bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anatomic Understanding of Subtotal Hemispherotomy Using Cadaveric Brain, 3-Dimensional Simulation Models, and Intraoperative Photographs
Authors: Uda Takehiro , Kunihiro Noritsugu , Koh Saya , Nakanishi Yoko , Nakajo Kosuke , Tanoue Yuta , Uda Hiroshi , Umaba Ryoko , Kuki Ichiro , Inoue Takeshi , Kawawaki Hisashi , Ohata Kenji 
Published: November 2019

Abstract

BACKGROUND
When the epileptogenic foci skip the motor area, the epilepsy can be cured by surgery while preserving the motor function. This surgery has been reported as subtotal hemispherectomy. The disconnective variant of this surgery, subtotal hemispherotomy, is described.

OBJECTIVE
To demonstrate each step clearly, a cadaveric brain, 3-dimensional reconstruction and simulation model, and intraoperative photographs were used.

METHODS
A formalin-fixed cadaveric brain was dissected to show each step of this surgery. For the 3-dimensional model, several brain structures were reconstructed from preoperative images, and the surgery was simulated. Intraoperative photographs and postoperative magnetic resonance images were taken from the representative cases.

RESULTS
Temporo-parieto-occipital disconnection is performed to disconnect these lobes and the insula, limbic system, and splenium of the corpus callosum. The postcentral sulcus is the anterior border of the disconnection. Next, prefrontal disconnection is performed to disconnect the frontal lobe and the insula, frontal lobe and basal ganglia, and the anterior part of the corpus callosum. The precentral sulcus is the posterior border of the disconnection. Finally, corpus callosotomy of the central part is performed. After these steps, subtotal hemispherotomy, with preservation of the pre- and postcentral gyrus, is achieved. The 3-dimensional model clearly shows the anatomic relationships between deep brain structures. In the representative cases, postoperative motor deterioration was transient or none, and seizure-free status was achieved after surgery.

CONCLUSION
Subtotal hemispherotomy is generally difficult because of the complicated anatomy and narrow and deep surgical corridors. Combined use of these methods facilitates a clearer understanding of this surgery.
Patterns of Parliamentary Opposition: Empirical Evidence from the Deliberations in the German Bundestag’s Committee on European Union Affairs
Authors: Albrecht Frederike , Karlsson Christer , Persson Thomas 
Published: November 2019

Abstract
This article examines patterns of oppositional behaviour in the German Bundestag’s Committee on European Union Affairs (EAC) for two separate legislative periods (2005–2009 and 2009–2013). The study makes two contributions to previous research. It, first, shed some much-needed empirical light on political opposition in the Bundestag by examining how much and what kind of opposition exists in the German EAC. Secondly, the article examines the differences in oppositional behaviour of the Members of Parliament between the two legislative periods following an institutional reform in 2009 that afforded the Bundestag with increased opportunity structures in Europen Union affairs.
Plasmin inhibition by bacterial serpin: Implications in gum disease
Authors: Sochaj‐Gregorczyk Alicja , Ksiazek Miroslaw , Waligorska Irena , Straczek Anna , Benedyk Malgorzata , Mizgalska Danuta , Thøgersen Ida B. , Enghild Jan J. , Potempa Jan 
Published: November 2019

AbstractTannerella forsythia is a periodontopathogen that expresses miropin, a protease inhibitor in the serpin superfamily. In this study, we show that miropin is also a specific and efficient inhibitor of plasmin; thus, it represents the first proteinaceous plasmin inhibitor of prokaryotic origin described to date. Miropin inhibits plasmin through the formation of a stable covalent complex triggered by cleavage of the Lys368‐Thr369 (P2‐P1) reactive site bond with a stoichiometry of inhibition of 3.8 and an association rate constant (kass) of 3.3 × 105 M−1s−1. The inhibition of the fibrinolytic activity of plasmin was nearly as effective as that exerted by α2‐antiplasmin. Miropin also acted in vivo by reducing blood loss in a mice tail bleeding assay. Importantly, intact T. forsythia cells or outer membrane vesicles, both of which carry surface‐associated miropin, strongly inhibited plasmin. In intact bacterial cells, the antiplasmin activity of miropin protects envelope proteins from plasmin‐mediated degradation. In summary, in the environment of periodontal pockets, which are bathed in gingival crevicular fluid consisting of 70% of blood plasma, an abundance of T. forsythia in the bacterial biofilm can cause local inhibition of fibrinolysis, which could have possible deleterious effects on the tooth‐supporting structures of the periodontium.
SAMHD1‐deficient fibroblasts from Aicardi‐Goutières Syndrome patients can escape senescence and accumulate mutations
Authors: Franzolin Elisa , Coletta Sara , Ferraro Paola , Pontarin Giovanna , D'Aronco Giulia , Stevanoni Martina , Palumbo Elisa , Cagnin Stefano , Bertoldi Loris , Feltrin Erika , Valle Giorgio , Russo Antonella , Bianchi Vera , Rampazzo Chiara 
Published: November 2019

