bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterizing and Assessing the Impact of Surgery on Healthcare Spending Among Medicare Enrolled Preoperative Super-utilizers
Authors: Hyer J. Madison , Ejaz Aslam , Diaz Adrian , Tsilimigras Diamantis I. , Gani Faiz , White Susan , Pawlik Timothy M. 
Published: July 2019

Objective:
The aim of this study was to characterize preoperative super-utilizers and examine the effect of surgery on service utilization among patients undergoing major elective surgery.

Summary Background Data:
Rising healthcare costs are becoming increasingly burdensome for Medicare. Super-utilizers have been increasingly identified and studied as this subset of patients consume a disproportionate amount of healthcare services compared with the majority of the population.

Methods:
Patients aged 65 or older who underwent any of the following general elective surgeries: abdominal aortic aneurysm repair (AAA), coronary artery bypass graft (CABG), colectomy, or hip replacement were identified using 100% Medicare Inpatient and Outpatient Standard Analytic Files (SAFs) from years 2012 to 2016. Medicare inpatient and outpatient expenditures the year before surgery, around the time of surgery, and the year after surgery were examined.

Results:
Among 603,105 Medicare beneficiaries, 32,145 patients (5.3%) were categorized as super-utilizers. Compared with low-utilizers, super-utilizers were more likely to be male (low-utilizer vs super-utilizer: 47.9% vs 54.2%) and African American (4.0% vs 7.2%), whereas 58.8% (n = 208,080) of low-utilizers presented without any comorbidity [Charlson Comorbidity Index (CCI) = 0] and 49.8% (n = 16,007) of super-utilizers presented with a CCI score of ≥3. Total preoperative spending among super-utilizers was approximately $1.7 billion with a median of $3,159 [interquartile range (IQR): $554–$15,181] per beneficiary. Spending among super-utilizers accounted for 39.6% of total spending for all Medicare beneficiaries versus only 8.4% among low-utilizers. Although the median spending per Medicare beneficiary in the year after surgery was higher for super-utilizers compared with low-utilizers [$1,837 (IQR: $341–$11,390) vs $18,223 (IQR: $3,466–$43,356)], super-utilizers accounted for 13.5% of total postoperative spending. The reduction in adjusted average annual Medicare expenditure ranged from >$15,000 per year for patients undergoing CABG to approximately $30,000 per year for patients undergoing a hip replacement.

Conclusions:
Although super-utilizers accounted for only 5.3% of patients, these patients accounted for 39.6% of total Medicare expenditures in the year before surgery. Among a subset of super-utilizers, surgical intervention was associated with a reduction in annual Medicare expenditure in the year after surgery.
ALPPS Versus Portal Vein Embolization for Hepatitis-related Hepatocellular Carcinoma
Authors: Chan Albert , Zhang Wei Yi , Chok Kenneth , Dai Jeff , Ji Ren , Kwan Crystal , Man Nancy , Poon Ronnie , Lo Chung Mau 
Published: July 2019

Objective:
The aim of this study was to evaluate the short- and long-term outcome of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for hepatitis-related hepatocellular carcinoma (HCC).

Summary Background Data:
ALPPS has been advocated for future liver remnant (FLR) augmentation in liver metastasis or noncirrhotic liver tumors in recent years. Data on the effect of ALPPS in chronic hepatitis or cirrhosis-related HCC remained scarce.

Methods:
Data for clinicopathological details, portal hemodynamics, and oncological outcome were reviewed for ALPPS and compared with portal vein embolization (PVE). Tumor immunohistochemistry for PD-1, VEGF, and AFP was evaluated in ALPPS and compared with PVE and upfront hepatectomy (UH).

Results:
From 2002 to 2018, 148 patients with HCC (hepatitis B: n = 136, 92.0%) underwent FLR modulation (ALPPS, n = 46; PVE: n = 102). One patient with ALPPS and 33 patients with PVE failed to proceed to resection (resection rate: 97.8% vs 67.7%, P < 0.001). Among those who had resections, 65 patients (56.5%) had cirrhosis. ALPPS induced absolute FLR volume increment by 48.8%, or FLR estimated total liver volume ratio by 12.8% over 6 days. No difference in morbidity (20.7% vs 30.4%, P = 0.159) and mortality (6.5% vs 5.8%, P = 1.000) with PVE was observed. Chronic hepatitis and intraoperative indocyanine green clearance rate ≤39.5% favored adequate FLR hypertrophy in ALPPS. Five-year overall survival for ALPPS and PVE was 46.8% and 64.1% (P = 0.234). Tumor immunohistochemical staining showed no difference in expression of PD-1, V-EGF, and AFP between ALPPS, PVE, and UH.

