bluuebunny/crossref_metadata_2025_split huggingface dataset:
Wheat Thioredoxin (TaTrxh1) Associates With RD19-Like Cysteine Protease TaCP1 to Defend Against Stripe Rust Fungus Through Modulation of Programmed Cell Death
Authors: Shi Beibei , Zhao Xinbei , Li Min , Dong Zihui , Yang Qichao , Wang Yang , Gao Haifeng , Day Brad , Ma Qing 
Published: December 2020

Thioredoxins (Trxs) function within the antioxidant network through modulation of one or more redox reactions involved in oxidative-stress signaling. Given their function in regulating cellular redox, Trx proteins also fulfill key roles in plant immune signaling. Here, TaTrxh1, encoding a subgroup h member of the Trx family, was identified and cloned in wheat (Triticum aestivum), which was rapidly induced by Puccinia striiformis f. sp. tritici invasion and salicylic acid (SA) treatment. Overexpression of TaTrxh1 in tobacco (Nicotiana benthamiana) induced programmed cell death. Silencing of TaTrxh1 in wheat enhanced susceptibility to P. striiformis f. sp. tritici in different aspects, including reactive oxygen species accumulation and pathogen-responsive or -related gene expression. Herein, we observed that the cellular concentration of SA was significantly reduced in TaTrxh1-silenced plants, indicating that TaTrxh1 possibly regulates wheat resistance to stripe rust through a SA-associated defense signaling pathway. Using a yeast two-hybrid screen to identify TaTrxh1-interacting partners, we further show that interaction with TaCP1 (a RD19-like cysteine protease) and subsequent silencing of TaCP1 reduced wheat resistance to P. striiformis f. sp. tritici. In total, the data presented herein demonstrate that TaTrxh1 enhances wheat resistance against P. striiformis f. sp. tritici via SA-dependent resistance signaling and that TaTrxh1 interaction with TaCP1 is required for wheat resistance to stripe rust. [Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Cellular interactions in aspirin-exacerbated respiratory disease
Authors: Badrani Jana H. , Doherty Taylor A. 
Published: December 2020

Purpose of review
The purpose of this review is to summarize the complex cellular interactions of aspirin-exacerbated respiratory disease (AERD) and how these interactions promote pathogenic mechanisms of AERD.

Recent findings
In addition to characteristic changes in eicosanoid levels, recent studies have identified increases in alarmin cytokines (IL-33, thymic stromal lymphopoietin) as well as activated innate lymphoid and plasma cell populations in samples from AERD patients.

Summary
Patients with AERD typically demonstrate high levels of proinflammatory eicosanoids including cysteinyl leukotrienes (CysLTs) and prostaglandin D2 (PGD2) and hyporesponsiveness to prostaglandin E2 (PGE2). CysLTs are released by mast cells, eosinophils, and adherent platelets and promote epithelial release of IL-33, which activates mast cells and group 2 innate lymphoid cells (ILC2s) in concert with CysLTs. TSLP induces PGD2 release from mast cells which activates and recruits eosinophils, basophils, Th2 cells, and ILC2s via CRTH2. In turn, ILC2s and other cell types produce Th2 cytokines IL-4, IL-5, and IL-13 that, along with CysLTs and PGD2, promote bronchoconstriction, eosinophilic tissue inflammation, and mucus production.
The Distinguished Teaching Society at the Johns Hopkins University School of Medicine: A Student-Led Initiative to Recognize Clinical Educators
Authors: Gupta Pranjal Bodh , McRae Ashlyn Elizabeth , Franke Jennifer Lynn , Saba James A. , Soroosh Garshasb Parkhideh , Solomon Barry S. , Cofrancesco Joseph 
Published: December 2020

Problem
Some focus on recognizing excellence in clinical teaching has been lost with the increasing emphasis placed on clinical efficiency and value. Clinical teaching awards and academies of educators aim to address this problem. In 2015, medical student leaders at the Johns Hopkins University School of Medicine created the Distinguished Teaching Society (DTS), a student-driven program to recognize the best clinical educators.

Approach
Medical students designed a comprehensive scoring rubric focusing on 3 domains: feedback and evaluation, role model behavior, and teaching process. A student committee solicits student nominations providing narratives endorsing faculty or house staff for potential inclusion in the DTS. Using the rubric, student judges score each deidentified narrative nomination, as well as an application from finalists and comments about finalists submitted by the student body. Inductees are recognized at an annual ceremony.