AbstractIn mammalian cells, the catabolic activity of the dNTP triphosphohydrolase SAMHD1 sets the balance and concentration of the four dNTPs. Deficiency of SAMHD1 leads to unequally increased pools and marked dNTP imbalance. Imbalanced dNTP pools increase mutation frequency in cancer cells, but it is not known if the SAMHD1‐induced dNTP imbalance favors accumulation of somatic mutations in non‐transformed cells. Here, we have investigated how fibroblasts from Aicardi‐Goutières Syndrome (AGS) patients with mutated SAMHD1 react to the constitutive pool imbalance characterized by a huge dGTP pool. We focused on the effects on dNTP pools, cell cycle progression, dynamics and fidelity of DNA replication, and efficiency of UV‐induced DNA repair. AGS fibroblasts entered senescence prematurely or upregulated genes involved in G1/S transition and DNA replication. The normally growing AGS cells exhibited unchanged DNA replication dynamics and, when quiescent, faster rate of excision repair of UV‐induced DNA damages. To investigate whether the lack of SAMHD1 affects DNA replication fidelity, we compared de novo mutations in AGS and WT cells by exome next‐generation sequencing. Somatic variant analysis indicated a mutator phenotype suggesting that SAMHD1 is a caretaker gene whose deficiency is per se mutagenic, promoting genome instability in non‐transformed cells.
A multilevel life course perspective on type 2 diabetes
Authors: Tzizik Dan 
Published: November 2019

ABSTRACT
The prevalence of type 2 diabetes has increased over the past 3 decades, particularly among adolescents as obesity also increases in this age group. Given the long-term effects associated with type 2 diabetes, public health intervention is needed. However, simply advising a patient to lose weight and increase physical exercise ignores the complex interplay of many levels of influences throughout a patient's life. This article describes type 2 diabetes from a multilevel life course perspective that can help clinicians find areas of possible intervention and understand the challenges patients face.
Compassionate and Clinical Behavior of Residents in a Simulated Informed Consent Encounter
Authors: Waisel David B. , Ruben Mollie A. , Blanch-Hartigan Danielle , Hall Judith A. , Meyer Elaine C. , Blum Richard H. 
Published: November 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Compassionate behavior in clinicians is described as seeking to understand patients’ psychosocial, physical and medical needs, timely attending to these needs, and involving patients as they desire. The goal of our study was to evaluate compassionate behavior in patient interactions, pain management, and the informed consent process of anesthesia residents in a simulated preoperative evaluation of a patient in pain scheduled for urgent surgery.

Methods
Forty-nine Clinical Anesthesia residents in year 1 and 16 Clinical Anesthesia residents in year 3 from three residency programs individually obtained informed consent for anesthesia for an urgent laparotomy from a standardized patient complaining of pain. Encounters were assessed for ordering pain medication, for patient-resident interactions by using the Empathic Communication Coding System to code responses to pain and nausea cues, and for the content of the informed consent discussion.

Results
Of the 65 residents, 56 (86%) ordered pain medication, at an average of 4.2 min (95% CI, 3.2 to 5.1) into the encounter; 9 (14%) did not order pain medication. Resident responses to the cues averaged between perfunctory recognition and implicit recognition (mean, 1.7 [95% CI, 1.6 to 1.9]) in the 0 (less empathic) to 6 (more empathic) system. Responses were lower for residents who did not order pain medication (mean, 1.2 [95% CI, 0.8 to 1.6]) and similar for those who ordered medication before informed consent signing (mean, 1.9 [95% CI, 1.6 to 2.1]) and after signing (mean, 1.9 [95% CI, 1.6 to 2.0]; F (2, 62) = 4.21; P = 0.019; partial η

2
= 0.120). There were significant differences between residents who ordered pain medication before informed consent and those who did not order pain medication and between residents who ordered pain medication after informed consent signing and those who did not.

