bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Centralized Management of Bariatric Surgery Complications on 90-day Mortality
Authors: Caiazzo Robert , Baud Gregory , Clément Guillaume , Lenne Xavier , Torres Fanelly , Dezfoulian Guelareh , Lebuffe Gilles , Kipnis Eric , Dervaux Benoit , Pattou Francois 
Published: August 2018

Background and Aims:
The potential benefit of the centralization of Bariatric surgery (BS) remains debated. The aim of this study was to evaluate the impact on 90-day mortality of an innovative organization aiming at centralizing the care of severe postoperative complications of BS.

Study Design:
The centralization of care for postoperative complication after BS was implemented by French Authorities in 2013 in the Nord-Pas-de-Calais Region, France. This unique formalized network (OSEAN), coordinated by 1 tertiary referral center, enrolled all regional institutions performing bariatric surgery. Data were extracted from the medico-administrative database providing information on all patients undergoing BS between 2009 and 2016 in OSEAN (n = 22,928) and in Rest of France (n = 288,942). The primary outcome was the evolution of 90-day mortality before and after the implementation of this policy. Rest of France was used as a control group to adjust the results to improvement with time of BS outcomes.

Results:
The numbers of primary procedure and reoperations increased similarly before and after 2013 within OSEAN and in Rest of France. The 90-day mortality rate became significantly lower within OSEAN than in the rest of France after 2013 (0.03% vs 0.08%, P < 0.01). This difference was confirmed in multivariate analysis after adjustment to the procedure specific mortality (P < 0.04). The reduction of 90-day mortality was most visible for sleeve gastrectomy.

Conclusion:
The implementation of centralized care for early postoperative complications after BS in OSEAN was associated with reduced 90-day mortality. Our results indicate that this reduction was not due to a lower incidence of complications but to the improvement of their management.
Analysis of the Learning Curve and Patient Outcomes of Endovascular Repair of Thoracoabdominal Aortic Aneurysms Using Fenestrated and Branched Stent Grafts
Authors: Schneider Darren B. , Agrusa Christopher J. , Ellozy Sharif H. , Connolly Peter H. , Meltzer Andrew J. , Graham Ashley R. , Michelassi Fabrizio 
Published: August 2018

Objective:
To evaluate the outcomes and learning curve of fenestrated and branched endovascular repair (F/BEVAR) of thoracoabdominal aneurysms.

Summary of Background Data:
Endovascular aneurysm repair has reduced morbidity and mortality compared with open surgical repair. However, application to thoracoabdominal aneurysm repair remains limited by procedural complexity and device availability.

Methods:
Fifty patients treated in a prospective, nonrandomized, single-center Investigational Device Exemption (IDE) study between January 2014 and July 2017 were analyzed. Patients (mean age 75.6 ± 7.5 years; mean aneurysm diameter 67.3 ± 9.8 mm) underwent F/BEVAR of thoracoabdominal aneurysms (58% type IV; 42% type I-III) using custom-manufactured endografts. The experience was divided into 3 cohorts (Early: 1 to 17; Mid: 18 to 34; Late: 35 to 50) to evaluate learning curve effects on key process measures.

Results:
F/BEVAR included 194 visceral arteries (average 3.9 per patient). Technical success was 99.5% (193/194 targeted arteries). Thirty-day major adverse events (MAEs) included 3 (6%) deaths, 1 (2%) new-onset dialysis, 3 (6%) paraparesis/paraplegia, and 2 (4%) strokes. One-year survival was 79 ± 7%. Comparing the Early and Late groups revealed reductions in procedure time (452 ± 74 vs 362 ± 53 minutes; P = 0.0001), fluoroscopy time (130 ± 40 vs 99 ± 27 minutes; P = 0.016), contrast administration (157 ± 73 vs 108 ± 38 mL; P = 0.028), and estimated blood loss (EBL; 1003 ± 933 vs 481 ± 317 mL; P = 0.042). Intensive care unit (ICU) and total length of stay (LOS) decreased from 4 ± 3 to 2 ± 1 days and from 7 ± 6 to 5 ± 2 days, respectively, but was not statistically significant.

