bluuebunny/crossref_metadata_2025_split huggingface dataset:
Benzodiazepine Use Is Associated With an Increased Risk of Neurocognitive Impairment in People Living With HIV
Authors: Saloner Rowan , Grelotti David J. , Tyree Griffin , Sundermann Erin E. , Ma Qing , Letendre Scott , Heaton Robert K. , Cherner Mariana 
Published: November 2019

Objective:
Despite potential for dependence and adverse neurological effects, long-term benzodiazepine (BZD) use is common among people living with HIV (PLWH). As PLWH are at risk for central nervous system dysfunction, we retrospectively examined the association between BZD use and HIV-associated neurocognitive impairment (NCI).

Methods:
Three hundred six PLWH underwent comprehensive neurobehavioral evaluations. Current BZD use (BZD+) was determined through self-report. Using propensity scores, 153 BZD− individuals were matched to 153 BZD+ participants on demographics and medical comorbidities. Multiple regression models examined NCI and demographically adjusted neurocognitive T-scores as a function of BZD status, adjusting for estimated premorbid ability, current affective symptoms, and nadir CD4 count. Secondary analyses explored neurocognitive correlates of positive BZD urine toxicology screens (TOX+) and specific BZD agents.

Results:
Median duration of BZD use was 24 months. Current BZD use related to higher likelihood of NCI (odds ratio = 2.13, P = 0.003) and poorer global (d = −0.28, P = 0.020), processing speed (d = −0.23, P = 0.047), and motor T-scores (d = −0.32, P = 0.008). Compared with BZD−/TOX−, BZD+/TOX+ exhibited additional decrements in executive function (d = −0.48, P = 0.013), working memory (d = −0.49, P = 0.011), and delayed recall (d = −0.41, P = 0.032). For individual agents, diazepam, lorazepam, and alprazolam were most strongly associated with NCI (odds ratios >2.31).

Discussion:
BZD use may elevate risk for NCI in PLWH, potentially through diffuse neurocognitive slowing and acute compromise of recall and higher-order capacities. These effects are robust to psychosocial and HIV-specific factors and occur in comparison with a tightly matched BZD− group. Prospective and interventional studies should evaluate causal associations between NCI and BZD use and explore treatment alternatives to BZDs in PLWH.
Brief Report: Incidence of HIV in a Nationwide Cohort Receiving Pre-exposure Prophylaxis for HIV Prevention
Authors: Van Epps Puja , Wilson Brigid M. , Garner Will , Beste Lauren A. , Maier Marissa M. , Ohl Michael E. 
Published: November 2019

Background:
Cases of HIV, while infrequent, have been reported during tenofovir disoproxil fumarate/emtricitabine use as pre-exposure prophylaxis (PrEP). We describe the incidence of HIV and patterns of PrEP use within the Veterans Health Administration (VHA).

Methods:
We conducted a retrospective cohort study among persons initiating PrEP in the VHA between July 2012 and April 2016 using national VHA data. We defined time on PrEP and time at risk of HIV exposure as the total time from the first PrEP fill to exhaustion of supply of the final PrEP prescription. We identified incident cases of HIV infection after PrEP initiation based on laboratory data. Medication adherence measures and days without pills were calculated using pharmacy fill data. We used a chart review to determine patient-reported PrEP use around the time of diagnosis.

Results:
We identified 825 unique patients initiating PrEP; they were 97% men and 67% white, with a mean age of 41 years. Six HIV infections were observed during the study period, yielding an HIV incidence of 0.8 (Poisson exact 95% confidence interval: 0.3 to 1.8) cases per 100 person-years. Two cases occurred during active PrEP use by self-report and perfect adherence based on fill data. Both were infected with viruses containing the M184V mutation. Four additional cases were diagnosed after self-reported discontinuation.

