bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intraductal Papillary Mucinous Neoplasms: Have IAP Consensus Guidelines Changed our Approach?
Authors: Pulvirenti Alessandra , Margonis Georgios A. , Morales-Oyarvide Vicente , McIntyre Caitlin A. , Lawrence Sharon A. , Goldman Debra A. , Gonen Mithat , Weiss Matthew J. , Ferrone Cristina R. , He Jin , Brennan Murray F. , Cameron John L. , Lillemoe Keith D. , Kingham T. Peter , Balachandran Vinod , Qadan Motaz , D’Angelica Michael I. , Jarnagin William R. , Wolfgang Christopher L. , Castillo Carlos Fernández-del , Allen Peter J. 
Published: December 2019

Objective:
To evaluate the influence of consensus guidelines on the management of intraductal papillary mucinous neoplasms (IPMN) and the subsequent changes in pathologic outcomes.

Background:
Over time, multiple guidelines have been developed to identify high-risk IPMN. We hypothesized that the development and implementation of guidelines should have increased the percentage of resected IPMN with high-risk disease.

Methods:
Memorial Sloan-Kettering (MSK), Johns Hopkins (JH), and Massachusetts General Hospital (MGH) databases were queried for resected IPMN (2000–2015). Patients were categorized into main-duct (MD-IPMN) versus branch-duct (BD-IPMN). Guideline-specific radiographic/endoscopic features were recorded. High-risk disease was defined as high-grade dysplasia/carcinoma. Fisher's exact test was used to detect differences between institutions. Logistic regression evaluated differences between time-points [preguidelines (pre-GL, before 2006), Sendai (SCG, 2006–2012), Fukuoka (FCG, after 2012)].

Results:
The study included 1210 patients. The percentage of BD-IPMN with ≥1 high-risk radiographic feature differed between centers (MSK 69%, JH 60%, MGH 45%; P < 0.001). In MD-IPMN cohort, the presence of radiographic features such as solid component and main pancreatic duct diameter ≥10 mm also differed (solid component: MSK 38%, JH 30%, MGH 18%; P < 0.001; duct ≥10 mm: MSK 49%, JH 32%, MGH 44%; P < 0.001). The percentage of high-risk disease on pathology, however, was similar between institutions (BD-IPMN: P = 0.36, MD-IPMN: P = 0.48). During the study period, the percentage of BD-IPMN resected with ≥1 high-risk feature increased (52% pre-GL vs 67% FCG; P = 0.005), whereas the percentage of high-risk disease decreased (pre-GL vs FCG: 30% vs 20%). For MD-IPMN, there was not a clear trend towards guideline adherence, and the rate of high-risk disease was similar over the time (pre-GL vs FCG: 69% vs 67%; P = 0.63).

Conclusion:
Surgical management of IPMN based on radiographic criteria is variable between institutions, with similar percentages of high-risk disease. Over the 15-year study period, the rate of BD-IPMN resected with high-risk radiographic features increased; however, the rate of high-risk disease decreased. Better predictors are needed.
Not ready for prime time: Intermittent versus partial resuscitative endovascular balloon occlusion of the aorta for prolonged hemorrhage control in a highly lethal porcine injury model
Authors: Johnson Michael Austin , Hoareau Guillaume L. , Beyer Carl A. , Caples Connor A. , Spruce Marguerite , Grayson J. Kevin , Neff Lucas P. , Williams Timothy K. 
Published: December 2019

BACKGROUND
Partial resuscitative endovascular balloon occlusion of the aorta (pREBOA) and intermittent REBOA (iREBOA) are techniques to extend the therapeutic duration of REBOA by balloon titration for distal flow or cyclical balloon inflation/deflation to allow transient distal flow, respectively. We hypothesized that manually titrated pREBOA would reduce blood losses and ischemic burden when compared with iREBOA.

METHODS
Following 20% blood volume controlled hemorrhage, 10 anesthetized pigs underwent uncontrolled hemorrhage from the right iliac artery and vein. Once in hemorrhagic shock, animals underwent 15 minutes of complete zone 1 REBOA followed by 75 minutes of either pREBOA or iREBOA (n = 5/group). After 90 minutes, definitive hemorrhage control was obtained, animals were resuscitated with the remaining collected blood, and then received 2 hours of critical care.

