bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal and Neonatal Hair Cortisol Levels and Psychological Stress Are Associated With Onset of Secretory Activation of Human Milk Production
Authors: Caparros-Gonzalez Rafael A. , Romero-Gonzalez Borja , Gonzalez-Perez Raquel , Lara-Cinisomo Sandraluz , Martin-Tortosa Pablo L. , Oliver-Roig Antonio , Peralta-Ramirez Maria Isabel 
Published: November 2019

Background:
Several factors can influence the production of mothers' own milk.

Purpose:
To assess the influence of maternal psychological stress, maternal cortisol levels, and neonatal hair cortisol levels on timing of secretory activation.

Methods:
A prospective study was conducted at 2 public health centers in Andalusia, Spain. Participants were 60 pregnant women and their 60 neonates. Hair cortisol levels and psychological stress (pregnancy-specific stress [Prenatal Distress Questionnaire, PDQ] and perceived stress [Perceived Stress Scale, PSS]) were evaluated during the third trimester and the postpartum period. This study was part of the GESTASTRESS cohort study on the effects of stress during pregnancy.

Results:
Higher PDQ and PSS scores (P < .05) in the third trimester were associated with later onset of secretory activation. Higher postpartum maternal hair cortisol levels were associated with a delayed secretory activation of mother's own milk (P < .05).

Implications for Research:
Future studies should look at the influence of psychological stress and cortisol levels on hormones involved in mother's own milk production.

Implications for Practice:
Neonatal nurses and other healthcare providers should be familiar with levels of neonates' exposure to maternal prenatal stress prior to birth.
Outcome analysis following arthroscopic augmentation with autologous hamstring graft in partial tear of the anterior cruciate ligament with preservation of an intact bundle: A case series
Authors: Joshi Narendra , Singh Kamaldeep , Modi Lalit K. , Dhukia Rakesh K. , Meena Bharatlal , Gora Rajendra K. 
Published: November 2019

Background:
The anatomic approach to anterior cruciate ligament (ACL) reconstruction has shifted management focus of the commonly encountered partial tear from resection and complete reconstruction to augmentation (i.e. selective bundle reconstruction with preservation of intact remnant bundle). The purpose of this study was to prospectively evaluate functional outcome after augmentation of partial ACL tears.

Methods:
Thirty-four patients with a partial ACL tear in whom a conservative trial failed were treated with either anteromedial or posteromedial single-bundle reconstruction, using an isolated semitendinosus graft and conserving the remnant bundle. Outcomes were evaluated clinically using the 2000 International Knee Documentation Committee [IKDC] knee examination forms, and manual laxity tests. Subjective evaluation was done using the 2000 IKDC subjective knee evaluation, Lysholm knee score, and 2000 IKDC functional score. Patient activity level was determined using the Tegner activity score. IKDC knee grades were assigned based on final evaluation on the 2000 IKDC knee examination forms.

Results:
At final follow-up 2000 IKDC knee examination grades significantly improved, with 21 in group B (61.8%) and 12 in group A (35.3%), while preoperatively most were classified as group C (76.5%). Similarly, IKDC subjective and Lysholm scores were significantly better after follow-up. The difference between mean Tegner activity level preinjury (6.029±0.9040) and at follow-up (5.67±1.006) was not significant.

Conclusions:
Selective bundle reconstruction with preservation of remnants restores knee stability and function. The results are encouraging, with excellent improvement in functional scores.

Level of Evidence:
Level IV.
Posterior Sternoclavicular Dislocation: Do We Need “Cardiothoracic Backup”? Insights From a National Sample
Authors: Leonard Dana A. , Segovia Nicole A. , Kaur Japsimran , Lucas Justin , Bishop Julius , Vorhies John S. 
Published: November 2019

Objectives:
To describe the incidence of and risk factors for vascular injury associated with P-SCD.

Methods:
We used data from the HCUP-NIS from 2015 to 2016 and defined a cohort of patients with sternoclavicular dislocation (SCD) using ICD-10-CM diagnosis codes. We further isolated a subset with P-SCD. We describe the incidence of thoracic vascular injury, demographics, and injury severity score in this cohort.

Results:
Of an estimated 550 patients who had SCD, 140 (25%) were identified as having a P-SCD. No vascular injuries occurred in the P-SCD cohort. Among all patients with SCD, <2% of patients had a vascular injury, all of whom had an injury severity score ≥15, independent of the vascular injury itself. Among patients with an isolated P-SCD injury (55), overall length of stay was 1.8 days and total charges averaged $29,724.45. There was no mortality among patients with isolated P-SCD.

