bluuebunny/crossref_metadata_2025_split huggingface dataset:
TDIF overexpression in poplars retards internodal elongation and enhances leaf venation through interaction with other phytohormones
Authors: Yue Jing , Yang Heyu , Yang Shaohui , Wang Jiehua 
Published: December 2019

Abstract
As a member of the CLAVATA3 (CLV3)/EMBRYO SURROUNDING REGION-related (CLE) peptide family, tracheary element differentiation inhibitory factor (TDIF) plays crucial roles in vascular meristem maintenance by promoting cell proliferation and inhibiting xylem cell differentiation. In Populus trichocarpa, six TDIF-encoding genes are all expressed in vascular tissues, and in Arabidopsis PtTDIFpro:GUS lines, the expression driven by PtTDIF promoters were predominantly detected in stem vascular bundles, initiating leaves and leaf veins. Although exogenous application of two poplar TDIF peptides did not evidently affect the shoot growth in vitro, overexpression of PtTDIF genes in hybrid poplar severely retarded the internodal elongation by upregulating the expression of GA2ox and GA20ox genes and thus decreasing the level of endogenous gibberellins (GAs), which phenotypic defect could be rescued by exogenously applied GA3. In addition, TDIF overexpression unexpectedly induced a more complex venation pattern in poplar leaves, which was underpinned by the elevated expression of WOX4 and WOX13 genes. Upon TDIF treatment, the DR5:GUS poplar leaves revealed a higher GUS activity and in TDIF-overexpressing leaves, the transcript abundances of several PIN-FORMED (PIN) genes, especially that of PIN1, were increased, which implied an integration of TDIF and auxin in mediating this process. Collectively, data of this work presented novel activities of TDIF involved in internode elongation and leaf vein formation, thus revealing the divergent functions of TDIF in perennial tree species from those in annual herbaceous Arabidopsis.
Zika virus infection in asymptomatic persons in Myanmar, 2018
Authors: Ngwe Tun Mya Myat , Hmone Saw Wut , Soe Aung Min , Luvai Elizabeth , Nwe Khine Mya , Inoue Shingo , Buerano Corazon C , Thant Kyaw Zin , Morita Kouichi 
Published: December 2019

AbstractBackgroundZika virus (ZIKV) is a mosquito-borne flavivirus. Outbreaks of ZIKV infection have occurred in Africa, Southeast Asia, the Pacific Islands, the Americas and the Caribbean. Although most ZIKV infections are asymptomatic, cases of neurological manifestations have been described. The aim of the present study was to identify the prevalence of ZIKV infection among the asymptomatic persons in Myanmar in 2018.MethodsA total of 284 serum samples from apparently healthy persons were collected from Yangon, Myanmar in 2018. They were analysed for ZIKV infection by immunoglobulin M (IgM) capture enzyme-linked immunosorbent assay (ELISA), IgG indirect ELISA, 50% focus reduction neutralization test, real-time reverse transcription polymerase chain reaction (RT-PCR) and conventional RT-PCR.ResultsOf the 284 apparently healthy persons, 31.3% were positive for the presence of IgM against ZIKV and 94.3% were positive for anti-flavivirus IgG. Among the ZIKV IgM-positive samples, we confirmed ZIKV infection in 15.8% of asymptomatic persons by neutralization test and real-time RT-PCR.ConclusionsWe conclude that ZIKV infection was increasing among asymptomatic persons in the same area in Myanmar during 2018 compared with 2017. It is highly recommended to strengthen the surveillance system for ZIKV to prevent possible outbreaks.
Internal Medicine Resident Professionalism Assessments: Exploring the Association With Patients’ Overall Satisfaction With Their Hospital Stay
Authors: Ratelle John T. , Halvorsen Andrew J. , Mandrekar Jay , Sawatsky Adam P. , Reed Darcy A. , Beckman Thomas J. 
Published: December 2019

Purpose
Successful training of internal medicine (IM) residents requires accurate assessments. Patients could assess IM residents in a hospital setting, but medical educators must understand how contextual factors may affect assessments. The objective was to investigate relationships between patient, resident, and hospital-encounter characteristics and the results of patient assessments of IM resident professionalism.

