bluuebunny/crossref_metadata_2025_split huggingface dataset:
Urinary Bladder Matrix Grafting Versus Flap Coverage for Acute or Infected Wound Defects in Patients With Orthopaedic Trauma
Authors: Mundra Leela S. , Tucker Nicholas J. , Parry Joshua A. 
Published: May 2022

Objectives:
Urinary bladder matrix (UBM) grafting of acute or infected wound defects has been reported to be successful in small case series. The purpose of this study was to compare the outcomes of UBM grafting with flap coverage.

Design:
This is a retrospective comparative study.

Setting:
Level-1 trauma center.

Patients:
Orthopaedic trauma patients with wound defects not amenable to primary closure or skin grafting.

Intervention:
Wound coverage with UBM grafting (n = 26) by orthopaedic trauma surgeons versus flap coverage (n = 26) by microvascular-trained plastic surgeons.

Main Outcome Measurements:
Primary wound coverage success, complications, returns to the operating room, hospital length of stay, and time to wound healing.

Results:
The UBM group was more likely to have an American Society of Anesthesiologist class ≥3 (58% vs. 23%, P = 0.02), a foot/ankle wound (77% vs. 12%, P < 0.001), an infected wound defect (81% vs. 50%, P = 0.03), and smaller defects (21 vs. 100 cm2, P = 0.02). UBM grafting resulted in a longer time to wound healing (6 vs. 2 months, P = 0.002) and a shorter hospital length of stay (2 vs. 14 days, P < 0.0001). UBM and flap groups had similarly high rates of failure of primary wound coverage (31% vs. 31%; P = 1.0), complications (46% vs. 62%, P = 0.4), and returns to the operating room (46% vs. 65%; P = 0.2). All 3 acute traumatic wounds undergoing UBM grafting concurrently with fracture fixation experienced graft failure and osteomyelitis.

Conclusion:
UBM grafting is an effective alternative to flap coverage for small traumatic or infected wounds but should be avoided in acute traumatic wounds undergoing fracture fixation.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Neutrophil Extracellular Traps and Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage
Authors: Witsch Jens , Spalart Valérie , Martinod Kimberly , Schneider Hauke , Oertel Joachim , Geisel Jürgen , Hendrix Philipp , Hemmer Sina 
Published: May 2022

IMPORTANCE:
Myeloperoxidase (MPO)-DNA complexes, biomarkers of neutrophil extracellular traps (NETs), have been associated with arterial and venous thrombosis. Their role in aneurysmal subarachnoid hemorrhage (aSAH) is unknown.

OBJECTIVES:
To assess whether serum MPO-DNA complexes are present in patients with aSAH and whether they are associated with delayed cerebral ischemia (DCI).

DESIGN, SETTING, AND PARTICIPANTS:
Post-hoc analysis of a prospective, observational single-center study, with de novo serum biomarker measurements in consecutive patients with aSAH between July 2018 and September 2020, admitted to a tertiary care neuroscience ICU.

MAIN OUTCOMES AND MEASURES:
We analyzed serum obtained at admission and hospital day 4 for concentrations of MPO-DNA complexes. The primary outcome was DCI, defined as new infarction on brain CT. The secondary outcome was clinical vasospasm, a composite of clinical and transcranial Doppler parameters. We used Wilcoxon signed-rank-test to assess for differences between paired measures.

RESULTS:
Among 100 patients with spontaneous subarachnoid hemorrhage, mean age 59 years (sd ± 13 yr), 55% women, 78 had confirmed aSAH. Among these, 29 (37%) developed DCI. MPO-DNA complexes were detected in all samples. The median MPO-DNA level was 33 ng/mL (interquartile range [IQR], 18–43 ng/mL) at admission, and 22 ng/mL (IQR, 11–31 ng/mL) on day 4 (unpaired test; p = 0.015). We found a significant reduction in MPO-DNA levels from admission to day 4 in patients with DCI (paired test; p = 0.036) but not in those without DCI (p = 0.17). There was a similar reduction in MPO-DNA levels between admission and day 4 in patients with (p = 0.006) but not in those without clinical vasospasm (p = 0.47).