Conclusions:
HIV infection was rare in a nationwide cohort of PrEP users. Although most of the infections occurred during inconsistent PrEP use, infections during periods of high measured adherence were also observed. These findings highlight the importance of PrEP persistence during periods of risk.
Isolated Nasal Metastasis From Renal Cell Carcinoma 9 Years After Nephrectomy Seen on FDG PET
Authors: Yao Yutang , Zuo Zhuo , Cheng Zhuzhong 
Published: November 2019

Abstract
A 56-year-old man presented with intermittent epistaxis. Nasopharyngoscope revealed a hemorrhagic mass occupying the left nasal cavity. The patient had a history of renal clear cell carcinoma. 18F-FDG PET/CT was performed to evaluate the potential lesions systematically. PET/CT images showed low to moderate activity in the region of nasal cavity and paranasal sinuses. No abnormal uptake of 18F-FDG was observed in the rest of the body. Eventually, the mass was pathologically proved to be metastatic renal clear cell carcinoma.
Assessment of Response to Neoadjuvant Chemoradiotherapy by 18F-FDG PET/CT in Patients With Locally Advanced Esophagogastric Junction Adenocarcinoma
Authors: Sánchez-Izquierdo Nuria , Perlaza Pilar , Pagès Mario , Buxó Elvira , Rios José , Rubello Domenico , Colletti Patrick M. , Mayoral Maria , Casanueva Sebastian , Fernández-Esparrach Gloria , Ginés Angels , Fuster David 
Published: November 2019

Purpose
The outcome of locally advanced adenocarcinoma of the esophagogastric junction (AEG) treated with preoperative chemoradiotherapy is heterogeneous, and favorable response to this treatment is a key factor in the patient's prognosis. The aim of this study was to evaluate 18F-FDG PET/CT in assessing metabolic response in patients with AEG.

Materials and Methods
This prospective study evaluated all consecutive patients with potentially operable locally advanced AEG who were candidates for neoadjuvant chemoradiotherapy. PET/CT and contrast-enhanced thoracoabdominal CT were performed at baseline and 2 weeks after completion of chemoradiotherapy for response evaluation. The response rate was assessed using Response Evaluation Criteria in Solid Tumors criteria for contrast-enhanced thoracoabdominal CT and Positron Emission Tomography Response Criteria in Solid Tumors criteria for PET/CT. The regression rate was assessed using a 5-grade histopathology scoring system of the surgically resected tumor. Metastatic lesions were confirmed by histopathology examination or imaging and clinical follow-up at 6 months.

Results
A total of 40 cases were finally included in the study. Distant metastases were found in the baseline PET/CT in 6 of 40 cases (retroperitoneal [2] or mediastinal/hiliar [1] lymph nodes and liver [2] or bone [1] metastases) and were therefore excluded from surgery. Pathologic response correlated with the ΛSUVmax threshold of ≤45% (P = 0.033). CT response correlated well with both the baseline SUVmax (P = 0.039) and the ΛSUVmax (P = 0.001). Five-year survival curves for AEG correlated with the ΛSUVmax using a threshold of ≤45% for both progression-free and overall survival.

Conclusions

18F-FDG PET/CT is useful for diagnosing nonsuspected metastasis before neoadjuvancy in potentially operable AEG. The ΛSUV correlates with pathologic response and is a long-term independent prognostic factor of survival.
Severe Contralateral Striatal Hypometabolism in a Case of Diabetic Nonketotic Hyperglycemic Hemichorea on 18F-FDG PET/CT Brain
Authors: Kumar Vadi Shelvin , Mehta Sahil , Kumar Rajender , Tandyala Naresh , Singh Harmandeep , Mittal Bhagwant Rai 
Published: November 2019

Abstract
Chorea induced by diabetic nonketotic hyperglycemia is a rare and poorly understood entity with a favorable prognosis after correction of the hyperglycemia. We present a case of elderly diabetic woman with poorly controlled blood glucose levels, presenting with choreiform movements limited to the right side. 18F-FDG PET/CT showed marked hypometabolism in the basal ganglia contralateral to the side with hemichorea. The metabolic dysfunctions lead to nonketotic hyperglycemic chorea, although poorly understood; the index case demonstrated severe glucose hypometabolism in the striatum and adds to the other reported differential diagnoses for striatal hypometabolism.
Reconstruction With Fibula Musculocutaneous Flap in a Patient With Extensive Maxillary Osteoradionecrosis
Authors: Zhu Fengshuo , Li Xiaoguang , Liu Zhonglong , He Yue 
Published: November 2019

Abstract
The authors reported a case of extensive maxillary osteoradionecrosis. The maxilla was resected and reconstructed with fibula musculocutaneous flap. It was the first reported that the osteoradionecrotic maxilla was reconstructed with free vascularized bone. The musculocutaneous flap might be a better choice of maxillary osteoradionecrosis reconstruction instead of the simple soft-tissue flap.
The Role of Commercial Health Insurance Characteristics in Bariatric Surgery Utilization
Authors: Chhabra Karan R. , Fan Zhaohui , Chao Grace F. , Dimick Justin B. , Telem Dana A. 
Published: November 2019

Objective:
The aim of this study was to understand relationships among insurance plan type, out-of-pocket cost sharing, and the utilization of bariatric surgery among commercially insured patients.