Conclusions:
Use of F/BEVAR for treatment of thoracoabdominal aneurysms is safe and effective. During this early experience, there was a significant improvement in key process measures reflecting improvements in technique and physician learning over time.
Preperitoneal Ventral Hernia Repair
Authors: Heniford B. Todd , Ross Samuel W. , Wormer Blair A. , Walters Amanda L. , Lincourt Amy E. , Colavita Paul D. , Kercher Kent W. , Augenstein Vedra A. 
Published: August 2018

Objectives:
The aim of this study was to examine the outcomes of over a decade's experience utilizing preperitoneal ventral hernia repair (PP-VHR).

Background:
PP-VHR was first described by our group in 2006, and there have been no subsequent reports of outcomes with this technique.

Methods:
A prospective study of all PP-VHR from January, 2004 to April, 2016 was performed. Multivariate stepwise logistic regression and Cox proportional-hazard models were used to identify predictors of wound complications and hernia recurrence, respectively.

Results:
There were 1023 PP-VHRs. Mean age was 57.2 ± 12.6 years, BMI 33.7 ± 11.4 kg/m2, defect size 210.0 ± 221.4 cm2; 23.7% had diabetes, 13.9% were smokers, 68.7% were recurrent, and 23.6% incarcerated. Component separation was required in 43.6%, and a panniculectomy was performed in 30.0%. Wound complication was present in 27.3% of patients, with 1.7% having a mesh infection. In all, there were 53 (5.2%) hernia recurrences and 36 (3.9%) in the synthetic repairs, with a mean follow-up of 27.0 ± 26.4 months. On multivariate regression (odds ratio or hazard ratio, 95% confidence interval), diabetes (1.9, 1.4–3.0), panniculectomy (2.6, 1.8–3.9), and operations requiring biologic mesh were predictors of wound complications, whereas recurrent hernia repair (2.69, 1.14–6.35), biologic mesh (3.1, 1.67–5.75), and wound complications (3.01, 1.69–5.39) were predictors of hernia recurrence.

Conclusions:
An open PP-VHR is a very effective means to repair large, complex, and recurrent hernias resulting in a low recurrence rate. Mesh choice in VHR is important and was associated with hernia recurrence and wound complications in this population.
Disease-free Survival and Local Recurrence for Laparoscopic Resection Compared With Open Resection of Stage II to III Rectal Cancer
Authors: Fleshman James , Branda Megan E. , Sargent Daniel J. , Boller Anne Marie , George Virgilio V. , Abbas Maher A. , Peters Walter R. , Maun Dipen C. , Chang George J. , Herline Alan , Fichera Alessandro , Mutch Matthew G. , Wexner Steven D. , Whiteford Mark H. , Marks John , Birnbaum Elisa , Margolin David A. , Larson David W. , Marcello Peter W. , Posner Mitchell C. , Read Thomas E. , Monson John R. T. , Wren Sherry M. , Pisters Peter W. T. , Nelson Heidi 
Published: August 2018

Objective:
To determine the disease-free survival (DFS) and recurrence after the treatment of patients with rectal cancer with open (OPEN) or laparoscopic (LAP) resection.

Background:
This randomized clinical trial (ACOSOG [Alliance] Z6051), performed between 2008 and 2013, compared LAP and OPEN resection of stage II/III rectal cancer, within 12 cm of the anal verge (T1-3, N0-2, M0) in patients who received neoadjuvant chemoradiotherapy. The rectum and mesorectum were resected using open instruments for rectal dissection (included hybrid hand-assisted laparoscopic) or with laparoscopic instruments under pneumoperitoneum. The 2-year DFS and recurrence were secondary endpoints of Z6051.

Methods:
The DFS and recurrence were not powered, and are being assessed for superiority. Recurrence was determined at 3, 6, 9, 12, and every 6 months thereafter, using carcinoembryonic antigen, physical examination, computed tomography, and colonoscopy. In all, 486 patients were randomized to LAP (243) or OPEN (243), with 462 eligible for analysis (LAP = 240 and OPEN = 222). Median follow-up is 47.9 months.

Results:
The 2-year DFS was LAP 79.5% (95% confidence interval [CI] 74.4–84.9) and OPEN 83.2% (95% CI 78.3–88.3). Local and regional recurrence was 4.6% LAP and 4.5% OPEN. Distant recurrence was 14.6% LAP and 16.7% OPEN.
Disease-free survival was impacted by unsuccessful resection (hazard ratio [HR] 1.87, 95% CI 1.21–2.91): composite of incomplete specimen (HR 1.65, 95% CI 0.85–3.18); positive circumferential resection margins (HR 2.31, 95% CI 1.40–3.79); positive distal margin (HR 2.53, 95% CI 1.30–3.77).

