bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exercise Rehabilitation for Peripheral Artery Disease
Authors: McDermott Mary M. 
Published: February 2018

Purpose:
To summarize evidence regarding exercise therapy for people with lower extremity peripheral artery disease (PAD).

Methods:
Literature was reviewed regarding optimal strategies for delivering exercise interventions for people with PAD. Randomized trial evidence and recent studies were emphasized.

Results:
Randomized clinical trial evidence consistently demonstrates that supervised treadmill exercise improves treadmill walking performance in people with PAD. A meta-analysis of 25 randomized trials (1054 participants) concluded that supervised treadmill exercise was associated with 180 m of improvement in maximal treadmill walking distance and 128 m of improvement in pain-free walking distance compared with a control group. Three randomized trials of 493 patients with PAD demonstrated that home-based walking exercise interventions that incorporate behavioral change techniques improve walking ability in patients with PAD. Furthermore, evidence suggests that home-based walking exercise improves the 6-min walk more than supervised treadmill exercise. Upper and lower extremity ergometry also significantly improved walking endurance in PAD. The Centers for Medicare & Medicaid Services recently determined that Medicare would cover 12 wk (36 sessions) of supervised treadmill exercise for patients with PAD.

Conclusions:
Supervised treadmill exercise and home-based walking exercise each improve walking ability in patients with PAD. The availability of insurance coverage for supervised treadmill exercise for patients with PAD will make supervised treadmill exercise more widely available and accessible. Home-based exercise that incorporates behavioral change technique is an effective alternative for patients unwilling or unable to attend 3 supervised exercise sessions per week.
Ketamine-Associated Brain Changes: A Review of the Neuroimaging Literature
Authors: Ionescu Dawn F. , Felicione Julia M. , Gosai Aishwarya , Cusin Cristina , Shin Philip , Shapero Benjamin G. , Deckersbach Thilo 
Published: February 2018

Abstract
Major depressive disorder (MDD) is one of the most prevalent conditions in psychiatry. Patients who do not respond to traditional monoaminergic antidepressant treatments have an especially difficult-to-treat type of MDD termed treatment-resistant depression. Subanesthetic doses of ketamine—a glutamatergic modulator—have shown great promise for rapidly treating patients with the most severe forms of depression. As such, ketamine represents a promising probe for understanding the pathophysiology of depression and treatment response. Through neuroimaging, ketamine’s mechanism may be elucidated in humans. Here, we review 47 articles of ketamine’s effects as revealed by neuroimaging studies. Some important brain areas emerge, especially the subgenual anterior cingulate cortex. Furthermore, ketamine may decrease the ability to self-monitor, may increase emotional blunting, and may increase activity in reward processing. Further studies are needed, however, to elucidate ketamine’s mechanism of antidepressant action.
A new prognostic score can predict survival after hepatocellular carcinoma treatment in a cohort of 1302 Egyptian hepatocellular carcinoma patients
Authors: Abdelaziz Ashraf O. , Shousha Hend I. , Abdelmaksoud Ahmed H. , Saad Yasmin , Elbaz Tamer M. , Soliman Zeinab A. , Salah Ayman , Lithy Rania , Ahmed Mona , Nabil Mohamed M. 
Published: February 2018

Introduction
Survival of hepatocellular carcinoma (HCC) differs between regions and countries according to the different underlying factors and the degree of standard of care that enables early diagnosis and management. Our aim was to identify the most potent predictive factors of survival in Egyptian HCC patients receiving curative or palliative treatments.

Patients and methods
This retrospective study included 1302 HCC patients attending the HCC multidisciplinary clinic, Cairo University, between February 2009 and December 2016. Clinical, laboratory, tumor characteristics, and treatment data were collected. Prognostic scores for each of the treatment categories, curative or palliative, were developed using routine laboratory tests.

Results
Patients were predominantly men, mean age 57.79±7.56 years. All cases developed HCC in addition to cirrhosis, mainly hepatitis C virus-related (88.2%). Most of the patients were Child–Pugh A (56.8%) or B (34.4%) and had single lesions. Transarterial chemoembolization was the most common line of treatment (42.08%). The overall median survival was 18.3 months from the date of diagnosis. Cigarette smoking, Child–Pugh score, performance status, number and size of the focal lesion, α-fetoprotein, and application of a specific treatment, particularly curative treatment, were the significant independent prognostic factors for survival. We found no impact of diabetes mellitus or hypertension on survival. Multidisciplinary HCC clinic predictive scores of survival after palliative and curative treatments were developed including independent prognostic factors, age, and portal vein status.

