervention, considering risk factors, investigating eating habits and ED associated behaviors.
Multimodal analgesia is superior to opiates alone after tibial fracture in patients with substance abuse history
Authors: Lenk Erica , Strecker Sara E. , Nolan William 
Published: October 2022

Abstract

Objectives: To evaluate the effectiveness of multimodal analgesia in patients with a tibial shaft fracture.

Design: Retrospective review.

Setting: Large, urban, academic center.

Patients: One hundred thirty-eight patients were evaluated before implementation of multimodal analgesia. Thirty-four patients were evaluated after implementation. All patients were treated operatively with internal fixation for their tibial shaft fracture. Patients with polytrauma were excluded.

Intervention: Multimodal analgesia.

Main Outcome Measures: Pain levels at rest and with movement were assessed. Morphine milligram equivalents (MMEs) dosed per patient were calculated each day. Length of stay was also documented.

Results: After implementation of a multimodal analgesic program, there was a statistically significant decrease in pain score at rest (4.7–4.0, P = 0.034) and with movement (5.8–4.8, P = 0.007). MMEs dosed in the multimodal analgesic program correlated with pain score (R2 = 0.5), whereas before implementation of the program, MMEs dosed were not dependent on pain score (R2 = 0.007). Patients with a history of substance abuse had the most profound effect from this paradigm change. For those with a history of substance abuse, treatment of pain using a multimodal approach reduces MMEs dosed and length of stay (5.7–3.1 days, P = 0.016).

Conclusions: Multimodal analgesia improves patient pain scores both at rest and during movement. In patients with a history of substance abuse, multimodal analgesia not only decreases pain but also decreases length of stay and MMEs dosed to levels consistent with someone who does not have a substance abuse history.

Level of Evidence: Therapeutic Level III.
Direct versus indirect posterior malleolar fixation in the treatment of trimalleolar ankle fractures: Is there a difference in outcomes?
Authors: Saad Bishoy N. , Rampertaap Yajesh , Menken Luke G. , Whitlock Keith G. , Crook Bryan S. , Baker Rafael L. , Keller David M. , Liporace Frank A. , Gage Mark J. , Yoon Richard S. 
Published: October 2022

Abstract

Purpose:
The purpose of this study was to examine the differences in functional outcomes between direct and indirect surgical fixation methods of the posterior malleolus in the setting of trimalleolar fractures and identify any variables affecting patient outcomes.

Methods:
Primary outcomes were evaluated by PROMIS scores for short-term outcomes regarding total pain (TP) and total function (TF) comparing 40 patients with direct fixation with 77 with indirect fixation. Continuous variables were analyzed using t tests for parametric variables and the Mann–Whitney U test for nonparametric variables. Categorical variables were analyzed using a χ2 test. Univariate and multivariate linear regression models were performed to analyze factors that affect outcomes of TP and TF.

Results:
There was no difference in TP or TF between groups (P = 0.65 vs. P = 0.19). On univariate linear regression for TP, BMI, incidence of complication, tobacco use, and open injury showed significance in increasing pain levels with open injuries providing the greatest effect (coef = 11.8). On multivariate analysis, BMI, incidence of complication, open injury, and tourniquet time all significantly increased pain. For TF, univariate analysis showed age, BMI, incidence of complication, and diabetes to decrease function, and use of external fixator and tourniquet time increased function. In the multivariate model, increased BMI, open injuries, and increasing tourniquet time all decreased TF while use of an external fixator increased TF.

Conclusion:
This study showed no difference in TP and TF using the PROMIS outcome scores when comparing direct fixation versus indirect fixation under univariate and multivariate models.