Conclusions:
Here, we report no vascular injuries in the largest known series of P-SCD. Among all patients with SCD, vascular injury was rare, occurring only in severely polytraumatized patients. The recommendation for routine involvement of cardiothoracic surgeons in all cases of P-SCD should be re-examined.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
A Medical School Dean's Guide to Orienting Educational Leaders on Roles, Responsibilities, and Resources
Authors: Christner Jennifer G. , Smith Jamie S. , Appelbaum Nital P. 
Published: November 2019

Abstract:
Continuing professional development of physicians often revolves around clinical activities. Accordingly, there is a lack of intentional development and support of medical education leaders despite such individuals having critical influence over key organizational functions. Unequivocally, educational leaders have complex and dynamic jobs that require clear delineation of roles, responsibilities, and resources available to successfully train the next generation of health professionals. Although there is guidance on how to longitudinally onboard medical education leaders, there is little information on how to effectively orient such leaders on the functional nature of their jobs. Baylor College of Medicine’s medical school dean developed and delivered a 2-day orientation program to educational leaders to clarify roles, responsibilities, and resources. Postevaluation surveys aimed to identify key session content that would be frequently used by educational leaders to oversee key aspects of medical education. The purpose of this article is to outline the structure and content of an orientation program designed for medical education leaders, and share postevaluation data to identify which sessions were most used in practice. Other deans are encouraged to take ownership over the professional development of their educational leaders and delivering similar programming.
Dilation of Multiple Eccrine Ducts as a Highly Specific Marker for Cicatricial Alopecia
Authors: Tan Timothy L. , Doytcheva Kristina , Guitart Joan , Gerami Pedram , Yazdan Pedram 
Published: November 2019

Background:
Eccrine duct dilation (EDD) was recently described to occur more frequently in cicatricial alopecias than noncicatricial alopecias. Because single EDD can be useful in the evaluation of alopecias, we aimed to determine whether dilation of multiple eccrine duct units, or “multiple eccrine duct dilation (MEDD),” could more specifically discriminate between cicatricial and noncicatricial alopecias.

Methods:
We retrospectively evaluated 611 scalp biopsies (342 cicatricial alopecias and 269 noncicatricial alopecias).

Results:
Among cicatricial alopecias, MEDD was found in 21% (25/118) of central centrifugal cicatricial alopecia, 26% (29/109) of lichen planopilaris, 13% (10/73) of discoid lupus erythematosus, 31% (5/16) of acne keloidalis nuchae, and 26% (7/26) of folliculitis decalvans. In noncicatricial alopecias, MEDD was found in 1% (1/102) of androgenetic alopecia, 0.7% (1/150) of alopecia areata, and 0% (0/17) of telogen effluvium. In cicatricial alopecias, MEDD occurred in a significantly higher frequency (22%; 76/342) compared with noncicatricial alopecias (0.7%; 2/269) (P-value <0.0001). The presence of MEDD correlated with a diagnosis of cicatricial alopecia with 22% sensitivity and 99% specificity. MEDD also occurred more frequently in cases with moderate to severe inflammation and fibroplasia, suggesting that EDD is a reactive change secondary to the scarring processes.

Conclusion:
The presence of MEDD on scalp biopsies may be a highly specific marker of cicatricial alopecia and can aid in rendering a more accurate diagnosis. MEDD without other definitive histopathologic features of cicatricial alopecia may compel pathologists to pursue additional workup and/or raise the possibility that a cicatricial alopecia cannot be entirely excluded.
Psychiatric Symptoms: Prevalence, Co-occurrence, and Functioning Among Extremely Low Gestational Age Newborns at Age 10 Years
Authors: Dvir Yael , Frazier Jean A. , Joseph Robert M. , Mokrova Irina , Moore Phoebe S. , O'Shea T. Michael , Hooper Stephen R. , Santos Hudson P. , Kuban Karl ,   for the ELGAN Study Investigators
Published: November 2019

ABSTRACT:

Objective:
To evaluate the percentage of children born extremely preterm (EP) who screen positive for ≥1 DSM-IV psychiatric disorders, the co-occurrence of and sex-related differences in these classifications, and the functional correlates of psychiatric symptoms.

Methods:
The Extremely Low Gestational Age Newborn (ELGAN) Study is a prospective cohort follow-up of children born <28 weeks' gestation. For 871 10-year-old children, parents completed the Child Symptom Inventory-4 (CSI-4), a child educational/medical history questionnaire, and the Pediatric Quality of Life Inventory (PedsQL).