Conclusions:
ALPPS conferred a higher resection rate in hepatitis-related HCC with comparable short- and long-term oncological outcome with PVE.
Development of transfusion guidelines for injured children using a Modified Delphi Consensus Process
Authors: Trappey A. Francois , Thompson Kyle M. , Kuppermann Nathan , Stephenson Jacob T. , Nuno Miriam A. , Hewes Hilary A. , Meyers Sage R. , Stanley Rachel M. , Galante Joseph M. , Nishijima Daniel K. 
Published: July 2019

BACKGROUND
There is wide variability of transfusion practices for children with hemorrhagic injuries across trauma centers. We are planning a multicenter, randomized clinical trial evaluating tranexamic acid in children with hemorrhage. Standardization of transfusion practices across sites is important to minimize confounding. Therefore, we sought to generate consensus-based transfusion guidelines for the trial.

METHODS
We used a modified Delphi process utilizing a multi-site, multi-disciplinary panel of experts to develop our transfusion guidelines. A survey of 23 clinical categories on various aspects of transfusion practices was developed and distributed via SurveyMonkey®. Statements were graded on a 5-point Likert scale (“Strongly agree” to “This intervention may be harmful”). Statements were accepted if ≥ 80% of the panelists rated the statement as “Strongly agree” or “Agree”. After each round, the responses were calculated and the results included on subsequent rounds.

RESULTS
35 panelists from four pediatric trauma centers participated in the study, including 11 (31%) pediatric EM physicians, 8 (23%) pediatric trauma surgeons, 5 (14%) transfusionists, 5 (14%) pediatric anesthesiologists, and 6 (17%) pediatric critical care physicians (range of 8 to 10 from each clinical site). Four survey iterations were performed. In total 176 statements were rated and 39 were accepted by criteria across all 23 categories. An rational algorithm for transfusion in trauma was then developed.

CONCLUSIONS
We successfully developed transfusion guidelines for various aspects of the management of children with hemorrhagic injuries using a modified Delphi process with broad interdisciplinary participation. We anticipate implementation of these guidelines will help minimize heterogeneity of transfusion practices across clinical sites for the upcoming clinical trial evaluating tranexamic acid in children with hemorrhage.
Is early chemical thromboprophylaxis in patients with solid organ injury a solid decision?
Authors: Skarupa David , Hanna Kamil , Zeeshan Muhammad , Madbak Firas , Hamidi Mohammad , Haddadin Zaid , Northcutt Ashley , Gries Lynn , Kulvatunyou Narong , Joseph Bellal 
Published: July 2019

BACKGROUND
The optimal time to initiate chemical thromboprophylaxis (CTP) in patients who have undergone nonoperative management (NOM) of blunt solid organ injuries (SOI) remains controversial. The aim of our study was to assess the impact of early initiation of CTP in patients with blunt abdominal SOIs.

METHODS
We performed a 2-year (2013–2014) retrospective analysis of American College of Surgeons Trauma Quality Improvement Program. We included all adult trauma patients (age, ≥ 18 years) with blunt SOI who underwent NOM. Patients were stratified into three groups based on timing of CTP (early, ≤48 hours of injury; late, >48 hours of injury,; and no prophylaxis group). Our primary outcomes were rates of failure of NOM, pRBC transfusion, and mortality. Our secondary outcomes were the rate of venous thromboembolic (VTE) events (i.e., deep venous thrombosis [DVT] and/or pulmonary embolism [PE]) and length of stay.

RESULTS
A total of 36,187 patients met the inclusion criteria. Mean age was 49.5 ± 19 years and 36% of patients received CTP (early, 37% (n = 4,819) versus late, 63% (n = 8,208)). After controlling for confounders, patients receiving early CTP had lower rates of DVT (p = 0.01) and PE (p = 0.01) compared with the no prophylaxis and late CTP groups. There was no difference between the three groups regarding the postprophylaxis pRBC transfusions, failure of NOM, and mortality.

CONCLUSION
Our results suggest that in patients undergoing NOM of blunt abdominal SOI, early initiation of CTP should be considered. It is associated with decreased rates of DVT and PE, with no significant difference in post prophylaxis pRBC transfusion, failure of nonoperative management, and mortality.

