bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Anterolateral Complex Sectioning and Tenodesis on Patellar Kinematics and Patellofemoral Joint Contact Pressures
Authors: Inderhaug Eivind , Stephen Joanna M. , Williams Andy , Amis Andrew A. 
Published: August 2018

Background: Anterolateral complex injuries are becoming more recognized. While these are known to affect tibiofemoral mechanics, it is not known how they affect patellofemoral joint behavior. Purpose: To determine the effect of (1) sectioning the anterolateral complex and (2) performing a MacIntosh tenodesis under various conditions on patellofemoral contact mechanics and kinematics. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric knees were tested in a customized rig, with the femur fixed and tibia free to move, with optical tracking to record patellar kinematics and with thin pressure sensors to record patellofemoral contact pressures at 0°, 30°, 60°, and 90° of knee flexion. The quadriceps and iliotibial tract were loaded with 205 N throughout testing. Intact and anterolateral complex–sectioned states were tested, followed by 4 randomized tenodeses applying 20- and 80-N graft tension, each with the tibia in its neutral intact alignment or left free to rotate. Statistical analyses were undertaken with repeated measures analysis of variance, Bonferroni post hoc analysis, and paired samples t tests. Results: Patellar kinematics and contact pressures were not significantly altered after sectioning of the anterolateral complex (all: P > .05). Similarly, they were not significantly different from the intact knee in tenodeses performed when fixed tibial rotation was combined with 20- or 80-N graft tension (all: P > .05). However, grafts tensioned with 20 N and 80 N while the tibia was free hanging resulted in significant increases in lateral patellar tilt ( P < .05), and significantly elevated lateral peak patellofemoral pressures ( P < .05) were observed for 80 N. Conclusion: This work did not find that an anterolateral injury altered patellofemoral mechanics or kinematics, but adding a lateral tenodesis can elevate lateral contact pressures and induce lateral patellar tilting if the tibia is pulled into external rotation by the tenodesis. Although these in vitro changes were small and might not be relevant in a fully loaded knee, controlling the position of the tibia at graft fixation is effective in avoiding overconstraint at time zero in a lateral tenodesis. Clinical Relevance: Small changes in lateral patellar tilt and patellofemoral contact pressures were found at time zero with a MacIntosh tenodesis. These changes were eliminated when the tibia was held in neutral rotation at the time of graft fixation. The risk of overconstraint after a lateral tenodesis therefore seems low and in accordance with recent published reports.
Monitoring of Delay to Pharmacy Refill in Assessing Adherence to Antiretroviral Therapy
Authors: Cruz Camille Carvalho Peixoto , Mistro Sóstenes , Mendes Carlos Maurício Cardeal , Schooley Robert Turner , Badaró Roberto José da Silva 
Published: August 2018

Background: Adherence to antiretroviral (ARV) therapy remains a major challenge in HIV therapeutics. Objective: To assess the adherence to ARV therapy by measuring the delay in monthly refilling of ARV drugs using pharmacy records and to correlate this with HIV plasma RNA measurements and CD4+ cell count. Method: Records of 170 HIV-positive patients were examined to identify HIV viral load (VL)/CD4+ results and the time interval to refill ARVs at the pharmacy. The correlation between the number of days missed to refill ARVs and plasma HIV-RNA detectability/CD4+ count was performed using the Spearman’s correlation coefficient ( r). Results: Fewer days missed to refill ARV was positively correlated with undetectable VL and increase in CD4+ count ( r = 0.407 and 0.237, respectively). Increase in adherence was correlated with longer retention in the cohort ( r = 0.208). Conclusion: Monitoring the delay to pick up ARVs from the pharmacy can be an important and simple tool to identify patients requiring assessment of their adherence.
Stent-assisted coiling of posterior inferior cerebellar artery aneurysm complicated by arterial avulsion
Authors: Cora EA , Finitsis S , Woulfe J , Essbaiheen F , AlQahtani H , Drake B , Lesiuk H , Iancu D 
Published: August 2018