Results:
At age 10 years, ELGANs were more likely to screen positive for a number of psychiatric disorders when compared with normative expectations on the CSI-4, with a few sex-related differences. Fifteen percent of participants screened positive for 1 disorder, 7% for 2, 3% for 3, and 4% for ≥4 psychiatric disorders. Compared with children who did not screen positive for psychiatric disorders, children who screened positive for ≥3 psychiatric disorders were approximately twice as likely to have repeated a grade, have an individualized educational program, have an individual school aide, and to require special remediation classes. Children who screened positive for any psychiatric disorder were 4 times more likely to use 1 or more psychotropic medication, and those who screened positive for ≥2 psychiatric disorders had lower PedsQL scores.

Conclusion:
Among 10-year-old children born EP, rates of psychiatric symptoms exceeded normative expectation, and children who screened positive for more than 1 psychiatric disorder were at increased risk of having multiple functional impairments.
Spatiotemporal Dynamics of Immune Cells in Early Left Ventricular Remodeling After Acute Myocardial Infarction in Mice
Authors: Bejjani Anthony T. , Saab Sally A. , Muhieddine Dina H. , Habeichi Nada J. , Booz George W. , Zouein Fouad A. 
Published: November 2019

Abstract:
Myocardial infarction remains a leading cause of morbidity and death. Insufficient delivery of oxygen to the myocardium sets into play a complicated process of repair that involves the temporal recruitment of different immune cells so as to remove debris and necrotic cells expeditiously and to form effective scar tissue. Clearly defined and overlapping phases have been identified in the process, which transitions from an overall proinflammatory to anti-inflammatory phenotype with time. Variations in the strength of the phases as well as in the co-ordination among them have profound consequences. Too strong of an inflammatory phase can result in left ventricular wall thinning and eventual rupture, whereas too strong of an anti-inflammatory phase can lead to cardiac stiffening, arrhythmias, or ventricular aneurisms. In both cases, heart failure is an intermediate consequence with death being the likely outcome. Here, we summarize the role of key immune cells in the repair process of the heart after left ventricular myocardial infarction, along with the associated cytokines and chemokines. A better understanding of the immune response ought to lead hopefully to improved therapies that exploit the natural repair process for mending the infarcted heart.
Promoting Patient Utilization of Outpatient Cardiac Rehabilitation
Authors: Santiago de Araújo Pio Carolina , Beckie Theresa M. , Varnfield Marlien , Sarrafzadegan Nizal , Babu Abraham S. , Baidya Sumana , Buckley John , Chen Ssu-Yuan , Gagliardi Anna , Heine Martin , Khiong Jong Seng , Mola Ana , Radi Basuni , Supervia Marta , Trani Maria R. , Abreu Ana , Sawdon John A. , Moffatt Paul D. , Grace Sherry L. 
Published: November 2019

Purpose:
Cardiac rehabilitation (CR) is a recommendation in international clinical practice guidelines given its benefits; however, use is suboptimal. The purpose of this position statement was to translate evidence on interventions that increase CR enrollment and adherence into implementable recommendations.

Methods:
The writing panel was constituted by representatives of societies internationally concerned with preventive cardiology and included disciplines that would be implementing the recommendations. Patient partners served, as well as policy makers. The statement was developed in accordance with AGREE II, among other guideline checklists. Recommendations were based on our update of the Cochrane review on interventions to promote patients' utilization of CR. These were circulated to panel members, who were asked to rate each on a 7-point Likert scale in terms of scientific acceptability, actionability, and feasibility of assessment. A Web call was convened to achieve consensus and confirm strength of the recommendations (based on Grading of Recommendations Assessment, Development, and Evaluation [GRADE]). The draft underwent external review and public comment.

Results:
The 3 drafted recommendations were that to increase enrollment, health care providers, particularly nurses (strong), should promote CR to patients face-to-face (strong), and that to increase adherence, part of CR could be delivered remotely (weak). Ratings (mean ± SD) for the 3 recommendations were 5.95 ± 0.69, 5.33 ± 1.12, and 5.64 ± 1.08, respectively.