Conclusion:
Laparoscopic assisted resection of rectal cancer was not found to be significantly different to OPEN resection of rectal cancer based on the outcomes of DFS and recurrence.
Stem cell transplantation for amyotrophic lateral sclerosis
Authors: Baloh Robert H. , Glass Jonathan D. , Svendsen Clive N. 
Published: August 2018

Purpose of review
This review analyses the recent efforts to develop therapeutics using transplantation of stem cells for amyotrophic lateral sclerosis (ALS).

Recent findings
Stem cells are considered as a potential therapeutic for a variety of neurodegenerative diseases, in an effort to either replace cells that are lost, or to enhance the survival of the remaining cells. In ALS, meaningful attempts to verify the safety and feasibility of many cell transplantation approaches have only recently been completed or are underway. Due to the complexities of reconstructing complete motor neuron circuits in adult patients, current approaches aim rather to prolong the survival and function of existing motor neurons through paracrine effects or production of new interneurons or astrocytes. Recent trials showed that autologous mesenchymal stem cells can be safely injected intrathecally, transiently enhancing growth factor concentrations and anti-inflammatory cytokines into the cerebrospinal fluid. Likewise, a small pilot study investigating safety of autologous transplantation of regulatory T-cells for immunomodulation was recently completed. Finally, early phase trials demonstrated safety of direct surgical transplantation of heterologous fetal-derived neural progenitor cells into the spinal cord of ALS patients, as an attempt to provide a lasting source of local trophic support for motor neurons.

Summary
With clinical trials recently demonstrating that stem cell transplantation can be safe and well tolerated in ALS, the field is positioned to complete pivotal controlled trials to determine efficacy.
Sequential Specification of Oligodendrocyte Lineage Cells by Distinct Levels of Hedgehog and Notch Signaling
Authors: Ravanelli Andrew M. , Kearns Christina A. , Powers Rani K. , Wang Yuying , Hines Jacob H. , Donaldson Maranda J. , Appel Bruce 
Published: August 2018

SUMMARYDuring development of the central nervous system oligodendrocyte precursor cells (OPCs) give rise to both myelinating oligodendrocytes and NG2 glia, which are the most proliferative cells in the adult mammalian brain. NG2 glia retain characteristics of OPCs, and some NG2 glia produce oligodendrocytes, but many others persist throughout adulthood. Why some OPCs differentiate as oligodendrocytes during development whereas others persist as OPCs and acquire characteristics of NG2 glia is not known. Using zebrafish spinal cord as a model, we found that OPCs that differentiate rapidly as oligodendrocytes and others that remain as OPCs arise in sequential waves from distinct neural progenitors. Additionally, oligodendrocyte and persistent OPC fates are specified during a defined critical period by small differences in Shh signaling and Notch activity, which modulates Shh signaling response. Thus, our data indicate that OPCs fated to produce oligodendrocytes or remain as OPCs during development are specified as distinct cell types, raising the possibility that the myelinating potential of OPCs is set by graded Shh signaling activity.
Changes in structural network topology correlate with severity of hallucinatory behaviour in Parkinson’s disease
Authors: Hall Julie M. , O’Callaghan Claire , Muller Alana. J. , Martens Kaylena A. Ehgoetz , Phillips Joseph R. , Moustafa Ahmed A. , Lewis Simon J. G. , Shine James M. 
Published: August 2018