Outcomes
From academic years 2015–2016 to 2018–2019, students nominated 254 unique candidates, and 82 nominees (32%) were inducted into the DTS. The majority of inductees were faculty and male. In 2017–2018 and 2018–2019, nearly half of inductees were female, and less than 10% of inductees self-reported as underrepresented in medicine and/or LGBTQ+. The Department of Internal Medicine had the greatest departmental representation. There were no statistically significant differences in the proportional representation within the nomination and inductee cohorts by gender, rank, and department. Several process changes were made in response to student feedback and to increase nominee and inductee diversity.

Next Steps
Next steps include adding a diversity and inclusion chair to the student committee and collecting survey data on student and DTS inductee opinions on how to improve learner–teacher engagement and the clinical learning environment. Future activities may include educational workshops, panel discussions, mentorship programs, and networking events. Other medical schools may find value in considering similar structures.
Using Predictive Modeling and Machine Learning to Identify Patients Appropriate for Outpatient Anterior Cervical Fusion and Discectomy
Authors: Wang Kevin Y. , Suresh Krishna V. , Puvanesarajah Varun , Raad Micheal , Margalit Adam , Jain Amit 
Published: December 2020

Study Design.
Retrospective, case–control.

Objective.
The aim of this study was to use predictive modeling and machine learning to develop novel tools for identifying patients who may be appropriate for single-level outpatient anterior cervical fusion and discectomy (ACDF), and to compare these to legacy metrics.

Summary of Background Data.
ACDF performed in an ambulatory surgical setting has started to gain popularity in recent years. Currently there are no standardized risk-stratification tools for determining which patients may be safe candidates for outpatient ACDF.

Methods.
Adult patients with American Society of Anesthesiologists (ASA) Class 1, 2, or 3 undergoing one-level ACDF in inpatient or outpatient settings were identified in the National Surgical Quality Improvement Program database. Patients were deemed as “unsafe” for outpatient surgery if they suffered any complication within a week of the index operation. Two different methodologies were used to identify unsafe candidates: a novel predictive model derived from multivariable logistic regression of significant risk factors, and an artificial neural network (ANN) using preoperative variables. Both methods were trained using randomly split 70% of the dataset and validated on the remaining 30%. The methods were compared against legacy risk-stratification measures: ASA and Charlson Comorbidity Index (CCI) using area under the curve (AUC) statistic.

Results.
A total of 12,492 patients who underwent single-level ACDF met the study criteria. Of these, 9.79% (1223) were deemed unsafe for outpatient ACDF given development of a complication within 1 week of the index operation. The five clinical variables that were found to be significant in the multivariable predictive model were: advanced age, low hemoglobin, high international normalized ratio, low albumin, and poor functional status. The predictive model had an AUC of 0.757, which was significantly higher than the AUC of both ASA (0.66; P < 0.001) and CCI (0.60; P < 0.001). The ANN exhibited an AUC of 0.740, which was significantly higher than the AUCs of ASA and CCI (all, P < 0.05), and comparable to that of the predictive model (P > 0.05).

Conclusion.
Predictive analytics and machine learning can be leveraged to aid in identification of patients who may be safe candidates for single-level outpatient ACDF. Surgeons and perioperative teams may find these tools useful to augment clinical decision-making.

Level of Evidence: 3
Learning Curve for a Dual Attending Surgeon Strategy in Posterior Spinal Fusion (PSF)
Authors: Chan Chris Yin Wei , Lee Sin Ying , Ch’ng Pei Ying , Chung Weng Hong , Chiu Chee Kidd , Hasan Mohd Shahnaz , Kwan Mun Keong 
Published: December 2020

Study Design.
Retrospective study.

Objective.
To assess the learning curve of a dual attending surgeon strategy in severe adolescent idiopathic scoliosis patients.

Summary of Background Data.
The advantages of a dual attending surgeon strategy in improving the perioperative outcome in scoliosis surgery had been reported. However, the learning curve of this strategy in severe scoliosis had not been widely studied.