Level of Evidence:
Therapeutic III.
Routine Perioperative Esmolol After Infant Tetralogy of Fallot Repair: Single-Center Retrospective Study of Hemodynamics
Authors: Affolter Jeremy T. , Well Andrew , Gottlieb Erin A. , Fraser Charles D. 
Published: October 2022

OBJECTIVES:
Currently, surgical repair of tetralogy of Fallot (TOF) is associated with an 1.1% 30-day mortality rate. Those with junctional ectopic tachycardia (JET) and restrictive right ventricular physiology have poorer outcomes. Routine postoperative adrenergic or inodilator therapy has been reported, while beta-blockade following cardiopulmonary bypass has not. This study evaluated routine perioperative treatment with esmolol in infants undergoing TOF repair.

DESIGN:
Retrospective chart review of the perioperative course following TOF repair.

SETTING:
Single-center case series describing perioperative management of TOF in a cardiac ICU.

PATIENTS:
This study reviewed all patients less than 18 months old who underwent TOF repair, excluding cases of TOF with absent pulmonary valve or atrioventricular septal defect, at our institution from June 2018 to April 2021.

INTERVENTIONS:
This review investigates the hemodynamic effects of esmolol following cardiopulmonary bypass for TOF repair.

MEASUREMENTS AND MAIN RESULTS:
Preoperative clinical characteristics and perioperative course were extracted from the medical record. Descriptive statistics were used. Twenty-six patients receiving perioperative esmolol after TOF repair were identified and included. Postoperative hemodynamic parameters were within a narrow range with minimal vasoactive support in most patients. Three of 26 patients experienced JET, and one of 26 of whom had a brief cardiac arrest. Median and interquartile range (IQR) for hospital and postoperative length of stay was 7 days (IQR, 6–9 d) and 6 days (IQR, 5–8 d), respectively. There were no 30-day or 1-year mortalities.

CONCLUSIONS:
In this infant cohort, our experience is that the routine use of postoperative esmolol is associated with good cardiac output with minimal requirement for vasoactive support in most patients. We believe optimal postoperative management of infant TOF repair requires a meticulous multidisciplinary approach, which in our experience is enhanced with routine postoperative esmolol treatment.
Balancing Clinician Workload Through Strategic Patient Panel Designs
Authors: Huang Yu-Li , Berg Bjorn P. , Horn Jennifer L. , Nagaraju Darshan , Rushlow David R. 
Published: October 2022

Background and Objectives:
Clinician workload is a key contributor to burnout and well-being as well as overtime and staff shortages, particularly in the primary care setting. Appointment volume is primarily driven by the size of patient panels assigned to clinicians. Thus, finding the most appropriate panel size for each clinician is essential to optimization of patient care.

Methods:
One year of appointment and panel data from the Department of Family Medicine were used to model the optimal panel size. The data consisted of 82 881 patients and 105 clinicians. This optimization-based modeling approach determines the panel size that maximizes clinician capacity while distributing heterogeneous appointment types among clinician groups with respect to their panel management time (PMT), which is the percent of clinic work.

Results:
The differences between consecutive PMT physician groups in total annual appointment volumes per clinician for the current practice range from 176 to 348. The optimization-based approach for the same PMT physician group results in having a range from 211 to 232 appointments, a relative reduction in variability of 88%. Similar workload balance gains are also observed for advanced practice clinicians and resident groups. These results show that the proposed approach significantly improves both patient and appointment workloads distributed among clinician groups.

Conclusion:
Appropriate panel size has valuable implications for clinician well-being, patients' timely access to care, clinic and health system productivity, and the quality of care delivered. Results demonstrate substantial improvements with respect to balancing appointment workload across clinician types through strategic use of an optimization-based approach.
Using the Electronic Medical Record to Increase Laboratory Test Monitoring in Ocular Inflammation Patients: A Quality Improvement Study
Authors: Tipton Caroline W. , Burkholder Bryn M. , Chaon Benjamin C. , Berkenstock Meghan K. 
Published: October 2022

Background and Objectives:
Treatment of chronic, noninfectious ocular inflammation includes corticosteroids, disease-modifying antirheumatic medications, and biologics. To mitigate adverse effects associated with the use of these medications, routine laboratory test monitoring is recommended throughout treatment. We evaluated the effectiveness of an alert added to the electronic medical record (EMR) to aid in laboratory test monitoring for patients prescribed these high-risk medications.

