bluuebunny/crossref_metadata_2025_split huggingface dataset:
Absorption and Safety With Sustained Use of RELiZORB Evaluation (ASSURE) Study in Patients With Cystic Fibrosis Receiving Enteral Feeding
Authors: Stevens John , Wyatt Colby , Brown Perry , Patel Dhiren , Grujic Danica , Freedman Steven D. 
Published: August 2018

ABSTRACTObjectives:Pancreatic insufficiency (PI) and malabsorption of fats lead to reduced caloric intake, inability to maintain weight, and increased gastrointestinal symptoms. Thus, enteral nutrition (EN) is used in patients with cystic fibrosis (CF) and poor nutritional status. The current study evaluated safety, tolerability, and improvement of fatty acid (FA) status in red blood cell (RBC) membranes, a marker of long‐term FA absorption, with an in‐line digestive cartridge (RELiZORB) that hydrolyzes fat in enteral formula.Methods:Patients with CF receiving EN participated in a multicenter, 90‐day open‐label study during which RELiZORB was used with overnight EN. The primary endpoint was change over time in RBC uptake of docosahexaenoic acid (DHA)+ eicosapentaenoic acid (EPA). Gastrointestinal symptoms were collected to evaluate safety and tolerability. Several clinical and anthropometric parameters were also assessed throughout the study.Results:A total of 36 subjects completed the study with a mean age of 13.8 years, body mass index of 17.7 and 6.2 years mean use of overnight EN. Fat absorption significantly improved as shown by increased RBC levels of DHA+EPA, improved ω‐6/ω‐3 ratio, and increased plasma levels of DHA+EPA. RELiZORB use was not associated with any unanticipated adverse events.Conclusions:RELiZORB use was found to be safe, well tolerated, and resulted in increased levels of FAs in RBCs and plasma. This is the first prospective study to show EN can improve FA abnormalities in CF. Because improvement in omega‐3 levels has been shown to help pulmonary and inflammatory status as well as anthropometric parameters in CF, RELiZORB may have important long‐term therapeutic benefits in patients with CF.
Unexpected High Rates of Persistent Trichomonas vaginalis Infection in a Retrospective Cohort of Treated Pregnant Women
Authors: Lazenby Gweneth B. , Thompson Lauren , Powell Anna M. , Soper David E. 
Published: August 2018

Background
Our primary objective was to determine the rate of persistent Trichomonas infection among pregnant women posttreatment. The secondary objective was to determine if oral multidose metronidazole was associated with fewer cases of persistent Trichomonas compared with single-dose treatment.

Methods
This is a retrospective cohort study of women diagnosed with genital Trichomonas vaginalis from 2008 to 2017. We calculated the rate of persistent Trichomonas by dividing the number of positive Trichomonas tests collected 21 days or longer posttreatment by the total number of women treated and retested. Bivariate analysis was performed to compare the rates of positive tests after single and multidose metronidazole. Multivariate logistic regression was used to evaluate factors associated with persistent infection.

Results
Five hundred forty-two women with 565 pregnancies were diagnosed with Trichomonas infection. The majority of subjects were prescribed either single-dose (n = 352) or multidose metronidazole (n = 74). Posttreatment Trichomonas tests were collected 21 days or longer in 326 subjects and 44% (143) were positive. Rates of positive Trichomonas tests among women receiving single-dose and multidose regimens were similar (45% vs. 40%, P = 0.50). Women who had ≥1 pregnancy affected by Trichomonas infection were more likely to have a positive test posttreatment (adjusted odds ratio, 20.1; 95% confidence interval, 1.9–215.3). Obese women were less likely to have a positive test posttreatment (adjusted odds ratio, 0.3; 95% confidence interval, 0.1–0.9).