Methods.
A total of 105 patients with adolescent idiopathic scoliosis with Cobb angle of 90° or greater, who underwent posterior spinal fusion using a dual attending surgeon strategy were recruited. Primary outcomes were operative time, total blood loss, allogeneic blood transfusion requirement, length of hospital stay from time of operation and perioperative complications. Cases were sorted chronologically into group 1: cases 1 to 35, group 2: cases 36 to 70, and group 3: case 71 to 105. Mean operative time (≤193.3 min), total blood loss (≤1612.2 mL), combination of both and allogeneic blood transfusion were the selected criteria for receiver operating characteristic analysis of the learning curve.

Results.
The mean Cobb angle was 104.5° ± 12.3°. The operative time, total blood loss, and allogeneic blood transfusion requirement reduced significantly for group 1 (220.6 ± 54.8 min; 2011.3 ± 881.8 mL; 12 cases) versus group 2 (183.6 ± 36.7 min; 1481.6 ± 1035.5 mL; 3 cases) and group 1 versus group 3 (175.6 ± 38.4 min; 1343.7 ± 477.8 mL; 3 cases) (P < 0.05). There were six perioperative complications. Fifty-seven cases were required to achieve the preset criteria (mean operative time and mean total blood loss) (area under the curve 0.740; P < 0.001; sensitivity 0.675; specificity 0.662).

Conclusion.
There was significant improvement in operative time and total blood loss when comparing group 1 versus group 2 and group 1 versus group 3. The cut-off point for the learning curve was 57 cases when the preset criteria were fulfilled (≤193.3 min operative time and ≤1612.2 mL of total blood loss).

Level of Evidence: 4
Dispersion in the hospital network of shared patients is associated with less efficient care
Authors: Everson Jordan , Adler-Milstein Julia R. , Hollingsworth John M. , Lee Shoou-Yih D. 
Published: December 2020

Background
There is growing recognition that health care providers are embedded in networks formed by the movement of patients between providers. However, the structure of such networks and its impact on health care are poorly understood.

Purpose
We examined the level of dispersion of patient-sharing networks across U.S. hospitals and its association with three measures of care delivered by hospitals that were likely to relate to coordination.

Methodology/Approach
We used data derived from 2016 Medicare Fee-for-Service claims to measure the volume of patients that hospitals treated in common. We then calculated a measure of dispersion for each hospital based on how those patients were concentrated in outside hospitals. Using this measure, we created multivariate regression models to estimate the relationship between network dispersion, Medicare spending per beneficiary, readmission rates, and emergency department (ED) throughput rates.

Results
In multivariate analysis, we found that hospitals with more dispersed networks (those with many low-volume patient-sharing relationships) had higher spending but not greater readmission rates or slower ED throughput. Among hospitals with fewer resources, greater dispersion related to greater readmission rates and slower ED throughput. Holding an individual hospital’s dispersion constant, the level of dispersion of other hospitals in the hospital’s network was also related to these outcomes.

Conclusion
Dispersed interhospital networks pose a challenge to coordination for patients who are treated at multiple hospitals. These findings indicate that the patient-sharing network structure may be an overlooked factor that shapes how health care organizations deliver care.

Practice Implications
Hospital leaders and hospital-based clinicians should consider how the structure of relationships with other hospitals influences the coordination of patient care. Effective management of this broad network may lead to important strategic partnerships.
ASSOCIATION BETWEEN PLATELET INDICES AND RETINAL VEIN OCCLUSION
Authors: Liu Zhengyang , Perry Luke A. , Edwards Thomas L. 
Published: December 2020

Purpose:
Platelet count, mean platelet volume, platelet distribution width, and plateletcrit are standard indices of platelet activation that have been studied in retinal vein occlusion (RVO) and its subtypes: branch retinal vein occlusion and central retinal vein occlusion. This systematic review and meta-analysis aimed to assess the association between these platelet parameters and RVO.

Methods:
We searched for studies investigating the association between these platelet indices and RVO in multiple online databases from inception to August 2020. Mean differences and the associated confidence intervals were obtained and calculated for each included study and pooled using random-effects inverse variance modeling. Meta-regression was used to explore interstudy and intrastudy heterogeneity.

Results:
Thousand three hundred and twenty-five unique studies were screened, from which 24 studies encompassing 2,718 patients were included. Mean platelet volume and platelet distribution width were significantly elevated in RVO, with pooled mean differences of 0.45 fL (95% CI 0.24–0.66, P < 0.0001) and 1.43% (95% CI 0.57–2.29, P = 0.0011), respectively. Platelet count and plateletcrit were not significantly associated with RVO. Mean platelet volume was also independently elevated in branch retinal vein occlusion and central retinal vein occlusion.