Conclusions:
Interventions can significantly increase utilization of CR and hence should be widely applied. We call upon cardiac care institutions to implement these strategies to augment CR utilization and to ensure that CR programs are adequately resourced to serve enrolling patients and support them to complete programs.
Selective afferent renal denervation mitigates renal and splanchnic sympathetic nerve overactivity and renal function in chronic kidney disease-induced hypertension
Authors: Veiga Amanda C. , Milanez Maycon I.O. , Ferreira Giovanna R. , Lopes Nathalia R. , Santos Camila P. , De Angelis Katia , Garcia Michelle L. , Oyama Lila M. , Gomes Guiomar N. , Nogueira Fernando N. , Carvalho Polliane M. , Campos Ruy R. , Bergamaschi Cássia T. , Nishi Erika E. 
Published: November 2019

Background:
Clinical and experimental evidence have shown that renal denervation, by removing both the sympathetic and afferent nerves, improves arterial hypertension and renal function in chronic kidney disease (CKD). Given the key role of renal sympathetic innervation in maintaining sodium and water homeostasis, studies have indicated that the total removal of renal nerves leads to impaired compensatory mechanisms during hemodynamic challenges.

Method:
In the present study, we hypothesized that afferent (or sensory) fibers from the diseased kidney contribute to sympathetic overactivation to the kidney and other target organ, such as the splanchnic region, contributing to hypertension in CKD. We used a method to remove selectively the afferent renal fibers (periaxonal application of 33 mmol/l capsaicin) in a rat model of CKD, the 5/6 nephrectomy.

Results:
Three weeks after afferent renal denervation (ARD), we found a decrease in mean arterial pressure (∼15%) and normalization in renal and splanchnic sympathetic nerve hyperactivity in the CKD group. Interestingly, intrarenal renin--angiotensin system, as well as renal fibrosis and function and proteinuria were improved after ARD in CKD rats.

Conclusion:
The findings demonstrate that afferent fibers contribute to the maintenance of arterial hypertension and reduced renal function that are likely to be mediated by increased sympathetic nerve activity to the renal territory as well as to other target organs in CKD.
Estimation of Radiation Doses for a Case-control Study of Thyroid Cancer Among Ukrainian Chernobyl Cleanup Workers
Authors: Drozdovitch Vladimir , Kryuchkov Victor , Bakhanova Elena , Golovanov Ivan , Bazyka Dimitry , Gudzenko Natalia , Trotsyuk Natalia , Hatch Maureen , Cahoon Elizabeth K. , Mabuchi Kiyohiko , Bouville André , Chumak Vadim 
Published: November 2019

Abstract
Thyroid doses were estimated for 607 subjects of a case-control study of thyroid cancer nested in the cohort of 150,813 male Ukrainian cleanup workers who were exposed to radiation as a result of the 1986 Chernobyl nuclear power plant accident. Individual thyroid doses due to external irradiation, inhalation of 131I and short-lived radioiodine and radiotellurium isotopes (132I, 133I, 135I, 131mTe, and 132Te) during the cleanup mission, and intake of 131I during residence in contaminated settlements were calculated for all study subjects, along with associated uncertainty distributions. The average thyroid dose due to all exposure pathways combined was estimated to be 199 mGy (median: 47 mGy; range: 0.15 mGy to 9.0 Gy), with averages of 140 mGy (median: 20 mGy; range: 0.015 mGy to 3.6 Gy) from external irradiation during the cleanup mission, 44 mGy (median: 12 mGy; range: ~0 mGy to 1.7 Gy) due to 131I inhalation, 42 mGy (median: 7.3 mGy; range: 0.001 mGy to 3.4 Gy) due to 131I intake during residence, and 11 mGy (median: 1.6 mGy; range: ~0 mGy to 0.38 Gy) due to inhalation of short-lived radionuclides. Internal exposure of the thyroid gland to 131I contributed more than 50% of the total thyroid dose in 45% of the study subjects. The uncertainties in the individual stochastic doses were characterized by a mean geometric standard deviation of 2.0, 1.8, 2.0, and 2.6 for external irradiation, inhalation of 131I, inhalation of short-lived radionuclides, and residential exposure, respectively. The models used for dose calculations were validated against instrument measurements done shortly after the accident. Results of the validation showed that thyroid doses could be estimated retrospectively for Chernobyl cleanup workers two to three decades after the accident with a reasonable degree of reliability.
Different Methods of Measuring Neutron Dose/Fluence Generated During Radiation Therapy with Megavoltage Beams
Authors: Farhood Bagher , Ghorbani Mehdi , Abdi Goushbolagh Nouraddin , Najafi Masoud , Geraily Ghazale 
Published: November 2019