Method
The authors performed a prospective cohort study of postgraduate year 1 (PGY-1) IM residents and their patients at 4 general medicine inpatient teaching services at Mayo Clinic Hospital–Rochester, Saint Marys Campus in Rochester, Minnesota, from July 1, 2015, through June 30, 2016. Patient assessments of resident professionalism were adapted from validated instruments. Multivariable modeling with generalized estimating equations was used to determine associations between patient assessment scores and characteristics of residents, residents’ clinical performance and evaluations (including professionalism assessments in other settings), patients, and hospital encounters and to account for repeated assessments of residents.

Results
A total of 409 patients assessed 72 PGY-1 residents (mean [SD], 5.7 [3.0] patient assessments per resident). In the multivariable model, only the highest rating out of 5 levels for overall satisfaction with hospital stay was significantly associated with patient assessment scores of resident professionalism (β [SE], 0.80 [0.08]; P < .001). Hospitalized patients’ assessment scores of resident professionalism were not significantly correlated with assessment scores of resident professionalism in other clinical settings.

Conclusions
Hospitalized patients’ assessment scores of in-hospital resident professionalism were strongly correlated with overall patient satisfaction with hospital stay but were not correlated with resident professionalism in other settings. The limitations of patient evaluations should be considered before incorporating these evaluations into programs of assessment.
A Quality Improvement Project to Improve the Use of Mother's Own Milk (MOM) With Precision Oropharyngeal Therapy
Authors: Wetzel Christine M. , Davis Lisa , Grohler Nikki , Oprondek David , Ruff Debra , Lowery Kaci , Heuer Jessica , Mullvain Maddi , Wolff Jessica 
Published: December 2019

Background:
Bioprotective properties of mother's own milk (MOM) support the use of targeted MOM administration methods, including oropharyngeal therapy (OPT) with MOM, which may mimic the protective effects of swallowed amniotic fluid, thereby improving infant health outcomes.

Purpose:
To increase the use of MOM-OPT in premature infants in the first week of life.

Methods:
Quality improvement methods were used to implement precision dosing of OPT.

Results:
After changing processes and replacing the colostrum immune therapy practice with longer-term precision OPT, the percentage of ordered doses administered to infants in the first week of life increased from 24% to 64%. There was also a 15% increase in very low birth-weight infants who received MOM (from 50% to 65%) at discharge. There were no reported adverse events related to OPT administration.

Implications for Practice:
Replacing the unit's short-term colostrum immune therapy protocol with the longer-term precision OPT increased the number of doses given in the first week of life and increased the number of very low birth-weight infants discharged receiving MOM.

Implications for Research:
Researchers should consider studying the reported positive effects of OPT related to infant response (positive oral stimulation, reduction in oral aversion, and improved oral feeding skills), parent participation in care, and maternal milk expression behaviors (longer milk expression duration).
Maternal and Neonatal Morbidity After 4 and 6 Hours of Protracted Active Labor in Nulliparous Term Pregnancies
Authors: Govindappagari Shravya , Greene Naomi , Burwick Richard , Wong Melissa S. , Gregory Kimberly D. 
Published: December 2019

OBJECTIVE:
To evaluate whether women with protracted active phase labor longer than 6 hours have an increased risk of adverse maternal and neonatal outcomes after the implementation of new labor management guidelines.

METHODS:
This was a retrospective study of nulliparous, term, singleton, vertex deliveries at Cedars Sinai Medical Center from August 2016 to September 2017. Women were included if they progressed to active phase labor, defined by cervical dilation of 6 cm or more. Women then were divided into three groups based on the time course of cervical change between 6 and 10 cm: 1) normal active phase: cervical change 1 cm or more within 4 hours throughout active labor; 2) mildly protracted active phase: cervical change 1 cm or less over 4–6 hours; and 3) very protracted active phase: cervical change 1 cm or less over 6 hours. Rate of change was assessed between cervical examinations. Primary outcome was a composite of maternal morbidity by study group. Secondary outcome was a composite of neonatal morbidity. We hypothesized that women with very protracted active phase had higher rates of adverse outcomes when compared with normal active phase. Regression analyses were performed to compare maternal and neonatal outcomes by study group.