Conclusion
A new Egyptian prognostic score of tumor and patients factors can predict the survival of patients with HCC after palliative and curative treatments.
Expansion Vibration Lipofilling: A New Technique in Large-Volume Fat Transplantation
Authors: Del Vecchio Daniel , Wall Simeon 
Published: February 2018

Background:
Despite rapid growth, gluteal fat transplantation is an operation in search of science and a teachable technique. Long operating times, tedious syringe transfers, inability to shape the recipient site, and the risk of fat embolism all headline as impediments to clinical adoption of the procedure. Expansion vibration lipofilling is a syringe-free surgical strategy that is a logical extension of Separation, Aspiration, and Fat Equalization (SAFELipo). In expansion vibration lipofilling, there is simultaneous disruption of recipient-site connective tissue, internal expansion using exploded-tip cannulas, and backfilling of these spaces with roller pump–propelled fat.

Methods:
Two thousand four hundred nineteen consecutive cases of expansion vibration lipofilling fat transplantation to the buttocks were reviewed. Average follow-up was 12 months. The technique of expansion vibration lipofilling is dependent on the use of larger caliber cannulas attached to a roller pump and to an oscillatory power-assisted liposuction device, which is less labor-intensive, potentially allowing for better knowledge of cannula-tip location at all times during the procedure.

Results:
Operating times averaged 1 hour 40 minutes. The average volume of fat inserted was 1003 cc. Complications included donor-site seroma, infection, and one pulmonary embolism treated with anticoagulation. There were no cases of fat embolism or death.

Conclusions:
Expansion vibration lipofilling is a new method for large-volume fat transplantation. Avoidance of fatal fat emboli demands a surgeon’s complete knowledge of cannula tip location at all times during the procedure. Syringe-free, larger caliber, and less flexible cannulas, combined with techniques requiring less operator upper extremity effort resulting in less fatigue, may contribute to avoidance of this dreadful complication.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Elevated Cell-Free Mitochondrial DNA in Filtered Plasma Is Associated With HIV Infection and Inflammation
Authors: Arshad Omair , Gadawska Izabella , Sattha Beheroze , Côté Hélène C. F. , Hsieh Anthony Y. Y. ,   for the Canadian Institutes of Health Research Team on Cellular Aging and HIV Comorbidities in Women and Children (CARMA)
Published: February 2018

Background:
Increased cell-free DNA levels are associated with poor health outcomes, and cell-free mitochondrial DNA (cf-mtDNA) has proinflammatory properties. Given that HIV infection is associated with chronic inflammation, we investigated the relationship between cf-mtDNA and proinflammatory cytokine interleukin-6 (IL-6) in the context of HIV infection. We also optimized separation of cell-free plasma from blood.

Setting:
In this retrospective cross-sectional study, we collected blood, demographic information, and clinical data from 99 HIV-infected and 103 HIV-uninfected adults and children enrolled in the Children and Women: AntiRetrovirals and Markers of Aging pan-Canadian (CARMA) cohort.

Methods:
Plasma was separated from blood by 14,000g centrifugation followed by 0.45-μm filtration to remove cells and platelets. Cf-mtDNA and cell-free nuclear DNA were quantified simultaneously via monochrome, multiplex, quantitative polymerase chain reaction. IL-6 was measured using enzyme-linked immunosorbent assay.

Results:
Higher speed centrifugation and filtration was necessary to isolate truly cell-free plasma. Higher cf-mtDNA levels were univariately associated with HIV infection, elevated IL-6 levels, younger age, higher white blood cell count, and higher cell-free nuclear DNA levels but not blood mtDNA content or HIV viral load. In a multivariable model, HIV infection (P < 0.001), elevated IL-6 (P = 0.021), younger age (P < 0.001), and higher blood nDNA levels (P = 0.007) were independently associated with higher cf-mtDNA.

