bluuebunny/crossref_metadata_2025_split huggingface dataset:
Celiac Diasease–associated lncRNA Named HCG14 Regulates NOD1 Expression in Intestinal Cells
Authors: Santin Izortze , Jauregi‐Miguel Amaia , Velayos Teresa , Castellanos‐Rubio Ainara , Garcia‐Etxebarria Koldo , Romero‐Garmendia Irati , Fernandez‐Jimenez Nora , Irastorza Iñaki , Castaño Luis , Bilbao Jose Ramón 
Published: March 2018

ABSTRACTObjective:The aim of the study is to identify additional celiac disease associated loci in the major histocompatibility complex (MHC) independent from classical HLA risk alleles (HLA‐DR3‐DQ2) and to characterize their potential functional impact in celiac disease pathogenesis at the intestinal level.Methods:We performed a high‐resolution single‐nucleotide polymorphism (SNP) genotyping of the MHC region, comparing HLA‐DR3 homozygous celiac patients and non‐celiac controls carrying a single copy of the B8‐DR3‐DQ2 conserved extended haplotype. Expression level of potential novel risk genes was determined by RT‐PCR in intestinal biopsies and in intestinal and immune cells isolated from control and celiac individuals. Small interfering RNA‐driven silencing of selected genes was performed in the intestinal cell line T84.Results:MHC genotyping revealed 2 associated SNPs, one located in TRIM27 gene and another in the non‐coding gene HCG14. After stratification analysis, only HCG14 showed significant association independent from HLA‐DR‐DQ loci. Expression of HCG14 was slightly downregulated in epithelial cells isolated from duodenal biopsies of celiac patients, and eQTL analysis revealed that polymorphisms in HCG14 region were associated with decreased NOD1 expression in duodenal intestinal cells.Conclusions:We have successfully employed a conserved extended haplotype‐matching strategy and identified a novel additional celiac disease risk variant in the lncRNA HCG14. This lncRNA seems to regulate the expression of NOD1 in an allele‐specific manner. Further functional studies are needed to clarify the role of HCG14 in the regulation of gene expression and to determine the molecular mechanisms by which the risk variant in HCG14 contributes to celiac disease pathogenesis.
Proton Pump Inhibitors and Infant Pneumonia/Other Lower Respiratory Tract Infections
Authors: Blank Mei‐Ling , Parkin Lianne , Zeng Jiaxu , Barson David 
Published: March 2018

ABSTRACTObjective:The possible association between the use of proton pump inhibitors (PPIs) and community‐acquired pneumonia (CAP) or another lower respiratory tract infection (LRTI) remains uncertain. We conducted a nested case‐control study using routinely collected national health and drug dispensing data in New Zealand to examine the risk of CAP or another LRTI resulting in hospitalization or death in infants dispensed a PPI.Study Design:The cohort included 21,991 patients without a history of CAP or another LRTI who were born between 1 January 2005 and 31 December 2012 and were dispensed omeprazole, lansoprazole, or pantoprazole (the PPIs available in New Zealand during the study period) on at least one occasion during the first year of life. Cases had a first diagnosis after cohort entry (first PPI dispensing) of CAP (n = 65) validated by hospital discharge letter or death record, and chest radiography; or LRTI (including CAP) (n = 566) validated by hospital discharge letter or death record, with or without chest radiography. Up to 10 controls, matched by sex and date of birth, were randomly selected for each case. We conducted complete case analyses for the fully adjusted models.Results:In the adjusted analysis based on CAP cases and their controls, the matched odds ratio for current versus past use of PPIs was 0.88 (95% confidence interval 0.36–2.16). For all LRTI cases and their controls, the matched odds ratio was 1.13 (0.87–1.48).Conclusion:In otherwise healthy community‐dwelling infants, current use of a PPI does not appear to increase the risk of CAP or other LRTIs.
Sudden Unexpected Death in Epilepsy
Authors: Ellis Steven P. , Szabó Charles Ákos 
Published: March 2018