Conclusion:
Mean platelet volume and platelet distribution width are significantly elevated in RVO. Further research is required to explore the independence and potential prognostic significance of these associations.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS BEFORE AND AFTER VITRECTOMY FOR MACULAR HOLES
Authors: Savastano Alfonso , Bacherini Daniela , Savastano Maria C. , Finocchio Lucia , Dragotto Francesco , Lenzetti Chiara , Moroni Rossana , Caporossi Tomaso , Rizzo Stanislao 
Published: December 2020

Purpose:
To investigate the vascular remodeling of optical coherence tomography angiography in full-thickness macular hole surgery.

Methods:
This retrospective, observational case series included 33 eyes of 33 patients with a full-thickness macular hole who underwent epiretinal membrane removal. Data were collected on best-corrected visual acuity, structural B-scan optical coherence tomography, and optical coherence tomography angiography preoperatively and at 1, 3, and 6 months postoperatively. Optical coherence tomography angiography was used to assess the retinal vascular density (VD) of the superficial vascular plexus and deep vascular plexus (DVP). Vascular density was assessed using the Early Treatment Diabetic Retinopathy Study grid for the whole, inner, and outer grids.

Results:
A statistically significant correlation was found between the VD (whole, inner, and outer grids) of the superficial vascular plexus alone from baseline to 1-month postoperatively (P < 0.001). Similarly, VD was correlated from baseline to 1, 3, and 6 months postoperatively to the whole (P < 0.0005, F = 23.22), inner (P < 0.0005, F = 28.23), and outer Early Treatment Diabetic Retinopathy Study grids of DVP (P = 0.033, F = 3.49). The best-corrected visual acuity and VD were significantly correlated with the superficial vascular plexus and DVP at baseline and 6 months (P < 0.05, all correlations). The most significant correlation was observed at 6 months between best-corrected visual acuity and DVP in the whole, inner, and outer Early Treatment Diabetic Retinopathy Study grids (P < 0.001).

Conclusion:
Superficial vascular plexus and DVP are affected by full-thickness macular holes, with the most significant effects being on the DVP. Full-thickness macular hole surgery leads to an improvement in the best-corrected visual acuity in many eyes and the restoration of the VD, especially of the DVP.
Pediatric COVID-19 and Appendicitis: A Gut Reaction to SARS-CoV-2?
Authors: Malhotra Amisha , Sturgill Marc , Whitley-Williams Patricia , Lee Yi-Horng , Esochaghi Chika , Rajasekhar Hariprem , Olson Birk , Gaur Sunanda 
Published: December 2020

Background:
We describe the temporal pattern of COVID-19 admissions to a tertiary care children’s hospital in central New Jersey during the SARS-CoV-2 surge, covering the time period from March 29 to July 26, 2020.

Methods:
Medical charts were reviewed for the date of admission, past medical history, and demographic variables, presenting signs and symptoms, admitting laboratory values, diagnostic imaging, diagnosis, treatment modalities, and outcomes including length of stay and disease severity.

Results:
Patients with symptomatic SARS-CoV-2 infection tended to present with pneumonia early during the study period, which coincided with the early surge in New Jersey cases. Approximately 2 weeks after the peak in reported SARS-CoV-2 cases in New Jersey, we began to see fewer pneumonia cases and an increase in admissions for Multi-Inflammatory Syndrome in Children and cases of acute appendicitis in association with a diagnosis of SARS-CoV-2 infection.

Conclusions:
We present a novel association of acute appendicitis in children infected with SARS-CoV-2 and postulate that it may represent a postinfectious hyperinflammatory complication of SARS-CoV-2 infection occurring 2 weeks after the early manifestation of acute pneumonia disease in children.
High Prevalence of Non-Communicable Diseases Risk Factors in 36,074 South African Financial Sector Employees
Authors: Hene Nceba , Wood Paola , Schwellnus Martin , Jordaan Esme , Laubscher Ria 
Published: December 2020

Objective:
To determine the prevalence of non-communicable disease (NCD) risk factors, total NCD risk category and 10-year risk for cardiovascular diseases (CVD) in financial sector employees.