Conclusions:
People living with HIV have higher levels of circulating cf-mtDNA than their uninfected peers. Increased levels of inflammatory marker IL-6 are associated with elevated cf-mtDNA, independent of the effect of HIV infection. Higher cf-mtDNA levels and white blood cell count in younger people may reflect higher cell turnover in that population.
99mTc-MDP SPECT-CT and Ultrasound in the Diagnosis and Staging of Thyroid Metastasis From Osteosarcoma
Authors: Roll Wolfgang , Weckesser Matthias , Pöppelmann Monika , Schiborr Manfred , Schäfers Michael , Rahbar Kambiz 
Published: February 2018

AbstractThe classification of thyroid nodules in children is often difficult, especially in pretreated patients with metastatic disease. In osteosarcoma patients,99mTc-MDP SPECT/CT is used for primary and follow-up staging. Bone and soft tissue metastases can be revealed because of99mTc-MDP imaging of osteoid-producing metastases. We present99mTc-MDP SPECT-CT, CT, and ultrasound images of a highly suspicious calcified thyroid lesion in a 17-year-old boy with osteosarcoma. High uptake in99mTc-MDP SPECT-CT provides diagnosis of thyroid metastasis of osteosarcoma, which was proven by histopathology.
Seizure-Induced Increased 18F-DOPA Uptake in a Child With Diffuse Astrocytoma and Transient Brain MRI Abnormalities Related to Status Epilepticus
Authors: Morana Giovanni , Bottoni Gianluca , Mancardi Maria Margherita , Verrico Antonio , Piccardo Arnoldo 
Published: February 2018

Abstract
We report the finding of increased 18F-DOPA uptake in the brain parenchyma surrounding a temporoparietal low-grade diffuse astrocytoma and corresponding to transient seizure-induced MRI abnormalities. There was concomitant markedly increased tumoral uptake. This 18F-DOPA PET phenomenon may represent increased amino acid transport induced by seizures. In the setting of brain tumor imaging, increased 18F-DOPA uptake of low-grade epileptogenic tumors and adjacent brain parenchyma should be carefully interpreted in light of clinical and electroencephalographic findings related to seizure activity.
The Impact of Surgeons on the Likelihood of Mastectomy in Breast Cancer
Authors: Boero Isabel J. , Paravati Anthony J. , Hou Jiayi , Gillespie Erin F. , Schoenbrunner Anna , Unkart Jonathan , Wallace Anne M. , Einck John P. , Mell Loren K. , Murphy James D. 
Published: February 2018

Objective:
This study evaluates the impact of individual surgeons and institutions on the use of mastectomy or breast conserving surgery (BCS) among elderly women with breast cancer.

Summary of Background Data:
Current literature characterizes patient clinical and demographic factors that increase likelihood of mastectomy use. However, the impact of the individual provider or institution is not well understood, and could provide key insights to biases in the decision-making process.

Methods:
A retrospective cohort study of 29,358 women 65 years or older derived from the SEER-Medicare linked database with localized breast cancer diagnosed from 2000 to 2009. Multilevel, multivariable logistic models were employed, with odds ratios (ORs) used to describe the impact of demographic or clinical covariates, and the median OR (MOR) used to describe the relative impact of the surgeon and institution.

Results:
Six thousand five hundred ninety-four women (22.4%) underwent mastectomy. Unadjusted rates of mastectomy ranged from 0% in the bottom quintile of surgeons to 58.0% in the top quintile. On multivariable analysis, the individual surgeon (MOR 1.97) had a greater impact on mastectomy than did the institution (MOR 1.71) or all other clinical and demographic variables except tumor size (OR 3.06) and nodal status (OR 2.95). Surgeons with more years in practice, or those with a lower case volume were more likely to perform mastectomy (P < 0.05).

Conclusion:
The individual surgeon influences the likelihood of mastectomy for the treatment of localized breast cancer. Further research should focus on physician-related biases that influence this decision to ensure patient autonomy.
An Economic Evaluation of the National Surgical Quality Improvement Program (NSQIP) in Alberta, Canada
Authors: Thanh Nguyen X. , Baron Tim , Litvinchuk Stacey 
Published: February 2018

Objective:
The aim of this study was to analyze the health care costs and savings associated with quality improvement (QI) interventions initiated and implemented utilizing NSQIP.

