bluuebunny/crossref_metadata_2025_split huggingface dataset:
Xanthogranulomatous adrenalitis masquerading as a functioning adrenocortical malignancy: a case report
Authors: Jayanth Kalkunte Sriram , Balamurugan S. , Sureshkumar Sathasivam , Anandhi Amaranathan , Sree Rekha J. , Abdulbasith K.M. , Rajesh B.S. , Tajudeen Muhamed 
Published: August 2020

Introduction: Xanthogranulomatous adrenalitis (XA) is a rare chronic inflammatory disease of the adrenal glands and resembles adrenal neoplasm in clinical and radiologic characteristics. There is no report on XA presenting as a functioning adrenal mass in the literature. We present a case of XA mimicking a functioning adrenocortical carcinoma. Case report: A 52-year-old man presented with right flank pain, fever, vomiting, and loss of appetite for 2 weeks. He had signs of dehydration and elevated blood glucose level. Ultrasonography revealed a right adrenal mass. Contrast-enhanced computed tomography showed lobulated and necrotic mass replacing the right suprarenal gland and encasing the right renal vein, adjacent inferior vena cava, psoas, and diaphragm. There was loss of fat planes with liver and upper pole of the right kidney. Biochemical evaluation indicated increased serum and urine cortisol levels. As a sequel to hypercortisolism-induced hyperglycemia, he developed spontaneous chest wall abscess and bilateral sudden vision loss due to vitreous hemorrhages. Pus and blood culture grew methicillin-sensitive Staphylococcus aureus. Adrenal suppressant ketoconazole was administered for better glycemic control. With a diagnosis of locally advanced adrenocortical malignancy, right radical adreno-nephrectomy was performed, and cut section revealed a pus collection of around 100 mL. Histopathology examination showed xanthogranulomatous inflammation involving adrenal gland, Gerota’s fascia, psoas, and lymph nodes. Postoperatively, the patient recovered satisfactorily with favorable glycemic control. Conclusion: XA can mimic adrenal neoplasms both clinically and radiologically and is associated with staphylococcal infection. It warrants surgical excision and culture-based antibiotics and is mostly diagnosed on postoperative histopathology.
A Retrospective Study Analyzing the Lack of Symptom Benefit With Antimicrobials at the End of Life
Authors: Lopez Santiago , Vyas Pooja , Malhotra Prashant , Finuf Kayla , Magalee Christopher , Nouryan Christian , Hirsch Bruce 
Published: August 2020

Background: Infections are common in terminally ill patients (pts), and although antibiotics are frequently prescribed, their benefit for symptom relief is not clear. Antimicrobials at the end of life (EOL) may increase the risk of antimicrobial resistance and Clostrioides difficile infection. Our aim was to determine the frequency of symptom occurrence at the EOL when comparing pts who did or did not receive antibiotics (AB+ or AB-). Methods: We reviewed electronic medical records of pts admitted to a palliative care unit of a quarternary care hospital between 01/09/2017 and 07/16/2017 and assessed antimicrobial use in the last 14 days of life. Differences in demographics and symptom control between AB+ and AB- pts were analyzed using chi-square analyses; p-values were computed using Mann-Whitney tests. Results: Of a total of 133 pts included, 90 (68%) received antimicrobials (AB+). The indication for antibiotics was documented in only 12% of pts. The AB+ and AB- groups were similar with respect to demographics, including sex, and Charleston Comorbidity Index except for age (p = 0.01) and race (p = 0.03). Documented infections were similar between AB+ and AB- groups, except urinary tract infections. No statistically significant differences were noted in documented symptoms including pain, dyspnea, fever, lethargy, and alteration of mental state or length of stay. Conclusion: Our study did not show differences in frequencies of documented symptoms with use of antimicrobials at EOL. Antimicrobial stewardship programs and further research can help with developing EOL care antimicrobial guidelines supporting patients and providers through shared decision-making.
Patient-Reported Outcome Measures and Radiological Outcomes in Mobile-Bearing Total Ankle Arthroplasty With Varus or Valgus Deformity
Authors: Allport Jack , Ramaskandhan Jayasree , Alkhreisat Mohammad , Siddique Malik S. 
Published: August 2020

