bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ethyl pyruvate attenuates ventilation‐induced diaphragm dysfunction through high‐mobility group box‐1 in a murine endotoxaemia model
Authors: Liu Yung‐Yang , Chen Ning‐Hung , Chang Chih‐Hao , Lin Shih‐Wei , Kao Kuo‐Chin , Hu Han‐Chung , Chang Gwo‐Jyh , Li Li‐Fu 
Published: June 2019

AbstractMechanical ventilation (MV) can save the lives of patients with sepsis. However, MV in both animal and human studies has resulted in ventilator‐induced diaphragm dysfunction (VIDD). Sepsis may promote skeletal muscle atrophy in critically ill patients. Elevated high‐mobility group box‐1 (HMGB1) levels are associated with patients requiring long‐term MV. Ethyl pyruvate (EP) has been demonstrated to lengthen survival in patients with severe sepsis. We hypothesized that the administration of HMGB1 inhibitor EP or anti‐HMGB1 antibody could attenuate sepsis‐exacerbated VIDD by repressing HMGB1 signalling. Male C57BL/6 mice with or without endotoxaemia were exposed to MV (10 mL/kg) for 8 hours after administrating either 100 mg/kg of EP or 100 mg/kg of anti‐HMGB1 antibody. Mice exposed to MV with endotoxaemia experienced augmented VIDD, as indicated by elevated proteolytic, apoptotic and autophagic parameters. Additionally, disarrayed myofibrils and disrupted mitochondrial ultrastructures, as well as increased HMGB1 mRNA and protein expression, and plasminogen activator inhibitor‐1 protein, oxidative stress, autophagosomes and myonuclear apoptosis were also observed. However, MV suppressed mitochondrial cytochrome C and diaphragm contractility in mice with endotoxaemia (P < 0.05). These deleterious effects were alleviated by pharmacologic inhibition with EP or anti‐HMGB1 antibody (P < 0.05). Our data suggest that EP attenuates endotoxin‐enhanced VIDD by inhibiting HMGB1 signalling pathway.
Robot‐assisted laparoscopic management of a vascular entrapment of the sacral nerve roots causing pelvic pain
Authors: Taner Usta , Aysel Ozkaynak , Ahmet Kale , Gulfem Basol 
Published: June 2019

AbstractThe aim of this case report is to demonstrate the robot‐assisted laparoscopic decompression approach to treat the aberrant vessels entrapping the sacral nerves causing pelvic pain. A 34‐year‐old female patient had been complaining about pelvic pain on the left perineal region which was radiating to the sacral 1–2 nerves dermatome for 3 years. Decompression of sacral nerve roots and sciatic nerve was performed via robot‐assisted and a four‐arm Da Vinci Si Surgical System laparoscopic approach. This case report is the first presentation of robot‐assisted laparoscopic management of a vascular entrapment of the sacral nerve roots. The robotic technique offers, three‐dimensional vision, improved maneuverability and enhanced ergonomics in the deepest area in the pelvis and could be a valid alternative to laparoscopy in the treatment of intrapelvic neurovascular entrapments.
Trainee perception of cognitive load during observed faculty staff teaching of procedural skills
Authors: Sewell Justin L , Young John Q , Boscardin Christy K , ten Cate Olle , O'Sullivan Patricia S 
Published: June 2019