Abstract
Medical linear accelerators (linacs) are the most frequently applied radiation therapy machines in the locoregional treatment of cancers by producing either high-energy electron or photon beams. However, with high-energy photons (>8 MeV), interaction of these photons with different high-Z nuclei of materials in components of the linac head unavoidably generates neutrons. On the other hand, the average energy of these generated neutrons has almost the highest radiation-weighting factor. Therefore, the produced neutrons should not be neglected. There are various tools for the measurement of neutron dose/fluence generated in a megavoltage linac, including thermoluminescent dosimeters, solid-state nuclear track detectors, bubble detectors, activation foils, Bonner sphere systems, and ionization chamber pairs. In this review article, each of the above-mentioned dosimetric methods will be described in detail.
Nordic Guidelines for Germline Predisposition to Myeloid Neoplasms in Adults: Recommendations for Genetic Diagnosis, Clinical Management and Follow-up
Authors: Baliakas Panagiotis , Tesi Bianca , Wartiovaara-Kautto Ulla , Stray-Pedersen Asbjørg , Friis Lone Smidstrup , Dybedal Ingunn , Hovland Randi , Jahnukainen Kirsi , Raaschou-Jensen Klas , Ljungman Per , Rustad Cecilie F. , Lautrup Charlotte K. , Kilpivaara Outi , Kittang Astrid Olsnes , Grønbæk Kirsten , Cammenga Jörg , Hellström-Lindberg Eva , Andersen Mette K. 
Published: November 2019

Abstract
Myeloid neoplasms (MNs) with germline predisposition have recently been recognized as novel entities in the latest World Health Organization (WHO) classification for MNs. Individuals with MNs due to germline predisposition exhibit increased risk for the development of MNs, mainly acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). Setting the diagnosis of MN with germline predisposition is of crucial clinical significance since it may tailor therapy, dictate the selection of donor for allogeneic hematopoietic stem cell transplantation (allo-HSCT), determine the conditioning regimen, enable relevant prophylactic measures and early intervention or contribute to avoid unnecessary or even harmful medication. Finally, it allows for genetic counseling and follow-up of at-risk family members. Identification of these patients in the clinical setting is challenging, as there is no consensus due to lack of evidence regarding the criteria defining the patients who should be tested for these conditions. In addition, even in cases with a strong suspicion of a MN with germline predisposition, no standard diagnostic algorithm is available. We present the first version of the Nordic recommendations for diagnostics, surveillance and management including considerations for allo-HSCT for patients and carriers of a germline mutation predisposing to the development of MNs.
Corneal Collagen Cross-Linking With Photoactivated Chromophore for Infectious Keratitis After Penetrating Keratoplasty
Authors: Ozbek-Uzman Selma , Yalniz-Akkaya Zuleyha , Burcu Ayse 
Published: November 2019

Purpose:
To evaluate the efficacy and safety of corneal collagen cross-linking with photoactivated chromophore (PACK-CXL) plus medical treatment in comparison with the non-CXL group in the management of graft infections after penetrating keratoplasty.

Methods:
Forty eyes of 40 patients, 18 eyes in the PACK-CXL group and 22 eyes in the non-CXL group, with graft infections were retrospectively reviewed. Patients with microbial keratitis who were resistant to medical treatment for at least 1 week were treated with PACK-CXL in conjunction with medical treatment. The non-CXL group received only medical treatment.

Results:
The median (interquartile range) size of the infiltrate was 11 (3–12.7) versus 7.5 (3.5–12.7) mm2 (P = 0.37), the epithelization time was 3 (2.7–5) versus 6 (3–11.2) days (P = 0.06), the complete healing time was 23.5 (17.7–33.5) versus 34 (27.7–41.2) days (P = 0.02), and the best-corrected distance visual acuity was 2.5 (0.5–3) versus 2.0 (0.9–3) logarithm of the minimum angle of resolution (P = 0.79) at presentation and 1 (0.3–3) versus 3 (1–3) logarithm of the minimum angle of resolution (P = 0.19) at the final visit for the PACK-CXL and non-CXL groups, respectively. Resolution of infiltrates was observed in 83.3% and 68.2% of cases in the PACK-CXL and non-CXL groups, respectively (P = 0.28). Graft failure was observed in 5 (27.8%) and 12 (54.5%) patients in the PACK-CXL and non-CXL groups, respectively (P = 0.08).

Conclusions:
PACK-CXL appears to be a promising adjuvant procedure in the management of resistant graft infections by reducing both the duration required for complete healing and rates of graft failure.