RESULTS:
There were 2,559 deliveries, of which 2,378 (90.8%) were vaginal deliveries. Composite maternal and neonatal morbidity was higher with longer labor. Maternal morbidity—very protracted active phase (42.0%) compared with normal active phase (22.6%) adjusted odds ratio (aOR) 2.15 (95% CI 1.62–2.86); mildly protracted active phase (39.5%) compared with normal active phase (22.6%) aOR 2.18 (95% CI 1.67–2.84). Neonatal morbidity: very protracted active phase (19.8%) compared with normal active phase (13.8%) aOR 1.38 (95% CI 0.98–1.96); mildly protracted active phase (19.4%) compared with normal active phase (13.8%) aOR 1.44; (95% CI 1.04–1.99). Composite maternal and neonatal morbidity was not different between mildly protracted and very protracted groups.

CONCLUSION:
Composite maternal morbidity was greater in women with cervical change consistent with mildly protracted (4–6 hours) and very protracted (more than 6 hours) labor compared with cervical change in the normal active phase (less than 4 hours) group. However, composite maternal and neonatal morbidity was not different between mildly protracted and very protracted groups.
Association Between Prenatal Smoking and Gestational Diabetes Mellitus
Authors: Bar-Zeev Yael , Haile Zelalem T. , Chertok Ilana Azulay 
Published: December 2019

OBJECTIVE:To evaluate whether there is an association between prenatal smoking and gestational diabetes mellitus (GDM).METHODS:We conducted a secondary data analysis using data from the Pregnancy Risk Assessment Monitoring System from 2009 to 2015. Outcome measures included self-reported GDM and change in smoking status during pregnancy (nonsmoker, quit smoking, reduced the amount smoked, smoked the same or more). Multivariable logistic regression analyses were performed to estimate the association between prenatal smoking and GDM status, adjusted for maternal age, race–ethnicity, prepregnancy body mass index (BMI) categories (underweight, normal [referent group], overweight, and obese), and gestational weight gain (inadequate, normal [referent group], and excessive), overall and stratified by prepregnancy BMI and gestational weight gain subgroups.RESULTS:A total of 222,408 women were included; 5.3% (n=12,897) had GDM. Most (48.1%) women had normal prepregnancy BMI, and 43.1% had excessive gestational weight gain. Mothers who continued to smoke the same or greater number of cigarettes or reduced the number of cigarettes smoked had higher odds of GDM (adjusted odds ratio [OR] 1.46, 95% CI 1.25–1.71 and OR 1.22, 95% CI 1.08–1.38, respectively). Smoking the same or more cigarettes was associated with higher odds of GDM in all subgroups of prepregnancy BMI or gestational weight gain.CONCLUSION:Prenatal smoking is associated with higher odds of GDM, after adjusting for known risk factors, and stratifying by prepregnancy BMI and gestational weight gain. Reducing smoking during pregnancy might reduce the risk of GDM and could be an additional reason for promoting smoking cessation among pregnant women.
Persistent Opioid Use After Hysterectomy in the United States, 2005–2015
Authors: Young Jessica C. , Wu Jennifer M. , Willis-Gray Marcella , Pate Virginia , Jonsson Funk Michele 
Published: December 2019

OBJECTIVE:
To assess variables associated with opioid prescriptions filled perioperatively after hysterectomy and the risk of prolonged opioid use through 1 year after hysterectomy.

METHODS:
In this retrospective cohort study, we used the 2005–2015 IBM MarketScan databases to identify women aged at least 18 years who underwent hysterectomy. For opioid use, we identified filled prescriptions for opioid medications. We excluded women with prevalent opioid use, defined as an opioid prescription filled 180 to 30 days preoperatively or at least two prescriptions filled in the 30 days before surgery. We defined perioperative opioid use as any opioid prescription filled within 30 days before or 7 days after surgery. We used log-binomial regression to identify independent predictors of perioperative opioid prescription fill. To assess the risk of long-term opioid use, we estimated the proportion of women with ongoing monthly opioid prescriptions through 12 months after surgery and the proportion of women with any opioid prescription 3–6 months after surgery, mimicking published estimates.

