bluuebunny/crossref_metadata_2025_split huggingface dataset:
HIV protease inhibitor ritonavir induces renal fibrosis and dysfunction: role of platelet-derived TGF-β1 and intervention via antioxidant pathways
Authors: Laurence Jeffrey , Elhadad Sonia , Gostynska Sandra , Yu Zhongxin , Terry Hunter , Varshney Rohan , Fung Kar-Ming , Choi Mary E. , Ahamed Jasimuddin 
Published: March 2020

Objective:
Chronic kidney disease (CKD) with tubular injury and fibrosis occurs in HIV infection treated with certain protease inhibitor-based antiretroviral therapies. The pathophysiology is unclear.

Design:
We hypothesized that fibrosis, mediated by platelet-derived transforming growth factor (TGF)-β1, underlies protease inhibitor-associated CKD. We induced this in mice exposed to the protease inhibitor ritonavir (RTV), and intervened with low-dose inhaled carbon monoxide (CO), activating erythroid 2-related factor (Nrf2)-associated antioxidant pathways.

Methods:
Wild-type C57BL/6 mice and mice deficient in platelet TGF-β1, were given RTV (10 mg/kg) or vehicle daily for 8 weeks. Select groups were exposed to CO (250 ppm) for 4 h after RTV or vehicle injection. Renal disorder, fibrosis, and TGF-β1-based and Nrf2-based signaling were examined by histology, immunofluorescence, and flow cytometry. Renal damage and dysfunction were assessed by KIM-1 and cystatin C ELISAs. Clinical correlations were sought among HIV-infected individuals.

Results:
RTV-induced glomerular and tubular injury, elevating urinary KIM-1 (P = 0.004). It enhanced TGF-β1-related signaling, accompanied by kidney fibrosis, macrophage polarization to an inflammatory phenotype, and renal dysfunction with cystatin C elevation (P = 0.008). Mice lacking TGF-β1 in platelets were partially protected from these abnormalities. CO inhibited RTV-induced fibrosis and macrophage polarization in association with upregulation of Nrf2 and heme oxygenase-1 (HO-1). Clinically, HIV infection correlated with elevated cystatin C levels in untreated women (n = 17) vs. age-matched controls (n = 19; P = 0.014). RTV-treated HIV+ women had further increases in cystatin C (n = 20; P = 0.05), with parallel elevation of HO-1.

Conclusion:
Platelet TGF-β1 contributes to RTV-induced kidney fibrosis and dysfunction, which may be amenable to antioxidant interventions.
Myocardial Mechanics Parameters That Predict Left Ventricular Outflow Tract Obstruction in Patients With Hypertrophic Cardiomyopathy: A Cardiovascular Magnetic Resonance Feature Tracking Analysis
Authors: Huang Lei , Que Lifeng , Xi Yue , Zhuang Jian , Yuan Haiyun , Liu Hui , Li Jinglei , Dong Yuhao , Jia Qianjun , Lin JiJin 
Published: March 2020

Objective
To identify left ventricular (LV) myocardial mechanics predictors of LV outflow tract obstruction (LVOTO) in patients with hypertrophic cardiomyopathy (HCM).

Methods
Thirty-nine adults with HCM and 21 controls underwent cardiovascular magnetic resonance. The feature tracking (FT) analysis results of HCM patients with and without LVOTO and controls were compared.

Results
Global radial strain measured on the short-axis slice (GRS-SAX) (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.02–1.15; P < 0.01), global longitudinal strain measured on the long-axis slice (GLS-LAX) (OR, 1.81; 95% CI, 1.21–2.73; P < 0.01) and GRS measured on the long-axis slice (GRS-LAX) (OR, 1.07; 95% CI, 1.01–1.13; P = 0.02) were independent predictors of LVOTO. The combination of GRS-SAX plus GLS-LAX and GRS-LAX showed great discriminatory power for identifying LVOTO with an area under the receiver operating characteristic curve value of 0.91 (95% CI: 0.81–1.00).

Conclusions
In adult HCM patients, GRS-SAX, GLS-LAX, and GRS-LAX were independent predictors of LVOTO. The combination of GRS-SAX plus GLS-LAX and GRS-LAX showed great discriminatory power for identifying LVOTO.
Minimizing Radiation Dose Outliers Through Systematic Analysis, Computed Tomography Technologist Education, and Standardized System Solutions
Authors: Appel Elisabeth , Boos Johannes , Fang Jieming , Zhang Da , Wilcox Carol , Camacho Andrés , Dommaraju Sujithraj , Brook Alexander , Brook Olga R. 
Published: March 2020

Objectives
The aims of the study were to systematically analyze causes for radiation dose outliers in emergency department noncontrast head computed tomographies (CTs), to develop and implement standardized system solutions, and audit program success for an extended period of time.

