bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mycovirus-Induced Hypervirulence of Leptosphaeria biglobosa Enhances Systemic Acquired Resistance to Leptosphaeria maculans in Brassica napus
Authors: Shah Unnati A. , Kotta-Loizou Ioly , Fitt Bruce D. L. , Coutts Robert H. A. 
Published: October 2019

Phoma stem canker (blackleg) is one of the most important diseases of winter oilseed rape (Brassica napus) worldwide and is caused by a complex that comprises at least two species: Leptosphaeria maculans and L. biglobosa. Screening a panel of field Leptosphaeria isolates from B. napus for the presence of mycoviruses revealed the presence of a novel double-stranded RNA quadrivirus in L. biglobosa and no viruses in L. maculans. Following elimination of the mycovirus, virus-infected and virus-free isogenic lines of L. biglobosa were created. A direct comparison of the growth and virulence of these isogenic lines illustrated that virus infection caused hypervirulence and resulted in induced systemic resistance toward L. maculans in B. napus following lower leaf preinoculation with the virus-infected isolate. Analysis of the plant transcriptome suggests that the presence of the virus leads to subtle alterations in metabolism and plant defenses. For instance, transcripts involved in carbohydrate and amino acid metabolism are enriched in plants treated with the virus-infected isolate, while pathogenesis-related proteins, chitinases and WRKY transcription factors are differentially expressed. These results illustrate the potential for deliberate inoculation of plants with hypervirulent L. biglobosa to decrease the severity of Phoma stem canker later in the growing season. [Formula: see text] Copyright © 2020 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Tofacitinib Receives New Boxed Safety Warning
Authors: Aschenbrenner Diane S. 
Published: October 2019

A new boxed warning has been added to the labeling of tofacitinib (Xeljanz, Xeljanz XR) based on preliminary safety data from an ongoing postmarketing trial showing an increased risk of thrombosis and death in patients with at least one cardiovascular risk factor who were taking the 10-mg twice-daily dose.Tofacitinib 10 mg twice daily is approved as induction treatment for ulcerative colitis; the dose is not approved to treat rheumatoid arthritis or psoriatic arthritis.NPs should adhere to the dosing regimens listed on tofacitinib's labeling. Patients should be assessed for thrombosis and taught to seek emergency help if they develop signs or symptoms of this condition.
Pelvic Organ Prolapse as a Function of Levator Ani Avulsion, Hiatus Size, and Strength
Authors: Handa Victoria L. , Roem Jennifer , Blomquist Joan L. , Dietz Hans Peter , Muñoz Alvaro 
Published: October 2019

(Abstracted from Am J Obstet Gynecol 2019;221:41.e1–41.e7)
Vaginal childbirth significantly increases the likelihood that a parous woman will develop pelvic organ prolapse (POP). Reasons for the association between vaginal childbirth and POP are unclear, but one postulated mechanism is injury to the obstetrical injury to the levator ani muscles.
Hydrocortisone Compared with Placebo in Patients with Septic Shock Satisfying the Sepsis-3 Diagnostic Criteria and APROCCHSS Study Inclusion Criteria
Authors: Venkatesh Balasubramanian , Finfer Simon , Cohen Jeremy , Rajbhandari Dorrilyn , Arabi Yaseen , Bellomo Rinaldo , Billot Laurent , Glass Parisa , Joyce Christopher , Li Qiang , McArthur Colin , Perner Anders , Rhodes Andrew , Thompson Kelly , Webb Steve , Myburgh John 
Published: October 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Two recent randomized controlled trials (Adjunctive Glucocorticoid Therapy in Patients with Septic Shock [ADRENAL] and Activated Protein C and Corticosteroids for Human Septic Shock [APROCCHSS]) of corticosteroids in patients with septic shock reported different treatment effects on 90-day mortality. Both trials enrolled patients who met the criteria for septic shock using the second international consensus definitions for sepsis and septic shock (Sepsis-2), but the APROCCHSS trial mandated a greater severity of shock as an inclusion criterion.

Methods
The authors conducted post hoc sensitivity analyses of the ADRENAL trial to determine the effects of hydrocortisone versus placebo in subgroups selected using third international consensus definitions for sepsis and septic shock (Sepsis-3) diagnostic criteria or APROCCHSS inclusion criteria.

