bluuebunny/crossref_metadata_2025_split huggingface dataset:
SUV39H1 Represses the Expression of Cytotoxic T-Lymphocyte Effector Genes to Promote Colon Tumor Immune Evasion
Authors: Lu Chunwan , Yang Dafeng , Klement John D. , Oh Il Kyu , Savage Natasha M. , Waller Jennifer L. , Colby Aaron H. , Grinstaff Mark W. , Oberlies Nicholas H. , Pearce Cedric J. , Xie Zhiliang , Kulp Samuel K. , Coss Christopher C. , Phelps Mitch A. , Albers Thomas , Lebedyeva Iryna O. , Liu Kebin 
Published: January 2019

AbstractDespite the presence of CTLs in the tumor microenvironment, the majority of immunogenic human colon cancer does not respond to immune checkpoint inhibitor immunotherapy, and microsatellite instable (MSI) tumors are not naturally eliminated. The molecular mechanism underlying the inactivity of tumor-infiltrating CTLs is unknown. We report here that CTLs were present in both MSI and microsatellite stable colon tumors. The expression of the H3K9me3-specific histone methyltransferase SUV39H1 was significantly elevated in human colon carcinoma compared with normal colon tissues. Using a mouse colon carcinoma model, we further determined that tumor-infiltrating CTLs in the colon tumor microenvironment have high expression of SUV39H1. To target SUV39H1 in the tumor microenvironment, a virtual chemical library was screened on the basis of the SET (suppressor of variegation 3–9, enhancer of zeste and trithorax) domain structure of the human SUV39H1 protein. Functional enzymatic activity assays identified a small molecule that inhibits SUV39H1 enzymatic activity. On the basis of the structure of this small molecule, we modified it and chemically synthesized a small molecule, termed F5446, which has an EC50 of 0.496 μmol/L for SUV39H1 enzymatic activity. H3K9me3 was enriched in the promoters of GZMB, PRF1, FASLG, and IFNG in quiescent T cells. F5446 inhibited H3K9me3, thereby upregulating expression of these effectors in tumor-infiltrating CTLs and suppressing colon carcinoma growth in a CD8+ CTL-dependent manner in vivo. Our data indicate that SUV39H1 represses CTL effector gene expression and, in doing so, confers colon cancer immune escape.
Drivers of Variation in 90-Day Episode Payments After Percutaneous Coronary Intervention
Authors: Sukul Devraj , Seth Milan , Dupree James M. , Syrjamaki John D. , Ryan Andrew M. , Nallamothu Brahmajee K. , Gurm Hitinder S. 
Published: January 2019

Background:
Percutaneous coronary intervention (PCI) is a common and expensive procedure that has become a target for bundled payment initiatives. We described the magnitude and determinants of variation in 90-day PCI episode payments across a diverse array of patients and hospitals.

Methods and Results:
We linked clinical registry data from PCIs performed at 33 Michigan hospitals to 90-day episodes of care constructed using Medicare fee-for-service and commercial insurance claims from January 2012 to October 2016. Payments were price standardized and risk adjusted using clinical and administrative variables in an observed-over-expected framework. Hospitals were stratified into quartiles based on average episode payments. Payment components between the highest and the lowest quartiles were compared with identified drivers of variation (ie, index hospitalization/procedure, readmissions, postacute care, and professional fees). Among 40 925 90-day PCI episodes, the average risk-adjusted 90-day episode payment by hospital ranged between $22 154 and $27 205 with a median of $24 696 (interquartile range, $24 190–$25 643). Hospitals in the lowest and the highest quartiles had average episode payments of $23 744 and $26 504, respectively (difference, $2760). Readmission payments were the primary driver of this variation (46.2%), followed by postacute care (22.6%). Readmissions remained the primary driver of variation in key subgroups, including inpatient and outpatient PCI, as well as PCI for acute myocardial infarction and nonacute myocardial infarction indications.