RESULTS
There were no differences in mortality. Animals randomized to iREBOA spent a larger portion of the time at full occlusion when compared with pREBOA (median, 70 minutes; interquartile range [IQR], 70–80 vs. median, 20 minutes; IQR, 20–40, respectively; p = 0.008). While the average blood pressure during the intervention period was equivalent between groups, this was offset by large fluctuations in blood pressure and significantly more rescue occlusions for hypotension with iREBOA. Despite lower maximum aortic flow rates, the pREBOA group tolerated a greater total amount of distal aortic flow during the intervention period (median, 20.9 L; IQR, 20.1–23.0 vs. median, 9.8 L; IQR, 6.8–10.3; p = 0.03) with equivalent abdominal blood losses. Final plasma lactate and creatinine concentrations were equivalent, although iREBOA animals had increased duodenal edema on histology.

CONCLUSION
Compared with iREBOA, pREBOA reduced the time spent at full occlusion and the number of precipitous drops in proximal mean arterial pressure while delivering more distal aortic flow but not increasing total blood loss in this highly lethal injury model. Neither technique demonstrated a survival benefit. Further refinement of these techniques is necessary before clinical guidelines are issued.
Does simulation work? Monthly trauma simulation and procedural training are associated with decreased time to intervention
Authors: Park Caroline , Grant Jennifer , Dumas Ryan P. , Dultz Linda , Shoultz Thomas H. , Scott Daniel J. , Luk Stephen , Abdelfattah Kareem R. , Cripps Michael W. 
Published: December 2019

BACKGROUND
Establishing proficiency in specific trauma procedures during surgical residency has been limited to annual courses with limited data on its effect on the delivery of health care and patient outcomes. There is a wide variety of training on content and complexity with recent studies looking at time to imaging or secondary survey. In this study, we implement monthly case-based simulation after initial training on a variety of bedside trauma procedures. The overall goal is to evaluate the effect of simulation on time to specific interventions.

METHODS
This is a prospective, observational study between July 2018 and February 2019 at a single-institution, Level I trauma center with a large surgical residency program. A trauma simulation program was implemented in November 2018 to train and evaluate surgical residents from post-graduate year 1 through 5. All rotating residents participated in an initial course on basic trauma procedures, such as percutaneous sheath placement, tube thoracostomy, and resuscitative thoracotomy followed by an end-of-month simulation. All Level I activations from preintervention starting in July to October 2018 (preintervention) and October 2018 through February 2019 (postintervention) were reviewed; monitored variables included age, sex, mechanism of injury, blunt or penetrating, and time to intervention in the trauma bay. Median times to intervention were recorded with interquartile ranges (IQR). Pearson's coefficient was used to measure the strength of the relationship between simulation and time to patient intervention.

RESULTS
Median time to most interventions improved over time but with more consistent improvement after the implementation of formal simulation and procedural training in November 2018. Median pretraining time for resuscitative thoracotomy was 14 minutes (IQR, 8–32 minutes); posttraining median time was 3 minutes (IQR, 2.7–8 minutes, p = 0.02). Median pretraining time to tube thoracostomy was 13 minutes (IQR, 5.5–19 minutes); posttraining time was 6 minutes (IQR, 4–31 minutes, p = 0.04). Pearson's coefficient (r
2) measured strength of correlation and was highest for tube thoracostomy followed by resuscitative thoracotomy and percutaneous sheath access with r
2 values of 0.46, 0.35, and 0.24, respectively.

CONCLUSION
High-complexity, routine procedural training, and trauma simulation are associated with decreased time to interventions within a short period of time. Routine implementation of a training program emphasizing efficient, effective approaches to bedside procedures is necessary to train our residents in these high-acuity, low-frequency situations. Future investigations are warranted in the effect of simulation on short-term and long-term patient outcomes.

LEVEL OF EVIDENCE
Therapeutic, level III.
Early single-dose treatment with exosomes provides neuroprotection and improves blood-brain barrier integrity in swine model of traumatic brain injury and hemorrhagic shock
Authors: Williams Aaron M. , Bhatti Umar F. , Brown Jordana F. , Biesterveld Ben E. , Kathawate Ranganath G. , Graham Nathan J. , Chtraklin Kiril , Siddiqui Ali Z. , Dekker Simone E. , Andjelkovic Anuska , Higgins Gerald A. , Buller Benjamin , Alam Hasan B. 
Published: December 2019

BACKGROUND
Administration of human mesenchymal stem cell (MSC)–derived exosomes can enhance neurorestoration in models of traumatic brain injury (TBI) and hemorrhagic shock (HS). The impact of early treatment with MSC-derived exosomes on brain injury in a large animal model remains unknown. We sought to evaluate the impact of early single-dose exosome treatment on brain swelling and lesion size, blood-based cerebral biomarkers, and blood-brain barrier (BBB) integrity.