Methods:
A prospective, interventional study assessed the effect of the alert within the EMR on laboratory test ordering at the Division of Ocular Immunology at the Wilmer Eye Institute. The primary outcome measure was the change in number of ordered laboratory tests at 3, 6, and 12 months after the alert activation compared with pre-intervention levels and overall through the study period. The laboratory tests that were monitored included complete blood count, comprehensive metabolic panel, dual-energy x-ray absorptiometry (DXA) scanning, fasting lipid panel, and interferon gamma release assays.

Results:
The laboratory test orders for 153 patients on high risk medications were analyzed. Only the frequency of ordering the DXA and interferon gamma release assays increased significantly, compared with baseline, throughout the study. Conversely, there was a significant decrease in the frequency of ordering of fasting lipid profiles and hemoglobin A1c at each time point and for complete blood count and comprehensive metabolic panel at the 6-month time point.

Conclusion:
An EMR alert results in increased laboratory test ordering initially for tests drawn on a yearly basis, but the effect on more frequently ordered tests wanes with time if the alert can be silenced by the provider. Nonetheless, it provides a novel mechanism to increase laboratory ordering in patients on high-risk medications that can be adapted for use in other EMR software. Future studies are needed to assess whether physician laboratory test ordering behavior is altered throughout the study period with the use of a non-silencable alert.
Chryseobacterium oryzae sp. nov. and Chryseobacterium suipulveris sp. nov., isolated from Andong sikhye and pigpen dust, respectively
Authors: Heo Jun , Won Miyoung , Lee Daseul , Kim Jeong-Seon , Han Byeong-Hak , Kim Soo-Jin , Hong Seung-Beom , Kwon Soon-Wo 
Published: October 2022

Two Gram-stain-negative, aerobic, mesophilic, rod-shaped bacteria, ADR-1T and SC2-2T, were isolated from Andong sikhye and dust in a pigpen, respectively. The phylogenetic tree on the basis of 16S rRNA gene sequences showed that strains ADR-1T and SC2-2T were members of the genus

Chryseobacterium

and revealed the highest sequence similarities to

Chryseobacterium binzhouense

LM2T (97.6 %) and

Chryseobacterium koreense

Chj707T (94.9 %), respectively. Phylogenomic treeing using 92 core genes clearly indicated that strain ADR-1T clustered with

Chryseobacterium echinoideorum

CC-CZW010T,

Chryseobacterium binzhouense

LM2T and

Chryseobacterium taihuense

CGMCC 1.10941T, and strain SC2-2T formed a compact cluster with

Chryseobacterium koreense

CCUG 49689T. The digital DNA–DNA hybridization (dDDH) and orthologous average nucleotide identity (ANI) values of strain ADR-1T with the closely related species of the genus

Chryseobacterium

were ≤24.4 % and ≤80.7 %, and those of strain SC2-2T were ≤24.0 % and ≤77.8 %, respectively, which are well below the cut-off values of species discrimination (>70 % dDDH and >95–96 % ANI). The only respiratory quinone in both strains was menaquinone 6. The polar lipid profile of strain ADR-1T comprised phosphatidylethanolamine, four unidentified aminolipids and three unidentified lipids, while strain SC2-2T contained phosphatidylethanolamine, two unidentified aminolipids, one unidentified aminophospholipid and five unidentified polar lipids. The major fatty acids (>10 %) of strain ADR-1T were iso-C15 : 0, summed feature 9 (iso-C17 : 1
ω9c and/or C16 : 0 10-methyl), iso-C17 : 0 3-OH and summed feature 3 (C16 : 1
ω7c and/or C16 : 1
ω6c), and those of strain SC2-2T were iso-C15 : 0 and anteiso-C15 : 0. On the basis of the results of phenotypic and phylogenetic analyses, strains ADR-1T and SC2-2T represent two distinct novel species in the genus