Results
There were 1,950 subjects (973 hydrocortisone and 977 placebo) who met the Sepsis-3 criteria (ADRENAL–Sepsis-3 cohort) and 905 patients (455 hydrocortisone and 450 placebo) who met the APROCCHSS criteria (ADRENAL–APROCCHSS cohort). At 90 days after randomization, in the ADRENAL–Sepsis-3 cohort, 312 of 963 (32.4%) and 337 of 958 (35.2%) patients assigned to hydrocortisone and placebo, respectively, had died (odds ratio, 0.86; 95% CI, 0.70 to 1.06; P = 0.166). The corresponding figures for the ADRENAL–APROCCHSS cohorts were 187 of 453 (41.3%) and 200 of 445 (44.9%), respectively (odds ratio, 0.84; 95% CI, 0.60 to 1.17; P = 0.303). There was no statistically significant difference in the time to death between the groups during the 90 days after randomization (hazard ratio = 0.87; 95% CI, 0.75 to 1.02; P = 0.082 for ADRENAL–Sepsis-3; and hazard ratio = 0.86; 95% CI, 0.71 to 1.06; P = 0.156 for ADRENAL–APROCCHSS cohorts). In both cohorts, patients assigned to hydrocortisone had faster resolution of shock. In the ADRENAL–Sepsis-3 cohort, patients assigned to hydrocortisone had an increase in the number of days alive and free of mechanical ventilation (57.0 ± 37.2 vs. 53.7 ± 38.2 days; 95% CI, 0.40 to 7.04; P = 0.028) and the number of days alive and free of the intensive care unit (54.3 ± 36.0 vs. 51.0 ± 37.1; 95% CI, 0.82 to 7.24; P = 0.014).

Conclusions
In a post hoc analysis of the ADRENAL trial participants who fulfilled either the Sepsis-3 or the APROCCHSS inclusion criteria, a continuous infusion of hydrocortisone did not result in a lower 90-day mortality than placebo in septic shock.
Recent Preoperative Concussion and Postoperative Complications: A Retrospective Matched-cohort Study
Authors: D’Souza Ryan S. , Sexton Matthew A. , Schulte Phillip J. , Pasternak Jeffrey J. , Abcejo Arnoley S. 
Published: October 2019

Background:
Physiological alterations during the perianesthetic period may contribute to secondary neurocognitive injury after a concussion.

Methods:
Patients exposed to concussion and who received an anesthetic within 90 days were matched to unexposed patients without concussion. Intraoperative and postoperative events were compared. Subgroup analyses assessed relationships among patients with a concussion in the prior 30, 31 to 60, and 61 to 90 days and their respective unexposed matches. To facilitate identification of potential targets for further investigation, statistical comparisons are reported before, as well as after, correction for multiple comparisons.

Results:
Sixty concussion patients were matched to 176 unexposed patients. Before correction, 28.3% postconcussion versus 14.8% unexposed patients reported postanesthesia care unit pain score≥7 (P=0.02); 16.7% concussion versus 6.5% unexposed patients reported headache within 90 days of anesthesia (P=0.02) and 23.5% of patients who received surgery and anesthesia within 30 days of concussion experienced headache within 90 days of anesthesia compared with 7.1% in the unexposed group (P=0.01). Patients who experienced concussion and had anesthesia between 31 and 60 days after injury had a postanesthesia care unit Richmond Agitation and Sedation Scale score of −1.61±1.29 versus a score of −0.2±0.45 in unexposed patients (P=0.002). After adjusting the P-value threshold for multiple comparisons, the P-value for significance was instead 0.0016 for the overall cohort. Our study revealed no significant associations with application of adjusted significance thresholds.

Conclusions:
There were no differences in intraoperative and postoperative outcomes in patients with recent concussion compared with unexposed patients. Before correction for multiple comparisons, several potential targets for further investigation are identified. Well-powered studies are warranted.
Readmissions Are Not What They Seem: Incidence and Classification of 30-Day Readmissions After Orthopedic Trauma Surgery
Authors: Kelly Erin A. , Gonzalez Leah J. , Hutzler Lorraine , Konda Sanjit R. , Leucht Philipp , Egol Kenneth A. 
Published: October 2019