RESULTS:
Among 569,634 women who underwent hysterectomy during the study period, 176,537 (30.9%) were excluded owing to prevalent opioid use. We found that 331,322 (84.3%) women filled a perioperative opioid prescription, with median quantity of 30 pills (interquartile range 25–40), and that younger (adjusted risk ratio [adjRR]18–24 0.91) and older (adjRR65–74 0.84; adjRR75+ 0.70) patients were less likely to receive a perioperative prescription compared with women aged 45–54. The proportion of women with continuous monthly fills of opioids through 2, 3, 6, and 12 months after surgery was 1.40%, 0.34%, 0.06%, and 0.02%, respectively.

CONCLUSION:
Most women who underwent hysterectomy in the United States from 2005 to 2015 filled a perioperative opioid prescription with a median quantity of 30 pills. The risk of prolonged opioid use through 6 months is quite low, at 0.06% or 1 in 1,547.
Risk of Stillbirth for Fetuses With Specific Birth Defects
Authors: Heinke Dominique , Nestoridi Eirini , Hernandez-Diaz Sonia , Williams Paige L. , Rich-Edwards Janet W. , Lin Angela E. , Van Bennekom Carla M. , Mitchell Allen A. , Nembhard Wendy N. , Fretts Ruth C. , Roberts Drucilla J. , Duke C. Wes , Carmichael Suzan L. , Yazdy Mahsa M. ,   for the National Birth Defects Prevention Study
Published: December 2019

OBJECTIVE:
To estimate the risk of stillbirth (fetal death at 20 weeks of gestation or more) associated with specific birth defects.

METHODS:
We identified a population-based retrospective cohort of neonates and fetuses with selected major birth defects and without known or strongly suspected chromosomal or single-gene disorders from active birth defects surveillance programs in nine states. Abstracted medical records were reviewed by clinical geneticists to confirm and classify all birth defects and birth defect patterns. We estimated risks of stillbirth specific to birth defects among pregnancies overall and among those with isolated birth defects; potential bias owing to elective termination was quantified.

RESULTS:
Of 19,170 eligible neonates and fetuses with birth defects, 17,224 were liveborn, 852 stillborn, and 672 electively terminated. Overall, stillbirth risks ranged from 11 per 1,000 fetuses with bladder exstrophy (95% CI 0–57) to 490 per 1,000 fetuses with limb-body-wall complex (95% CI 368–623). Among those with isolated birth defects not affecting major vital organs, elevated risks (per 1,000 fetuses) were observed for cleft lip with cleft palate (10; 95% CI 7–15), transverse limb deficiencies (26; 95% CI 16–39), longitudinal limb deficiencies (11; 95% CI 3–28), and limb defects due to amniotic bands (110; 95% CI 68–171). Quantified bias analysis suggests that failure to account for terminations may lead to up to fourfold underestimation of the observed risks of stillbirth for sacral agenesis (13/1,000; 95% CI 2–47), isolated spina bifida (24/1,000; 95% CI 17–34), and holoprosencephaly (30/1,000; 95% CI 10–68).

CONCLUSION:
Birth defect-specific stillbirth risk was high compared with the U.S. stillbirth risk (6/1,000 fetuses), even for isolated cases of oral clefts and limb defects; elective termination may appreciably bias some estimates. These data can inform clinical care and counseling after prenatal diagnosis.
Intramedullary Cage Fixation for Proximal Humerus Fractures Has Low Reoperation Rates at 1 Year: Results of a Multicenter Study
Authors: Goodnough Lawrence Henry , Campbell Sean T. , Githens Thomas C. , DeBaun Malcolm R. , Bishop Julius A. , Gardner Michael J. 
Published: December 2019

Objectives:
To determine reoperation rates after treatment of a proximal humerus fracture with cage fixation.

Design:
Retrospective case series.

Setting:
Eleven U.S. hospitals.

Patients:
Fifty-two patients undergoing surgical treatment of proximal humerus fractures.

Intervention:
Open reduction and internal fixation of a proximal humerus fracture with a proximal humerus cage.

Main Outcome Measurements:
Reoperation rate at 1 year.

Results:
At a minimum follow-up of 1 year, reoperations occurred in 4/52 patients (7.7%). Avascular necrosis (2/41) occurred in 4.9% of patients.