Background:
Only 1% of eligible persons undergo bariatric operations, and this underutilization is often attributed to lack of insurance coverage. But even among the insured, underinsurance is now recognized as a major barrier to accessing medical care. The relationships among commercial insurance design, out-of-pocket cost sharing, and elective surgery utilization, particularly in bariatrics, are not well understood.

Methods:
Retrospective review of 73,002 commercially insured members of the IBM MarketScan commercial claims database who underwent bariatric surgery from 2014 to 2017. The exposure variables were insurance plan type and out-of-pocket cost sharing. The outcome was utilization of bariatric surgery. We also examined seasonal trends in bariatric surgery utilization stratified by average levels of cost sharing.

Results:
Utilization of bariatric surgery was higher in plans with lower cost sharing, such as PPOs (20 operations/100,000 enrollees) than in HDHPs (high-deductible health plans, 12.1 operations/100,000 enrollees). Overall, every $1000 increase in cost sharing was associated with 5 fewer bariatric operations per 100,000 insured lives; this association was strongest in plans with high cost sharing (high-deductible and consumer-directed health plans). Members of all plan types had higher surgical utilization in quarter 4 relative to quarter 1 of each year; these seasonal variations were also most pronounced in plans with high cost sharing.

Conclusions:
Insurance plan types with higher cost sharing have lower utilization of bariatric surgery. Underinsurance may represent a newly identified barrier to surgical care that should be addressed by advocates and policymakers.
Clinical and Genetic Factors Impact Time to Surgical Recurrence After Ileocolectomy for Crohn's Disease
Authors: Kline Bryan P. , Weaver Taelor , Brinton David L. , Harris Leonard , Yochum Gregory S. , Berg Arthur S. , Koltun Walter A. 
Published: November 2019

Objective:
The aim of this study was to evaluate factors associated with time to surgical recurrence after Crohn's ileocolectomy.

Summary Background Data:
The most common surgery performed for Crohn's disease is ileocolectomy. Identifying patients at high risk for surgical recurrence may assist with medical and surgical decision-making.

Methods:
Data were obtained from 409 patients with Crohn's disease (CD) who had undergone ≥1 ileocolectomies at Penn State Hershey Medical Center. Six single-nucleotide polymorphisms (SNPs) associated with CD were evaluated in these patients: rs2076756, rs2066844, and rs2066845 in NOD2, rs4958847 and rs13361189 in IRGM, and rs2241880 in ATG16L1. Genotype and clinical factors were analyzed to determine associations with time to recurrent ileocolectomy. A subgroup analysis was performed on 241 patients naïve to biologics before initial ileocolectomy to assess the effect of biologic therapy on time to recurrent surgery.

Results:
There were 286 patients who underwent a single ileocolectomy, whereas 123 required multiple ileocolectomies. Ileocolonic involvement [hazard ratio (HR) 1.90, 95% confidence interval (CI) 1.21–3.00, P = 0.006] and rs2066844 in NOD2 (HR 1.8, 95% CI 1.17–2.77, P = 0.007) were associated with decreased time to surgical recurrence by multivariate analysis. In patients naïve to preoperative biologics, the initiation of postoperative biologics was associated with a 40% decreased incidence of surgical recurrence (HR 0.60, CI 0.39–0.93, P = 0.02) over time.

Conclusions:
Ileocolonic distribution of disease and the rs2066844 SNP in NOD2 are associated with shorter time to recurrent ileocolectomy. The initiation of postoperative biologics in naïve patients was associated with a reduced incidence of recurrence over time.
Hospital and Surgeon Selection for Medicare Beneficiaries With Stage II/III Rectal Cancer
Authors: Chioreso Catherine , Gao Xiang , Gribovskaja-Rupp Irena , Lin Chi , Ward Marcia M. , Schroeder Mary C. , Lynch Charles F. , Chrischilles Elizabeth A. , Charlton Mary E. 
Published: November 2019

Objective:
To determine factors associated with rectal cancer surgery performed at high-volume hospitals (HVHs) and by high-volume surgeons (HVSs), including the roles of rurality and diagnostic colonoscopy provider characteristics.