ObjectivesAlthough teachers impact learners’ cognitive load, how specific teaching activities affect intrinsic, germane and extraneous load during procedural skills training is unknown. We sought to characterise teaching activities used in the exemplar procedural setting of colonoscopy, and to explore how they were enacted and how learners perceived them as affecting intrinsic, germane and extraneous cognitive load.MethodsWe observed 10 colonoscopies performed by eight different gastroenterology fellows and supervised by 10 different attending physicians at two hospitals, and recorded the teaching activities observed, as well as details of when they were used and how they were enacted. After the colonoscopy, each fellow completed the Cognitive Load Inventory for Colonoscopy to quantify intrinsic, germane and extraneous load. We then interviewed each fellow to determine how he or she perceived teaching as affecting cognitive load. Qualitative data were subjected to content analysis. Instances of germane load‐promoting activities were correlated with measured germane load.ResultsWe observed 515 instances of teaching activities. The intensity of teaching varied substantially, ranging from 0.7 to 3.3 activities per minute, as did the pattern of teaching activities used by different attending physicians. Little teaching occurred immediately before or after a procedure. Fellows usually perceived teaching as affecting cognitive load in ways that promoted learning, particularly by reducing intrinsic load and increasing germane load. Fellows strongly perceived that the provision of autonomy promoted germane load. Conversely, fellows perceived that excessive teaching increased extraneous load. Instances of germane load‐promoting teaching activities correlated moderately with measured germane load.ConclusionsTeaching in the exemplar procedural setting of colonoscopy affected learners’ cognitive load in mostly beneficial ways, yet even ‘good’ teaching activities had detrimental effects when used excessively. Teachers of procedures should consider learner experience, task complexity and environmental factors to modulate the modality, content and intensity of teaching to promote balanced cognitive load and learning. Teaching more reservedly during the procedure and taking advantage of pre‐ and post‐procedure opportunities may help.
Intratumoural immune cell landscape in germinoma reveals multipotent lineages and exhibits prognostic significance
Authors: Takami H. , Fukushima S. , Aoki K. , Satomi K. , Narumi K. , Hama N. , Matsushita Y. , Fukuoka K. , Yamasaki K. , Nakamura T. , Mukasa A. , Saito N. , Suzuki T. , Yanagisawa T. , Nakamura H. , Sugiyama K. , Tamura K. , Maehara T. , Nakada M. , Nonaka M. , Asai A. , Yokogami K. , Takeshima H. , Iuchi T. , Kanemura Y. , Kobayashi K. , Nagane M. , Kurozumi K. , Yoshimoto K. , Matsuda M. , Matsumura A. , Hirose Y. , Tokuyama T. , Kumabe T. , Ueki K. , Narita Y. , Shibui S. , Totoki Y. , Shibata T. , Nakazato Y. , Nishikawa R. , Matsutani M. , Ichimura K. ,   the Intracranial Germ Cell Tumor Genome Analysis Consortium (the iGCT Consortium)
Published: June 2019

AimsAlterations in microenvironments are a hallmark of cancer, and these alterations in germinomas are of particular significance. Germinoma, the most common subtype of central nervous system germ cell tumours, often exhibits massive immune cell infiltration intermingled with tumour cells. The role of these immune cells in germinoma, however, remains unknown.MethodsWe investigated the cellular constituents of immune microenvironments and their clinical impacts on prognosis in 100 germinoma cases.ResultsPatients with germinomas lower in tumour cell content (i.e. higher immune cell infiltration) had a significantly longer progression‐free survival time than those with higher tumour cell contents (P = 0.03). Transcriptome analyses and RNA in‐situ hybridization indicated that infiltrating immune cells comprised a wide variety of cell types, including lymphocytes and myelocyte‐lineage cells. High expression of CD4 was significantly associated with good prognosis, whereas elevated nitric oxide synthase 2 was associated with poor prognosis. PD1 (PDCD1) was expressed by immune cells present in most germinomas (93.8%), and PD‐L1 (CD274) expression was found in tumour cells in the majority of germinomas examined (73.5%).ConclusionsThe collective data strongly suggest that infiltrating immune cells play an important role in predicting treatment response. Further investigation should lead to additional categorization of germinoma to safely reduce treatment intensity depending on tumour/immune cell balance and to develop possible future immunotherapies.
Increased matrix metalloproteinases expression in tuberous sclerosis complex: modulation by microRNA 146a and 147bin vitro
Authors: Broekaart D. W. M. , van Scheppingen J. , Anink J. J. , Wierts L. , van het Hof B. , Jansen F. E. , Spliet W. G. , van Rijen P. C. , Kamphuis W. W. , de Vries H. E. , Aronica E. , van Vliet E. A. 
Published: June 2019