Background:
Five acute care facilities of Alberta Health Services (AHS) adopted NSQIP in 2015 for a pilot project.

Methods:
The cost-savings of NSQIP were estimated from the start of NSQIP to the end of 2017 under an AHS perspective using this formula: Gross cost-savings = N ∗ (p1 – p2) ∗ unit cost, where N was the number of surgical patients after the intervention, p1 was the probability of event occurrence (within 30 days of surgery) before the intervention, p2 was the probability of event occurrence after the intervention, and unit cost is health care cost per event. To calculate the net cost-savings, we deducted the costs of NSQIP and its interventions from the gross cost-savings.

Results:
The QI initiatives initiated by NSQIP to reduce surgical events had significant impacts clinically and economically. The gross cost-savings of NSQIP were estimated at $11.4 million. Subtracting the costs of NSQIP and its interventions ($2.6 million) from the gross cost-savings, the net cost-savings were $8.8 million. The return on investment ratio was 4.3, meaning that every $1.00 invested in NSQIP would bring $4.30 in returns. The sensitivity analysis showed the probability for NSQIP to be cost-saving was 95%.

Conclusion:
QI interventions initiated and implemented utilizing NSQIP appear to be effective and cost-saving for AHS. These cost-savings would be even larger if NSQIP was prolonged in the pilot sites and/or expanded to other sites across the province.
Resident Autonomy in the Operating Room
Authors: Chen Xiaodong (Phoenix) , Sullivan Amy M. , Smink Douglas S. , Alseidi Adnan , Bengtson Joan M. , Kwakye Gifty , Dalrymple John L. 
Published: February 2018

Objective:
This study aimed to identify the empirical processes and evidence that expert surgical teachers use to determine whether to take over certain steps or entrust the resident with autonomy to proceed during an operation.

Background:
Assessing real-time entrustability is inherent in attending surgeons’ determinations of residents’ intraoperative autonomy in the operating room. To promote residents’ autonomy, it is necessary to understand how attending surgeons evaluate residents’ performance and support opportunities for independent practice based on the assessment of their entrustability.

Methods:
We conducted qualitative semi-structured interviews with 43 expert surgical teachers from 21 institutions across 4 regions of the United States, using purposeful and snowball sampling. Participants represented a range of program types, program size, and clinical expertise. We applied the Framework Method of content analysis to iteratively analyze interview transcripts and identify emergent themes.

Results:
We identified a 3-phase process used by most expert surgical teachers in determining whether to take over intraoperatively or entrust the resident to proceed, including 1) monitoring performance and “red flags,” 2) assessing entrustability, and 3) granting autonomy. Factors associated with individual surgeons (eg, level of comfort, experience, leadership role) and the context (eg, patient safety, case, and time) influenced expert surgical teachers’ determinations of entrustability and residents’ final autonomy.

Conclusion:
Expert surgical teachers’ 3-phase process of decisions on take-over provides a potential framework that may help surgeons identify appropriate opportunities to develop residents’ progressive autonomy by engaging the resident in the determination of entrustability before deciding to take over.
A High-Resolution Genetic Map for the Laboratory Rat
Authors: Littrell John , Tsaih Shirng-Wern , Baud Amelie , Rastas Pasi , Solberg-Woods Leah , Flister Michael J 
Published: February 2018

ABSTRACTAn accurate and high-resolution genetic map is critical for mapping complex traits, yet the resolution of the current rat genetic map is far lower than human and mouse, and has not been updated since the original ensen-Seaman map in 2004. For the first time, we have refined the rat genetic map to sub-centimorgan (cM) r solution (<0.02 cM) by using 95,769 genetic markers and 870 informative meioses from a cohort of 528 heterogeneous stock (HS) rats. Global recombination rates in the revised sex-averaged map (0.66 cM/Mb) did not difeer compared to the historical map (0.65 cM/Mb); however, substantial refinement was made to the localization of highly recombinant regions within the revised map. Also for the first time, sex-specific rat genetic maps were generated, which revealed both genomewide and fine-scale variation in recombination rates between male and female rats. Reanalysis of multiple quantitative trait loci (QTL) using the historical and refined rat genetic maps demonstrated marked changes to QTL localization, shape, and effect size. As a resource to the rat research community, we have provided revised centimorgan positions for all physical positions within the rat genome and commonly used genetic markers for trait mapping, including 44,828 SSLP markers and the RATDIV genotyping array. Collectively, this study provides a substantial improvement to the rat genetic map and an unprecedented resource for analysis of complex traits and recombination in the rat.
TRPV4 is the temperature-sensitive ion channel of human sperm
Authors: Mundt Nadine , Spehr Marc , Lishko Polina V. 
Published: February 2018