Summary of Background Data:
Although higher-volume hospitals/surgeons often achieve superior surgical outcomes, many rectal cancer resections are performed by lower-volume hospitals/surgeons, especially among rural populations.

Methods:
Patients age 66+ diagnosed from 2007 to 2011 with stage II/III primary rectal adenocarcinoma were selected from surveillance, epidemiology, and end results-medicare data. Patient ZIP codes were used to classify rural status. Hierarchical logistic regression was used to determine factors associated with surgery by HVH and HVS.

Results:
Of 1601 patients, 22% were rural and 78% were urban. Fewer rural patients received surgery at a HVH compared to urban patients (44% vs 65%; P < 0.0001). Compared to urban patients, rural patients more often had colonoscopies performed by general surgeons (and less often from gastroenterologists or colorectal surgeons), and lived substantially further from HVHs; these factors were both associated with lower odds of surgery at a HVH or by a HVS. In addition, whereas over half of both rural and urban patients received their colonoscopy and surgery at the same hospital, rural patients who stayed at the same hospital were significantly less likely to receive surgery at a HVH or by a HVS compared to urban patients.

Conclusions:
Rural rectal cancer patients are less likely to receive surgery from a HVH/HVS. The role of the colonoscopy provider has important implications for referral patterns and initiatives seeking to increase centralization.
Hematoma Risk After Needle Electromyography in Patients Using Newer Oral Anticoagulants
Authors: Nagarajan Elanagan , Dyer Nolan , Bailey Emily , Bollu Pradeep C. , Yelam Anudeep , Sivaraman Manjamalai , Govindarajan Raghav 
Published: November 2019

Purpose:
To assess the safety of needle electromyography in patients on non–vitamin K oral anticoagulants (NOACs) compared with warfarin.

Methods:
A retrospective chart review was done in patients who underwent needle electromyography studies while they were using warfarin and NOACs. After the needle electromyography, all the patients were monitored for 2 hours and ultrasound of high-risk muscle groups was done. The complications were classified based on the International Society on Thrombosis and Hemostasis definitions.

Results:
Fifty-eight patients were included: 29 were using NOACs and the other 29 were on warfarin. The mean age was 59.33 ± 16 years. Hemorrhagic complications from needle electromyography were noted in 9 patients: 7 (77.7%) NOACs and 2 (22.3%) warfarin. Among them, 6 patients (66.6%) met the diagnostic criteria for Clinically Relevant Non-Major Bleeding criteria proposed by International Society on Thrombosis and Hemostasis and 3 patients (33.4%) had an asymptomatic hematoma on ultrasound evaluation. A total of 267 muscles were tested and only 9 (3.3%) muscles had hemorrhagic complications. One patient (rivaroxaban) had acute bleeding requiring pressure bandage, five patients (two apixaban, two rivaroxaban, and one warfarin) had clinical hematoma that required ice packs, and three patients (two rivaroxaban and one warfarin) had a hematoma on ultrasound of deep muscles.

Conclusions:
Patients on NOACs had minimal risk of clinically relevant hemorrhagic complications, and the risk is not significantly different from those on warfarin.
Patients’ and physicians’ perspectives and experiences on the quality of medical consultations: a qualitative study
Authors: Bahadori Mohammadkarim , Yaghoubi Maryam , Haghgoshyie Elaheh , Ghasemi Matina , Hasanpoor Edris 
Published: November 2019

ABSTRACT

Aim:
Medical consultation is not only one of the most important steps in disease diagnosis and patient treatment, but also every patient's right. The purpose of this review was to explore patients’ and physicians’ perspectives and experiences of the quality of medical consultations.

Methods:
A qualitative interview study was carried out in outpatient clinics. A combination of face-to-face and telephone interviews was used due to the geographical spread of the respondents. Interviews were recorded and transcribed verbatim. Thematic descriptive analysis was used to interpret the data. Eligible physicians (n = 21) and patients (n = 27) were invited to take part in a semistructured interview to explore the views, perceptions, and experiences of patients on various factors affecting the quality of medical consultations.