AimMatrix metalloproteinases (MMPs) and their endogenous tissue inhibitors (TIMPs) control proteolysis within the extracellular matrix (ECM) of the brain. Dysfunction of this enzymatic system due to brain inflammation can disrupt the blood‐brain barrier (BBB) and has been implicated in the pathogenesis of epilepsy. However, this has not been extensively studied in the epileptogenic human brain.MethodsWe investigated the expression and cellular localization of major MMPs (MMP2, MMP3, MMP9 and MMP14) and TIMPs (TIMP1, TIMP2, TIMP3 and TIMP4) using quantitative real‐time polymerase chain reaction (RT‐PCR) and immunohistochemistry in resected epileptogenic brain tissue from patients with tuberous sclerosis complex (TSC), a severe neurodevelopmental disorder characterized by intractable epilepsy and prominent neuroinflammation. Furthermore, we determined whether anti‐inflammatory microRNAs, miR146a and miR147b, which can regulate gene expression at the transcriptional level, could attenuate dysregulated MMP and TIMP expression in TSC tuber‐derived astroglial cultures.ResultsWe demonstrated higher mRNA and protein expression of MMPs and TIMPs in TSC tubers compared to control and perituberal brain tissue, particularly in dysmorphic neurons and giant cells, as well as in reactive astrocytes, which was associated with BBB dysfunction. More importantly, IL‐1β‐induced dysregulation ofMMP3,TIMP2,TIMP3 and TIMP4could be rescued by miR146a and miR147b in tuber‐derived TSC cultures.ConclusionsThis study provides evidence of dysregulation of the MMP/TIMP proteolytic system in TSC, which is associated with BBB dysfunction. As dysregulated MMP and TIMP expression can be amelioratedin vitroby miR146a and miR147b, these miRNAs deserve further investigation as a novel therapeutic approach.
Calcium signals in guard cells enhance the efficiency by which abscisic acid triggers stomatal closure
Authors: Huang Shouguang , Waadt Rainer , Nuhkat Maris , Kollist Hannes , Hedrich Rainer , Roelfsema M. Rob G. 
Published: June 2019

Summary

During drought, abscisic acid (ABA) induces closure of stomata via a signaling pathway that involves the calcium (Ca2+)‐independent protein kinase OST1, as well as Ca2+‐dependent protein kinases. However, the interconnection between OST1 and Ca2+ signaling in ABA‐induced stomatal closure has not been fully resolved.

ABA‐induced Ca2+ signals were monitored in intact Arabidopsis leaves, which express the ratiometric Ca2+ reporter R‐GECO1‐mTurquoise and the Ca2+‐dependent activation of S‐type anion channels was recorded with intracellular double‐barreled microelectrodes.

ABA triggered Ca2+ signals that occurred during the initiation period, as well as in the acceleration phase of stomatal closure. However, a subset of stomata closed in the absence of Ca2+ signals. On average, stomata closed faster if Ca2+ signals were elicited during the ABA response. Loss of OST1 prevented ABA‐induced stomatal closure and repressed Ca2+ signals, whereas elevation of the cytosolic Ca2+ concentration caused a rapid activation of SLAC1 and SLAH3 anion channels.

Our data show that the majority of Ca2+ signals are evoked during the acceleration phase of stomatal closure, which is initiated by OST1. These Ca2+ signals are likely to activate Ca2+‐dependent protein kinases, which enhance the activity of S‐type anion channels and boost stomatal closure.
A safe minimum standard, the elasticity of substitution, and the cleanup of the Ganges in Varanasi
Authors: Xing Shiqi , Batabyal Amitrajeet A. 
Published: June 2019

AbstractDespite repeated calls for a thorough cleanup of water pollution in the Ganges river, there are only two papers in the social sciences by Batabyal and Beladi (2017, 2019) that have shed theoretical light on this cleanup problem and its connection to the sustainability of tourism in Varanasi. Hence, we extend the above‐mentioned analyses and focus on two specific questions. First, we introduce the notion of a safe minimum standard (SMS) into the study and show how to analyze a probabilistic model of the Ganges cleanup problem when the SMS is accounted for. Second, for a representative citizen of Varanasi, we study how the magnitude of the elasticity of substitution between a composite consumption good and water quality in the Ganges—modeled by the SMS—affects the tradeoff between consumption and water quality maintenance.
Haemophilus influenzae type b vaccination and anthropometric, cognitive, and schooling outcomes among Indian children
Authors: Nandi Arindam , Deolalikar Anil B. , Bloom David E. , Laxminarayan Ramanan 
Published: June 2019