Abstract
Epilepsy is a common neurological disorder associated with increased morbidity and mortality, including premature death from different causes. Sudden unexpected death in epilepsy, or SUDEP, is one of the most common causes of death in people with epilepsy and originally brought to light by medical examiners. It accounts for 5% to 30% of all deaths in individuals with epilepsy and up to 50% in individuals with medically refractory epilepsy. It is commonly associated with a history of generalized tonic-clonic seizures and may be mitigated by other electroclinical risk factors, such as postictal electroencephalographic suppression, prone position, altered heart rate variability, conduction abnormalities, gender, or antiepileptic medications, to name a few. More recently, potential neuroimaging biomarkers have also been identified. Still, despite the increased mortality risk in people with epilepsy due to SUDEP, little is known about its underlying pathophysiology. The pathogenesis is likely to be multifactorial, resulting in neurogenic pulmonary edema or, in some cases, fatal cardiac arrhythmias. Medical examiners can provide an important role in our understanding of the magnitude of the problem and ongoing research into the underlying mechanisms. In this review, we discuss diagnostic criteria, incidence, risk factors, and current theories regarding the pathophysiology of SUDEP.
Electronic Medical Record in the ED
Authors: Franco Marleny , Baird Janette , Brown Linda L. , Overly Frank L. 
Published: March 2018

Objectives
The aims of this study were to describe current practices in nursing documentation of trauma and medical resuscitations across emergency departments (EDs) and explore physicians' and nurses' perceptions of electronic medical record (EMR) use for nursing documentation of resuscitations.

Methods
An anonymous Web-based survey was developed and distributed to a convenience sample of ED physicians and nurses in the United States.

Results
Of 438 respondents, 154 were nurses; 97.2% of respondents reported that their EDs use EMR generally. Of those, 51.2% use EMR to document resuscitations. When describing documentation processes, 19% (95% confidence interval [CI], 15%–23%) reported direct documentation on EMR, 18% (95% CI, 14%–21%) reported documenting on paper before transferring to EMR, and 22% (95% CI, 18%–26%) reported simultaneously documenting on EMR and paper. Thirty-seven percent of respondents reported that the “documentor” frequently performs other tasks during resuscitations. Few nurses (39.6%) and physicians (26.4%) perceived EMR as more efficient than paper. Nurses (66.2%) and physicians (51.8%) perceived paper as more complete than EMR. Few nurses (31.6%) and physicians (25.6%) agreed that paper would facilitate continuity of care better than EMR. No associations between nurses' perceptions of EMR, professional experience, or technology use were found.

Conclusions
Although EMR adoption was common among respondents, only half reported using EMR to document resuscitations. Even fewer reported documenting directly on EMR, whereas a significant proportion reported processes that may be inefficient, redundant, or prone to errors. Respondents endorsed mostly negative perceptions of EMR. Our findings suggest that there may be factors inherent to resuscitations and the existing EMR interfaces that render documenting resuscitations on EMR uniquely challenging.
Adolescent Sexual Behavior and Emergency Department Use
Authors: Weisman Julie , Chase Alyse , Badolato Gia M. , Teach Stephen J. , Trent Maria E. , Chamberlain James M. , Goyal Monika K. 
Published: March 2018

Objectives
The objective of this study was to determine whether adolescents in emergency departments (EDs) who report engaging in high-risk sexual behaviors are less likely to identify a primary care provider (PCP) and more likely to access the ED than their sexually inexperienced peers.

Methods
This was a secondary analysis of adolescents presenting to a pediatric ED with non–sexually transmitted infection (STI)–related complaints who completed surveys to assess sexual behavior risk and health care access. We measured differences in self-reported PCP identification, preferential use of the ED, and number of ED visits over a 12-month period by sexual experience. Secondary outcomes included clinician documented sexual histories and STI testing.

Results
Of 758 patients meeting inclusion criteria, 341 (44.9%) were sexually experienced, and of those, 129 (37.8%) reported engaging in high-risk behavior. Participants disclosing high-risk behavior were less likely to identify a PCP (adjusted odds ratio, 0.5; 95% confidence interval [CI], 0.3–0.9), more likely to prefer the ED for acute care issues (adjusted odds ratio, 1.6; 95% CI, 1.0–2.6), and had a higher rate of ED visits (adjusted relative risk, 1.2; 95% CI, 1.0–1.3) compared with sexually inexperienced peers. Among patients disclosing high-risk behavior, 10.9% had clinician-documented sexual histories and 2.6% underwent STI testing.