Conclusions:
Substantial hospital-level variation exists in 90-day PCI episode payments. Over half the variation between high- and low-payment hospitals was related to care after the index procedure, primarily because of readmissions and postacute care. Hospitals and policymakers should consider targeting these components when developing initiatives to reduce PCI-related spending.
Impact of Socioeconomic Status on Clinical Outcomes in Patients With ST-Segment–Elevation Myocardial Infarction
Authors: Biswas Sinjini , Andrianopoulos Nick , Duffy Stephen J. , Lefkovits Jeffrey , Brennan Angela , Walton Antony , Chan William , Noaman Samer , Shaw James A. , Ajani Andrew , Clark David J. , Freeman Melanie , Hiew Chin , Oqueli Ernesto , Reid Christopher M. , Stub Dion 
Published: January 2019

Background:
Low socioeconomic status (SES) has been previously shown to be associated with worse cardiovascular outcomes. However, unlike in Australia, many of these studies have been performed in countries without universal healthcare where SES may be expected to have a greater impact on care and outcomes. We sought to determine whether there is an association between SES and baseline characteristics, clinical outcomes and use of secondary prevention therapy in patients with ST-segment–elevation myocardial infarction undergoing percutaneous coronary intervention (PCI).

Methods and Results:

We prospectively collected data on 5665 consecutive ST-segment–elevation myocardial infarction PCI patients between 2005 and 2015 from 6 government-funded hospitals participating in a multicenter registry. Patients were categorized into SES quintiles using the Index of Relative Socioeconomic Disadvantage system, a score allocated to each residential postcode based on factors like income, educational level, and employment status by the Australian Bureau of Statistics. In our study, lower SES patients were more likely to have diabetes mellitus, smoke, and initially present to a non-PCI capable hospital (all
P
≤0.01). Among primary PCI patients, the median time to reperfusion was slightly higher in lower SES groups (211 [144–337] versus 193 [145–285] minutes,
P
<0.001). Drug-eluting stent use was higher in the higher SES groups (
P
<0.001). At 12 months after PCI, lower SES patients had higher rates of ongoing smoking and lower use of guideline-recommended secondary prevention therapy (both
P
<0.01). Despite these differences, SES group was not found to be an independent predictor of 12-month major adverse cardiovascular events.

Conclusions:
Lower SES patients have more comorbidities and experienced slightly longer reperfusion times but otherwise similar care. Despite these baseline differences, clinical outcomes after ST-segment–elevation myocardial infarction PCI were similar regardless of SES.
The Online Support Group as a Community: A Thematic Content Analysis of an Online Support Group for Idiopathic Subglottic Stenosis
Authors: Haik Daniel , Kashanchi Kevin , Tajran Sarah , Heilbronn Cameron , Anderson Catherine , Francis David Oliver , Gelbard Alexander , Verma Sunil Pal 
Published: January 2019

Objective: Idiopathic subglottic stenosis (iSGS) is a rare disease with few local resources for individuals to use. With the explosive growth of online social networking, platforms such as Facebook possess compelling potential to facilitate user-driven sharing of health information and peer support. This study was performed to better understand the content shared in a busy online community for individuals with iSGS. Methods: The largest online community (OC) for individuals with iSGS, Living With Idiopathic Subglottic Stenosis (LwiSGS), was examined. A thematic content analysis of the communications shared in February of 2018 was performed. A conventional qualitative analysis model was employed to analyze aggregated data. The data were then codified. Results: Analysis demonstrated that communications primarily encompassed three major thematic elements: (1) information sharing; (2) emotional support, expression, and experience sharing; and (3) community building. Positively toned posts grossly overshadowed negatively toned posts by almost a factor of 3. A significant portion of group members requested information from their peers, suggesting a high level of trust toward the resources provided in this group, even those involving a surgical procedure or medication. Conclusion: LwiSGS is a forum for patients with a rare chronic condition to share informational resources, personal experiences, and emotional support, as well as a community with their peers. These data suggest that LwiSGS could be a powerful resource for individuals with iSGS to share information, personal experiences, or emotional support.
Bilateral Ear Canal Cholesteatoma with Underlying Type I First Branchial Cleft Anomalies
Authors: Banakis Hartl Renee M. , Said Sherif , Mann Scott E. 
Published: January 2019