Conclusions
Given high rates of positive Trichomonas tests and increased detection with nucleic acid amplification tests (NAATs), all pregnant women should be retested with NAATs approximately 3 weeks posttreatment. Further studies are needed to determine the most effective treatment of Trichomonas infection in pregnant women.
Assessment of Visual Acuity in Children Using Crowded Lea Symbol Charts
Authors: Sailoganathan Ananth , Rou Leong Xin , Buja Kenny Anak , Siderov John 
Published: August 2018

SIGNIFICANCEVision charts comprising single Lea symbols surrounded by either flanking bars or flanking Lea symbols are available for measurement of visual acuity in children. However, the results obtained with such charts may not be interchangeable owing to potential differences in the crowding effect.PURPOSEThe purpose of this study was to compare habitual visual acuity in a sample of young children using two versions of the single Lea symbols charts with different crowding features.METHODSMonocular habitual visual acuity was measured in a sample of 77 young children aged between 4 and 6 years using crowded Lea symbols charts with either flanking bars separated from the central symbol by 0.5 optotype width or flanking Lea optotypes separated from the central symbol by 1.0 optotype width.RESULTSMean visual acuity was higher (i.e., lower logarithm of the minimum angle of resolution) with the Lea symbols crowded using flanking optotypes, equivalent to about 1.5 optotype difference. Visual acuity measured with the two charts was significantly correlated; however, the 95% limits of agreement were larger than expected from repeatability studies using Lea symbols.CONCLUSIONSLea symbols with flanking optotypes resulted in higher visual acuity than the Lea symbols with flanking bars, probably as a result of differences in the crowding effect. The two charts showed insufficient agreement, and we do not recommend their use interchangeably. We recommend using the Lea symbols with flanking bars because of the closer flanker-target separation.
Population Pharmacokinetics of Vancomycin in Pediatric Extracorporeal Membrane Oxygenation*
Authors: Moffett Brady S. , Morris Jennifer , Galati Marianne , Munoz Flor , Arikan Ayse A. 
Published: August 2018

Objectives:Describe the pharmacokinetics of vancomycin in pediatric patients undergoing extracorporeal membrane oxygenation and provide dosing recommendations to attain an area under the curve for 24 hours greater than 400 in this population.Design:Retrospective, population pharmacokinetic analysis.Setting:PICU of a large tertiary care children’s hospital.Interventions:Population pharmacokinetic analysis and simulation were performed with NONMEM v7.3 (Icon, PLC, Dublin, Ireland).Patients:Patients less than 19 years old who received IV vancomycin and had serum vancomycin concentration monitoring while undergoing extracorporeal membrane oxygenation from January 1, 2011, to June 30, 2017.Measurements and Main Results:A total of 93 patients met study criteria (male 51%, median age 0.64 yr [interquartile range 0.07–6.7 yr]). Mean estimated creatinine clearance was 65 ± 47 mL/min/1.73 m2. Patients received 1,116 vancomycin doses (14.6 ± 1.9 mg/kg/dose) and had 433 vancomycin serum concentrations (13.6 ± 6.9 mg/L) at 13.2 ± 10.7 hours after a dose. A two-compartment pharmacokinetic model with allometrically scaled weight on clearance (0.75) and volumes of distribution (1) was developed. Serum creatinine, postmenstrual age were significant covariates for clearance, patient age for central volume of distribution, and albumin for peripheral volume of distribution. Simulation identified a doses of 25–30 mg/kg/dose every 12–24 hours as having the highest percentage of patients with an area under the curve for 24 hours greater than 400 with the highest percentage trough concentrations in the less than 15 mg/L range.Conclusions:A vancomycin dose of 25–30 mg/kg/dose every 12–24 hours with serum concentration monitoring is a reasonable empiric dosing strategy to obtain an area under the curve for 24 hours greater than 400 in pediatric extracorporeal membrane oxygenation patients.
Enteroaggregative Escherichia coli subclinical and clinical infections
Authors: Lima Aldo A.M. , Medeiros Pedro H.Q.S. , Havt Alexandre 
Published: August 2018