Methods
This study was performed in a large, tertiary academic center between January 2015 and September 2017. Four phases of radiation dose data collection with and without prior interventions were performed. Outliers from 5 categories were evaluated for appropriateness in consensus by 2 radiologists and a senior CT technologist.

Results
A total of 275 ± 15 CTs per period were included. Fifty-seven inappropriate scanning parameters were found in 24 (9%) of 254 CTs during the first analysis, 27 in 21 (7%) of 290 CTs during the second, 11 in 10 (4%) of 276 during the third assessment (P = 0.006). After a year without additional intervention, the number remained stable (14 in 11/281 CTs, 4%).

Conclusions
Combining a dose reporting system, individual case analysis, staff education, and implementation of systemic solutions lead to sustained radiation exposure improvement.
Prevalence of Machine Learning in Craniofacial Surgery
Authors: Mak Martin L. , Al-Shaqsi Sultan Z. , Phillips John 
Published: March 2020

Abstract
Machine learning (ML) revolves around the concept of using experience to teach computer-based programs to reliably perform specific tasks. Healthcare setting is an ideal environment for adaptation of ML applications given the multiple specific tasks that could be allocated to computer programs to perform. There have been several scoping reviews published in literature looking at the general acceptance and adaptability of surgical specialities to ML applications, but very few focusing on the application towards craniofacial surgery. This study aims to present a detailed scoping review regarding the use of ML applications in craniofacial surgery.
Nasolabial Perforator Flap: A Multi-Tool for Reconstruction of Facial Units
Authors: Ercan Alp , Ercan Leman Damla , Demiroz Anil 
Published: March 2020

Background:
Nasolabial flap is a work-horse flap for coverage of many facial units. However, these flaps have limited mobility and these limit their use in many instances. Facial artery with its numerous small cutaneous perforators can be a source for free-style skin flaps that can be islanded and have greater reach, one of which is nasolabial perforatory flap.

Methods:
The authors present a case series of 35 patients with central facial unit defects reconstructed by a single flap harvested from the nasolabial sulcus.

Results:
In our series, we did not encounter any significant flap loss and patient satisfaction was high both functionally and aesthetically. Main drawbacks were temporary venous congestion and hair bearing flaps in male patients.

Conclusion:
The authors think with its reliability and versatility nasolabial perforator flaps, based on the same donor area as the traditional nasolabial flap can be a valuable addition to our arsenal in reconstruction of central facial unit defects.
Variability in Current Procedural Terminology Codes for Craniomaxillofacial Trauma Reconstruction: A National Survey
Authors: Jazayeri Hossein E. , Khavanin Nima , Yu Jason W. , Wu Brendan , Payne Eric , Mundinger Gerhard S. , Patel Kamlesh B. , Peacock Zachary S. , Villa Mark T. , Dorafshar Amir H. 
Published: March 2020

Background:
Current Procedural Terminology (CPT) codes are an important part of surgical documentation and billing for services provided within the United States. This limited coding language presents a challenge in the heterogenous and rapidly evolving field of craniofacial surgery. The authors aimed to survey members of the American Society of Maxillofacial Surgery (ASMS) to characterize the variability in coding practices in the surgical management of craniofacial trauma.

Methods:
A cross-sectional of 500 members of the ASMS survey was carried out. Descriptive statistics were calculated. The effect of various practice characteristics on coding practices was evaluated using Chi-squared tests and Fisher's exact tests.

Results:
In total, 79 participants responded including 77 plastic surgeons. About 75% worked in academic centers and 38% reported being in practice over 20 years. Coding practices were not significantly associated with training background or years in practice. Unilateral mandibular and unilateral nasoorbitoethmoid fractures demonstrated the greatest agreement with 99% and 88% of respondents agree upon a single coding strategy, respectively. Midface fractures, bilateral nasoorbitoethmoid fractures, and more complex mandibular demonstrated considerable variability in coding.