Background: There is increasing evidence that varus deformity does not negatively affect total ankle arthroplasty (TAA) outcomes, but there is a sparsity of evidence for valgus deformity. We present our outcomes using a mobile-bearing prosthesis for neutral, varus, and valgus ankles. Methods: This is a retrospective cohort study of consecutive cases identified from a local joint registry. In total, 230 cases were classified based on preoperative radiographs as neutral (152 cases), varus greater than 10 degrees (60 cases), or valgus greater than 10 degrees (18 cases). Tibiotalar angle was again measured postoperatively and at final follow-up (mean follow-up of 55.9 months). A total of 164 cases had adequate patient-reported outcome measures data (Foot and Ankle Outcome Score, Short Form–36 [SF-36] scores, and patient satisfaction) for analysis (mean follow-up of 61.6 months). The groups were similar for body mass index and length of follow-up, but neutral ankles were younger ( P = .021). Results: Baseline scores were equal except SF-36 physical health, with valgus ankles scoring lowest ( P = .045). Valgus ankles had better postoperative pain ( P = .025) and function ( P = .012) than neutral. Pre- to postoperative change did not reach statistical significance except physical health, in which valgus performed best ( P = .039). Mean final angle for all groups was less than 5 degrees. There was no significant difference in revision rates. Conclusion: Our study is consistent with previous evidence that varus deformity does not affect outcome in TAA. In addition, in our cohort, outcomes were satisfactory with valgus alignment. Postoperative coronal radiological alignment was affected by preoperative deformity but within acceptable limits. Coronal plane deformity did not negatively affect radiological or clinical outcomes in TAA. Level of Evidence: Level III, retrospective comparative study.
A telemedicine communication exchange network in Gorno-Badakhshan Autonomic Oblast in collaboration with Swiss Surgical Teams
Authors: Mamadnabiev Intizor , Imfeld Stephan , Gürke Lorenz , Aschwanden Markus , Isaak Andrej 
Published: August 2020

Introduction The purpose of this article is to report on the implementation of a telemedicine network serving as a second opinion pool for a surgeon in a remote area of a developing country. Methods This study involved an international collaboration between two members of Swiss Surgical Teams at a tertiary referral hospital and a surgeon in a remote area in Gorno-Badakhshan Autonomic Oblast, Tajikistan, which established a second opinion pool discussing diagnostics and therapeutic options via a messenger application. A retrospective analysis of response times was performed using a series of 50 challenging cases. Results The median time to receive a first telemedical response from any of the two contacts was 24 min (interquartile range 6–73). Urgent and emergent pathologies accounted for 57% of cases. The suggested treatment was carried out in 90% ( n = 44) of cases. Conclusions Timely and convenient telemedicine support to provide diagnostic and therapeutic reassurance and improve treatment quality for patients presenting to a general and vascular surgeon in the large and remote region of Gorno-Badakhshan Autonomic Oblast can be installed via a messenger application.
Rudimentary Dexterity Corresponds With Reduced Ability to Move in Synergy After Stroke: Evidence of Competition Between Corticoreticulospinal and Corticospinal Tracts?
Authors: Senesh Merav R. , Barragan Karina , Reinkensmeyer David J. 
Published: August 2020

Objective When a stroke damages the corticospinal tract (CST), it has been hypothesized that the motor system switches to using the corticoreticulospinal tract (CRST) resulting in abnormal arm synergies. Is use of these tracts mutually exclusive, or can the motor system spontaneously switch between them depending on the type of movement it wants to make? If the motor system can share control at will, then people with a rudimentary ability to make dexterous movements should be able to perform synergistic arm movements as well. Methods We analyzed clinical assessments of 319 persons’ abilities to perform “out-of-synergy” and “in-synergy” arm movements after chronic stroke using the Upper Extremity Fugl-Meyer (UEFM) scale. Results We identified a moderate range of arm impairment (UEFM = ~30-40) where subjects had a rudimentary ability to make out-of-synergy (~23%-50% on the out-of-synergy score) and dexterous hand movements (~3-10 blocks on Box and Blocks Test). Below this range persons could perform in-synergy but not out-of-synergy or dexterous movements. In the moderate range, however, scoring better on out-of-synergy movements correlated with scoring worse on in-synergy movements ( P = .001, r ≈ −0.6). Conclusion Rudimentary dexterity corresponded with reduced ability to move the arm in-synergy. This finding supports the idea that CST and CRST compete and has implications for rehabilitation therapy.
Attentional Resource Associated With Visual Feedback on a Postural Dual Task in Parkinson’s Disease
Authors: Yu Shu-Han , Wu Ruey-Meei , Huang Cheng-Ya 
Published: August 2020