CONCLUSIONS AND RELEVANCE:
This is the first study to detect the NET biomarkers MPO-DNA complexes in peripheral serum of patients with aSAH and to associate them with DCI. A pronounced reduction in MPO-DNA levels might serve as an early marker of DCI. This diagnostic potential of MPO-DNA complexes and their role as potential therapeutic targets in aSAH should be explored further.
Conjunctival Histopathological Changes in Children With Vitamin D Deficiency
Authors: Aksoy Aydemir Gozde , Ilhan Cagri , Pehlıvanoglu Burcin , Aydemir Emre , Kiziltoprak Hasan , Bolu Semih 
Published: May 2022

Purpose:
The aim of this study was to investigate tear function–associated clinical findings and conjunctival histopathological changes in children with vitamin D (Vit-D) deficiency.

Methods:
This study used a prospective case–control design. Group 1 (n=38) comprised pediatric patients with Vit-D deficiency, and group 2 (n=45) was the control group. Tear break-up times (TBUTs), Schirmer-1 test measurements, ocular surface disease index (OSDI) scores, and conjunctival impression cytology (CIC) results of the groups were compared.

Results:
The participant demographic characteristics, including the mean age and the male-to-female ratio, were similar (P>0.05). The median TBUT and Schirmer-1 test measurement were 10 s (5–15) and 12 mm (6–19) in group 1 and 11 s (6–16) and 15 mm (8–21) in group 2 (P=0.004 and P=0.013, respectively). The median OSDI scores were 16 (10–20) in group 1 and 17 (10–21) in group 2 (P=0.092). According to the CIC, 25 samples in group 1 and 40 samples in group 2 were categorized as grade 0, 11 samples in group 1 and 5 samples in group 2 were categorized as grade 1, and 2 samples in group 1 and no sample in group 2 were categorized as grade 2 (P=0.027).

Conclusion:
Significant conjunctival histopathological changes occur in children with Vit-D deficiency, and these changes have effects on some tear function–associated clinical findings including the Schirmer-1 test and TBUT measurements.
Visual Outcomes of Patients With Peripheral Ulcerative Keratitis and the Effect of Immunosuppression—A 6-Year Experience in Queensland, Australia
Authors: Li Ye , McKelvie James , McLintock Cameron 
Published: May 2022

Objective:
Peripheral ulcerative keratitis (PUK) can cause significant ocular morbidity and mortality. This study aimed to review the effects of systemic immunosuppression on visual outcomes.

Methods:
A state-wide, retrospective case series based in Queensland, Australia, was performed. A review of patients who presented with PUK to the major tertiary ophthalmology referral centers between January 2015 and January 2021 was undertaken. Parameters recorded included clinical features at presentation, investigations undertaken, treatment provided, visual outcomes, and mortality outcomes. The effect of immunomodulatory therapy on the change in vision from presentation to the most recent review was analyzed.

Results:
Twenty-two eyes of 26 patients with PUK (average age 69.81±14.54 years) were included and had a mean follow-up period of 577.73 days. Twelve patients (54.5%) had systemic autoimmune disease, one patient (4.5%) had positive syphilis serology, and nine patients (40.9%) had idiopathic PUK. Eighteen patients (81.8%) were treated with systemic steroids and 10 patients (45.5%) were treated with steroid-sparing immunomodulatory therapy. Average logarithm of the minimum angle of resolution best-corrected visual acuity (BCVA) at presentation and final follow-up were 0.63±0.65 and 0.64±0.82, respectively. Those who were treated with immunomodulatory therapy had a nonstatistically significant improvement in BCVA (−0.10±0.29 with vs. +0.10±0.35 without), and a similar trend was seen for doxycycline (−0.08±0.09 with vs. +0.22±0.49 without). Four of five perforations (80%) were surgically managed. Four patients (18.2%) were deceased.