Conclusion:
There is a wide variability among members of the ASMS in CPT coding practices for the operative management of craniofacial trauma. To more accurately convey the complexity of craniofacial trauma reconstruction to billers and insurance companies, the authors must develop a more descriptive coding language that captures the heterogeneity of patient presentation and surgical procedures.
Peer Role-Play for Training Communication Skills in Medical Students
Authors: Gelis Anthony , Cervello Sophie , Rey Romain , Llorca Guy , Lambert Philippe , Franck Nicolas , Dupeyron Arnaud , Delpont Marion , Rolland Benjamin 
Published: March 2020

Summary Statement
Peer role-play (PRP) is a simulation-based training method (SBTM) in which medical students alternately play the patient's and clinician's role. This review aimed to assess the effectiveness of PRP for improving the communication skills of medical students. A systematic search was conducted in the MedLine, PsycInfo, and ERIC databases. Studies were qualitatively analyzed according to the Kirkpatrick evaluation level (Kirkpatrick level) and the Medical Education Research Study Quality Instrument.
Twenty-two studies were included. Studies assessing the “reaction” of students (Kirkpatrick level 1, n = 15) found that PRP was appreciated, whereas those assessing the effect of PRP on “learning” (Kirkpatrick level 2, n = 12) found that PRP improves communication skills but no more than other SBTMs. No study assessed real-life “attitudes” or “clinical outcomes” (Kirkpatrick levels 3 and 4), whereas 2 studies found that using PRP had a better cost-efficacy ratio than the use of simulated patients. Compared with other SBTMs, PRP improved communication skills similarly in medical students and seemed less expensive.
Developing a Profile of Procedural Expertise
Authors: Kerrey Benjamin T. , Boyd Stephanie D. , Geis Gary L. , MacPherson Ryan P. , Cooper Edward , Kiefer Adam W. 
Published: March 2020

Background
Improving the assessment and training of tracheal intubation is hindered by the lack of a sufficiently validated profile of expertise. Although several studies have examined biomechanics of tracheal intubation, there are significant gaps in the literature. We used 3-dimensional motion capture to study pediatric providers performing simulated tracheal intubation to identify candidate kinematic variables for inclusion in an expert movement profile.

Methods
Pediatric anesthesiologists (experienced) and pediatric residents (novices) were recruited from a pediatric institution to perform tracheal intubation on airway mannequins in a motion capture laboratory. Subjects performed 21 trials of tracheal intubation, 3 each of 7 combinations of laryngoscopic visualization (direct or indirect), blade type (straight or curved), and mannequin size (adult or pediatric). We used repeated measures analysis of variance to determine whether various kinematic variables (3-trial average for each participant) were associated with experience.

Results
Eleven experienced and 15 novice providers performed 567 successful tracheal intubation attempts (9 attempts unsuccessful). For laryngoscopy, experienced providers exhibited shorter path length (total distance traveled by laryngoscope handle; 77.6 ± 26.0 cm versus 113.9 ± 53.7 cm; P = 0.013) and greater angular variability at the left wrist (7.4 degrees versus 5.5 degrees, P = 0.013) and the left elbow (10.1 degrees versus 7.6 degrees, P = 0.03). For intubation, experienced providers exhibited shorter path length of the right hand (mean = 61.1 cm versus 99.9 cm, P < 0.001), lower maximum acceleration of the right hand (0.19 versus 0.14 m/s2, P = 0.033), and smaller angular, variability at the right elbow (9.7 degrees versus 7.9 degrees, P = 0.03).

Conclusions
Our study and the available literature suggest specific kinematic variables for inclusion in an expert profile for tracheal intubation. Future studies should include a larger sample of practitioners, actual patients, and measures of the cognitive and affective components of expertise.
Bone Mineral Density and Aortic Calcification: Evidence for a Bone-vascular Axis After Kidney Transplantation
Authors: Sotomayor Camilo G. , Benjamens Stan , Gomes-Neto António W. , Pol Robert A. , Groothof Dion , te Velde-Keyzer Charlotte A. , Chong Guillermo , Glaudemans Andor W.J.M. , Berger Stefan P. , Bakker Stephan J.L. , Slart Riemer H.J.A. 
Published: March 2020

Background.
Chronic kidney disease mineral and bone disorders (CKD-MBD) and vascular calcification are often seen in kidney transplantation recipients (KTR). This study focused on the bone–vascular axis hypothesis, the pathophysiological mechanisms driving both bone loss and vascular calcification, supported by an association between lower bone mineral density (BMD) and higher risk of vascular calcification.