Objectives: To describe a case of bilateral ear canal cholesteatomas in the setting of underlying first branchial cleft cyst anomalies and to review the pathophysiology underlying the development of external auditory canal cholesteatomas from branchial cleft cyst abnormalities. Methods and Results: We present a case study of a 61-year-old man who presented with chronic right-sided hearing loss and left-sided postauricular drainage. Clinical evaluation, radiographic work-up, and pathologic analysis confirmed a diagnosis of bilateral ear canal cholesteatoma in the setting of underlying first branchial cleft cyst anomalies. The patient’s clinical course, surgical treatment, and management considerations are discussed here. Conclusion: Ear canal cholesteatoma represents a rare clinical disease entity deserving a thorough initial assessment. Careful consideration of underlying diseases that result in chronic inflammation, such as branchial cleft lesions, should be included in the differential diagnosis of idiopathic canal cholesteatoma in the absence of prior otologic surgery or trauma.
The Effect of an Orthotic Device for Balancing Neck Muscles During Daily Office Tasks
Authors: Quinzi Federico , Scalia Martina , Giombini Arrigo , Di Cagno Alessandra , Pigozzi Fabio , Casasco Maurizio , Macaluso Andrea 
Published: January 2019

Objective: This study aimed at evaluating the acute effect of the combined and single use of two orthotic devices (neck balance system [NBS] and lumbar support [LS]) on muscle activity of neck and back muscles during typical computer working tasks. Background: An excessive activation of neck muscles could threaten the balance between agonist and antagonist muscles, resulting in a lower stability of the head and possibly leading to neck pain. At present, no study evaluated the effect of a specific orthotic device in reducing neck muscles activation. Methods: Surface electromyography (sEMG) from neck flexor (sternocleidomastoid [SCMD]) and extensor muscles (semispinalis capitis [SPC]) and back extensor muscles (erector spinae [ERS]) of 20 healthy individuals was recorded during three computer working tasks performed with the NBS, with NBS and LS, with the LS, and without devices (ND). Results: In the NBS condition, the SPC showed a reduced activation (NBS = 3.97%; NBS + LS = 4.49%; LS = 4.48%; ND = 4.61% of the maximal voluntary contraction) compared to the other conditions. Conclusions: The use of the NBS promotes a reduction of neck extensor muscles, possibly due to the inertial mass added in the occipital part of the head, producing an external neck extensor moment that cooperates with that produced by neck extensor muscles. Application: Orthotic devices such as the NBS may be used by computer workers to reduce the activation of their neck extensor muscles and possible risks of developing neck pain.
Understanding diabetes self-management using the Model of Human Occupation
Authors: Youngson Bel 
Published: January 2019

Introduction Over 400 million people worldwide are living with diabetes. Research suggests that people struggle to manage their diabetes and an in-depth understanding of the lived experience of diabetes is required to inform and promote occupational therapy practice. This article reports on one part of a PhD study into the role of occupational therapy in diabetes self-management. Method Semi-structured interviews using an intuitive inquiry methodology were conducted with 22 people with diabetes in three separate studies. Analysis of the lived experience of all participants was drawn together to explore the understanding of diabetes self-management from an occupational perspective using the Model of Human Occupation. Findings The occupation of diabetes self-management was conceptualised with seven inter-related occupational forms. Challenges were related to occupational identity, volition, habituation, performance capacity and the context in which these took place. Conclusion This study, embedded in the experiences of those with diabetes, suggests that occupational therapy has a distinct role in diabetes self-management, through seeing this self-management as an occupation. The use of the Model of Human Occupation enables a focus on the characteristics of the occupational forms and how these might be adapted for successful occupational engagement.
Potential Dietary Contributions From Rice and Wheat Flour Fortification in the Solomon Islands: Results From the 2012-2013 Household Income and Expenditure Survey
Authors: Imhoff-Kunsch Beth , Shakya Iju , Namohunu Salome Aroma Diatalau , Pitaboe Anna , Wong Pierre , Tsang Becky L , Codling Karen , Foley Jessica , Pachón Helena 
Published: January 2019