Conclusions:
Peripheral ulcerative keratitis poses significant clinical challenges and requires intensive medical treatment, frequently involving systemic immunomodulatory therapy. Surgical treatment is required in a significant minority of cases. Ocular management alongside the use of doxycycline and immunomodulatory therapy in consultation with specialist physicians can optimize visual and systemic outcomes.
The Prevalence and Related Effects of HIV Drug-Resistant Strains Against Antiretroviral Therapy in China
Authors: Xing Hui , Ruan Yuhua , Liao Lingjie , Shao Yingming 
Published: May 2022

Abstract
Anti-human immunodeficiency virus (HIV) treatment resistance surveillance has been going on for nearly 18 years in China. In this paper, we review the prevalence in China of resistance to reverse transcriptase and protease inhibitors in the HIV-infected population receiving antiretroviral therapy (ART) and the population that stopped ART in recent years. Drug resistance is an important factor affecting the death of patients with acquired immune deficiency syndrome (AIDS). With the extension of the duration of ART and the expansion of the population receiving ART, especially the widespread promotion of preventive drugs before and after exposure, it is important to obtain insight into the prevalence and types of drug-resistant strains and their impact on the overall AIDS prevention and treatment effect.
Evaluation of the Validity and Reliability of ANKUTRIAGE, a New Decision Support System in Pediatric Emergency Triage
Authors: Göktuğ Aytaç , Çullas İlarslan Nisa Eda , Vatansever Göksel , Özdemir İhsan , Polat Onur , Oğuz Ahmet Burak , Koca Ayça , Genç Sinan , Tanrıöver Ömer Özgür , Demir Salih , Sevindik Mesut , Elhan Atilla Halil , Tekin Deniz 
Published: May 2022

Background
The intensity of emergency services is an increasing health problem all over the world, necessitating an effective triage system. The aim of this study was to evaluate the validity and reliability of the “ANKUTRIAGE” in children.

Methods
This prospective, longitudinal study was carried out at a pediatric emergency department. ANKUTRIAGE, a 5-level computer-aided triage decision support system, was developed. Patients younger than 18 years who do not need emergency intervention, who had complete vital sign measurements, who gave consent for the study, and who were admitted to the emergency service during working hours with trained personnel were included. For validity, agreement between the urgency levels determined by ANKUTRIAGE and the reference triage systems: Pediatric Canadian Triage and Acuity Scale and Emergency Severity Index, was evaluated. In addition, the association of urgency levels with clinical outcomes was studied. To assess reliability, patients were evaluated by 2 blinded healthcare professionals using ANKUTRIAGE and a quadratic weighted κ was estimated.

Results
A total of 1232 children with a median age of 4.00 years were included. ANKUTRIAGE acuity levels significantly correlated with the number of resources used, the number of patients undergoing life-saving procedures, pediatric intensive care unit, and overall hospitalization rates, respectively (P < 0.001, P < 0.001, P < 0.001, P < 0.001). The agreement of ANKUTRIAGE with Pediatric Canadian Triage and Acuity Scale was found to be 0.94 (95% confidence interval [CI], 0.93–0.94), with an Emergency Severity Index of 0.75 (95% CI, 0.70–0.80). The interrater agreement between 2 evaluators who used ANKUTRIAGE reflected as excellent consistency 0.92 (95% CI, 0.89–0.95; κ > 0.8).

Conclusions
ANKUTRIAGE demonstrated high agreement with clinical outcomes and with proven triage systems and reflected high reliability between users. ANKUTRIAGE will enable a more standardized and practical triage, especially in crowded pediatric emergency departments and in situations where triage is performed by health professionals with different experience and professions.
Hepcidin Alleviates LPS-Induced ARDS by Regulating the Ferritin-Mediated Suppression of Ferroptosis
Authors: Jiao Yang , Yong Chaoying , Zhang Renzi , Qi Di , Wang Daoxin 
Published: May 2022