Background Rapid development of new devices and techniques in endovascular neurosurgery allows treatment of complex intracranial vascular lesions. These treatments, however, are not without risk. We report a case of unusual vascular laceration during stent-assisted coiling of a posterior inferior cerebellar artery (PICA) aneurysm. Case presentation A 75-year-old female with a recurrent, previously coiled PICA aneurysm developed avulsion of the parent vessel followed by fatal bleeding while an attempt was made to place a microcatheter across the aneurysmal neck for stent-assisted coiling. Conclusions Pathological examination was performed to understand the mechanism of the rupture. The most likely mechanism was straightening of the significant vascular tortuosity, excessive tension on the vessel origin and avulsion upon advancement of the microcatheter over the microguidewire.
Salivary Immunoglobulin A, E, and G4 Levels Specific to Dermatophagoides pteronyssinus in Allergic Rhinitis Patients Treated With Subcutaneous Immunotherapy
Authors: Liu Yan , Xing Zhimin , Wang Junge , Geng Congli 
Published: August 2018

Background Allergen-specific immunotherapy (AIT) is an effective treatment for allergic rhinitis (AR). During the course of AIT, many biomarkers in body fluids change. It is necessary to find effective indicators of AIT. Objective To examine levels of salivary immunoglobulin A, E, and G4 (IgA, IgE, and IgG4, respectively) specific to Dermatophagoides pteronyssinus (Dp-IgA, Dp-IgE, and Dp-IgG4, respectively) and their changes in AR patients undergoing subcutaneous immunotherapy (SCIT). Methods This study included 82 patients with AR sensitized only to Dp and 14 healthy controls. Among patients with AR, 30 patients were not treated with specific immunotherapy (group A), while the remainder (n = 52) received house dust mite SCIT in the up-dosing phase (n = 27; group B) or the maintenance treatment phase (n = 25; group C). Dp-IgA, Dp-IgE, and Dp-IgG4 levels in the saliva were measured using the enzyme-linked immunosorbent assay. Clinical symptoms, concomitant medication, and the Rhinoconjunctivitis Quality of Life Questionnaire score were recorded and correlated with immunoglobulin levels. Results Salivary Dp-IgG4 and Dp-IgA levels were significantly lower in AR patients than in healthy controls ( P < .001 for both), while Dp-IgE levels were significantly higher ( P < .001). SCIT resulted in sustained increases in Dp-IgG4 and Dp-IgA in the maintenance phase compared to the up-dosing phase ( P < .001 for both), whereas Dp-IgE only increased in the up-dosing phase ( P = .004, P < .0125). There was no correlation between the different salivary immunoglobulins and clinical scores during SCIT. Conclusions This study shows that allergen-specific IgE levels are increased in the saliva of sensitized patients, suggesting that measuring salivary IgE testing should be further considered for the diagnosis of AR. Moreover, allergen-specific IgA and IgG4 in the saliva, which may play protective roles against allergy, may serve as objective indicators for evaluating treatment response to SCIT. However, none of the immunoglobulin reflects subjective symptoms.
Process improvement for reducing side discrepancies in radiology reports
Authors: Digumarthy Subba Rao , Vining Rachel , Tabari Azadeh , Nandimandalam Sireesha , Otrakji Alexi , Shepard JoAnne O , Kalra Mannudeep K 
Published: August 2018

Background Laterality errors in radiology reports can lead to serious errors in management. Purpose To reduce errors related to side discrepancies in radiology reports from thoracic imaging by 50% over a six-month period with education and voice recognition software tools. Material and Methods All radiology reports at the Thoracic Imaging Division from the fourth quarter of 2016 were reviewed manually for presence of side discrepancies (baseline data). Side discrepancies were defined as a lack of consistency in side labeling of any abnormality in the “Findings” to “Impression” sections of the reports. Process map and Ishikawa fishbone diagram (Microsoft Visio) were created. All thoracic radiologists were educated on side-related errors in radiology reports for plan–design–study–act cycle 1 (PDSA #1). Two weeks later, voice recognition software was configured to capitalize sides (RIGHT and LEFT) in the reports during dictated (PDSA# 2). Radiology reports were analyzed to determine side-discrepancy errors following each PDSA cycle (post-interventional data). Statistical run charts were created using QI Macros statistical software. Results Baseline data revealed 33 side-discrepancy errors in 47,876 reports with an average of 2.5 errors per week (range = 1–8 errors). Following PDSA #1, there were seven errors pertaining to side discrepancies over a two-week period. Errors declined following implementation of PDSA #2 to meet the target of 0.85 side-discrepancy error per week over seven weeks. Conclusion Automated processes (such as capitalization of sides) help reduce left/right errors substantially without affecting reporting turnaround time.
A prospective surveillance study for multidrug-resistant bacteria colonization in hospitalized patients at a Thai University Hospital
Authors: Rattanaumpawan Pinyo , Choorat Chatiros , Takonkitsakul Kanchanaporn , Tangkoskul Teerawit , Seenama Chakrapong , Thamlikitkul Visanu 
Published: August 2018

Abstract
Background
Colonization with multidrug-resistant (MDR) bacteria is a major risk factor for developing subsequent MDR infections.