Purpose of reviewThe current review is to update the results on epidemiology, pathobiology, and genes related to virulence, clinical presentation, molecular diagnosis, antimicrobial resistance, and extraintestinal infection of enteroaggregativeEscherichia coli(EAEC).Recent findingsEAEC subclinical infection was significantly associated with reduced length at 2 years of age and EAEC and coinfections were associated with reduced delta weight-for-length and weight-for-agez-scores in the first 6 months of age in the MAL-ED birth cohort study. EAEC was associated with malnutrition in children 6–24 months of age in prospective case–control studies in Bangladesh and Brazil. Virulence gene-based studies have suggested aggregative fimbriae II may be a major contributor to disease, whereas AggR-activated regulator a marker of less severe disease. The high ability of EAEC colonization likely exacerbates effects of other microbial virulence strategies. Molecular diagnosis has been useful for understanding EAEC burden, although different criteria may relate to different pathogenic outcomes.SummaryEAEC gained special interest in the past few years, especially due to association with growth decrements in children with subclinical infections and its important role as a copathogen. Understanding of EAEC pathogenesis advanced but further research is needed for elucidating both microbial and host factors influencing infection outcomes.
Deep Learning in Diagnosis of Maxillary Sinusitis Using Conventional Radiography
Authors: Kim Youngjune , Lee Kyong Joon , Sunwoo Leonard , Choi Dongjun , Nam Chang-Mo , Cho Jungheum , Kim Jihyun , Bae Yun Jung , Yoo Roh-Eul , Choi Byung Se , Jung Cheolkyu , Kim Jae Hyoung 
Published: August 2018

Objectives
The aim of this study was to compare the diagnostic performance of a deep learning algorithm with that of radiologists in diagnosing maxillary sinusitis on Waters’ view radiographs.

Materials and Methods
Among 80,475 Waters’ view radiographs, examined between May 2003 and February 2017, 9000 randomly selected cases were classified as normal or maxillary sinusitis based on radiographic findings and divided into training (n = 8000) and validation (n = 1000) sets to develop a deep learning algorithm. Two test sets composed of Waters’ view radiographs with concurrent paranasal sinus computed tomography were labeled based on computed tomography findings: one with temporal separation (n = 140) and the other with geographic separation (n = 200) from the training set. Area under the receiver operating characteristics curve (AUC), sensitivity, and specificity of the algorithm and 5 radiologists were assessed. Interobserver agreement between the algorithm and majority decision of the radiologists was measured. The correlation coefficient between the predicted probability of the algorithm and average confidence level of the radiologists was determined.

Results
The AUCs of the deep learning algorithm were 0.93 and 0.88 for the temporal and geographic external test sets, respectively. The AUCs of the radiologists were 0.83 to 0.89 for the temporal and 0.75 to 0.84 for the geographic external test sets. The deep learning algorithm showed statistically significantly higher AUC than radiologist in both test sets. In terms of sensitivity and specificity, the deep learning algorithm was comparable to the radiologists. A strong interobserver agreement was noted between the algorithm and radiologists (Cohen κ coefficient, 0.82). The correlation coefficient between the predicted probability of the algorithm and confidence level of radiologists was 0.89 and 0.84 for the 2 test sets, respectively.

Conclusions
The deep learning algorithm could diagnose maxillary sinusitis on Waters’ view radiograph with superior AUC and comparable sensitivity and specificity to those of radiologists.
CT Manifestations of Tumor Spread Through Airspaces in Pulmonary Adenocarcinomas Presenting as Subsolid Nodules
Authors: de Margerie-Mellon Constance , Onken Allison , Heidinger Benedikt H. , VanderLaan Paul A. , Bankier Alexander A. 
Published: August 2018

Purpose:
The aim of this study was to identify potential computed tomography manifestations of pulmonary adenocarcinomas presenting as subsolid nodules and associated with the histologic evidence of spread of tumor through air spaces (STAS).

Materials and Methods:
From a radiologic-pathologic repository of resected pulmonary adenocarcinomas including 203 subsolid nodules, 40 STAS-positive nodules were randomly selected and matched to 40 STAS-negative nodules. Total average diameter, as well as average and long-axis diameters of the solid component, was measured. The proportion of solid component diameter to total average diameter was calculated. Measurements and proportions between STAS-positive and STAS-negative nodules were compared with paired samples t test, χ2 test, or the Fisher exact test.

Results:
The total average diameter in STAS-positive nodules was significantly larger than in STAS-negative nodules (P=0.024). The average and long-axis diameters of the solid component of STAS-positive nodules were significantly larger than that of STAS-negative nodules (P=0.001 and 0.003). The proportion of solid component to total average diameter was significantly larger in STAS-positive than in STAS-negative nodules (P=0.041). At a threshold of ≥10 mm for the average and the solid component long-axis diameters, significantly more nodules were STAS-positive than STAS-negative (P=0.015 and 0.001).