LEVEL OF EVIDENCE
Therapeutic, level V.
Multicolor Imaging of Myelinated Nerve Fibers Contiguous to the Optic Disc
Authors: Bhattacharya Subhajit , Goel Sugandha , Saurabh Kumar , Roy Rupak 
Published: July 2019

Abstract:
Myelinated nerve fibers (MNF) are characterized as whitish, relatively sharply demarcated, feather-like structures located in the retinal nerve fiber layer. MNF are located quite frequently in contiguity with the optic nerve head. This may lead to a diagnostic dilemma by preventing clear visualization of the optic disc margins. We herein describe the utility of multicolor imaging (MCI) in identifying optic disc anatomy in a case of MNF contiguous to the disc. MCI and infrared reflectance were superior to color fundus photography in delineating disc margins. Our pilot study describes the efficacy of MCI in delineating optic disc anatomy in a case of MNF.
The Role of EEG in the Erroneous Diagnosis of Epilepsy
Authors: Amin Ushtar , Benbadis Selim R. 
Published: July 2019

Summary:
Errors in diagnosis are relatively common in medicine and occur in all specialties. The consequences can be serious for both patients and physicians. Errors in neurology are often because of the overemphasis on "tests" over the clinical picture. The diagnosis of epilepsy in general is a clinical one and is typically based on history. Epilepsy is more commonly overdiagnosed than underdiagnosed. An erroneous diagnosis of epilepsy is often the result of weak history and an "abnormal" EEG. Twenty-five to 30% of patients previously diagnosed with epilepsy who did not respond to initial antiepileptic drug treatment do not have epilepsy. Most patients misdiagnosed with epilepsy turn out to have either psychogenic nonepileptic attacks or syncope. Reasons for reading a normal EEG as an abnormal one include over-reading normal variants or simple fluctuations of background rhythms. Reversing the diagnosis of epilepsy is challenging and requires reviewing the "abnormal" EEG, which can be difficult. The lack of mandatory training in neurology residency programs is one of the main reasons for normal EEGs being over-read as abnormal. Tests (including EEG) should not be overemphasized over clinical judgment. The diagnosis of epilepsy can be challenging, and some seizure types may be underdiagnosed. Frontal lobe hypermotor seizures may be misdiagnosed as psychogenic events. Focal unaware cognitive seizures in elderly maybe be blamed on dementia, and ictal or interictal psychosis in frontal and temporal lobe epilepsies may be mistaken for a primary psychiatric disorder.
Patterns Specific to Pediatric EEG
Authors: Sheth Raj D. 
Published: July 2019

Summary:
Misinterpretations of the EEG can result in erroneous diagnosis of epilepsy, causing considerable family anxiety, over protectiveness of children, and delays in normal development and developmental exploration. The burden of a chronic disease can result in expensive and unnecessary medical treatment. The misdiagnosis of epilepsy has been well documented in adults, but misdiagnosis in normal children can have a long-lasting impact on their health. Furthermore, the EEG has a wider range of morphology and hence a greater opportunity for the missed diagnosis of epilepsy. Lack of familiarity of normal sleep patterns and age-related changes from the premature neonate to the young child make children particularly susceptible to misdiagnosis of epilepsy.
An oomycete effector impairs autophagy in evolutionary distant organisms and favors host infection
Authors: Testi Serena , Kuhn Marie-Line , Allasia Valérie , Auroy Pascaline , Kong Fantao , Peltier Gilles , Pagnotta Sophie , Cazareth Julie , Keller Harald , Panabières Franck 
Published: July 2019

AbstractAn arsenal of effector proteins from plant pathogenic Phytophthora species manipulates their host from inside the cells. Phytophthora parasitica produces the effector AVH195 during an initial, biotrophic phase of infection. The protein transiently impairs plant immune-associated hypersensitive cell death in Nicotiana. ATG8 Interaction Motifs in the protein indicate that the effector targets the autophagic core machinery. We selected a photosynthetic microalga with a single copy ATG8 gene as an alternative model to dissect AVH195-induced autophagic perturbation. AVH195 slows down autophagic flux in Chlamydomonas reinhardtii thus promoting the accumulation of cargo-rich vesicles. In yeast, membrane-associated AVH195 interacts with ATG8 from Chlamydomonas and with different ATG8 isoforms from Arabidopsis thaliana. The overexpression of Avh195 in Arabidopsis promotes growth of both infecting P. parasitica and Hyaloperonospora arabidopsidis, an obligate biotroph. To our knowledge, this report provides first evidence that an oomycete effector non-selectively targets ATG8 in different organisms from the green lineage to slow down autophagic flux for infection.
Detection of Reticuloendotheliosis Virus in Brazil
Authors: Caleiro Giovana S. , Nunes Cristina F. , Urbano Paulo R. , Kirchgatter Karin , de Araujo Jansen , Durigon Edison Luiz , Thomazelli Luciano M. , Stewart Brittany M. , Edwards Dustin C. , Romano Camila M. 
Published: July 2019