Methods
We performed a prospective surveillance study in hospitalized patients at Siriraj Hospital. Nasal cavity, throat, inguinal area and rectal swabs were obtained within the first 48-h after admission, on day-5 after hospitalization and then every 7 days until discharge. Target bacteria included extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL), carbapenem-resistant-P.aeruginosa (CR-PA), carbapenem-resistant-A.baumannii (CR-AB) and methicillin-resistant S.aureus (MRSA).

Results
From January 2013–December 2014, 487 patients were enrolled. The baseline prevalence of colonization by ESBL, CR-PA, CR-AB and MRSA at any site was 52.2%, 6.8%, 4.7% and 7.2%, respectively. After 3-week of hospitalization, the prevalence of colonization by ESBL, CR-PA, CR-AB and MRSA increased to 71.7%, 47.2%, 18.9% and 18.9%, respectively. Multivariable analysis revealed that diabetes mellitus and recent cephalosporin exposure were the independent risk factors for baseline colonization by ESBL. The independent risk factors for CR-AB and/or CR-PA colonization were cerebrovascular diseases, previous hospitalization, transfer from another hospital/a LTCF and previous nasogastric tube use, whereas those for MRSA colonization were previous fluoroquinolone exposure and previous nasogastric tube use.

Conclusions
The baseline prevalence of colonization by ESBL was relatively high, whereas the baseline prevalence of colonization by CR-PA, CR-AB and MRSA was comparable to previous studies. There was an increasing trend in MDR bacteria colonization after hospitalization.
Circulating Tumor DNA Measurements As Early Outcome Predictors in Diffuse Large B-Cell Lymphoma
Authors: Kurtz David M. , Scherer Florian , Jin Michael C. , Soo Joanne , Craig Alexander F.M. , Esfahani Mohammad Shahrokh , Chabon Jacob J. , Stehr Henning , Liu Chih Long , Tibshirani Robert , Maeda Lauren S. , Gupta Neel K. , Khodadoust Michael S. , Advani Ranjana H. , Levy Ronald , Newman Aaron M. , Dührsen Ulrich , Hüttmann Andreas , Meignan Michel , Casasnovas René-Olivier , Westin Jason R. , Roschewski Mark , Wilson Wyndham H. , Gaidano Gianluca , Rossi Davide , Diehn Maximilian , Alizadeh Ash A. 
Published: August 2018

Purpose Outcomes for patients with diffuse large B-cell lymphoma remain heterogeneous, with existing methods failing to consistently predict treatment failure. We examined the additional prognostic value of circulating tumor DNA (ctDNA) before and during therapy for predicting patient outcomes. Patients and Methods We studied the dynamics of ctDNA from 217 patients treated at six centers, using a training and validation framework. We densely characterized early ctDNA dynamics during therapy using cancer personalized profiling by deep sequencing to define response-associated thresholds within a discovery set. These thresholds were assessed in two independent validation sets. Finally, we assessed the prognostic value of ctDNA in the context of established risk factors, including the International Prognostic Index and interim positron emission tomography/computed tomography scans. Results Before therapy, ctDNA was detectable in 98% of patients; pretreatment levels were prognostic in both front-line and salvage settings. In the discovery set, ctDNA levels changed rapidly, with a 2-log decrease after one cycle (early molecular response [EMR]) and a 2.5-log decrease after two cycles (major molecular response [MMR]) stratifying outcomes. In the first validation set, patients receiving front-line therapy achieving EMR or MMR had superior outcomes at 24 months (EMR: EFS, 83% v 50%; P = .0015; MMR: EFS, 82% v 46%; P < .001). EMR also predicted superior 24-month outcomes in patients receiving salvage therapy in the first validation set (EFS, 100% v 13%; P = .011). The prognostic value of EMR and MMR was further confirmed in the second validation set. In multivariable analyses including International Prognostic Index and interim positron emission tomography/computed tomography scans across both cohorts, molecular response was independently prognostic of outcomes, including event-free and overall survival. Conclusion Pretreatment ctDNA levels and molecular responses are independently prognostic of outcomes in aggressive lymphomas. These risk factors could potentially guide future personalized risk-directed approaches.
The root cause of Duchenne muscular dystrophy is the lack of dystrophin in smooth muscle of blood vessels rather than in skeletal muscle per se
Authors: Gajendran Nadesan 
Published: August 2018