AbstractHaemophilus influenzae type b (Hib) affects 337,000 Indian children every year. A vaccine against Hib was introduced in 2011 as part of the pentavalent vaccine and scaled up nationwide. This study investigated the associations between Hib vaccination and child anthropometry, cognition, and schooling outcomes in India. We used longitudinal survey data and employed propensity score matching to control for observed systematic differences between children who reported receipt or nonreceipt of Hib vaccine before age 6 years (n = 1824). Z‐scores of height‐for‐age (HAZ) and BMI‐for‐age (BMIZ), percentage scores of English, mathematics, reading, and Peabody Picture Vocabulary tests, and attained schooling grade of children were examined. Hib‐vaccinated children had 0.25 higher HAZ, scored 4.09 percentage points (pp) higher on the English test and 4.78 pp higher on the mathematics test, and attained 0.16 more schooling grades than Hib‐unvaccinated children at age 11–12 years. At age 14–15 years, they had 0.18 higher HAZ, scored 3.63 pp higher on the reading test and 3.22 pp higher on the mathematics test, and attained 0.15 more schooling grades than Hib‐unvaccinated children. The findings indicate potential long‐term health, cognitive, and schooling benefits of the Hib vaccine, subject to the effect of unobserved confounding factors.
Technical Note: Pedicle Cement Augmentation with Proximal Screw Toggle and Loosening
Authors: Choy Wen Jie , Walsh William R , Phan Kevin , Mobbs Ralph J 
Published: June 2019

BackgroundCement augmentation is a technique used to increase the stability and purchase of pedicle screws in poor quality bone. Various methods can be applied for cement delivery, such as cement injection before screw placement and the use of fenestrated screws. However, potential problems can arise with the use of cement augmentation.Case PresentationA 66‐year‐old man with a lower trunk deformity, severe kyphosis, and sagittal imbalance following fusion (L2‐5), with minimal comorbidities, was referred to our unit 9 months after surgery. Pain and progressive kyphosis were investigated clinically and radiographically with computed tomography (CT) scans to assess the status of the hardware and fusion. CT imaging revealed that cement was present only at the distal tip of the fenestrated screws at the L4 vertebral level. A non‐union was present along with loosening and a halo around the body of the pedicle screws, and there was evidence of pullout of inferior screws.ConclusionSingle‐level cement augmentation of pedicle screw in a posterior construct and distal tip cement augmentation of the screw results in a fixed pivot point. Micromotion in cranio‐caudal loading during flexion and extension may result in screw toggling with the single‐level cement‐augmented tip as a fulcrum. This may cause screw loosening, which can lead to pullout and loss of construct stability. The halo around the screw suggests bone loss and/or a fibrous tissue interface, which further complicates revision surgery. Stress shielding and polymethylmethacrylate cement present additional difficulties.The findings of this technical note question the risks and benefits of cement‐augmented fenestrated pedicle screw fixation for spinal fusion. Although incidences of such cases are uncommon, surgeons should perform this technique with caution. Accurate restoration of lumbar lordosis during index procedures is important to minimize the risk of construct failure.
Bilateral caudal maxillectomy for resection of tumors crossing palatal midline and use of the angularis oris axial pattern flap for primary closure or dehiscence repair in two dogs
Authors: Tuohy Joanne L. , Worley Deanna R. , Wustefeld‐Janssens Brandan G. , Mickelson Megan A. , Ehrhart Nicole P. , Seguin Bernard 
Published: June 2019

AbstractObjectiveTo describe the technique and outcomes for bilateral caudal maxillectomy for resection of large caudal maxillary tumors crossing palatal midline in two dogs.Study designClinical case report.AnimalsTwo client‐owned dogs.MethodsTwo client‐owned dogs with primary caudal maxillary tumors, a poorly differentiated sarcoma, and a multilobulated osteochondrosarcoma. Bilateral caudal maxillectomies were performed for curative‐intent resection of these tumors. The angularis oris axial pattern flap was used for primary closure in one dog and for dehiscence repair in the other.ResultsBoth tumors were resected with complete histologic margins. The defects were closed with local buccal mucosal flaps, with or without a unilateral angularis oris flap. Esophagostomy tubes were placed at time of surgery to bypass oral feeding. Incisional dehiscence and subsequent oronasal fistula formation occurred as a postoperative complication in both dogs (3 and 10 days, respectively). Both were successfully repaired with a combination of local buccal mucosal flaps and the angularis oris flap. Both dogs had good functional outcome and quality of life after recovery from revision surgery.ConclusionBilateral caudal maxillectomy allowed resection of caudal maxillary tumors crossing palatal midline, with good function and quality of life after recovery in 2 dogs.Clinical significanceGood outcomes including complete resections are achievable with bilateral caudal maxillectomy despite complications. Local mucosal and axial pattern flaps can be used for dehiscence repair.
Development of a prediction model for 30-day acute readmissions among older medical patients: the influence of social factors along with other patient-specific and organisational factors
Authors: Lehn Sara Fokdal , Zwisler Ann-Dorthe , Pedersen Solvejg Gram Henneberg , Gjørup Thomas , Thygesen Lau Caspar 
Published: June 2019