Objectives:To evaluate the causes of 30-day readmissions after orthopedic trauma surgery and classify them based on their relation to the index admission.Design:Retrospective chart review.Setting:One large, academic, medical center.Participants:Patients admitted to a large, academic, medical center for a traumatic fracture injury over a 9-year period.Intervention:Assignment of readmission classification.Main Outcome Measures:Readmissions within 30 days of discharge were identified and classified into orthopedic complications, medical complications, and noncomplications. A χ2test was performed to assess any difference in the proportion of readmissions between the hospital-reported readmission rate and the orthopedic complication readmission rate.Results:One thousand nine hundred fifty-five patients who were admitted between 2011 and 2018 for an acute orthopedic trauma fracture injury were identified. Eighty-nine patients were readmitted within 30 days of discharge with an overall readmission rate of 4.55%. Within the 30-day readmission cohort, 30 (33.7%) were the direct result of orthopedic treatment complications, 36 (40.4%) were unrelated medical conditions, and 23 (25.8%) were noncomplications. Thus, the readmission rate directly due to orthopedic treatment complications was 1.53%. A χ2test of homogeneity revealed a statistically significant difference between the hospital-reported readmission rate and the orthopedic-treatment complication readmission rate (P< 0.0005).Conclusion:The use of 30-day readmissions as a measure of hospital quality of care overreports the number of preventable readmissions and penalizes surgeons and hospitals for caring for patients with less optimal health.Level of Evidence:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Fracture Patterns and Comminution Zones in OTA/AO 34C Type Patellar Fractures
Authors: Misir Abdulhamit , Kizkapan Turan Bilge , Uzun Erdal , Oguzkaya Sinan , Cukurlu Mustafa , Golgelioglu Fatih 
Published: October 2019

Objectives:
To characterize the fracture patterns and comminution zones for complete articular (OTA/AO 34C type) patellar fractures, using a computed tomography mapping technique.

Methods:
Eighty-three OTA/AO 34C type patellar fractures were included. Images of patellar fractures were superimposed on a coronal template of the patella, created from a healthy right knee, to identify fracture patterns and comminution zones.

Results:
Our analysis was based on 83 computed tomography images of patellar fractures, contributed by 69 male and 14 female patients (mean age, 52 years; range, 18–79 years), and included 13 type C1, 26 type C2 and 44 type C3 fractures. A transverse fracture, including both the medial and lateral facets, was the most common fracture pattern, identified in 92.8% of cases. In the C1 and C2 types, the fracture line affecting the medial and lateral joint surface was either transverse or oblique. In the C3 type, the transverse and vertical fracture line of the medial articular surface extended to the inferior pole of the patella, with transverse and oblique fractures lines on the lateral joint surface. In addition, a concentration of the fracture lines around the vertical ridge was observed.

Conclusions:
The patterns of fracture lines and comminution zones OTA/AO 34C type fractures were repeatable on the constructed maps. A transverse fracture line on the inferior pole which was observed in the C2 and C3 type fractures may be used for the modification of current classification systems to direct treatment.
Superficial Basal Cell Cancers Demonstrate Higher Rates of Mixed Histology on High-Risk Anatomical Sites
Authors: Petersen Erik T. , Ahmed Saqib R. , Pradhan Dinesh , MacFarlane Deborah F. 
Published: October 2019

BACKGROUND
The Mohs Appropriate Use Criteria (MAUC) have come into question recently regarding the most appropriate treatment for superficial basal cell carcinoma (sBCC). At the heart of this debate is the limited body of evidence describing tumor behavior of sBCC based on clinical factors relevant to the MAUC.

OBJECTIVE
To determine whether sBCC is more likely to harbor aggressive subtypes in high-risk anatomical locations and in immunocompromised patients.

MATERIALS AND METHODS
A single institution retrospective review produced 133 evaluable Mohs cases performed on sBCC over a 10-year period. All slides from the respective cases were reviewed for the presence of histologic patterns other than known sBCC. Cases were then grouped by both MAUC anatomical zone (H, M, and L) and patient immune status for statistical analysis.

RESULTS
A significantly higher rate of mixed histology (MH) was observed when comparing Zone H with Zone L across all patients, healthy patients, and immunocompromised patients. The same was true when comparing Zone M with Zone L for all patients and healthy patients (immunocompromised did not reach significance).