Background Restricted attentional resource and central processing in patients with Parkinson’s disease (PD) may reduce the benefit of visual feedback in a dual task. Objectives Using brain event-related potentials (ERPs), this study aims to investigate the neural mechanisms of posture visual feedback and supraposture visual feedback during performing of a posture-motor dual task. Methods Eighteen patients with PD and 18 healthy controls stood on a mobile platform (postural task) and executed a manual force-matching task (suprapostural task) concurrently with provided visual feedback of platform movement (posture-feedback condition) or force output (force-feedback condition). The platform movement, force-matching performance, and ERPs (P1, N1, and P2 waves) were recorded. Results Both PD and control groups had superior force accuracy in the force-feedback condition. Decreased postural sway by posture-feedback was observed in healthy controls but not in PD. Force-feedback led to a greater frontal area N1 peak in PD group but smaller N1 peaks in control group. In addition, force-feedback led to smaller P2 peaks of the frontal and sensorimotor areas among PD patients but greater P2 peaks of the sensorimotor and parietal-occipital areas among healthy controls. However, P1 modulations was present only in healthy controls. Conclusions Force-feedback had positive effect on force accuracy in both PD and healthy individuals; however, the beneficial effect of posture-feedback on posture balance is not observed in PD. These findings are the first to suggest that PD could recruit more attentional resources in dual-task preparation to enhance suprapostural accuracy and avoid degrading postural stability by supraposture visual feedback.
Pathogenesis and management of superficial venous aneurysms through a case of thrombosed large great saphenous vein aneurysm
Authors: Aggarwal Vaibhav 
Published: August 2020

Introduction Superficial venous aneurysms are uncommon entities though venous Doppler has facilitated the detection of asymptomatic small aneurysms. Thromboembolic complications are rare with superficial venous aneurysms. The data regarding optimal therapy and pathogenesis of superficial venous aneurysm is sparse and is limited to isolated case reports. Methods Here, we present an unusual case of thrombosed large great saphenous vein aneurysm which was managed with Doppler, preoperative anticoagulation and surgical excision. Results and conclusion This paper is intended to review the current knowledge about the pathogenesis of superficial venous aneurysm of lower extremities, their optimal management and to guide future research in this area.
An Efficient Bifunctional Electrocatalyst of Phosphorous Carbon Co-doped MOFs
Authors: Du Li , Lv Mengyuan , Liu Dandan , Song Huiyu 
Published: August 2020

AbstractIt is eager to develop high-performance and cheap bifunctional electrochemical catalysts for both of the oxygen reduction reaction (ORR) or oxygen evolution reaction (OER) for the energy crisis and environmental problems. Herein, we report a series of ZIF-derived Co-P-C co-doped polyhedral materials with a well-defined morphology. The optimized catalyst Co/P/MOFs-CNTs-700 exhibited favorable electrochemical activities with the lowest overpotential of 420 mV to achieve the current density of 10 mA cm−2 for OER and the half potential of 0.8 V for ORR in 0.1 M NaOH. The performance can be well improved by doping phosphorous resource which greatly changed its morphology. Meanwhile, the doped carbon resources also improve the conductivity, which makes it a promising bifunctional electrochemical catalyst and can be comparable with the commercial electrocatalysts.
Freshwater amphipods (Gammarus pulex/fossarum) and brown trout as bioindicators for PFC contamination with regard to the aquatic ecological status of a small stream
Authors: Windisch Ute , Springer Fabian , Stahl Thorsten 
Published: August 2020