BackgroundReadmission rate is one way to measure quality of care for older patients. Knowledge is sparse on how different social factors can contribute to predict readmission. We aimed to develop and internally validate a comprehensive model for prediction of acute 30-day readmission among older medical patients using various social factors along with demographic, organisational and health-related factors.MethodsWe performed an observational prospective study based on a group of 770 medical patients aged 65 years or older, who were consecutively screened for readmission risk factors at an acute care university hospital during the period from February to September 2012. Data on outcome and candidate predictors were obtained from clinical screening and administrative registers. We used multiple logistic regression analyses with backward selection of predictors. Measures of model performance and performed internal validation were calculated.ResultsTwenty percent of patients were readmitted within 30 days from index discharge. The final model showed that low educational level, along with male gender, contact with emergency doctor, specific diagnosis, higher Charlson Comorbidity Index score, longer hospital stay, cognitive problems, and medical treatment for thyroid disease, acid-related disorders, and glaucoma, predicted acute 30-day readmission. Area under the receiver operating characteristic curve (0.70) indicated acceptable discriminative ability of the model. Calibration slope was 0.98 and calibration intercept was 0.01. In internal validation analysis, both discrimination and calibration measures were stable.ConclusionsWe developed a model for prediction of readmission among older medical patients. The model showed that social factors in the form of educational level along with demographic, organisational and health-related factors contributed to prediction of acute 30-day readmissions among older medical patients.
Risk Factors and Long-Term Clinical Outcomes of Second-Generation Drug-Eluting Stent Thrombosis
Authors: Kuramitsu Shoichi , Ohya Masanobu , Shinozaki Tomohiro , Otake Hiromasa , Horie Kazunori , Kawamoto Hiroyoshi , Yamanaka Futoshi , Natsuaki Masahiro , Shiomi Hiroki , Nakazawa Gaku , Ando Kenji , Kadota Kazushige , Saito Shigeru , Kimura Takeshi ,   on behalf of the REAL-ST Investigators
Published: June 2019

Background:
The risk factors and long-term clinical outcomes of patients with definite stent thrombosis (ST) after second-generation drug-eluting stent (DES) implantation have not yet been adequately assessed.

Methods and Results:

The REAL-ST (Retrospective Multicenter Registry of ST After First- and Second-Generation DES Implantation) included 313 definite ST of second-generation DES (early ST, n=179; late ST, n=66; very late ST, n=68). Four patients without definite ST of second-generation DES were identified as control patients for each ST case. Risk factors of definite ST were mostly different according to the timing of ST: ST-segment–elevation myocardial infarction, non–ST-segment–elevation myocardial infarction, and unstable angina at presentation, current smoking, left ventricular ejection fraction <40%, prior percutaneous coronary intervention, stent overlap, severely calcified lesion, left main coronary artery lesion, proximal left anterior descending lesion, postdiameter stenosis ≥20%, for early ST; age <70 years, ST-segment–elevation myocardial infarction at presentation, hemodialysis, left ventricular ejection fraction <40%, in-stent restenosis, and severely calcified lesion for late ST; and proximal left anterior descending lesion and in-stent restenosis for very late ST. Cumulative 4-year incidence of death after the index ST events was significantly higher in the ST patients than control patients (33.0% versus 12.3%,
P
<0.001 for early ST versus control; 30.6% versus 14.2%,
P
<0.001 for late ST versus control; and 28.0% versus 13.0%,
P
<0.001 for very late ST versus control, respectively).

Conclusions:
Risk factors of definite ST after second-generation DES implantation were mostly different according to the timing of ST. Definite ST patients showed unfavorable long-term clinical outcomes compared with those without definite ST.

Clinical Trial Registration:

URL:
https://www.umin.ac.jp
. Unique identifier: UMIN000025181.