AbstractAn inefficient integration between bottom-up visual input and higher-order visual processing regions is implicated in the manifestation of visual hallucinations (VH) in Parkinson’s disease (PD). Using graph theory, the current study aimed to investigate white matter contributions to this perceptual imbalance hypothesis. Twenty-nine PD patients reported their hallucinatory behaviour on a questionnaire and performed a behavioural test that has been shown to elicit misperceptions. A composite score derived from these measures was used as a proxy for hallucinations severity and was correlated to connectivity strength of the network using the Network Based Statistic approach. The results showed that the severity of VH was associated with reduced connectivity within a large sub-network. This network included the majority of the diverse club and showed overall greater between- and within-module scores, compared to nodes not associated with hallucination severity. Furthermore, a reduction in between-module connectivity in the lateral occipital cortex, insula and pars orbitalis, as well as decreased within-module connectivity in the prefrontal, somatosensory and primary visual cortices were associated with VH severity. In contrast, the severity of VH was associated with an increase in between- and within-module connectivity in the orbitofrontal and temporal cortex, as well as regions comprising the dorsal attentional and DMN. These results suggest that the severity of VHs is associated with marked alterations in structural network topology, highlighted by a reduction in connectivity strength across a large sub-network, as well as changes in participation across top-down visual processing centres, visual and attentional networks. Therefore, impaired integration across the perceptual hierarchy may result in the inefficient transfer of information that gives rise to VHs in PD.
Disentangling the contribution of childhood and adulthood circumstances and genetics to phenotypic aging: prospective cohort study
Authors: Liu Zuyun , Chen Xi , Gill Thomas M. , Ma Chao , Crimmins Eileen M. , Levine Morgan E. 
Published: August 2018

AbstractObjectivesTo evaluate the extent to which childhood and adulthood circumstances and genetics contribute to phenotypic aging, using a multi-system-based signature of aging that has been shown to capture mortality and morbidity risk.DesignProspective population-based cohort study.SettingUnited States (U.S.).Participants2,339 adults (aged 51+ years) from U.S. Health and Retirement Study, who participated in the Core Survey, the 2016 Venous Blood Study, the 2015 Life History Mail Survey, the Enhanced Face-To-Face interview (2006-2016), and were part of the genetic sample.Main outcomes measurePhenotypic Age, a validated aging measure based on a linear combination of chronological age and nine multi-system biomarkers. For most analyses, we examined “PhenoAgeAccel”, which represents phenotypic aging after accounting for chronological age (i.e. whether a person appears older [positive value] or younger [negative value] than expected, physiologically).ResultsThe Shapley Value Decomposition approach revealed that together all 11 domains (four childhood and adulthood circumstances domains, five polygenic scores [PGSs] domains, demographics, and behaviors domains) accounted for about 30% of variance in PhenoAgeAccel. Among the four circumstances domains, adulthood adversity was the largest contributor (9%), while adulthood socioeconomic status (SES), childhood adversity, and childhood SES accounted for 2.8%, 2.1%, 0.7%, respectively. Collectively, all PGSs contributed 3.8% of variance in PhenoAgeAccel. Further, six subpopulations/clusters—identified using a hierarchical cluster analysis based on childhood and adulthood SES and adversity—showed differences in average levels of phenotypic aging. Finally, there was a significant gene-by-environment interaction between a previously validated PGS for coronary artery disease and the most apparently disadvantaged subpopulation/cluster—suggesting a multiplicative effect of adverse environment coupled with genetic risk on phenotypic aging.ConclusionsSocioenvironmental circumstances during both childhood and adulthood account for a sizable proportion of the difference in phenotypic aging among U.S. older adults. The detrimental effects may further be exacerbated among persons with a genetic predisposition to coronary artery disease.
Two spatially distinct posterior alpha sources fulfill different functional roles in attention
Authors: Sokoliuk R. , Mayhew S.D. , Aquino K.M. , Wilson R. , Brookes M.J. , Francis S.T. , Hanslmayr S. , Mullinger K.J. 
Published: August 2018