Conclusions
In a simulated preoperative evaluation, anesthesia residents have variable and, at times, flawed recognition of patient cues, responsiveness to patient cues, pain management, and patient interactions.
How Often Are Study Design and Level of Evidence Misreported in the Pediatric Orthopaedic Literature?
Authors: LeBrun Drake G. , Kocher Mininder S. , Baldwin Keith D. , Patel Neeraj M. 
Published: November 2019

Background:
Observational studies are the most commonly used study designs in the pediatric orthopaedic literature. The differences between observational study designs are important but not widely understood, leading to potential discrepancies between the reported and actual study design. Study design misclassification is associated with a potential for misreporting level of evidence (LOE). The purpose of this study was to determine the degree of study design and LOE misclassification in the pediatric orthopaedic literature.

Methods:
The Institute for Scientific Information (ISI) Web of Science was queried to identify all pediatric orthopaedic observational studies published from 2014 to 2017. Reported study design and LOE were recorded for each study. The actual study design and LOE were determined on the basis of established clinical epidemiological criteria by reviewers with advanced epidemiological training. Studies with a discrepancy between reported versus actual study design and LOE were identified. The following covariates were recorded for each study: subspecialty, inclusion of a statistician coauthor, sample size, journal, and journal impact factor. χ2 test was used to identify factors associated with study design and LOE misreporting.

Results:
In total, 1000 articles were screened, yielding 647 observational studies. A total of 335 publications (52%) did not clearly report a study design in the abstract or manuscript text. Of those that did, 59/312 (19%) reported the incorrect study design. The largest discrepancy was in the 109 studies that were reported to be case series, among which 30 (27.5%) were actually retrospective cohort studies. In total, 313 publications (48%) did not report a LOE. Of those that did, 95/334 (28%) reported the incorrect LOE. In total, 33 studies (19%) reported a LOE that was higher than the actual LOE and 62 (35%) under-reported the LOE.

Conclusions:
The majority of observational pediatric orthopaedic studies did not report a study design or reported the wrong study design. Similarly, the majority of studies did not report or misreported their LOE. Greater epidemiological rigor in evaluating observational studies is required on the part of investigators, reviewers, and editors.

Level of Evidence:
Level II.
Frontal Crash Injury Metrics Are Below Mandated Limits for a Spica Casted Child Dummy in Currently Available Restraints
Authors: Collins Angela C. , Caskey Sean , Peck Jeffrey B. , Walter Norman , Atkinson Theresa S. , Atkinson Patrick J. 
Published: November 2019

Background:
There is a paucity of data defining safe transport protocols for children treated with hip spica casting. Although restraint devices for casted children are available, all federally mandated testing uses a noncasted anthropomorphic test device (ATD or crash dummy). The purpose of this study was to evaluate current restraint options in simulated frontal crash testing using a casted pediatric ATD to determine injury risk to the head, cervical spine, chest, and pelvis.

Methods:
Using a 3-year-old ATD, dynamic crash sled tests simulating frontal crash were performed in accordance with government safety standards. The ATD was casted in a double-leg spica and the following restraint devices were tested: a seat designed for spica casted children, a restraint vest-harness, a traditional booster seat, and 2 traditional forward-facing car seats.

Results:
Although the presence of the cast increased many of the injury metrics measured, all seats passed current federal guidelines for the head and chest. No single seat performed best in all metrics. The greatest magnitude of neck loading and second-highest head injury criterion values were observed for the booster seat. The vest-harness produced the highest head injury criterion and the chest compression exceeded proposed federal limits.

Conclusions:
The results suggest safe transport in commercially available seats is possible with the child properly restrained in a correctly fitting seat. However, parents should not assume a child restraint system is appropriate for use just based on fit as, for example, seats with harnesses outperformed an easy to fit booster seat.