CONCLUSION
The authors' data very clearly demonstrate a higher rate of MH in sBCC of the head and neck which provides strong support to the current MAUC scoring.
MicroRNA-200a-3p Is a Positive Regulator in Cardiac Hypertrophy Through Directly Targeting WDR1 as Well as Modulating PTEN/PI3K/AKT/CREB/WDR1 Signaling
Authors: Yang Xiaomei , Chen Gang , Chen Zhengxu 
Published: October 2019

Abstract:
Cardiac hypertrophy is an adaptive expansion of the myocardium due to the overloaded stress of heart. Recently, emerging studies have drawn a conclusion that microRNAs (miRNAs) are involved in myocardial hypertrophy and even heart failure. To figure out the role of microRNA-200a-3p (miR-200a-3p) in cardiac hypertrophy, the in vitro cardiac hypertrophy model was established in H9c2 cells using angiotensin II (Ang-II) as previously described. First of all, we observed a significant increase of miR-200a-3p expression in Ang-II–induced hypertrophic H9c2 cells. Moreover, inhibition of miR-200a-3p dramatically reversed the Ang-II–upregulated expression of hypertrophic markers (atrial natriuretic peptide, brain natriuretic peptide, and β-MHC) and the expanded cell surface area in H9c2 cells. In addition, our results indicated that miR-200a-3p directly targeted both WDR1 and phosphatase and tensin homolog (PTEN). In this regard, miR-200a-3p further activated PI3K/AKT/CREB pathway so as to intensify its negative regulation on WDR1. At length, WDR1 silence, PTEN inhibitor, and PI3K activator recovered the repressive effect of miR-200a-3p suppression on the development of cardiac hypertrophy. Jointly, our study suggested that miR-200a-3p facilitated cardiac hypertrophy by not only directly targeting WDR1 but also through modulating PTEN/PI3K/AKT/CREB/WDR1 signaling, therefore proving novel downstream molecular pathway of miR-200a-3p in cardiac hypertrophy.
Utilizing a Physician Scribe in a Pediatric Plastic Surgical Practice: A Time-driven Activity-based Costing Study
Authors: Cho Jonathan , Sanchez Karl , Ganor Oren , Afshar Salim , Ruditsky Alex , Bierman Alex , Taghinia Amir H. 
Published: October 2019

Background:
To use time-driven activity-based costing methodology to compare the costs of routine pediatric plastic surgical patient visits with and without a physician scribe.

Methods:
Pediatric plastic surgical clinic visits at a tertiary care facility with the following diagnoses were studied: skin lacerations, skin lesions, and plagiocephaly. Two plastic surgeons saw patients individually either with or without a scribe over a 10-month period. The time that the scribe and physician spent on the patient was recorded, including the duration of the clinic visit and time spent creating, dictating, reviewing, and signing the note. An average appointment activity time for each measurement component was produced, and a capacity cost rate was introduced to derive the cost per minute for a scribe and physician. Sensitivity analysis and paired t-test were conducted to analyze the results.

Results:
A total of 45 cases with a physician scribe were observed with an average appointment activity time of 12.83 minutes (4.97 min for the scribe, 0.92 min for the physician, and 6.95 min combined). A total of 72 cases without a physician scribe were observed with an average appointment activity time of 12.01 minutes. The total attributable cost saving per appointment was $13.82 when a physician scribe was utilized.

Conclusion:
Time-driven activity-based costing methodology showed that the use of a physician scribe reduced cost per office visit by substituting physician time for a less expensive resource.
Interaction Between Ethnicity and Helicobacter pylori Infection in the Occurrence of Reflux Disease
Authors: Sonnenberg Amnon , Turner Kevin O. , Genta Robert M. 
Published: October 2019

Background and Aims:
Few reports are available to reliably assess the ethnic distribution of Barrett metaplasia and reflux esophagitis. The present study served to analyze the joint influence of Helicobacter pylori infection and patient demographics on the diagnoses of Barrett metaplasia and reflux esophagitis.

Methods:
The Inform Diagnostics database is a national electronic repository of histopathologic records of patients distributed throughout the United States. In a case-control study of 52,096 cases with Barrett metaplasia, 189,235 cases with reflux esophagitis, and 152,322 controls without any signs or symptoms suggestive of gastroesophageal reflux disease, we assessed the influence of age, gender, ethnicity, and H. pylori status on occurrence of Barrett metaplasia or reflux esophagitis.