ABSTRACT
The effects of ferroptosis, an iron-dependent cell death, on acute respiratory distress syndrome (ARDS) remain largely elusive. Hepcidin, encoded by the HAMP gene, affects inflammation, and iron homeostasis. The present study aimed to investigate whether hepcidin protects against ferroptosis in lipopolysaccharide (LPS)-induced ARDS. Our results confirmed that ferroptosis aggravated lung inflammation and damage in LPS-induced ARDS. Hepcidin defended against ferroptosis, with results similar to those of the ferroptosis inhibitor ferrostatin-1 (Fer-1). Moreover, hepcidin decreased iron uptake, as determined by Transferrin Receptor 1 (TfR1) expression levels, and increased iron storage, based on ferritin heavy chain (FTH) expression. The effects of hepcidin on the A549 cell line were in line with the in vivo results. In addition, we used si-FTH to knock down FTH expression and found that this suppressed the ability of hepcidin to protect against ferroptosis. Collectively, our data suggest that hepcidin inhibits ferroptosis by increasing FTH expression in LPS-induced ARDS; thus, hepcidin may represent a possible treatment targeting ferroptosis.
Transthoracic Esophagectomy: Hand-sewn Versus Side-to-side Linear-stapled Versus Circular-stapled Anastomosis: A Systematic Review and Meta-analysis
Authors: Schlottmann Francisco , Angeramo Cristian A. , Bras Harriott Camila , Casas María A. , Herbella Fernando A.M. , Patti Marco G. 
Published: May 2022

Background:
Three anastomotic techniques are mostly used to create an esophagogastric anastomosis in a transthoracic esophagectomy: hand-sewn (HS), side-to-side linear-stapled (SSLS), and circular-stapled (CS). The aim of this study was to compare surgical outcomes after HS, SSLS, and CS intrathoracic esophagogastric anastomosis.

Materials and Methods:
A systematic review using the MEDLINE database was performed to identify original articles analyzing outcomes after HS, SSLS, and CS esophagogastric anastomosis. The main outcome was an anastomotic leakage rate. Secondary outcomes included overall morbidity, major morbidity, and mortality. A meta-analysis of proportions and linear regression models were used to assess the effect of each anastomotic technique on the different outcomes.

Results:
A total of 101 studies comprising 12,595 patients were included; 8835 (70.1%) with CS, 2532 (20.1%) with HS, and 1228 (9.8%) with SSLS anastomosis. Anastomotic leak occurred in 10% [95% confidence interval (CI), 6%-15%], 9% (95% CI, 6%-13%), and 6% (95% CI, 5%-7%) of patients after HS, SSLS, and CS anastomosis, respectively. Risk of anastomotic leakage was significantly higher with HS anastomosis (odds ratio=1.73, 95% CI: 1.47-2.03, P<0.0001) and SSLS (odds ratio=1.68, 95% CI: 1.36-2.08, P<0.0001), as compared with CS. Overall morbidity (HS: 52% vs. SLSS: 39% vs. CS: 35%) and major morbidity (HS: 33% vs. CS: 19%) rates were significantly lower with CS anastomosis. Mortality rate was 4% (95% CI, 3%-6%), 2% (95% CI, 2%-3%), and 3% (95% CI, 3%-4%) after HS, SSLS, and CS anastomosis, respectively.

Conclusion:
HS and SSLS intrathoracic esophagogastric anastomoses are associated with significantly higher rates of an anastomotic leak than CS anastomosis.
Risk Factors for Conversion in Laparoscopic Totally Extraperitoneal Inguinal Hernioplasty
Authors: Karabulut Mehmet , Donmez Turgut , Sahbaz Nuri A. , Akarsu Cevher , Ferahman Sina , Surek Ahmet , Gemici Eyup , Aydin Husnu , Sunamak Oguzhan , Dural Ahmet C. 
Published: May 2022

Background:
Conversion is a surgical concern because the surgical technique can change during surgery. Surprisingly, there is no study in the literature on the causes and risk factors leading to conversion in laparoscopic total extraperitoneal inguinal repair (TEP). There is also no consensus on the prevention and causes of this condition in TEP. The aim of this study was to evaluate the risk factors underlying the development of conversion during TEP.