Clinical Relevance:
Each child and the position of the child’s cast are unique and discharge planning involves consideration of safe transportation. Although this study suggests several seats used to transport spica casted children pass the federal head and chest injury prevention requirements, it is important to recognize that some children may still require emergency vehicle transport.
Comparative Performance of Pulmonary Ultrasound, Chest Radiograph, and CT Among Patients With Acute Respiratory Failure*
Authors: Tierney David M. , Huelster Joshua S. , Overgaard Josh D. , Plunkett Michael B. , Boland Lori L. , St. Hill Catherine A. , Agboto Vincent K. , Smith Claire S. , Mikel Bryce F. , Weise Brynn E. , Madigan Katelyn E. , Doshi Ameet P. , Melamed Roman R. 
Published: November 2019

Objectives:
The study goal was to concurrently evaluate agreement of a 9-point pulmonary ultrasound protocol and portable chest radiograph with chest CT for localization of pathology to the correct lung and also to specific anatomic lobes among a diverse group of intubated patients with acute respiratory failure.

Design:
Prospective cohort study.

Setting:
Medical, surgical, and neurologic ICUs at a 670-bed urban teaching hospital.

Patients:
Intubated adults with acute respiratory failure having chest CT and portable chest radiograph performed within 24 hours of intubation.

Interventions:
A 9-point pulmonary ultrasound examination performed at the time of intubation.

Measurements and Main Results:
Sixty-seven patients had pulmonary ultrasound, portable chest radiograph, and chest CT performed within 24 hours of intubation. Overall agreement of pulmonary ultrasound and portable chest radiograph findings with correlating lobe (“lobe-specific” agreement) on CT was 87% versus 62% (p < 0.001), respectively. Relaxing the agreement definition to a matching CT finding being present anywhere within the correct lung (“lung-specific” agreement), not necessarily the specific mapped lobe, showed improved agreement for both pulmonary ultrasound and portable chest radiograph respectively (right lung: 92.5% vs 65.7%; p < 0.001 and left lung: 83.6% vs 71.6%; p = 0.097). The highest lobe-specific agreement was for the finding of atelectasis/consolidation for both pulmonary ultrasound and portable chest radiograph (96% and 73%, respectively). The lowest lobe-specific agreement for pulmonary ultrasound was normal lung (79%) and interstitial process for portable chest radiograph (29%). Lobe-specific agreement differed most between pulmonary ultrasound and portable chest radiograph for interstitial findings (86% vs 29%, respectively). Pulmonary ultrasound had the lowest agreement with CT for findings in the left lower lobe (82.1%). Pleural effusion agreement also differed between pulmonary ultrasound and portable chest radiograph (right: 99% vs 87%; p = 0.009 and left: 99% vs 85%; p = 0.004).

Conclusions:
A clinical, 9-point pulmonary ultrasound protocol strongly agreed with specific CT findings when analyzed by both lung- and lobe-specific location among a diverse population of mechanically ventilated patients with acute respiratory failure; in this regard, pulmonary ultrasound significantly outperformed portable chest radiograph.
Validation of Photonumeric Assessment Scales for Temple Volume Deficit, Infraorbital Hollows, and Chin Retrusion
Authors: Moradi Amir , Lin Xiaoming , Allen Shawn , Fagien Steven , Norberg Maria , Smith Stacy 
Published: November 2019

BACKGROUND
Assessment scales are valuable tools in aesthetic clinical research and practice.

OBJECTIVE
To validate 3 photonumeric scales covering temple volume deficit, infraorbital hollows, and chin retrusion.

MATERIALS AND METHODS
Subjects reflecting the whole range of the scales were assessed independently by 3 evaluators at 2 separate occasions. Intraobserver agreement (the ability of each evaluator to assess the same grade for a specific subject at both evaluation occasions) and interobserver agreement (the degree to which evaluators independently provided identical grades for the same subject) were measured by weighted kappa statistics and percent exact agreement.

RESULTS
Approximately 70 subjects were included in each scale validation. The predefined success criteria of an intraobserver weighted kappa coefficient of ≥0.6 and an interobserver median pairwise weighted kappa coefficient of ≥0.6 were met for each scale. These results indicate substantial agreement, both between the 2 evaluations, and between the 3 evaluators.