Methods.
KTR referred for a dual-energy X-ray absorptiometry procedure within 6 mo after transplantation were included in a cross-sectional study (2004–2014). Areal BMD was measured at the proximal femur, and abdominal aortic calcification (AAC) was quantified (8-points score) from lateral single-energy images of the lumbar spine. Patients were divided into 3 AAC categories (negative-AAC: AAC 0; low-AAC: AAC 1–3; and high-AAC: AAC 4–8). Multivariable-adjusted multinomial logistic regression models were performed to study the association between BMD and AAC.

Results.
We included 678 KTR (51 ± 13 y old, 58% males), 366 (54%) had BMD disorders, and 266 (39%) had detectable calcification. High-AAC was observed in 9%, 11%, and 25% of KTR with normal BMD, osteopenia, and osteoporosis, respectively (P < 0.001). Higher BMD (T-score, continuous) was associated with a lower risk of high-AAC (odds ratio 0.61, 95% confidence interval 0.42-0.88; P = 0.008), independent of age, sex, body mass index, estimated glomerular filtration rate, and immunosuppressive therapy. KTR with normal BMD were less likely to have high-AAC (odds ratio 0.24, 95% confidence interval 0.08-0.72; P = 0.01).

Conclusions.
BMD disorders are highly prevalent in KTR. The independent inverse association between BMD and AAC may provide evidence to point toward the existence, while highlighting the clinical and epidemiological relevance, of a bone–vascular axis after kidney transplantation.
The onjisaponin B metabolite tenuifolin ameliorates dopaminergic neurodegeneration in a mouse model of Parkinson’s disease
Authors: Peng Fang , Lu Linyu , Wei Fei , Wu Die , Wang Kai , Tang Juanjuan 
Published: March 2020

Onjisaponin B (OB) is the main active ingredient of the traditional Chinese medicinal herb polygala, which is effective against neurodegenerative disorders. However, the target of OB is currently unknown. Neuroinflammation and oxidative stress are both risk factors for the pathogenesis and progression of Parkinson’s disease (PD). Here, we used a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced subacute mouse model of PD to explore the efficacy and neuroprotective mechanism of OB in PD. Immunohistochemistry was used to mark dopaminergic (DA) neurons and microglia in the substantia nigra pars compact. Administration of OB (20 and 40 mg/kg) prevented the degeneration of DA neurons and improved motor impairment in the rotarod test. Furthermore, OB attenuated microglia over-activation and reduced the secretion of inflammatory factors including tumor necrosis factor-alpha, interleukin-1 beta (IL-1β) and interleukin-6 (IL-6), as determined by ELISA. Meanwhile, the activities of superoxide dismutase and malondialdehyde were used to measure the level of oxidative stress in brain homogenates and suppression of excessive lipid epoxidation and increased antioxidant enzyme activity were found in OB-treated PD mice. Finally, OB inhibits the expression of the p65 subunit of NF-κB in the nucleus and attenuated expression of the RhoA and ROCK2 proteins in PD mice. Consequently, our results show that OB ameliorates DA neurodegeneration in a MPTP-induced mouse model of PD through anti-oxidant and anti-inflammatory activities mediated via the RhoA/ROCK2 signaling pathway. This finding demonstrates that OB may be a promising drug for DA neuron degeneration, which may provide a new therapeutic agent for future discovery of drugs for PD.
See video abstract: http://links.lww.com/WNR/A580
Molecular epidemiology of human rhinovirus from one-year surveillance within a school setting in rural coastal Kenya
Authors: Luka Martha M. , Kamau Everlyn , Adema Irene , Munywoki Patrick K. , Otieno Grieven P. , Gicheru Elijah , Gichuki Alex , Kibinge Nelson , Agoti Charles N. , Nokes D. James 
Published: March 2020