AbstractReticuloendotheliosis retroviruses (REV) are known to cause immunosuppressive and oncogenic disease that affects numerous avian species. REV is present worldwide and recently has been reported in South America with cases of infected commercial flocks in Argentina. We surveyed for the presence of REV in birds from a state in the northern region of Brazil using real-time PCR. We report the first cases of REV in Brazil, detected in Muscovy ducks (Cairina moschata), wild turkeys (Meleagris gallopavo), and chickens (Gallus gallus) at a relatively high prevalence rate (16,8%). Phylogenetic analysis indicated a close relationship of this strain to variants in the United States. This study provides evidence of REV in the Amazon biome and provides a baseline for future surveillance of the virus in the region and throughout Brazil.
Brucella effector hijacks endoplasmic reticulum quality control machinery to prevent premature egress
Authors: Luizet Jean-Baptiste , Raymond Julie , Lacerda Thais Lourdes Santos , Bonici Magali , Lembo Frédérique , Willemart Kévin , Borg Jean-Paul , Gorvel Jean-Pierre , Salcedo Suzana P. 
Published: July 2019

AbstractPerturbation of endoplasmic reticulum (ER) functions can have critical consequences for cellular homeostasis. An elaborate surveillance system known as ER quality control (ERQC) ensures that only correctly assembled proteins reach their destination. Persistence of misfolded or improperly matured proteins upregulates the unfolded protein response (UPR) to cope with stress, activates ER associated degradation (ERAD) for delivery to proteasomes for degradation. We have identified a Brucella abortus type IV secretion system effector called BspL that targets Herp, a key component of ERQC and is able to augment ERAD. Modulation of ERQC by BspL results in tight control of the kinetics of autophagic Brucella-containing vacuole formation, preventing premature bacterial egress from infected cells. This study highlights how bacterial pathogens may hijack ERAD components for fine regulation of their intracellular trafficking.
A patatin-like phospholipase is crucial for gametocyte induction in the malaria parasite Plasmodium falciparum
Authors: Flammersfeld Ansgar , Panyot Atscharah , Yamaryo Yoshiki , Auraß Philipp , Pryborski Jude M. , Flieger Antje , Botté Cyrille , Pradel Gabriele 
Published: July 2019

AbstractPatatin-like phospholipases (PNPLAs) are highly conserved enzymes of prokaryotic and eukaryotic organisms with major roles in lipid homeostasis. The genome of the malaria parasite Plasmodium falciparum encodes four putative PNPLAs with predicted functions during phospholipid degradation. We here investigated the role of one of the plasmodial PNPLAs, a putative PLA2 termed PNPLA1, during blood stage replication and gametocyte development. PNPLA1 is present in the asexual and sexual blood stages and here localizes to the cytoplasm. PNPLA1-deficiency due to gene disruption or conditional gene-knockdown had no effect on erythrocytic replication, gametocyte maturation and gametogenesis. However, blood stage parasites lacking PNPLA1 were severely impaired in gametocyte induction, while PNPLA1 overexpression promotes gametocyte formation. The loss of PNPLA1 further leads to transcriptional down-regulation of genes related to gametocytogenesis, including the gene encoding the sexual commitment regulator AP2-G. Additionally, lipidomics of PNPLA1-deficient asexual blood stage parasites revealed overall increased levels of major phospholipids, including phosphatidylcholine (PC), which is a substrate of PLA2. Because PC synthesis is pivotal for erythrocytic replication, while the reduced availability of PC precursors drives the parasite into gametocytogenesis, we hypothesize that the high PC levels due to PNPLA1-deficiency prevent the blood stage parasites from entering the sexual pathway.
The nervous system is the major target for Gold nanoparticles: Evidence from RNA sequencing data of C. elegans
Authors: Mo Jihao , Sun Ning , Yang Baolin , Li Shaoxia , Wang Lei 
Published: July 2019