Chryseobacterium

, for which the names Chryseobacterium oryzae sp. nov. (type strain ADR-1T=KACC 19311T=NBRC 113104T) and Chryseobacterium suipulveris sp. nov. (type strain SC2-2T=KACC 19313T=NBRC 113106T) are proposed.
Feasibility of Conducting Comparative Effectiveness Research and Validation of a Clinical Disease Activity Score for Chronic Nonbacterial Osteomyelitis
Authors: Wu Eveline Y. , Oliver Melissa , Scheck Joshua , Lapidus Sivia , Akca Ummusen Kaya , Yasin Shima , Stern Sara M. , Insalaco Antonella , Pardeo Manuela , Simonini Gabriele , Marrani Edoardo , Wang Xing , Huang Bin , Kovalick Leonard K. , Rosenwasser Natalie , Casselman Gabriel , Liau Adriel , Shao Yurong , Yang Claire , Mosa Doaa Mosad , Tucker Lori , Girschick Hermann , Laxer Ronald M. , Akikusa Jonathan D. , Hedrich Christian , Onel Karen , Dedeoglu Fatma , Twilt Marinka , Ferguson Polly J. , Ozen Seza , Zhao Yongdong 
Published: October 2022

AbstractIntroductionProspective comparative effectiveness research in chronic nonbacterial osteomyelitis (CNO) is lacking.ObjectivesStudy objectives were to: 1) determine the use and safety of each consensus treatment plan (CTP) regimen for CNO, 2) the feasibility of usingchronic nonbacterialosteomyelitis international registry (CHOIR) data for comparative effectiveness research, and 3) develop and validate a CNO clinical disease activity score (CDAS) using CHOIR.MethodsConsenting children or young adults with CNO were enrolled into CHOIR. Demographic, clinical, and imaging data were prospectively collected. The CNO CDAS was developed through a Delphi survey and nominal group technique. External validation surveys were administered to CHOIR participants.Results140 (76%) CHOIR participants enrolled between August 2018 and September 2020 received at least one CTP regimen. Baseline characteristics from the three groups were well matched. Patient pain, patient global assessment, and clinical CNO lesion count were key variables included in the CNO CDAS. The CDAS showed a strong correlation with patient/parent report of difficulty using a limb, back, or jaw and patient/parent report of disease severity, but a weak correlation with patient/parent report of fatigue, sadness, and worry. The change in CDAS was significant in patients reporting disease worsening or improvement. The CDAS significantly decreased after initiating second-line treatments from median 12 (8-15.5) to 5 (3-12). While second-line treatments were well tolerated, psoriasis was the most common adverse event.ConclusionThe CNO CDAS was developed and validated for disease monitoring and assessment of treatment effectiveness. CHOIR provided a comprehensive framework for future comparative effectiveness research.Key messagesThechronic nonbacterialosteomyelitis international registry (CHOIR) provides comprehensive prospective data for comparison of treatment effectivenessThe clinical disease activity score (CDAS) has content and construct validity to assess CNO
Mucosal-associated invariant T (MAIT) cell responses in Salmonella enterica serovar Typhi strain Ty21a oral vaccine recipients
Authors: Trivedi Shubhanshi , Cheng Olivia , Brintz Ben J , Charles Richelle C. , Leung Daniel T 
Published: October 2022