Conclusion
Adolescents who reported engaging in high-risk sexual behaviors were less likely to identify a PCP, as well as more likely to prefer ED-based care and make more ED visits. However, ED clinicians infrequently obtained sexual histories and performed STI testing in asymptomatic youth, thereby missing opportunities to screen high-risk adolescents who may lack access to preventive care.
Intimate Partner Violence Educational Materials in the Acute Care Setting
Authors: Randell Kimberly A. , Sherman Ashley , Walsh Irene , O'Malley Donna , Dowd Mary Denise 
Published: March 2018

Objectives
This study aimed to determine acceptability of intimate partner violence (IPV) materials and effect of the materials on caregiver attitudes toward IPV screening.

Methods
We used an anonymous computerized survey to assess approval of IPV materials and screening, and willingness to disclose IPV in response to screening among mothers bringing a child to an urban pediatric emergency department or 2 suburban pediatric urgent care centers affiliated with a free-standing academic children's hospital. We compared responses between participants recruited before and after display of the IPV materials, as well as between subgroups, using χ2 tests.

Results
A total of 522 participated (predisplay, n = 261; postdisplay, n = 261). More subjects in the postdisplay group approved of display of IPV materials in pediatric emergency department/urgent care center restrooms (94% pre vs 98% post, P = 0.04) and examination rooms (94% pre vs 98% post, P = 0.01). We found no differences in acceptability of IPV screening between the pre and post groups (73% pre and post, P = 0.92). Willingness to disclose IPV in response to screening was higher in the postdisplay group for those with a personal IPV history (55% pre, 73% post; P = 0.02), African Americans (60% pre, 78% post; P = 0.02), and those with a high school degree or less education (66% pre, 77% post; P = 0.04).

Conclusions
Intimate partner violence materials in this study were acceptable to most participants and did not negatively impact attitudes toward IPV screening or willingness to disclose IPV. Display of IPV materials should be considered as a component of IPV intervention.
Rising Clinical Burden of Psychiatric Visits on the Pediatric Emergency Department
Authors: Nadler Ariella , Avner Deena , Khine Hnin , Avner Jeffrey R. , Fein Daniel M. 
Published: March 2018

Objective
The mental health epidemic in pediatrics has resulted in a growing clinical burden on the health care system, including pediatric emergency departments (PED). Our objective was to describe the changing characteristics of visits to an urban PED, in particular length of stay, for emergency psychiatric evaluations (EPEs) over a 10-year period.

Methods
A retrospective study of children with an EPE in the PED at a large urban quaternary care children's hospital was performed during two discrete periods a decade apart: July 1, 2003–June 30, 2004 (period 1) and July 1, 2013–June 30, 2014 (period 2). Visit information, including length of stay and demographic data, were compared between groups.

Results
There was a significant increase in the percentage of PED visits for EPE from period 1 to period 2 (1.1% vs 2.2% P < 0.0001). Overall, the median (interquartile range [IQR]) length of stay for children requiring an EPE increased significantly for all visits (5.3 [3.2–15.4] hours vs 17.0 [6.0–26.0] hours, P < 0.0001), including for patients who were admitted (17.8 [7.4–24.6] hours vs 27.0 [21.0–36.0] hours, P < 0.0001) and for those who were discharged (4.5 [2.8–7.7] hours vs 8 [5–20] hours, P < 0.0001).

Conclusions
Over a decade, the percentage of children with an EPE has doubled, with a significant increase in the amount of time spent in the PED. This highlights a continued surge in the utilization of PED resources for EPE.
Liquid Biopsies and Cancer Immunotherapy
Authors: Thompson Jonathan R. , Menon Smitha P. 
Published: March 2018

Abstract
Cancer immunotherapy has recently undergone rapid advances and has become an integral part of the treatment armamentarium in various malignancies. However, tissue-based biomarker development in this arena has been slow, and valid biomarker identification to guide immunotherapeutic management is desperately needed. “Liquid” or blood-based biopsies potentially offer more convenient and efficient means to judge the immune milieu of individual patients and identify who will benefit most from immunotherapy. The following review highlights the current literature regarding the application of liquid biopsies to cancer immunotherapy.
Future of Liquid Biopsies With Growing Technological and Bioinformatics Studies: Opportunities and Challenges in Discovering Tumor Heterogeneity With Single-Cell Level Analysis
Authors: Ramalingam Naveen , Jeffrey Stefanie S. 
Published: March 2018