Materials and Methods:
We recruited 962 consecutive patients who underwent TEP between May 2016 and May 2021. All data were collected retrospectively. The outcomes of patients who converted to open surgery were compared with those without conversion. Multivariate analysis identified independent risk factors for conversion.

Results:
The overall incidence of conversion was 4.05% (n=39). The median age was 42 years (18 to 83) and body mass index was 25.2 kg/m2 (15.67 to 32.9). Significant clinical factors associated with conversion included old age, American Society of Anesthesiologists (ASA) score, large peritoneal tear (PT), Charlson comorbidity index, previous surgery, large hernial defects, presence of scrotal hernia, and the defect size of inguinal hernia. Multivariate analysis identified independent risk factors for conversion: large hernial defect, large PT, previous lower abdominal surgery, previous hernia surgery, and scrotal hernia.

Conclusion:
Conversion is a minor complication seen during TEP and its incidence varies depending on many factors. Previous lower abdominal surgery and a large PT carries a 6-fold increased risk for conversion from laparoscopic to open surgery during TEP.
The Effect of Laparoscopic Sleeve Gastrectomy With Concomitant Hiatal Hernia Repair on Gastroesophageal Reflux Disease
Authors: Şen Ozan , Sekmen Ümit , Türkçapar Ahmet G. 
Published: May 2022

Aim:
The aim of this study is to reveal incidence of gastroesophageal reflux disease (GERD) after laparoscopic sleeve gastrectomy (LSG) and to determine the effect of LSG with hiatal hernia repair on GERD.

Methods:
A total of 440 patients, 395 of them underwent primary LSG (group A) and 45 of them underwent LSG with concomitant hiatal hernia repair (group B) between March 2018 and September 2020 were included in the study. Presence of hiatal hernia was evaluated with endoscopy and confirmed intraoperatively. Patients were evaluated for GERD symptoms in the pre and postoperative period. Two groups’ data were compared.

Results:
Mean age of the 440 patients was 38.4±11 years (56% female) and mean body mass index was 44.2±7 kg/m2. Symptomatic GERD was detected in 103 (23.4%) and hiatal hernia was detected in 45 (10.2%) patients. İn the preoperative assessment there was no difference with regard to demographics and symptomatic GERD between the 2 groups. Mean duration of follow-up was 17±5.7 (12 to 28) months in the overall study population. Mean body mass index decreased to 28.3±4.9 kg/m2 at 12 months after LSG. Excess weight loss ratio was found to be 81±20.4%. The rate of symptomatic GERD after LSG in group A was found to be 20% (n=79/395). Of these patients, 46 (11.6%) had de novo GERD and 33 (38%) had persistent GERD. GERD resolved completely in 54 (62%) patients. In the group B, the rate of symptomatic GERD was detected as 33% (n=15/45) (P=0.04). The rate of de novo GERD (20%) was also higher in group B (P=0.03). The rate of persistent GERD (37%) and GERD resolution (62%) were similar in both groups.

Conclusion:
İn our study, symptomatic and de novo GERD rates were detected to be higher in the LSG+HH group than LSG alone.
Safety and Feasibility of Single-incision Laparoscopic Distal Pancreatectomy
Authors: Sasaki Toshihide , Yang Ching-Yao , Nakagawa Kenji , Nagai Minako , Nishiwada Satoshi , Terai Taichi , Sho Masayuki 
Published: May 2022

Background:
Comparative studies regarding single-incision laparoscopic distal pancreatectomy (SILS-DP) are limited. This study aimed to compare the short-term outcomes of SILS-DP with conventional laparoscopic DP (C-LDP) under strict indication criteria.

Materials and Methods:
We retrospectively reviewed the patient characteristics and surgical outcomes of those who underwent either SILS-DP or C-LDP at National Taiwan University (NTU) and C-LDP at Nara Medical University (NMU) between 2009 and 2019. SILS-DP was indicated for benign or low-grade malignant pancreatic tail tumors and was performed along with splenectomy.