ABSTRACTDirecting attention helps to extract relevant information and suppress distracters. Alpha brain oscillations (8-12Hz) play a fundamental role in this process, with a power decrease facilitating processing of important information and power increase inhibiting brain regions processing irrelevant information. Evidence for this phenomenon arises from visual attention studies (Worden et al., 2000), however, the effect also exists in other modalities, including the somatosensory system (Haegens et al., 2011) and inter-sensory attention tasks (Foxe and Snyder, 2011). We investigated what happens when attention is divided between two modalities using both a multi- and unimodal attention paradigm while recording EEG over 128 scalp electrodes in two separate experiments. In Experiment 1 participants divided their attention between the visual and somatosensory modality to determine the temporal or spatial frequency of a target stimulus (vibrotactile stimulus or Gabor grating). In Experiment 2, participants divided attention between two visual hemifields to identify the orientation of a target Gabor grating. In both experiments, pre-stimulus alpha power in visual areas decreased linearly with increasing attention to visual stimuli. In contrast, alpha power in parietal areas showed lower pre-stimulus alpha power when attention was divided between modalities, compared to unimodal attention. These results suggest that there are two different alpha sources, where one reflects the ‘visual spotlight of attention’ and the other reflects attentional effort. To our knowledge, this is the first study to show that attention recruits two spatially distinct alpha sources in occipital and parietal brain regions, which act simultaneously but serve different functions in attention.SIGNIFICANCE STATEMENTAttention to one spatial location/sensory modality leads to power changes of alpha oscillations (~10Hz) with decreased power over regions processing relevant information and power increases to actively inhibit areas processing ‘to-be-ignored’ information. Here, we used detailed source modelling to investigate EEG data recorded during separate uni-modal (visual) and multi- (visual and somatosensory) attention tasks. Participants either focused their attention on one modality/spatial location or directed it to both. We show for the first time two distinct alpha sources are active simultaneously but play different roles. A sensory (visual) alpha source was linearly modulated by attention representing the ‘visual spotlight of attention’. In contrast, a parietal alpha source was modulated by attentional effort, showing lowest alpha power when attention was divided.
Spatiotemporal prediction of wildfire extremes with Bayesian finite sample maxima
Authors: Joseph Maxwell B. , Rossi Matthew W. , Mietkiewicz Nathan P. , Mahood Adam L. , Cattau Megan E. , Denis Lise Ann St. , Nagy R. Chelsea , Iglesias Virginia , Abatzoglou John T. , Balch Jennifer K. 
Published: August 2018

AbstractWildfires are becoming more frequent in parts of the globe, but predicting where and when wildfires occur remains difficult. To predict wildfire extremes across the contiguous United States, we integrate a 30 year wildfire record with meteorological and housing data in spatiotemporal Bayesian statistical models with spatially varying nonlinear effects. We compared different distributions for the number and sizes of large fires to generate a posterior predictive distribution based on finite sample maxima for extreme events (the largest fires over bounded spatiotemporal domains). A zero-inflated negative binomial model for fire counts and a lognormal model for burned areas provided the best performance. This model attains 99% interval coverage for the number of fires and 93% coverage for fire sizes over a six year withheld data set. Dryness and air temperature strongly predict extreme wildfire probabilities. Housing density has a hump-shaped relationship with fire occurrence, with more fires occurring at intermediate housing densities. Statistically, these drivers affect the chance of an extreme wildfire in two ways: by altering fire size distributions, and by altering fire frequency, which influences sampling from the tails of fire size distributions. We conclude that recent extremes should not be surprising, and that the contiguous United States may be on the verge of even larger wildfire extremes.
Host cell metabolism contributes to delayed-death kinetics of apicoplast inhibitors in Toxoplasma gondii
Authors: Amberg-Johnson Katherine , Yeh Ellen 
Published: August 2018

AbstractToxoplasma gondii and related human parasites contain an essential plastid organelle called the apicoplast. Clinically-used antibiotics and other inhibitors that disrupt apicoplast biogenesis cause a mysterious “delayed-death” phenotype, in which parasite growth is unaffected during the first lytic cycle of inhibitor treatment but is severely inhibited in the second lytic cycle even after drug removal. Critical to understanding the complex downstream cellular effects of these drug classes is the timing of apicoplast loss during inhibitor treatment and how it relates to this peculiar growth phenotype. Here we show that, upon treatment with diverse classes of apicoplast inhibitors, newly-replicated T. gondii parasites in the first lytic cycle initially form apicoplasts with defects in protein import or genome replication and eventually fail to inherit the apicoplast altogether. Despite the accumulation of parasites with defective or missing apicoplasts, growth is unaffected during the first lytic cycle, as previously observed. Strikingly, concomitant inhibition of host cell isoprenoid biosynthesis results in growth inhibition in the first lytic cycle and unmasks the apicoplast defects. These results suggest that defects in and even complete loss of the apicoplast in T. gondii are partially rescued by scavenging of host cell metabolites leading to death that is delayed. Our findings uncover host cell interactions that can alleviate apicoplast inhibition and highlight key differences in “delayed-death” inhibitors between T. gondii and Plasmodium falciparum.