Abstract
Liquid biopsy provides minimally invasive and readily obtainable access to tumor-associated biological material in blood or other body fluids. These samples provide important insights into cancer biology, such as primary tumor heterogeneity; real-time tumor evolution; response to therapy, including immunotherapy; and mechanisms of cancer metastasis. Initial biological materials studied were circulating tumor cells and circulating nucleic acids, including circulating tumor DNA and microRNAs; more recently, studies have expanded to investigate extracellular vesicles, such as exosomes, microvesicles, and large oncosomes; tumor-derived circulating endothelial cells; and tumor-educated platelets. Even with an ongoing ambitious investment effort to develop liquid biopsy as an early cancer detection test in asymptomatic individuals, current challenges remain regarding how to access and analyze rare cells and tumor-derived nucleic acids in cancer patients. Technologies and associated bioinformatics tools are continuously evolving to capture these rare materials in an unbiased manner and to analyze them with high confidence. After first presenting recent applications of liquid biopsy, this review discusses aspects affecting the field, including tumor heterogeneity, single-cell analyses, and associated computational tools that will shape the future of liquid biopsy, with resultant opportunities and challenges.
Plastic Surgery Complications from Medical Tourism Treated in a U.S. Academic Medical Center
Authors: Ross Kimberly M. , Moscoso Andrea V. , Bayer Lauren R. , Rosselli-Risal Liliana , Orgill Dennis P. 
Published: March 2018

Background:
Medical tourism is a growing, multi–billion dollar industry fueled by improvements in the global transportation infrastructure. The authors studied patients living in the United States who travel to other countries for plastic surgical procedures and returned to have their complications treated in the authors’ center.

Methods:
A retrospective patient evaluation was performed. Patients who had presented to an urban tertiary academic hospital plastic surgery service with complications or complaints associated with plastic surgery performed in a developing country were studied. The authors collected demographic information, types of surgery performed, destinations, insurance coverage, and complications.

Results:
Seventy-eight patients were identified over 7 years. Most commonly, complications were seen following abdominoplasty (n = 35), breast augmentation (n = 25), and foreign body injections (n = 15). Eighteen patients underwent multiple procedures in one operative setting. The most common destination country was the Dominican Republic (n = 59). Complications included surgical-site infections (n = 14), pain (n = 14), and wound healing complications (n = 12). Eighty-six percent of patients (n = 67) relied on their medical insurance to pay for their follow-up care or manage their complications, with the most common type of health insurance coverage being Massachusetts Medicaid (n = 48).

Conclusions:
Cosmetic surgery performed in developing countries can carry substantial risks of complications that can be challenging to patients, primary care providers, insurers, and plastic surgical teams not associated with the original surgery. These complications pose significant burdens on our public health systems.
Outcome of Palate Re-repair with Radical Repositioning of the Levator Muscle Sling as a First-Line Strategy in Postpalatoplasty Velopharyngeal Incompetence Management Protocol
Authors: Elsherbiny Ahmed , Amerson Meghan , Sconyers Laura , Grant John H. 
Published: March 2018

Background:
Palatal re-repair aims to improve velar function by retropositioning the levator muscles. Although it has become a popular procedure, very few studies document its efficacy. To date, this is the largest series reported to clarify its indications and efficacy.

Methods:
One hundred eighty-three consecutive cleft patients presenting with velopharyngeal incompetence and evidence of abnormally oriented levator muscles underwent palate re-repair (regardless of the gap size) performed by a single surgeon from 2000 to 2015. Perceptual speech assessment was performed using the Pittsburgh Weighted Speech Score. Other patients’ demographic data were collected.

Results:
Complete records of 111 patients were available. Eighteen cases were syndromic (18.9 percent). Postoperatively, there was highly significant improvement (p < 0.001) in nasal emission (from 2.24 to 0.64), nasality (from 3.44 to 1.27), articulation (from 5.32 to 2.01), and total score (from 11.29 to 4.11). Speech became normal/borderline normal, improved or did not improve in 66.7, 24.3, and 9 percent of patients, respectively. An initial diagnosis of isolated cleft palate, Caucasians, intravelar veloplasty in the primary repair, older patients, and nonsyndromic cases were associated with better outcome. There were no reported cases of postoperative fistula or new obstructive sleep apnea.