AbstractBackgroundPer- and polyfluorinated chemicals (PFC) have been in use for more than 60 years. As a result of their high thermal and chemical stability, they have found numerous applications in industrial processes. However, PFC also commonly show disadvantageous properties such as persistence and ubiquitous presence in the environment. The issue of PFC contamination of surface water is addressed in this publication. One aim of this study was to find a potential bioindicator for PFC contamination of small streams, and a second aim was to determine the aquatic ecological quality of such a stream. Standardized methods were used including structural quality mapping of a watercourse, the PERLODES method and electrofishing in four study sections of the stream. PFC contamination was determined in freshwater amphipods (Gammarus pulex/fossarum) and brown trout.ResultsThis study shows that PFC originating from water contamination can be detected both in amphipods and in internal organs of brown trout. The fingerprints in these two species differ considerably from one another. The highest concentrations of PFC were found in the liver and kidneys of brown trout. The methods used in this study also show that the four study sections of the small stream tested fail to achieve the “good” ecological status required by the Water Framework Directive. In particular, this is due to inadequate benthic invertebrates.ConclusionsEven though it is not possible to determine a causal relationship between the ecological status of the small stream and the detection of PFC in aquatic organisms, appropriate measures must be developed and applied to reduce the spreading of PFC in the environment. In addition to the brown trout, freshwater amphipods proved to be useful as a bioindicator for PFC contamination of streams. In the future it will be necessary to observe whether the number of species in the benthic invertebrates continue to decline.
Global transcriptomic responses orchestrate difenoconazole resistance in Penicillium spp. causing blue mold of stored apple fruit
Authors: Lichtner Franz J. , Gaskins Verneta L. , Cox Kerik D. , Jurick Wayne M. 
Published: August 2020

Abstract
Background
Blue mold is a globally important and economically impactful postharvest disease of apples caused by multiple Penicillium spp. There are currently four postharvest fungicides registered for blue mold control, and some isolates have developed resistance manifesting in decay on fungicide-treated fruit during storage. To date, mechanisms of fungicide resistance have not been explored in this fungus using a transcriptomic approach.

Results
We have conducted a comparative transcriptomic study by exposing naturally-occurring difenoconazole (DIF) resistant (G10) and sensitive (P11) blue mold isolates to technical grade difenoconazole, an azole fungicide in the commercial postharvest product Academy (Syngenta Crop Protection, LLC). Dynamic changes in gene expression patterns were observed encompassing candidates involved in active efflux and transcriptional regulators between the resistant and sensitive isolates. Unlike other systems, 3 isoforms of cytochrome P450 monoxygenase (CYP51A-C) were discovered and expressed in both sensitive and resistant strains upon difenoconazole treatment. Active efflux pumps were coordinately regulated in the resistant isolate and were shown to mediate the global resistance response as their inhibition reversed the difenoconazole-resistant phenotype in vitro.

Conclusions
Our data support the observation that global transcriptional changes modulate difenoconazole resistance in Penicillium spp. While the dogma of CYP51 overexpression is supported in the resistant isolate, our studies shed light on additional new mechanisms of difenoconazole resistance on a global scale in Penicillium spp. These new findings broaden our fundamental understanding of azole fungicide resistance in fungi, which has identified multiple genetic targets, that can be used for the detection, management, and abatement of difenoconazole-resistant blue mold isolates during long-term storage of apples.
N-terminal pro-B-type natriuretic peptide as a prognostic indicator for 30-day mortality following out-of-hospital cardiac arrest: a prospective observational study
Authors: Aarsetøy Reidun , Omland Torbjørn , Røsjø Helge , Strand Heidi , Lindner Thomas , Aarsetøy Hildegunn , Staines Harry , Nilsen Dennis W. T. 
Published: August 2020