Conclusions:
Total average diameter, average and long-axis diameters of the solid component, and a high proportion of solid component diameter compared with total average diameter are computed tomography manifestations of subsolid pulmonary adenocarcinomas with STAS. These findings could serve as an in-vivo tool for the likelihood estimation of STAS, and consequently influence management of subsolid adenocarcinomas.
Age-stratified Patterns of Thymic Involution on Multidetector CT
Authors: Drabkin Michael J. , Meyer John I. , Kanth Nalini , Lobel Shari , Fogel Joshua , Grossman Julia , Krumenacker John H. 
Published: August 2018

Purpose:
The aim of this study was to better assess the prevalence and appearance of thymic tissue in adults stratified by age using multidetector computed tomography (MDCT) in order to prevent misinterpretation of normal thymic tissue as pathology.

Materials and Methods:
This study examined the CT appearance of the thymus in 597 trauma patients aged 30 to 69 years (M=48.0 y, SD=11.3). Three body fellowship-trained attending radiologists independently reviewed the CT scans. Reviewers assigned one of 5 grades on the basis of the relative proportions of fat and soft tissue in the thymic bed: complete fatty replacement (grade 0), predominantly fat (grade 1), even mix of soft tissue and fat (grade 2), predominantly soft tissue (grade 3), and discrete confluent thymic tissue (grade 4). Objectively, fixed-area region of interest values of the thymic bed were obtained. Interrater reliability was calculated.

Results:
Increased fatty replacement of the thymus occurred with increasing age. We found residual thymic tissue (≥grade 1) in the following age categories: 30 to 39 years (83.0%), 40 to 49 years (71.9%), 50 to 59 years (52.6%), and 60 to 69 years (34.8%). Kappa comparisons for the entire sample were excellent (κ=0.86). Higher grades had higher region of interest values.

Conclusions:
Residual thymic tissue in adults on MDCT is both more prevalent and more prominent than that reported in earlier studies and can be visible into the seventh decade. We recommend that radiologists and clinicians familiarize themselves with the normal range appearances of the thymus on MDCT, in order to prevent misinterpretation of normal thymic tissue as pathology, which may result in unnecessary procedures.
Clinical Impact of Iatrogenic Small Bowel Perforation Secondary to Laparoscopic Cholecystectomy: A Single-center Experience
Authors: Künzli Beat M. , Spohnholz Johannes , Braumann Chris , Shrikhande Shailesh V. , Uhl Waldemar 
Published: August 2018

Objective:
Bowel, vascular, and biliary injuries during laparoscopic cholecystectomy (LC) have to be addressed with high priority. The focus of this study was on small bowel injury (SBI) and its impact on clinical management.

Methods:
We report 5 cases of SBI in a retrospective database of 2062 consecutive LC between January 2004 and December 2017.

Results:
We report isolated iatrogenic SBI in 0.24% (5 of 2062) after LC. We identified 3 cases with SBI associated with the technique of Hasson or related problems with intraoperative relaxation toward the end of the LC. All 5 patients needed at least 1 reoperation. There was no mortality in this series and all patients with iatrogenic SBI got discharged from the clinic in good health. Nevertheless, 3 of 5 patients (60%) with SBI filed a law suit.

Conclusions:
Isolated iatrogenic SBI is a rare but dreaded complication after LC with high impact on patient’s health and prone for medicolegal claims. Strict precaution on thorough relaxation throughout the operation, meticulous handling of closing technique of the fascial layer and “eternal vigilance” are mandatory to reduce risks of SBI after LC.
Breathlessness in the emergency care setting
Authors: Johnson Miriam J. , Hutchinson Ann 
Published: August 2018