Results:
The consultation quality was categorized into three topics: structure quality, process quality, and outcome quality. Data synthesis identified the following major themes for structure quality of consultations: administrative-organizational quality (with eight subthemes), physical environment quality (with six subthemes), and educational quality (with three subthemes). In addition, process quality was categorized into two major themes: examination quality (with nine subthemes) and interpersonal quality (with 13 subthemes). Outcome quality consisted of three major themes: patient satisfaction (with four subthemes), clinical outcomes (with two subthemes), and organizational outcomes (with three subthemes).

Conclusion:
Medical consultation plays a central role in the quality and effectiveness of the received health care. Using the indicators of consultation quality improvement can develop physicians’ clinical competence and skills. Furthermore, decision-makers can use them to monitor and evaluate physicians’ performance.
A small molecule antagonist for the Tudor domain of SMN disrupts the interaction between SMN and RNAP II
Authors: Liu Yanli , Iqbal Aman , Li Weiguo , Ni Zuyao , Wang Yalong , Ramprasad Jurupula , Abraham Karan Joshua , Zhang Mengmeng , Zhao Dorothy Yanling , Qin Su , Loppnau Peter , Guo Xinghua , Zhou Mengqi , Brown Peter J , Zhen Xuechu , Xu Guoqiang , Mekhail Karim , Ji Xingyue , Bedford Mark T. , Greenblatt Jack F. , Min Jinrong 
Published: November 2019

AbstractSurvival of motor neuron (SMN), a Tudor-domain-containing protein, plays an important role in diverse biological pathways via recognition of symmetrically dimethylated arginine (Rme2s) on proteins by its Tudor domain, and deficiency of SMN leads to the motor neuron degenerative disease spinal muscular atrophy (SMA). Here we report a potent and selective antagonist with a 4-iminopyridine scaffold targeting the Tudor domain of SMN. Our structural and mutagenesis studies indicate that the sandwich stacking interactions of SMN and compound 1 play a critical role in selective binding to SMN. Various on-target engagement assays support that compound 1 recognizes SMN specifically in a cellular context. In cell studies display that the SMN antagonist prevent the interaction of SMN with R1810me2s of DNA-directed RNA polymerase II subunit POLR2A and results in transcription termination and R-loop accumulation, mimicking depletion of SMN. Thus, in addition to the antisense, RNAi and CRISPR/Cas9 techniques, the potent SMN antagonist could be used as an efficient tool in understanding the biological functions of SMN and molecular etiology in SMA.
Interrogating theoretical models of neural computation with emergent property inference
Authors: Bittner Sean R. , Palmigiano Agostina , Piet Alex T. , Duan Chunyu A. , Brody Carlos D. , Miller Kenneth D. , Cunningham John P. 
Published: November 2019

1AbstractA cornerstone of theoretical neuroscience is the circuit model: a system of equations that captures a hypothesized neural mechanism. Such models are valuable when they give rise to an experimentally observed phenomenon – whether behavioral or a pattern of neural activity – and thus can offer insights into neural computation. The operation of these circuits, like all models, critically depends on the choice of model parameters. A key step is then to identify the model parameters consistent with observed phenomena: to solve the inverse problem. In this work, we present a novel technique, emergent property inference (EPI), that brings the modern probabilistic modeling toolkit to theoretical neuroscience. When theorizing circuit models, theoreticians predominantly focus on reproducing computational properties rather than a particular dataset. Our method uses deep neural networks to learn parameter distributions with these computational properties. This methodology is introduced through a motivational example inferring conductance parameters in a circuit model of the stomatogastric ganglion. Then, with recurrent neural networks of increasing size, we show that EPI allows precise control over the behavior of inferred parameters, and that EPI scales better in parameter dimension than alternative techniques. In the remainder of this work, we present novel theoretical findings gained through the examination of complex parametric structure captured by EPI. In a model of primary visual cortex, we discovered how connectivity with multiple inhibitory subtypes shapes variability in the excitatory population. Finally, in a model of superior colliculus, we identified and characterized two distinct regimes of connectivity that facilitate switching between opposite tasks amidst interleaved trials, characterized each regime via insights afforded by EPI, and found conditions where these circuit models reproduce results from optogenetic silencing experiments. Beyond its scientific contribution, this work illustrates the variety of analyses possible once deep learning is harnessed towards solving theoretical inverse problems.