Results:
We compared 12 cases of SILS-DP with 31 of C-LDP from NTU and 17 of C-LDP from NMU. Patients in the SILS-DP group had significantly less blood loss than the C-LDP group at NTU (P=0.028). Postoperative outcomes, including the postoperative hospital stay and clinically relevant pancreatic fistula, were not significantly different between the 2 groups. Although SILS-DP was performed by a surgeon who was well-experienced with laparoscopic surgeries, the first few cases had a larger amount of blood loss, longer operation time, and a higher rate of complications. Such unfavorable outcomes were likely to be resolved shortly. No reoperations and deaths were noted.

Conclusion:
SILS-DP is feasible when performed by an experienced surgeon and in carefully selected patients.
GlycoVHH: Introducing N-glycans on the camelid VHH antibody scaffold - Optimal sites and use for macrophage delivery
Authors: van Schie Loes , Van Breedam Wander , Roels Charlotte , Schepens Bert , Frank Martin , Mehdipour Ahmad Reza , Laukens Bram , Nerinckx Wim , Santens Francis , Devos Simon , Rossey Iebe , Thooft Karel , Vanmarcke Sandrine , Van Hecke Annelies , Callewaert Nico 
Published: May 2022

AbstractAs small and stable high-affinity antigen binders, VHHs boast attractive characteristics both for therapeutic use in various disease indications, and as versatile reagents in research and diagnostics. To further increase the versatility of VHHs, we explored the VHH scaffold in a structure-guided approach to select regions where the introduction of an N-glycosylation N-X-T sequon and its associated glycan should not interfere with protein folding or epitope recognition. We expressed variants of such glycoengineered VHHs in the Pichia pastoris GlycoSwitchM5 strain, allowing us to pinpoint preferred sites at which Man5GlcNAc2-glycans can be introduced at high site occupancy without affecting antigen binding. A VHH carrying predominantly a Man5GlcNAc2 N-glycan at one of these preferred sites showed highly efficient, glycan-dependent uptake by Mf4/4 macrophages in vitro and by alveolar lung macrophages in vivo, illustrating one potential application of glyco-engineered VHHs: a glycan-based targeting approach for lung macrophage endolysosomal system delivery. The set of optimal artificial VHH N-glycosylation sites identified in this study can serve as a blueprint for targeted glyco-engineering of other VHHs, enabling site-specific functionalization through the rapidly expanding toolbox of synthetic glycobiology.
LDL1 and LDL2 histone demethylases interact with FVE to regulate flowering in Arabidopsis
Authors: Mahima  , Chatterjee Sourav , Singh Sharmila , Sarkar Ananda K. 
Published: May 2022

AbstractIn higher plants, epigenetic modifications provide a stage for both transient and permanent cellular reprogramming required for vegetative to reproductive phase transition. Arabidopsis LSD1-like 1 (LDL1), a histone demethylase positively regulates floral transition, but the molecular and biochemical nature of LDL1 mediated flowering is poorly understood. Here we have shown that LDL1 mediated regulation of flowering is dependent on MADS AFFECTING FLOWERING 4 (MAF4) and MAF5 floral repressors. LDL1 binds on the chromatin of MAF4 and MAF5 and removes H3K4me2 activation marks to repress their expression. Further we show that LDL2 negatively regulates the expression of MAF4 and MAF5 redundantly with LDL1. Both LDL1 and LDL2 interact with an autonomous flowering pathway protein, FLOWERING LOCUS VE (FVE), to regulate the floral transition and thus could be a part of the FVE-corepressor complex. We show that MAF5 interacts with other floral repressors FLC and SHORT VEGETATIVE PHASE (SVP) and repress the expression of FT to delay floral transition. Thus, our results deepen the mechanistic understanding of LDL1/LDL2-FVE mediated floral transition in Arabidopsis.