Background: Solomon Islands (SI) mandated wheat flour fortification in 2010. Rice is a key staple food in SI, and its fortification may provide an opportunity to deliver additional micronutrients to the population. Objective: To determine whether fortified rice (proposed) and fortified wheat flour potentially benefit women of reproductive age (WRA). Methods: We analyzed data from the 2012-2013 Household Income and Expenditure Survey to quantify food purchases, which served as a proxy for food consumption. We accounted for varied household composition by using adult male equivalent (AME) adjustments. Results: Among 4478 households, 95.6% purchased rice and 86.6% purchased at least 1 food containing fortified wheat flour in the previous 14 days. Median apparent intake of rice among WRA was 205 g/d/AME. If fortified according to proposed standards, this apparent intake could result in the consumption of 12.3 mg iron/d, fulfilling 44% of the estimated average requirement (EAR), and 226 µg folic acid/d, satisfying 57% of World Health Organization’s recommended intake of 400 µg/d. Overall, apparent rice consumption could fulfill 113%, 114%, and 131% of the EAR for WRA for zinc, thiamin, and niacin, respectively. Fortified wheat flour was consumed in much lower quantities, with an estimated apparent median intake of 22 g/d/AME among WRA and 78 g/d/AME among women in urban populations. Conclusions: The potential benefit of fortified wheat flour in SI is likely limited to urban populations. Apparent consumption of fortified rice in SI could contribute considerably to daily intake of iron, B vitamins including folic acid, and zinc among WRA.
Long-Term Effects of In-Game Purchases and Event Game Mechanics on Young Mobile Social Game Players in Japan
Authors: Shibuya Akiko , Teramoto Mizuha , Shoun Akiyo , Akiyama Kumiko 
Published: January 2019

Background. The mobile game market has been rapidly growing worldwide, especially in Japan. Because mobile games often use a free-to-play business model that involves additional in-game purchases, some monetary and event mechanics of mobile games have been controversial in Japan. Purpose. This study explored the long-term effects of monetary and event features of game mechanics on pathological gaming, weekly exposure and monthly expenditure among teenagers and young adults in Japan. Method. A total of 948 teenagers and young adults participated two surveys in November 2013 and in May 2014. Pathological gaming, weekly game exposure, monthly expenditure and preference for gambling were measured. The participants listed up to three games they played, and their monetary and event mechanics were analysed using content analysis. The degrees of exposure to each mechanics were calculated by combining the content analysis with a longitudinal study. Results. Players who were exposed to a higher amount of limited-time only gacha, a virtual lottery machine, were likely to spend more money six months later. However, players who were exposed to a lower amount of normal gacha were likely to spend more money later among players who preferred gambling. No monetary effects on pathological gaming per se were found. Conclusion. This study shows that some game mechanics can cause excessive use of time and money for certain players.
Does the Use of Locking Screws Decrease the Rate of Hardware Removal in Ankle Fractures?
Authors: Walley Kempland C. , Gonzalez Tyler A. , Nandyala Sreeharsha V. , Macauley Alec , Elnabawi Youssef , Rodriguez Edward K. , Appleton Paul T. 
Published: January 2019