Background:The dystrophin protein is part of the dystrophin associated protein complex (DAPC) linking the intracellular actin cytoskeleton to the extracellular matrix. Mutations in the dystrophin gene cause Duchenne and Becker muscular dystrophy (D/BMD). Neuronal nitric oxide synthase associates with dystrophin in the DAPC to generate the vasodilator nitric oxide (NO). Systemic dystrophin deficiency, such as in D/BMD, results in muscle ischemia, injury and fatigue during exercise as dystrophin is lacking, affecting NO production and hence vasodilation. The role of neuregulin 1 (NRG) signaling through the epidermal growth factor family of receptors ERBB2 and ERBB4 in skeletal muscle has been controversial, but it was shown to phosphorylate α-dystrobrevin 1 (α-DB1), a component of the DAPC. The aim of this investigation was to determine whether NRG signaling had a functional role in muscular dystrophy.Methods:Primary myoblasts (muscle cells) were isolated from conditional knock-out mice containing lox P flanked ERBB2 and ERBB4 receptors, immortalized and exposed to CRE recombinase to obtainErbb2/4double knock-out (dKO) myoblasts where NRG signaling would be eliminated. Myotubes, thein vitroequivalent of muscle fibers, formed by fusion of the lox P flankedErbb2/4myoblasts as well as theErbb2/4dKO myoblasts were then used to identify changes in dystrophin expression.Results:Elimination of NRG signaling resulted in the absence of dystrophin demonstrating that it is essential for dystrophin expression. However, unlike the DMD mouse model mdx, with systemic dystrophin deficiency, lack of dystrophin in skeletal muscles ofErbb2/4dKO mice did not result in muscular dystrophy. In these mice, ERBB2/4, and thus dystrophin, is expressed in the smooth muscle of blood vessels allowing normal blood flow through vasodilation during exercise.Conclusions:Dystrophin deficiency in smooth muscle of blood vessels, rather than in skeletal muscle, is the main cause of disease progression in DMD.
Distinct Co-Modulation Rules of Synapses and Voltage-Gated Currents Coordinate Interactions of Multiple Neuromodulators
Authors: Li Xinping , Bucher Dirk , Nadim Farzan 
Published: August 2018

Multiple neuromodulators act in concert to shape the properties of neural circuits. Different neuromodulators usually activate distinct receptors but can have overlapping targets. Therefore, circuit output depends on neuromodulator interactions at shared targets, a poorly understood process. We explored quantitative rules of co-modulation of two principal targets of neuromodulation: synapses and voltage-gated ionic currents. In the stomatogastric ganglion of the male crabCancer borealis, the neuropeptides proctolin (Proc) and the crustacean cardioactive peptide (CCAP) modulate synapses of the pyloric circuit and activate a voltage-gated current (IMI) in multiple neurons. We examined the validity of a simple dose-dependent quantitative rule, that co-modulation by Proc and CCAP is predicted by the linear sum of the individual effects of each modulator up to saturation. We found that this rule is valid for co-modulation of synapses, but not for the activation ofIMI, in which co-modulation was sublinear. The predictions for the co-modulation ofIMIactivation were greatly improved if we assumed that the intracellular pathways activated by two peptide receptors inhibit one another. These findings suggest that the pathways activated by two neuromodulators could have distinct interactions, leading to distinct co-modulation rules for different targets even in the same neuron. Given the evolutionary conservation of neuromodulator receptors and signaling pathways, such distinct rules for co-modulation of different targets are likely to be common across neuronal circuits.SIGNIFICANCE STATEMENTWe examine the quantitative rules of co-modulation at multiple shared targets, the first such characterization to our knowledge. Our results show that dose-dependent co-modulation of distinct targets in the same cells by the same two neuromodulators follows different rules: co-modulation of synaptic currents is linearly additive up to saturation, whereas co-modulation of the voltage-gated ionic current targeted in a single neuron is nonlinear, a mechanism that is likely generalizable. Given that all neural systems are multiply modulated and neuromodulators often act on shared targets, these findings and the methodology could guide studies to examine dynamic actions of neuromodulators at the biophysical and systems level in sensory and motor functions, sleep/wake regulation, and cognition.
Politinė įtaka Lietuvos nacionalinio radijo ir televizijos vadybai ir finansavimui: kaita ir pasekmės
Authors: Jastramskis Deimantas 
Published: August 2018