Results:
Barrett metaplasia was less common among East Asians (with odds ratio, 0.48; 95% confidence interval, 0.44-0.53) and Hispanics (0.60, 0.57-0.63) than other ethnic groups living in the United States. Reflux esophagitis was also less common among East Asians (0.86, 0.82-0.90), but more common among Hispanics (1.18, 1.14-1.21). Both types of esophageal disease were associated with a lower prevalence rates of gastric H. pylori infection than controls, with 0.48, 0.44-0.53 for Barrett metaplasia and 0.60, 0.57-0.63 for reflux esophagitis. The prevalence rates of gastric H. pylori and both esophageal diseases were greater in older than younger and male than female patients in all ethnic groups alike.

Conclusions:
Gastric H. pylori infection, ethnicity, gender, and age all influence the occurrence of Barrett metaplasia, and reflux esophagitis.
How harmless are E-cigarettes? Effects in the pulmonary system
Authors: Bozier Jack , Zakarya Razia , Chapman David Geoffrey , Oliver Brian Gregory George 
Published: October 2019

Purpose of review
Electronic cigarettes have quickly risen to be the leading alternative nicotine source to tobacco. E-cigarette use is hard to research and regulate because of the novelty and rapid evolution of the devices and E-liquids. Epidemiological data on long-term usage is currently lacking, but in smaller cohort studies we are starting to understand the usage patterns and demographics of users, which differ depending on where the study takes place and the regulatory environment. The present review describes the current knowledge of the effects of E-cigarettes on the pulmonary system and knowledge of their usage patterns worldwide.

Recent findings
E-cigarette use is continuing to rise in young adults in United States and Canada, but not in United Kingdom. These suggest that regulation is influencing uptake in young adults. If E-cigarettes are to be considered as a harm minimisation smoking cessation product, use in young never smokers must be factored into the risk assessment. A recent surge in cases of lung injury associated with vaping in America has resulted in the definition of vaping associated pulmonary injury, although the exact cause remains unknown.

Summary
It is our opinion that E-cigarettes can no longer be defined as harmless. Further studies are needed to determine the risks for all populations as it is evident that a large proportion of E-cigarette users are never-smokers, meaning they cannot only be considered from a harm reduction perspective.
IV Ibuprofen for Prevention of Post‐ERCP Pancreatitis in Children
Authors: Troendle David M. , Gurram Bhaskar , Huang Rong , Barth Bradley A. 
Published: October 2019

ABSTRACTBackground:Post‐endoscopic retrograde cholangiopancreatography (post‐ERCP) pancreatitis (PEP) is reported to occur in up to 11% of pediatric patients. To date, no study has prospectively evaluated an intervention to prevent PEP in children. It is unclear if such a study is even feasible.Objective:The aim of the study was to evaluate the feasibility of studying IV ibuprofen for PEP prevention in the pediatric population.Methods:This was a prospective randomized double‐blind placebo‐controlled feasibility study. Patients younger than 19 years of age undergoing ERCP were randomized to receive 10 mg/kg IV ibuprofen (max of 800 mg) or placebo (saline) at the time of ERCP. The primary outcome was PEP. Secondary outcomes included post‐ERCP–related bleeding, rates of other procedural and medication‐related adverse events.Results:Fifty‐eight patients were randomized and received either IV ibuprofen or placebo. Preprocedure‐ and procedure‐related factors were not significantly different between the groups except that patients in the placebo group tended to weigh less (48.7 vs 63.7 kg, P = 0.03). There were 7 episodes of PEP (12%). PEP was less frequently identified in the Ibuprofen group than in the control group (7% vs 17%), but this was not statistically significant (P = 0.42). Mean postprocedural abdominal pain scores were significantly lower in the IV Ibuprofen group than in the control group (1.1 vs 3.1, P = 0.01) and the number of patients who had increased abdominal pain after the procedure was significantly lower in ibuprofen group than in the control group (3% vs 38%, P = 0.002). There were no significant differences in procedure‐related or drug‐related adverse events.Conclusions:Postprocedural pain scores and the number of patients who had increased abdominal pain after the procedure were significantly lower in the IV ibuprofen group. The current study provides encouraging, but only very weak evidence that IV ibuprofen decreases PEP in children. Power analysis suggests that a small handful of high‐volume pediatric centers would be able to perform an adequate clinical trial in a reasonable time frame. Focusing on all cause postprocedural pain (PEP and non‐PEP) may allow for a more efficiency study design and be just as clinically relevant.