METHODS
Female Yorkshire swine were subjected to a severe TBI (12-mm cortical impact) and HS (40% estimated total blood volume). One hour into shock, animals were randomized (n = 5/cohort) to receive either lactated Ringer's (LR; 5 mL) or LR + exosomes (1 × 1012 exosome particles in 5 mL LR). Animals then underwent additional shock (1 hour) followed by normal saline resuscitation. After 6 hours of observation, brain swelling (% increase compared with the uninjured side) and lesion size (mm3) were assessed. Cerebral hemodynamics and blood-based biomarkers of brain injury were compared. Immunofluorescence and RNA sequencing with differential gene expression and pathway analysis were used to assess the integrity of the perilesion BBB.

RESULTS
Exosome-treated animals had significantly less (p < 0.05) brain swelling and smaller lesion size. They also had significantly decreased (p < 0.05) intracranial pressures and increased cerebral perfusion pressures. Exosome-treated animals had significantly decreased (p < 0.05) albumin extravasation and significantly higher (p < 0.05) laminin, claudin-5, and zonula occludens 1 levels. Differential gene expression and pathway analysis confirmed these findings. Serum glial fibrillary acidic protein levels were also significantly lower (p < 0.05) in the exosome-treated cohort at the end of the experiment.

CONCLUSION
In a large animal model of TBI and HS, early treatment with a single dose of MSC-derived exosomes significantly attenuates brain swelling and lesion size, decreases levels of blood-based cerebral biomarkers, and improves BBB integrity.
Anaerohalosphaera lusitana gen. nov., sp. nov., and Limihaloglobus sulfuriphilus gen. nov., sp. nov., isolated from solar saltern sediments, and proposal of Anaerohalosphaeraceae fam. nov. within the order Sedimentisphaerales
Authors: Pradel Nathalie , Fardeau Marie-Laure , Tindall Brian J. , Spring Stefan 
Published: December 2019

Two strains of anaerobic, coccoid, saccharolytic, Gram-stain-negative bacteria were isolated from samples of anoxic hypersaline sediments of evaporation ponds in Tavira (Portugal) and Mallorca (Spain). Both isolates were moderately halophilic, neutrophilic and had a temperature optimum at 37 °C. The highest 16S rRNA gene sequence identity values were found with members of the genus

Sedimentisphaera

(84.9–88.2 %) within the order Sedimentisphaerales, class

Phycisphaerae

. The strain SM-Chi-D1T could be assigned to the family

Sedimentisphaeraceae

, while phylogenetic analyses based on 16S rRNA gene sequences and genomic data indicate that strain ST-NAGAB-D1T is both a member of a novel genus and a novel family. SM-Chi-D1T could be distinguished from other cultured members of the

Sedimentisphaeraceae

mainly by the stimulatory effect of sulfur on growth, lack of ethanol production during fermentation and several differences in the cellular fatty acids and polar lipids patterns. Main differential characteristics of ST-NAGAB-D1T were a polytrichous flagellation, the absence of branched chain fatty acids and presence of large proportions of the unsaturated cellular fatty acids C16 : 1
c9 and C18 : 1
c11. On the basis of genomic, chemotaxonomic, biochemical and physiological data, we propose the novel species and genera Anaerohalosphaera lusitana gen. nov., sp. nov., and Limihaloglobus sulfuriphilus gen. nov., sp. nov., represented by the type strains ST-NAGAB-D1T (=DSM 103484T=JCM 31926T=KCTC 15600T) and SM-Chi-D1T (=DSM 100118T=JCM 31927T=KCTC 15601T), respectively. In addition, we propose the novel family Anaerohalosphaeraceae fam. nov. to accommodate the genus Anaerohalosphaera.
HIV-1 founder variant multiplicity is determined by the infection stage of the source partner
Authors: Villabona-Arenas Ch. Julián , Hall Matthew , Lythgoe Katrina A. , Gaffney Stephen G. , Regoes Roland R. , Hué Stéphane , Atkins Katherine E. 
Published: December 2019