AbstractIon channels control sperm fertilizing ability by triggering hyperactivated motility, which is regulated by membrane potential, intracellular pH, and cytosolic calcium. Previous studies unraveled three essential ion channels that regulate these parameters: 1) the Ca2+channel CatSper, 2) the K+channel KSper, and 3) the H+channel Hv1. However, the molecular identity of an additional sperm Na+conductance that mediates initial membrane depolarization and, thus, triggers downstream signaling events is yet to be defined. Here, we functionally characterize DSper, the Depolarizing Channel of Sperm, as the temperature-activated channel TRPV4. It is functionally expressed at both mRNA and protein levels, while other temperature-sensitive TRPV channels are not functional in human sperm. DSper currents are activated by warm temperatures and mediate cation conductance, that shares a pharmacological profile reminiscent of TRPV4. Together, these results suggest that TRPV4 activation triggers initial membrane depolarization, facilitating both CatSper and Hv1 gating and, consequently, sperm hyperactivation.
Growth- and stress-related defects associated to wall hypoacetylation are strigolactone-dependent
Authors: Ramírez Vicente , Xiong Guangyan , Mashiguchi Kiyoshi , Yamaguchi Shinjiro , Pauly Markus 
Published: February 2018

ABSTRACTMutants affected in the Arabidopsis TBL29/ESK1 xylan O-acetyltransferase display a strong reduction in total wall O-acetylation accompanied by a dwarfed plant stature, collapsed xylem morphology, and enhanced freezing tolerance. A newly identified tbl29/esk1 suppressor mutation affects the biosynthesis of strigolactones (SL) due to the reduced expression of the MAX4 gene. Genetic and biochemical evidence suggests that blocking the biosynthesis of SL is sufficient to recover all developmental and stress-related defects associated with the TBL29/ESK1 loss of function without affecting its direct effect - reduced wall O-acetylation. Altered levels of the MAX4 SL biosynthetic gene, reduced branch number, and higher levels of methyl carlactonoate, an active SL, were also found in tbl29/esk1 plants consistent with a constitutive activation of the SL pathway. These results indicate that the reduction of O-acetyl substituents in xylan is not directly responsible for the observed tbl29/esk1 phenotypes. Alternatively, plants may perceive defects in the structure of wall polymers and/or wall architecture activating the SL hormonal pathway as a compensatory mechanism.
Matrin 3-dependent neurotoxicity is modified by nucleic acid binding and nucleocytoplasmic localization
Authors: Malik Ahmed M. , Miguez Roberto A. , Li Xingli , Ho Ye-Shih , Feldman Eva L. , Barmada Sami J. 
Published: February 2018

ABSTRACTAbnormalities in nucleic acid processing are associated with the development of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). Mutations inMatrin 3(MATR3), a poorly understood DNA- and RNA-binding protein, cause familial ALS/FTD, and MATR3 pathology is a feature of sporadic disease, suggesting that MATR3 dysfunction is integrally linked to ALS pathogenesis. Using a primary neuron model to assess MATR3-mediated toxicity, we noted that neurons were bidirectionally vulnerable to MATR3 levels, with pathogenic MATR3 mutants displaying enhanced toxicity. MATR3’s zinc finger domains partially modulated toxicity, but elimination of its RNA recognition motifs had no effect on neuronal survival, instead facilitating its self-assembly into liquid-like droplets. In contrast to other RNA-binding proteins associated with ALS, cytoplasmic MATR3 redistribution mitigated neurodegeneration, suggesting that nuclear MATR3 mediates toxicity. Our findings offer a foundation for understanding MATR3-related neurodegeneration and how nucleic acid binding functions, localization, and pathogenic mutations drive sporadic and familial disease.