Purpose of reviewBreathlessness is one of the most common reasons for presentation at the emergency department (ED). The present review summarizes work published from 2017, which focuses on the symptom of breathlessness in its own right rather than as a signpost to diagnosis in relation to presentation to the ED.Recent findingsSeven relevant papers are included in the present review. Five describe the epidemiology of breathlessness presentation showing: a prevalence of approximately 5% all ED presentations, a high likelihood of hospital admission especially for those with heart failure, breathlessness as a predictor of re-presentation. A sixth study described self-management strategies for breathlessness crises used by expert patients in successfully avoiding presentations to the ED. The seventh study reported the validation of the shorter dyspnea severity scale for use in the ED using a mixture of symptom report and clinical observation measures.SummaryBreathlessness is a common presenting feature in the ED and carries clinical outcome significance irrespective of the causative disease. Routine enquiry is needed to identify, assess, and manage breathlessness alongside interventions to stabilize underlying reversible pathologies. Presentation to the ED because of breathlessness should trigger community-based, supported self-management for future episodes of breathlessness crises.
Experimentally induced social threat increases paranoid thinking
Authors: Saalfeld Vanessa , Ramadan Zeina , Bell Vaughan , Raihani Nichola J. 
Published: August 2018

The ability to attribute intentions to others is a hallmark of human social cognition but is altered in paranoia. Paranoia is the most common positive symptom of psychosis but is also present to varying degrees in the general population. Epidemiological models suggest that psychosis risk is associated with low social rank and minority status, but the causal effects of status and group affiliation on paranoid thinking remain unclear. We examined whether relative social status and perceived group affiliation, respectively, affect live paranoid thinking using two large-
N
(
N
= 2030), pre-registered experiments. Interacting with someone from a higher social rank or a political out-group led to an increase in paranoid attributions of harmful intent for ambiguous actions. Pre-existing paranoia predicted a general increase in harmful intent attribution, but there was no interaction with either type of social threat: highly paranoid people showed the same magnitude of increase as non-paranoid people, although from a higher baseline. We conclude social threat in the form of low social status and out-group status affects paranoid attributions, but ongoing paranoia represents a lowered threshold for detecting social threat rather than an impaired reactivity to it.
Central Dicer-miR-103/107 Controls Developmental Switch of POMC Progenitors into NPY Neurons and Impacts Glucose Homeostasis
Authors: Croizier Sophie , Maillard Julien , Bouret Sebastien G 
Published: August 2018

AbstractProopiomelanocortin (POMC) neurons are major negative regulators of energy balance. A distinct developmental property of POMC neurons is that they can adopt an orexigenic neuropeptide Y (NPY) phenotype. However, the mechanisms underlying the differentiation of Pomc progenitors remain unknown. Here, we show that the loss of the microRNA (miRNA)- processing enzyme Dicer in POMC neurons causes metabolic defects, an age-dependent decline in the number of Pomc mRNA-expressing cells, and an increased proportion of Pomc progenitors acquiring a NPY phenotype. miRNome microarray screening further identified miR-103/107 as candidates that may be involved in the maturation of Pomc progenitors. In vitro inhibition of miR-103/107 causes a reduction in the number of Pomc-expressing cells and increases the proportion of Pomc progenitors differentiating into NPY neurons. Moreover, in utero silencing of miR-103/107 causes perturbations in glucose homeostasis. Together, these data suggest a role for prenatal miR-103/107 in the maturation of Pomc progenitors and glucose homeostasis.
RAB6 and microtubules restrict secretion to focal adhesions
Authors: Fourrière L. , Kasri A. , Gareil N. , Bardin S. , Boulanger J. , Sikora R. , Boncompain G. , Miserey-Lenkei S , Perez F. , Goud B. 
Published: August 2018

ABSTRACTTo ensure their homeostasis and sustain differentiated functions, cells continuously transport diverse cargos to various cell compartments and in particular to the cell surface. Secreted proteins are transported along intracellular routes from the endoplasmic reticulum through the Golgi complex before reaching the plasma membrane along microtubule tracks. Using a synchronized secretion assay, we report here that exocytosis does not occur randomly at the cell surface but on localized hotspots juxtaposed to focal adhesions. Although microtubules are involved, the RAB6-dependent machinery plays an essential role. We observed that, irrespective of the transported cargos, most post-Golgi carriers are positive for RAB6 and that its inactivation leads to a broad reduction of protein secretion. RAB6 may thus be a general regulator of post-Golgi secretion.