AbstractDuring sexual transmission, the large genetic diversity of HIV-1 within an individual is frequently reduced to one founder variant that initiates infection1. Understanding the drivers of this bottleneck is crucial to develop effective infection control strategies2. Genetic characteristics of the potential founder viruses and events in the recipient partner are both known to contribute to this bottleneck, but little is understood about the importance of the source partner3. To test the hypothesis that the source partner affects the multiplicity of HIV founder variants, we developed a phylodynamic model calibrated using genetic and epidemiological data on all existing transmission pairs for whom the direction of transmission and the infection stage of the source partner are known. Our results demonstrate the importance of infection stage of the source partner, and not exposure route, in determining founder variant multiplicity. Specifically, acquiring infection from someone in the acute (early) stage of infection increases the risk of multiple variant transmission when compared with someone in the chronic (later) stage of infection. This study provides the first direct test of source partner characteristics to explain the low frequency of multiple founder strain infections and can inform clinical intervention study design and interpretation.
Independently Carriage ofIL-1RN*2 AlleleAssociated with Increased Risk of Gastric Cancer in The Sudanese Population
Authors: Idris Abeer Babiker , Ataelmanan Amany Eltayib , Eltaher Sulafa Mohamed , Idris Einas Babiker , Osman Arbab Bashir M. , Idris Ahmed Ibn , Mansour Mohamed , Ibrahim El-Amin Mohamed , Hassan Mohamed A. 
Published: December 2019

AbstractBackgroundHelicobacter pyloriis responsible for gastric cancer in approximately tens of millions of patients. Gastric cancer in Sudan represents one of the top causing death among cancers with about 686 cases per year and a 2.7 % mortality rate.IL-1RNVNTR polymorphism has been reported to increase the risk of gastric cancer.ObjectiveThe purpose of this study was to assess the association of the 86 bp VNTR polymorphism ofIL- 1RNgene and the susceptibility toH. pyloriinfection and gastric cancer in the Sudanese population.Materials and methodsGenomic DNA was extracted from 114 subjects. Of whom 60 had gastritis and duodenitis, 26 had a peptic ulcer, 16 had gastric cancer and 12 had normal gastroscopy findings.H. pyloriinfection was investigated by specific16S rRNA. AndIL-1RNVNTR polymorphism at intron 2 was genotyped using the PCR method and direct sequencing for random samples.ResultsThe positiveH. pyloriinfection rate among participants was 47.37%. There is a lack of a significant difference inIL- 1RNgenotype withH. pyloriinfection (p-value=1.0000). TheIL-1 RN L/Lgenotype was significantly more frequent in a patient with benign disorders (gastritis or duodenitis or peptic ulcer), Odd=6.000 (95% CI =1.750-20.57, P=0.0056). While the heterozygote genotype 2/L was associated with an increased risk of gastric cancer with OR = 12.83 (95% CI = 1.261-130.6, P=0.0302).ConclusionIndependently carriage ofIL-1RN *2allele was associated with increased risk of gastric cancer in the Sudanese population. Notwithstanding the relatively small sample size of the study population, our findings show that the host genetic can be a useful tool for identifying high-risk individuals among dyspeptic patients; and also underscore the role played by host genetics in gastric carcinogenesis. To the best of our knowledge, this is the first study in Sudan concerning this issue.
Alien limb in the corticobasal syndrome: phenomenological characteristics and relationship to apraxia
Authors: Lewis-Smith David J. , Wolpe Noham , Ghosh Boyd C.P. , Rowe James B. 
Published: December 2019