ABSTRACTBackgroundHuman rhinovirus (HRV) is the most common cause of the common cold but may also lead to more severe respiratory illness in vulnerable populations. The epidemiology and genetic diversity of HRV within a school setting have not been described.ObjectiveTo characterise HRV molecular epidemiology among children attending primary school in a rural location of Kenya.MethodsBetween May 2017 to April 2018, over three school terms, we collected 1859 nasopharyngeal swabs (NPS) from pupils and teachers with symptoms of acute respiratory infection in a public primary school in Kilifi County, coastal Kenya. The samples were tested for HRV using real-time RT-PCR. HRV positive samples were sequenced in the VP4/VP2 coding region for species and genotype classification.ResultsA total of 307 NPS (16.4%) from 164 individuals were HRV positive, and 253 (82.4%) were successfully sequenced. The proportion of HRV in the lower primary classes was higher (19.8%) than upper primary classes (12.2%),p-value <0.001. HRV-A was the most common species (134/253, 53.0%), followed by HRV-C (73/253, 28.9%) and HRV-B (46/253, 18.2%). Phylogenetic analysis identified 47 HRV genotypes. The most common genotypes were A2 and B70. Numerous (up to 22 in one school term) genotypes circulated simultaneously, there was no individual re-infection with the same genotype, and no genotype was detected in all three school terms.ConclusionHRV was frequently detected among school-going children with mild ARI symptoms, and particularly in the younger age groups (<5-year-olds). Multiple HRV introductions were observed characterised by the considerable genotype diversity.Summary pointsWe describe the molecular epidemiology of human rhinovirus (HRV) within a school setting over one-year in rural coastal Kenya. A high diversity of HRV infections was observed across all classes with evidence of introduction and transmission of 47 different genotypes.
The effect of control strategies that reduce social mixing on outcomes of the COVID-19 epidemic in Wuhan, China
Authors: Prem Kiesha , Liu Yang , Russell Timothy W , Kucharski Adam J , Eggo Rosalind M , Davies Nicholas ,   Centre for the Mathematical Modelling of Infectious Diseases COVID-19 Working Group, Jit Mark , Klepac Petra 
Published: March 2020

AbstractBACKGROUNDIn December 2019, a novel strain of SARS-CoV-2 emerged in Wuhan, China. Since then, the city of Wuhan has taken unprecedented measures and efforts in response to the outbreak.METHODSWe quantified the effects of control measures on population contact patterns in Wuhan, China, to assess their effects on the progression of the outbreak. We included the latest estimates of epidemic parameters from a transmission model fitted to data on local and internationally exported cases from Wuhan in the age-structured epidemic framework. Further, we looked at the age-distribution of cases. Lastly, we simulated lifting of the control measures by allowing people to return to work in a phased-in way, and looked at the effects of returning to work at different stages of the underlying outbreak.FINDINGSChanges in mixing patterns may have contributed to reducing the number of infections in mid-2020 by 92% (interquartile range: 66–97%). There are benefits to sustaining these measures until April in terms of reducing the height of the peak, overall epidemic size in mid-2020 and probability that a second peak may occur after return to work. However, the modelled effects of social distancing measures vary by the duration of infectiousness and the role school children play in the epidemic.INTERPRETATIONRestrictions on activities in Wuhan, if maintained until April, would likely contribute to the reduction and delay the epidemic size and peak, respectively. However, there are some limitations to the analysis, including large uncertainties around estimates of R0 and the duration of infectiousness.FUNDINGBill and Melinda Gates Foundation, National Institute for Health Research, Wellcome Trust, and Health Data Research UK.
Clinical features of imported cases of coronavirus disease 2019 in Tibetan patients in the Plateau area
Authors: Lei Yu , Huang Xiaobo , SiLang Bamu , Lan YunPing , Lu Jianli , Zeng Fan 
Published: March 2020

AbstractCoronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has rapidly spread throughout China, but the clinical characteristics of Tibetan patients living in the Qinghai-Tibetan plateau are unknown. We aimed to investigate the epidemiological, clinical, laboratory and radiological characteristics of these patients. We included 67 Tibetan patients with confirmed SARS-CoV-2 infection. The patients were divided into two groups based on the presence of clinical symptoms at admission, with 31 and 36 patients in the symptomatic and asymptomatic groups, respectively. The epidemiological, clinical, laboratory and radiological characteristics were extracted and analysed. No patient had a history of exposure to COVID-19 patients from Wuhan or had travelled to Wuhan. The mean age of Tibetan patients was 39.3 years and 59% of the patients were male. Seven patients presented with fever on admission and lymphocytopenia was present in 20 patients. 47 patients had abnormal chest CTs at admission instead of stating that 20 were unchanged. Lactate dehydrogenase levels were increased in 31 patients. Seven patients progressed to severe COVID-19; however, after treatment, their condition was stable. No patients died. Of the 36 asymptomatic patients, the mean age was younger than the symptomatic group (34.4±17.3vs 44.9±18.1 years, P=0.02). Lymphocyte count and prealbumin levels were higher in the asymptomatic group than the group with clinical symptoms (1.6±0.5 vs 1.3±0.6 and 241.8±68.2 vs 191.9±60.3, respectively; P<0.05). Imported cases of COVID-19 in Tibetan patients were generally mild in this high-altitude area. Absence of fever or radiologic abnormalities on initial presentation were common.