CONCLUSION
These scales covering temple volume deficit, infraorbital hollows, and chin retrusion are validated assessment tools, based on live evaluations. Intraobserver agreement (between the 2 evaluations) and interobserver agreement (between the 3 evaluators) were both substantial.
Spectrometric Estimation of Dose Rate Induced from Radioactive Cesium in the Ground Using a Mobile Gamma-Ray Spectrometry Based on a LaBr3(Ce) Detector
Authors: Ji Young-Yong , Lim Taehyung , Hitomi Keitaro , Yajima Tatsuo 
Published: November 2019

Abstract
The site characterization around the Fukushima Daiichi nuclear power plant (FDNPP) was conducted to measure the dose rate of radioactive cesium using mobile gamma-ray spectrometry through a backpack survey based on a LaBr3(Ce) detector. Four sites were selected in the Fukushima prefecture with diverse dose rate levels in residence and non-residence areas. One reference site in Sendai city was also designated with a low dose rate in comparison with sites in the Fukushima prefecture. The ambient dose rate was distributed from several tens of dose rate to above 1 μGy h−1 due to the radioactive cesium distributed on the ground of the Fukushima prefecture. To assess the dose rates of 134Cs and 137Cs using the backpack survey with a short acquisition time, a good correlation was identified between the dose rate of radioactive cesium and the gross count rate in specific regions of interest (ROIs) with gamma rays from radioactive cesium. The dose rates of 134Cs and 137Cs accounted for more than 25% of the ambient dose rate during the survey period. The ratio of the 134Cs dose rate to the 137Cs dose rate was shown to be about 30% for all survey sites.
Clinical and Microbiological Diagnosis of Nonprimary Cytomegalovirus Infection in Pregnancy With Symptomatic Congenital Cytomegalovirus Infection
Authors: Román-Soto Sergio , Romero-Gómez María Pilar , Montero-Vega María Dolores , Cendejas-Bueno Emilio 
Published: November 2019

Abstract
Cytomegalovirus (CMV) infection is the most common cause of congenital infection in developed countries. It is thought that symptomatic congenital CMV (cCMV) infections are produced by a primary CMV infection in the majority of the cases, but recent case series published show a similar prevalence and severity of clinical findings and long-term sequels in nonprimary and primary cCMV infection. We report a case of nonprimary CMV infection in pregnancy with fetal neurological alterations. A positive quantitative polymerase chain reaction in amniotic fluid (AF) confirmed the diagnosis of cCMV infection that triggered a voluntary termination of pregnancy. Quantitative polymerase chain reaction assays of AF are used to confirm a fetal cCMV infection, and the invasive amniocentesis procedure is justified when abnormalities are found in ultrasound control, although they are not validated to use in AF.
Skin Disease and Musculoskeletal Infection
Authors: Belden Katherine A. , Mascarenhas Tresa Reena , Hendricks Travis , Merkow David , Chen Antonia F. 
Published: November 2019

Background
Inflammatory skin disease including psoriasis and eczema predisposes to colonization with Staphylococcus aureus, a known virulent organism and cause of musculoskeletal infection. An association between skin disease and musculoskeletal infection may exist.

Methods
We evaluated the presence of skin disease in 65 patients who had undergone orthopedic surgery and had either native or surgical site musculoskeletal infection. Surgery was performed either for management of a native bone or joint infection or preceding the development of a surgical site infection. Four variables of interest, procedure, skin diagnosis, infection and organism, were compared with each other.

Results
Procedure and infection of the axial skeleton (74%) were more common than procedure and infection of the appendicular skeleton (26%). Inflammatory skin diagnoses were found in 45% of patients. Staphylococci accounted for 51% of infections with 38% due to S. aureus. A majority (60%) of S. aureus infections were in patients with inflammatory skin disease, and 48% of S. aureus infections were native spine osteomyelitis.

Conclusions
Skin disease may be a potentially modifiable risk factor for musculoskeletal infection, in particular infection due to S. aureus.
The Paradoxical Response in an Immunocompromised Patient With Disseminated Mycobacterium chelonae Infection
Authors: Modi Anita , Bravo Tricia 
Published: November 2019

Abstract
The paradoxical response, a form of immune reconstitution inflammatory syndrome, merits immunosuppression in addition to antimycobacterial therapy in patients with nontuberculous mycobacterial (NTM) infections. Well-described in Mycobacterium tuberculosis infections, the paradoxical response in NTM infections is less defined. We share an immunocompromised host with disseminated NTM and the paradoxical response.