Methods:
This descriptive observational cross-sectional analysis, data from 36,074 employees was analysed. NCD risk factor data was obtained from health risk assessments that included a questionnaire and clinical measures. The 10-year risk for CVD was calculated using the Framingham non-laboratory based equation.

Results:
Inadequate fruit and vegetable intake (89.3%), insufficient physical activity (77.4%), and being overweight (66.8%) were the most prevalent risk factors. Women had significantly higher prevalence ratios for central obesity (2.28; P < 0.001), insufficient physical activity (1.21; P < 0.001), hypercholesterolaemia (1.15; P < 0.001), and overweight (1.08; P < 0.001) compared with men.

Conclusion:
A more concerted effort is required to provide employees with appropriate tools and education at the workplace to decrease and manage NCDs.
A case report on concurrent occurrence of systemic mastocytosis and myeloid sarcoma presenting with extensive skin involvements and the results of genetic study
Authors: Wang Xinye , Zhang Lu , Zhou Daobin , Cai Hao , Wang Xuan , Jiang Xianyong 
Published: December 2020

Abstract

Introduction:
Systemic mastocytosis is a rare disease due to mast cell accumulation in various extracutaneous sites. Systemic mastocytosis with an associated clonal hematologic non-MC lineage disease is the second most common subtype of systemic mastocytosis. The most common mutation associated with both systemic mastocytosis and myeloid sarcoma is mutation in Kit. Here, we identified the novel KIT D816V and ARID1A G1254S mutations co-occurring in systemic mastocytosis with myeloid sarcoma.

Patient Concerns:
A 33-year old male patient presented multiple skin lesions for 10 years. Symptoms accelerated in 2017 with decreased body weight. Physical examination revealed enlarged lymph nodes in his neck, axilla and inguinal region; conjunctival hemorrhage; gingival hyperplasia. Skin biopsy showed mast cell infiltration. Flow cytometry detected CD2, CD25 and CD117 positive cells in lymph nodes. Codon 816 KIT mutation D816V and codon 1245 ARID1A mutation G1254S were found in peripheral blood. MPO, CD117, CD68 positive cells in lymph nodes indicated co-existing myeloid sarcoma.

Diagnosis:
Systemic mastocytosis with an associated clonal hematologic non-MC lineage disease of myeloid sarcoma

Interventions:
Cytarabine and daunorubicin for myeloid sarcoma and dasatinib for systemic mastocytosis were initiated. Anti-histamine and anti-leukotrienes therapy were used to prevent NSAIDs-induced shock. Platelets were infused to treat bone marrow suppression.

Outcomes:
Patient was discharged after recovered from bone marrow suppression. Dasatinib continued on outpatient.

Conclusion:
This is the first case of patient with systemic mastocytosis and myeloid sarcoma simultaneously presenting extensive skin involvements. Mutations of Kit and Arid1a emphasis the importance to notice possibility of various tumors occurring in patients with multiple mutations. In addition, cysteine-leukotrienes-receptor antagonists should always be used to prevent anaphylactic shock due to mast cell activation.
Primary leptomeningeal melanomatosis successfully treated with PD-1 inhibitor pembrolizumab
Authors: Misir Krpan Ana , Rakusic Zoran , Herceg Davorin 
Published: December 2020

Abstract

Rationale:
Primary leptomeningeal melanoma is an extremely rare disease of the central nervous system. There are no standard treatment protocols with a poor prognosis in very few reported cases. Immunotherapy in primary brain melanoma has not been successfully applied so far.

Patient concerns:
We describe a female patient 72-year-old diagnosed in the Neurosurgery Department which presented with generalized seizures.

Diagnoses:
Histological examination confirmed atypical melanocytes immunohistochemically positive for melan A, HMB45 and S-100 protein in the meninges, BRAF V600E negative. Dermatological, ophthalmological examinations, and 18-FDG PET/CT were negative.

Interventions:
The patient was successfully treated with pembrolizumab 2 mg/kg every 3 weeks for 2 years.

Outcomes:
The disease was stable for 2 years and the patient had no significant toxicity.

Lessons:
Our report describes durable intracranial tumor response suggesting the efficacy of PD-1 inhibitor pembrolizumab for central nervous system primary leptomeningeal melanoma.