[only abstract in English; full article and abstract in Lithuanian]
The aim of this article is to find out whether the structural conditions for an effective activity of the public broadcaster were created in Lithuania. The legal regulation of management and financing of the Lithuanian public broadcaster (LRT) are analyzed. The article also explores what political and economic circumstances were decisive in the media policy process regarding the change of the structural conditions for the effectiveness of the LRT. It is claimed in the article that the structural conditions for the effective activity of the LRT were only partially created during the 27 years of statehood. First, the model of formation of the LRT Council balanced the political representation between the LRT Council members that are delegated by three sides: the governing coalition, the opposition of the Seimas and the President. However, such regulation does not decouple the LRT’s management from any concrete political conjuncture and from any possible political coalitions in the LRT Council. Second, since 2015, the funding of LRT has been related to the revenues of the state and municipalities’ budgets (1.5 percent from the income tax and 1.3 percent from the excise revenues). However, such a financing model of the LRT is not sufficient to exclude it from the level of the least financed public service media outlets in the European Union.
Socialinės globos įstaigų, teikiančių paslaugas senyvo amžiaus asmenims, darbuotojų požiūris į teikiamų paslaugų kokybę
Authors: Gečienė Jolita , Gudžinskienė Vida 
Published: August 2018

[straipsnis, santrauka, reikšminiai žodžiai lietuvių kalba; santrauka ir reikšminiai žodžiai anglų kalba]
Straipsnyje socialinės globos paslaugų kokybė analizuojama viešųjų paslaugų organizavimo ir vertinimo kontekste, atsižvelgiant į institucinės globos pertvarkos aspektus. Atskleisti pagrindiniai iššūkiai, su kuriais susiduria socialinės globos įstaigos, dirbančios su senyvo amžiaus asmenimis. Empiriniams duomenims surinkti 2017 m. atliktas kiekybinis tyrimas. Tyrimo metodas – anketinė apklausa. Socialinių paslaugų kokybė vertinta ir klausimynas sudarytas remiantis EQUASS metodika. Tyrimo nustatyta, kad, subjektyviu tiriamųjų vertinimu, bendras paslaugų kokybės lygmuo socialinės globos įstaigose, dirbančiose su senyvo amžiaus asmenimis, apskritai yra gana aukštas.
The Power of Play: A Pediatric Role in Enhancing Development in Young Children
Authors: Yogman Michael , Garner Andrew , Hutchinson Jeffrey , Hirsh-Pasek Kathy , Golinkoff Roberta Michnick ,   COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH,   COUNCIL ON COMMUNICATIONS AND MEDIA
Published: August 2018

This Clinical Report was reaffirmed January 2025.
Children need to develop a variety of skill sets to optimize their development and manage toxic stress. Research demonstrates that developmentally appropriate play with parents and peers is a singular opportunity to promote the social-emotional, cognitive, language, and self-regulation skills that build executive function and a prosocial brain. Furthermore, play supports the formation of the safe, stable, and nurturing relationships with all caregivers that children need to thrive.
Play is not frivolous: it enhances brain structure and function and promotes executive function (ie, the process of learning, rather than the content), which allow us to pursue goals and ignore distractions.
When play and safe, stable, nurturing relationships are missing in a child’s life, toxic stress can disrupt the development of executive function and the learning of prosocial behavior; in the presence of childhood adversity, play becomes even more important. The mutual joy and shared communication and attunement (harmonious serve and return interactions) that parents and children can experience during play regulate the body’s stress response. This clinical report provides pediatric providers with the information they need to promote the benefits of play and and to write a prescription for play at well visits to complement reach out and read. At a time when early childhood programs are pressured to add more didactic components and less playful learning, pediatricians can play an important role in emphasizing the role of a balanced curriculum that includes the importance of playful learning for the promotion of healthy child development.