AbstractThe increasing use of gold nanoparticles (NPs) raises concerns about the potential effect of gold NPs exposure on human health. Therefore, gold NPs exposure is hard to evaluate at the organ level with current measurement technology. The bio-distribution assay showed that intestine was the organ with most gold NPs accumulated in C. elegans. However, our data indicated that 62.8% of the significant altered genes were function in the nervous system using tissue enrichment analysis. Notably, developmental stage analysis has demonstrated that NP exposure interfered with the development of animals. Furthermore, the transcription factors DAF-16 was regulating the oxidative stress genes induced by gold NPs. Therefore, we proposed the localization of the oxidative stress genes in the neuron cells and how their expression affect neuron communication. Our results demonstrate that the gold NPs-induced oxidative stress affects the nervous system via physical damage to the neurons and disruption of cell-to-cell communication. Future toxicology research on gold NPs should focus on neurons.
Graphical abstract
tRNA 2’-O-methylation modulates small RNA silencing and life span in Drosophila
Authors: Angelova Margarita T. , Dimitrova Dilyana G. , Da Silva Bruno , Marchand Virginie , Goyenvalle Catherine , Achour Cyrinne , Jacquier Caroline , Bourguignon-Igel Valérie , Shehzada Salman , Lence Tina , Guerineau Vincent , Roignant Jean-Yves , Antoniewski Christophe , Teysset Laure , Bregeon Damien , Schaefer Matthias R. , Motorin Yuri , Carré Clément 
Published: July 2019

Abstract2’-O-methylation (Nm) represents one of the most common RNA modifications. Nm affects RNA structure and function with crucial roles in various RNA-mediated processes ranging from RNA silencing, translation, self versus non-self recognition to viral defense mechanisms. Here, we identify two novel Nm methyltransferases (Nm-MTases) in Drosophila melanogaster (CG7009 and CG5220) as functional orthologs of yeast TRM7 and human FTSJ1, respectively. Genetic knockout studies together with MALDI-TOF mass spectrometry and RiboMethSeq mapping revealed that CG7009 is responsible for methylating the wobble position in tRNAPhe, tRNATrp and tRNALeu, while subsequently, CG5220 methylates position C32 in the same tRNAs and targets also additional tRNAs. CG7009 or CG5220 mutant animals were viable and fertile but exhibited various phenotypes such as life span reduction, small RNA pathways dysfunction and increased sensitivity to RNA virus infections. Our results provide the first detailed characterization of two TRM7 family members in Drosophila and uncover a molecular link between enzymes catalysing Nm at specific tRNAs and small RNA-induced gene silencing pathways.
Durability of alumina silicate concrete based on slag/fly ash blends against corrosion
Authors: Rajagopalan Gopalakrishnan 
Published: July 2019

Purpose
The durability of concrete structures, especially built-in corrosive environments, starts to deteriorate after 20–30 years, even though they have been designed for more than 60 years of service life. The durability of concrete depends on its resistance against a corrosive environment. Inorganic Polymer concrete, or geopolymer concrete, has been emerging as a new engineering material with the potential to form an alternative to conventional concrete for the construction industry. The purpose of this paper is to conduct the investigation on corrosion of the geopolymer materials prepared using GGBS blended with low calcium fly ash in different percentages and sodium hydroxide, sodium silicate as activators and cured in ambient conditions (25±5°C).

Design/methodology/approach
GGBS was replaced by fly ash at different levels from 0 to 50 percent in a constant concentration of 12M. The main parameters of this study are the evaluation of strength characteristics of geopolymer concrete and resistance against corrosion by conducting accelerated corrosion test (Florida method).

Findings
From the test results it is observed that the strength of the geopolymer concrete with GGBS in ambient curing performs well compared to geopolymer concrete with GGBS blended with fly ash. The GPCE sample (40 percent replacement of fly ash to GGBS) shows better results and the resistance against corrosion was good, compared to all other mixes.

Research limitations/implications
The outcomes of this investigation will be useful for the researchers and the construction industry.

Practical implications
This paper results that optimum percentage of fly ash should be blended with GGBS against the corrosion attack. This investigation indicates that GGBS without the combination of fly ash can be utilized in a normal environment. These findings will definitely be useful for the ready-mix concrete manufacturers and the construction Industry.

Social implications
Disposal of industrial wastes causes pollution to the environment. Industrial wastes are utilized for the production of geopolymer concrete, which is the alternative material for the construction industry.

Originality/value
From the observation of the previous literature, till now there was no investigation on geopolymer concrete for corrosion under ambient curing conditions, as such this investigation could be considered as the new investigation.