AbstractBackgroundEarly risk stratification applying cardiac biomarkers may prove useful in sudden cardiac arrest patients. We investigated the prognostic utility of early-on levels of high sensitivity cardiac troponin-T (hs-cTnT), copeptin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with out-of-hospital cardiac arrest (OHCA).MethodsWe conducted a prospective observational unicenter study, including patients with OHCA of assumed cardiac origin from the southwestern part of Norway from 2007 until 2010. Blood samples for later measurements were drawn during cardiopulmonary resuscitation or at hospital admission.ResultsA total of 114 patients were included, 37 patients with asystole and 77 patients with VF as first recorded heart rhythm. Forty-four patients (38.6%) survived 30-day follow-up. Neither hs-cTnT (p = 0.49), nor copeptin (p = 0.39) differed between non-survivors and survivors, whereas NT-proBNP was higher in non-survivors (p <  0.001) and significantly associated with 30-days all-cause mortality in univariate analysis, with a hazard ratio (HR) for patients in the highest compared to the lowest quartile of 4.6 (95% confidence interval (CI), 2.1–10.1),p <  0.001. This association was no longer significant in multivariable analysis applying continuous values, [HR 0.96, (95% CI, 0.64–1.43),p = 0.84]. Similar results were obtained by dividing the population by survival at hospital admission, excluding non-return of spontaneous circulation (ROSC) patients on scene [HR 0.93 (95% CI, 0.50–1.73),P = 0.83]. We also noted that NT-proBNP was significantly higher in asystole- as compared to VF-patients,p <  0.001.ConclusionsEarly-on levels of hs-cTnT, copeptin and NT-proBNP did not provide independent prognostic information following OHCA. Prediction was unaffected by excluding on-scene non-ROSC patients in the multivariable analysis.Trial registrationClinicalTrials. gov,NCT02886273.
Factors correlated with drug use for constipation: perspectives from the 2016 open Japanese National Database
Authors: Mihara Hiroshi , Murayama Aiko , Nanjo Sohachi , Ando Takayuki , Tajiri Kazuto , Fujinami Haruka , Yamada Masaaki , Yasuda Ichiro 
Published: August 2020

Abstract
Background
The prevalence of chronic constipation is increased in females and with age or environmental (low temperature), racial, socioeconomic, and habitual risk factors. The impact of low outside temperature on constipation drug use remains unclear. Here, we investigated risk factors for constipation drug use by evaluating data from the Japanese National Database.

Methods
This ecological study used the 2016 open Japanese National Database of health insurance claims (prescriptions) to acquire the number of health insurance prescription claims in all 47 prefectures for drugs to relieve constipation, antihypertensives, vasodilators, as well as medical check-ups and questionnaire responses. Internet survey on room temperatures in 2010 were also used. Pearson correlation coefficients (r) between the number of population-based prescriptions for each item were calculated and multiple linear regression analysis (MLR) was performed.

Results
Prescriptions for magnesium laxatives significantly correlated with aging (r = 0.58), vasodilators (r = 0.53), being female (r = 0.43), antihypertensives (r = 0.39), and inversely with eating ≤2 h before bedtime (r = − 0.37), total crime rate (r = − 0.33), insomnia (r = − 0.33), and population density (r = − 0.31). Stimulant laxatives (sennoside and picosulfate) were significantly correlated with antihypertensives (r = 0.79), aging (r = 0.69), vasodilators (r = 0.67), and being female (r = 0.56), and were inversely associated with average outside temperature (r = − 0.62), total crime rate (r = − 0.52), average income (r = − 0.51), and 30-min of vigorous exercise (r = − 0.44). Fecal interventions were significantly correlated with aging (r = 0.55) and female (r = 0.59), and inversely correlated with population density (r = − 0.41) and total crime rate (r = − 0.38). MLR analysis identified aging as the only significant risk factor for magnesium laxative use (partial slope [β] = 1241.0). Female sex and antihypertensives were independent risk factors for stimulant laxative prescriptions (β = 44,547.0 and 0.2) and average outside temperature and 30-min of vigorous exercise were independent preventive factors (β = − 616.8 and − 219.1).

Conclusion
We identified associations of magnesium laxatives with aging, stimulant laxatives with female sex, antihypertensives, low outside temperature and less 30 min of vigorous exercise.