Conclusion:
Standard locked plating remains an imperfect solution for proximal humerus fractures. Proximal humerus cage fixation had low rates of revision surgery at 1 year. Proximal humerus cage fixation may offer reduced rates of complication and reoperation when compared with conventional locked plating for the management of proximal humerus fractures.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Neurological Outcome and Complications in Patients With Surgically Treated Spinal Metastases
Authors: de Andrade Erion Junior , Martins Samilly Conceição Maia , Formentin Cleiton , Turolo Otávio , Vasconcelos Victor Leal de , Ghizoni Enrico , Tedeschi Helder , Joaquim Andrei Fernandes 
Published: December 2019

Study Design.
Retrospective cohort.

Objective.
Evaluate the epidemiology of surgical patients with spinal metastases, identify the complications, and evaluate their neurological prognoses.

Summary of Background Data.
The development of new oncological treatments and screening tests have increased the survival of oncologic patients, and consequently, the incidence of metastatic lesions of the spine.

Methods.
Retrospective cohort of 40 patients surgically treated at the Hospital de Clínicas of UNICAMP for spinal metastases from January 2010 to September 2018, after diagnosis of symptomatic spinal cord compression and/or mechanical instability of the spine. Retrospectively analyzed patient charts applied the SINS score to evaluate the presence of mechanical instability. Neurological function was classified based on the Frankel index preoperative and postoperatively. To evaluate the association between variables, the Chi-square test, Fisher exact test, or Fisher–Freeman–Halton test was applied. For evaluating the improvement of neurological status between the Frankel scores before and after surgery, the McNemar test was applied for categorical and qualitative variables. In both the tests, variables with values of P > 0.05 were considered.

Results.
Pain as the reason for the first visit presented an odds ratio (OR) = 2.44 (95% [CI]: 1.14–5.2) for instrumentation need (P = 0.024). A higher SINS score corresponded to the indication for instrumentation surgery due to the instability of the spine (P = 0.004). Within 30 days postoperative, five patients (11.1%) had complications. There was a statistically significant neurological improvement in patients who underwent surgery (P = 0.002).

Conclusion.
Pain as the first symptom was related to mechanical instability of the spine and surgical instrumentation. Patients treated with surgery presented improvement of the neurological function in the postoperative period.

Level of Evidence: 3
Pedicle Screw Instrumentation in Scoliosis Surgery
Authors: Peiro-Garcia Alejandro , Teles Alisson R. , Ojaghi Reza , Ferri-de-Barros Fábio 
Published: December 2019

Study Design.
Prospective experimental study with on-site simulation.

Objective.
To compare the accuracy and efficiency of different techniques for pedicle screw instrumentation (PSI).

Summary of Background Data.
Improving the safety and efficiency of PSI is a critical step to reduce the complication rates and the cost of scoliosis surgery. Innovative operative techniques for PSI have shown to safely improve efficiency, thereby reducing cost. Surgical simulation is a valuable tool to study different operative techniques.

Methods.
Five spine fellows instrumented 20 simulation models of a scoliotic spine with 10 pedicle screws per model. Four techniques were studied, including the conventional pedicle probe and the innovative sequential drilling technique, with or without computed tomography (CT)-based navigation. Our primary outcome measures were efficiency and accuracy of PSI. We analyzed the data with bivariate analyses using the Chi-square test for categorical variables and the Student t test or ANalysis Of VAriance with Bonferroni post-hoc tests for continuous variables.

Results.
The drilling techniques (free hand and navigated) were more efficient as compared with the pedicle probe techniques (P < 0.01). The navigated techniques resulted in better accuracy as compared with the free hand techniques (P = 0.036). Most pedicle breaches were medial (n = 32/52). The concave apical pedicle (T4 right side) had the highest incidence of breaches. There was no significant difference in efficiency comparing the free hand and the navigated pedicle probe techniques (P = 0.261) or comparing the free hand drilling and the navigated drilling techniques (P = 1.00).

Conclusion.
On site surgical simulation is a promising concept for teaching advanced procedural skills. Our findings suggest that navigation improves the accuracy of PSI while sequential drilling safely improves efficiency. Combining navigation with sequential drilling can significantly improve the accuracy and the efficiency of PSI in scoliosis surgery, as previously suggested with our published clinical data.

Level of Evidence: 4