ABSTRACTAlien limb refers to movements that seem purposeful but are independent of patients’ reported intentions. Alien limb often co-occurs with apraxia in the corticobasal syndrome, and anatomical and phenomenological comparisons have led to the suggestion that alien limb and apraxia may be causally related as failures of goal-directed movements. Here, we characterised the nature of alien limb symptoms in patients with the corticobasal syndrome (n=30) and their relationship to limb apraxia. Twenty-five patients with progressive supranuclear palsy Richardson syndrome served as a disease-control group. Structured examinations of praxis, motor function, cognition and alien limb were undertaken in patients attending a regional specialist clinic. Twenty-eight patients with corticobasal syndrome (93%) demonstrated significant apraxia and this was often asymmetrical, with the left hand preferentially affected in 77% of patients. Moreover, 83% reported one or more symptoms consistent with alien limb. The range of these phenomena was broad, including changes in the sense of ownership and control as well as unwanted movements. Regression analyses showed no significant association between the severity of limb apraxia and both the occurrence of an alien limb and the number of alien limb phenomena reported. Bayesian estimation showed a low probability for a positive association between alien limb and apraxia, suggesting that alien limb phenomena are not likely to be related to severe apraxia. Our results shed light on the phenomenology of these disabling and as yet untreatable clinical features, with relevance to theoretical models of voluntary action.
Making densenet interpretable a case study in clinical radiology
Authors: Ngan Kwun Ho , Garcez Artur d’Avila , Knapp Karen M. , Appelboam Andy , Reyes-Aldasoro Constantino Carlos 
Published: December 2019

ABSTRACTThe monotonous routine of medical image analysis under tight time constraints has always led to work fatigue for many medical practitioners. Medical image interpretation can be error-prone and this can increase the risk of an incorrect procedure being recommended. While the advancement of complex deep learning models has achieved performance beyond human capability in some computer vision tasks, widespread adoption in the medical field has been held back, among other factors, by poor model interpretability and a lack of high-quality labelled data. This paper introduces a model interpretation and visualisation framework for the analysis of the feature extraction process of a deep convolutional neural network and applies it to abnormality detection using the musculoskeletal radiograph dataset (MURA, Stanford). The proposed framework provides a mechanism for interpreting DenseNet deep learning architectures. It aims to provide a deeper insight about the paths of feature generation and reasoning within a DenseNet architecture. When evaluated on MURA at abnormality detection tasks, the model interpretation framework has been shown capable of identifying limitations in the reasoning of a DenseNet architecture applied to radiography, which can in turn be ameliorated through model interpretation and visualization.
Measurement of Prostate Volume with MRI (A Guide for the Perplexed): Biproximate Method with Analysis of Precision and Accuracy
Authors: Wasserman Neil F. , Niendorf Eric , Spilseth Benjamin 
Published: December 2019

AbstractPurposeTo review the anatomic basis of prostate boundary selection on T2-weighted magnetic resonance imaging (MRI). To introduce an alternative 3D ellipsoid measuring technique that maximizes precision, report the intra- and inter-observer reliability, and to advocate it’s use for research involving multiple observers.MethodsA demonstration of prostate boundary anatomy using gross pathology and MRI examples provides background for selection of key boundary marks when measuring prostate volume. An alternative ellipsoid volume method is illustrated. An IRB approved retrospective study of 140 patients with elevated serum prostate specific antigen levels and/or abnormal digital rectal examinations was done with T2-weighted MRI applying the new (Biproximate) technique. Measurements were made by 2 examiners, correlated with each other for interobserver precision and with an expert observer for accuracy. Correlation statistics, linear regression analysis, and tests of means were applied using p≤0.05 as the threshold for significance.ResultsInter-observer correlation (precision) was 0.95 between observers. Correlation between these observers and the expert (accuracy) was 0.94 and 0.97 respectively. Intra-observer correlation for the expert was 0.98. Means for inter-rater reliability and accuracy were all the same (p=0.001).ConclusionsAnatomic foundations for the boundaries of the prostate are reviewed. Precision and accuracy of total prostate volume using an alternative method is reported and found to be reproducible.
The smfBox: an open-source platform for single-molecule FRET
Authors: Ambrose Benjamin , Baxter James , Cully John , Willmott Matthew , Steele Elliot , Bateman Benji C. , Martin-Fernandez Marisa L. , Cadby Ashley , Shewring Jonathan , Aaldering Marleen , Craggs Timothy D. 
Published: December 2019

AbstractSingle-molecule Förster Resonance Energy Transfer (smFRET) is a powerful technique capable of resolving both relative and absolute distances within and between structurally dynamic biomolecules. High instrument costs, and a lack of open-source hardware and acquisition software have limited smFRET’s broad application by non-specialists. Here, we present the smfBox, a cost-effective confocal smFRET platform, providing detailed build instructions, open-source acquisition software, and full validation, thereby democratising smFRET for the wider scientific community.