Conclusions:
This large series study provides confirmatory evidence of the effectiveness and safety of the re-repair procedure. It is recommended as a first-line procedure in all velopharyngeal incompetence cases with abnormally oriented levator muscles regardless of gap size, even if the primary operation included prior muscle dissection. The pharyngoplasty rate could be significantly reduced with the current protocol.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Surgical Approach to Injuries of the Cervical Plexus and Its Peripheral Nerve Branches
Authors: Brown David L. , Dellon A. Lee 
Published: March 2018

Background:
Located in the neck beneath the sternocleidomastoid muscle, the cervical plexus comprises a coalition of nerves originating from C1 through C4, which provide input to four cutaneous, seven motor, and three cranial nerves and the sympathetic trunk. Sporadic instances of injury to these superficial nerves have been reported. Nevertheless, this specific anatomical cause of neurogenic pain remains incompletely described and underrecognized.

Methods:
Twelve patients presented with pain and were diagnosed with various combinations of injury to the lesser occipital, great auricular, transverse cervical, and supraclavicular nerves. Inciting events included prior face lift, migraine, and thoracic outlet procedures; and traumatic events including seatbelt trauma, a fall, and a clavicular fracture. History and examination suggested injury to the cervical plexus, and nerve blocks confirmed the diagnoses. Neurectomy with intramuscular transposition was performed for three nerve branches in one patient, two branches in two patients, and one branch in the remaining nine patients.

Results:
Nine of the twelve patients had complete relief of their cervical plexus–related pain. The three failures were in patients with pain after previous face-lift surgery. Residual perception of neck tightness and choking sensation persisted despite relief of cheek and ear pain.

Conclusions:
Knowledge of the cervical plexus anatomy and its branches is crucial for surgeons operating in this area to minimize iatrogenic nerve injury. In addition, neuromas should be considered a likely cause of pain and dysesthesia following surgery or injury. Proper diagnosis and surgical intervention can have a significantly positive effect on these debilitating problems.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Comparison of Cartilage-Scoring and Cartilage-Sparing Otoplasty: A Retrospective Analysis of Complications and Aesthetic Outcome of 1060 Ears
Authors: Smittenberg Marije N. , Marsman Martijn , Veeger Nic J. G. M. , Moues Chantal M. 
Published: March 2018

Background:
Various techniques are used to correct prominent ears. The authors describe their experience with four different otoplasty techniques in 565 patients with congenital deformities of the ears (1060 ears) that were performed in their hospital during an 11-year period (2002 to 2012).

Methods:
The authors divided the techniques into two groups: group I, cartilage-sparing techniques (i.e., IA, Mustardé; and IB, Furnas); and group II, cartilage-cutting techniques (i.e., IIA, Chongchet; and IIB, concha shell reduction). The authors compared early and late and minor and major complications, recurrence rates, and revision surgery. Furthermore, aesthetic outcome was scored by three different groups (consultant plastic surgeons, plastic surgery residents, and laymen) on a visual analogue scale using a blinded random selection of preoperative and postoperative photographs.

Results:
The percentage of complications without the need for reoperation was 20 percent and 21 percent in the cartilage-sparing and cartilage-cutting groups, respectively (p = 0.44). In 6 percent of all cases, a reoperation of the otoplasty was required (7 percent and 6 percent in the cartilage-sparing and cartilage-cutting groups, respectively). Aesthetic postoperative results showed that the cartilage-cutting group scored significantly lower on postoperative shape (p = 0.04), result (p = 0.03), and satisfaction (p = 0.04) compared with the cartilage-sparing group.

Conclusions:
The study shows that patients who have undergone operations with cartilage-sparing or cartilage-cutting techniques have a similar rate of complications and need for reoperation. However, the cartilage-sparing techniques have a better aesthetic outcome, as judged by the different groups.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Factors Affecting Women’s Success in Academic and Private Practice Plastic Surgery
Authors: Shah Amita R. , Haws Melinda J. , Kalliainen Loree K. 
Published: March 2018

Summary:
Because plastic surgery trainees generally spend the majority of their training in academic centers and may have minimal exposure to other practice models, it can be difficult to decide which is the best route to achieve satisfaction and success. Surgeons need to be aware of benefits and challenges associated with different practice models and with workplace factors in general that contribute to happiness at work. This article reviews common practice models and provide specific and practical advice for the female surgeon.