AbstractBackgroundMucosal–associated invariant T (MAIT) cells are unconventional innate-like T cells abundant in mucosal tissue of humans, and associated with protective responses to microbial infections. MAIT cells have capacity for rapid effector function, including the secretion of cytokines and cytotoxic molecules. However, limited information is available regarding the activity of MAIT cells in mucosal vaccine-mediated immune responses in humans.MethodsWe enrolled healthy adults who received a course of oral live-attenuated S. Typhi strain Ty21a vaccine and collected peripheral blood samples pre-vaccination, and at 7 days and one month post-vaccination. We used flow cytometry, cell migration assays, and tetramer decay assay to assess MAIT cell responses.ResultsWe show that following vaccination, circulating MAIT cells are decreased in frequency but have increased activation markers. Post-vaccine timepoints had higher levels of MAIT cells expressing gut-homing marker integrin α4β7 and chemokine receptor CCR9, suggesting the potential of MAIT cells to migrate to mucosal sites. While we found higher frequencies of TNF-α expression on MAIT cells post-vaccination, we did not find significant differences in expression of other effector molecules, TCR avidity, or cell migration.ConclusionsWe show how MAIT cell immune responses are modulated post-vaccination against S.Typhi. This study contributes to our understanding of MAIT cells’ potential role in oral vaccination against bacterial mucosal pathogens.
Potential use of Immunodaat® (Botanical extract of Elderberry -Sambucus Nigra L.) in the management of Post Covid-19 symptoms- a comparative, multi-centric, randomized, clinical study
Authors: Deshpande Shailesh , Mundhe Narendra , Deshpande Vaishali , Tamoli Sanjay , Mahadik Swapnali , Pawar Vinay 
Published: October 2022

AbstractBackgroundImmunodaat™, a proprietary botanical extract, contains standardized extract of Elderberry (Sambucus Nigra L.). Elderberry is used as an immunity enhancer for prevention and management of various respiratory diseases and as an anti-oxidant.ObjectivesThe present study evaluated the effect of Immunodaat™, in Post Covid-19 recovery.MethodsAn open labeled, comparative, randomized, multi-centric, prospective clinical study was conducted on 74 subjects who had post COVID-19 symptoms recovery from mild-moderate COVID-19 within the last 15 days. Subjects were divided equally, with 37 subjects in trial and control groups each, where subjects in trial group were given Immunodaat™ capsules in a dose of 250 mg Capsules twice daily along with the standard care for COVID-19 for consecutive 30 days while subjects in control group were given only the standard care for Post Covid. Subjects were evaluated for post clinical recovery signs and symptoms (like cough, fatigue, Myalgia, Joint pain, confusion, altered mood, anxiety, insomnia etc.) and lab parameters. Subjects were evaluated for quality of life using WHO QOL BREF.ResultsContinuous 30 days administration of Immunodaat™ showed a significant difference in reducing physical as well as mental symptoms when compared to the control group. Also, a significant improvement in quality of life was observed on WHO QOL BREF scale with the use of Immunodaat compared to the control group. Overall quality of life, energy levels and stamina levels improved with the use of Immunodaat™.Subjects showed excellent tolerability and did not have any adverse effect with the use of Immunodaat™.ConclusionThe study concludes that use of Immunodaat™ over 30 days aided to normalize the physical and mental symptoms that occurred due to Post COVID and long COVID. Immunodaat™ can be considered as a safe and effective natural ingredient in the management of Post COVID-19 or long COVID condition.
Orthogonal tRNA Expression using Endogenous Machinery in Cell-Free Systems
Authors: Seki Kosuke , Galindo Joey L. , Jewett Michael C. 
Published: October 2022

AbstractA wide variety of non-canonical amino acids (ncAAs) can be incorporated into proteins through the coordinated action of a stop codon suppressing tRNA and aminoacyl-tRNA synthetase. However, methods to discover and characterize suppressor tRNAs are generally lacking. In this work, we show that cell-free systems can express functional suppressor tRNAs using endogenous machinery and characterize their activity. This method is compatible with widely used orthogonal tRNAs, such as the Methanocaldococus jannaschii tyrosyl tRNA, the Methanosarcina barkeri pyrrolysyl tRNA, the Methanomethylophilus Alvus pyrrolysyl tRNA, and an engineered Int pyrroysyl tRNA. Modifying the workflow to evaluate TAA suppression revealed that the M. jannaschii and M. alvus are highly functional TAA suppressors in cell-free systems. Finally, we show that we can express two distinct tRNAs simultaneously, enabling the incorporation of multiple, distinct ncAAs. In total, our work shows that cell-free systems are useful platforms to express and characterize tRNAs.