Background. While biomechanical characteristics of locking screw fixation versus traditional plating has been studied extensively in orthopaedic literature, clinical outcome studies are lacking. The goal of this study was to evaluate the efficacy and complications rate of locking versus traditional nonlocking screws in complex ankle fractures employing distal fibula internal fixation with 1/3 semitubular small fragment plates. Methods. A retrospective review was performed between January 2010 and June 2013 of all patients in whom internal fixation of the fibula in an ankle fracture (open or closed) was performed using only 1/3 semitubular small fragment fibular plates. Patient characteristics, fracture patterns, specific screw choice that were placed in the most distal 2 fibular plate holes (either locking or nonlocking), infectious wound complications, and concomitant syndesmotic injury and the need and corresponding purpose for hardware removal were recorded. Results. A total of 135 patients were found to meet inclusion criteria and were analyzed for this study. Of the patients with locking screws, 25 of 98 (25%) elected to have hardware removed, while 13 of 37 (35%) of those with nonlocking screws elected hardware removal. This did not reach statistical significance (P = .30). There was no statistically significant difference between the groups with regards to age, smoking status, body mass index, diabetes, or use of syndesmotic screw fixation. There was no significant difference in loss of fixation, infection, or other surgical complications in between the groups. Conclusions. There was no significant decrease in the rate of hardware removal with the use of 1/3 tubular locking versus nonlocking plates in the treatment of distal fibula fractures. Despite these screws locking flush to the plate, the hardware is equally symptomatic in both groups. There was no significant difference in the rate of complications between the 2 groups and our data suggest that the added expense of using locking screws routinely when fixing lateral malleolar fractures should be carefully considered, especially if the fracture pattern does not warrant locking technology. Levels of Evidence: Prognostic, Level III
The Origin of the Anterior Lateral Malleolar Artery From the Anterior Tibial Artery: A Fresh Cadaveric Study
Authors: Tonogai Ichiro , Hayashi Fumio , Tsuruo Yoshihiro , Sairyo Koichi 
Published: January 2019

The anterior lateral malleolar artery (ALMA), which usually originates from the anterior tibial artery (ATA), courses transversely and laterally, passing under the extensor digitorum longus and peroneus tertius tendons. Variations in the origin of the ALMA from the ATA can occur. Branches of the ATA, such as the ALMA, are prone to pseudoaneurysm. This study reviewed the origin of the ALMA from the ATA and aimed to identify problems in anterior ankle arthroscopy that might cause injury to the ALMA. Enhanced computed tomography scans of 24 feet of 24 fresh cadavers (13 males, 11 females; average age 78.1 years) were assessed. The limb was injected with barium sulfate suspension through the external iliac artery; the origin of the ALMA from the ATA on the sagittal plane was recorded. The origin was at the ankle joint level in 4 specimens and below the ankle joint in 17 specimens. The distance from the ankle joint to the branching point of the ALMA on the sagittal plane was 5.2 mm distal to the joint. The level of origin of the ALMA from the ATA was established. Instruments should not be inserted from the distal direction when placing anterolateral portals. Levels of Evidence: Level IV, cadaveric study
Assessing Integrative Psychiatry Curriculum Needs
Authors: Ranjbar Noshene , Villagomez Amelia , Brooks Audrey J , Ricker Mari , Lebensohn Patricia , Maizes Victoria 
Published: January 2019

Background Research on incorporating integrative medicine (IM) into medical training is increasing. Programs and organizations around IM have been established, but there has not previously been a needs assessment focused on integrating IM into psychiatry training. Objectives The results of a needs assessment of training directors and faculty, focused on interest and priorities for developing an IM curriculum for psychiatry training programs, are described. Methods Psychiatry Training Directors and faculty were invited to participate in a detailed electronic survey. Areas of inquiry included (a) IM content areas to include in training; (b) IM approaches to specific medical conditions; (c) existing IM content; (d) importance, interest, and strategies for IM training; and (e) availability of wellness programs for trainees. Results Thirty-six respondents from psychiatry training programs completed the survey. Of the training programs represented by the respondents, 50% indicated that they currently had IM content in their curriculum; only 11.8% of them rated their programs’ existing IM content as sufficient. Content areas rated most highly for inclusion in a psychiatry IM curriculum included sleep health, motivational interviewing, and self-care. Respondents indicated incorporating IM into the psychiatry training curriculum (47%) or as an elective (44%) as the desired implementation strategy, with experiential onsite activities demonstrating IM topics (67%) and online modules supplemented by local faculty (58%) as the 2 most desirable learning formats. Significant barriers identified were time constraints, lack of faculty expertise in IM, current lack of curricular requirements for IM competencies, and budgetary limitations. Conclusion Responses to the survey suggest that faculty need support and additional education in implementing IM training. A standardized, online curriculum could help meet that need. Our results also indicate that wellness programs for residents are currently inadequate; bolstering them could help address burnout and increase the knowledge psychiatrists have of IM modalities. The types of institutions represented by faculty interested in further developing IM offerings vary considerably, as do their current efforts to integrate IM into training programs.