bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Polypharmacy with Survival, Complications, and Healthcare Resource Use after Elective Noncardiac Surgery
Authors: McIsaac Daniel I. , Wong Coralie A. , Bryson Gregory L. , van Walraven Carl 
Published: February 2018

Abstract

Background
Polypharmacy is increasingly prevalent in older patients and is associated with adverse events among medical patients. The impact of polypharmacy on outcomes after elective surgery is poorly described. The authors’ objective was to measure the association of polypharmacy with survival, complications, and resource use among older patients undergoing elective surgery.

Methods
After registration (NCT03133182), the authors identified all individuals older than 65 yr old having their first elective noncardiac surgery in Ontario, Canada, between 2002 and 2014. Using linked administrative data, the authors identified all prescriptions dispensed in the 90 days before surgery and classified people receiving five or more unique medications with polypharmacy. The associations of polypharmacy with 90-day survival (primary outcome), complications, length of stay, costs, discharge location, and readmissions were estimated after multilevel, multivariable adjustment for demographics, comorbidities, previous healthcare use, and surgical factors. Prespecified and post hoc sensitivity analyses were also performed.

Results
Of 266,499 patients identified, 146,026 (54.8%) had polypharmacy. Death within 90 days occurred in 4,356 (3.0%) patients with polypharmacy and 1,919 (1.6%) without (adjusted hazard ratio = 1.21; 95% CI, 1.14 to 1.27). Sensitivity analyses demonstrated no increase in effect when only high-risk medications were considered and attenuation of the effect when only prescriptions filled in the 30 preoperative days were considered (hazard ratio = 1.07). Associations were attenuated or not significant in patients with frailty and higher comorbidity scores.

Conclusions
Older patients with polypharmacy represent a high-risk stratum of the perioperative population. However, the authors’ findings call into question the causality and generalizability of the polypharmacy-adverse outcome association that is well documented in nonsurgical patients.
POSTERIOR PRECORTICAL VITREOUS POCKETS IN HIGH MYOPIA OBSERVED BY ENHANCED VITREOUS IMAGING OF SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY
Authors: Wang Xiaohan , Shen Mengxi , Wang Ruoshi , Zhou Yanping , Li Tong , Xiao Meichun , Song Minlu , Sun Xiaodong , Wang Fenghua 
Published: February 2018

Purpose:
To observe the vitreous in highly myopic eyes with posterior precortical vitreous pockets (PPVPs) using enhanced vitreous imaging of spectral domain optical coherence tomography.

Methods:
Fifty-two highly myopic eyes with PPVPs of 36 patients were included in this study. All subjects underwent enhanced vitreous imaging optical coherence tomography. The size of PPVPs was measured, and the frequency of imaging features was recorded.

Results:
Nine imaging features of the vitreous in highly myopic eyes with PPVPs were found. The average age of subjects was 38.1 ± 10.8 years. The mean height of PPVPs was 1,177 ± 704 μm, and the mean width was 7,440 ± 755 μm. Hyperreflective line and the interlayer were observed in 30 (57.7%) eyes. Hyperreflective dots were found in 37 (71.2%) eyes. More central vitreous space was more frequently detected in younger patients. Prevascular vitreous fissure was detected in 7 (13.5%) eyes. W-shaped cavity, identified as an empty space with a smooth W-shaped edge, was demonstrated to be the fusion of Cloquet's canal and the extension of PPVPs. Perpendicular hyperreflective parallel strands were detected in 3 (5.8%) eyes. Hyperreflective network was observed in 10 (19.2%) eyes. Hyperreflective parapapillary tubercle was found in 7 (13.5%) eyes.

Conclusion:
Nine imaging features of the vitreous in highly myopic eyes with PPVPs were visualized by enhanced vitreous imaging optical coherence tomography.
MULTIMODAL IMAGING OF ANGIOID STREAKS ASSOCIATED WITH TURNER SYNDROME
Authors: Chiu Bing Q. , Tsui Edmund , Hussnain Syed Amal , Barbazetto Irene A. , Smith R. Theodore 
Published: February 2018

Purpose:
To report multimodal imaging in a novel case of angioid streaks in a patient with Turner syndrome with 10-year follow-up.

Methods:
Case report of a patient with Turner syndrome and angioid streaks followed at Bellevue Hospital Eye Clinic from 2007 to 2017. Fundus photography, fluorescein angiography, and optical coherence tomography angiography were obtained.

Results:
Angioid streaks with choroidal neovascularization were noted in this patient with Turner syndrome without other systemic conditions previously correlated with angioid streaks.

Conclusion:
We report a case of angioid streaks with choroidal neovascularization in a patient with Turner syndrome. We demonstrate that angioid streaks, previously associated with pseudoxanthoma elasticum, Ehlers–Danlos syndrome, Paget disease of bone, and hemoglobinopathies, may also be associated with Turner syndrome, and may continue to develop choroidal neovascularization, suggesting the need for careful ophthalmic examination in these patients.
Association Between Visual Acuity and the Corneal Area Occupied by Granular Lesions, Linear Lesions, or Diffuse Haze in Patients With Granular Corneal Dystrophy Type 2
Authors: Kim Hong Seok , Rim Tyler Hyungtaek , Kim Tae-im , Kim Eung Kweon 
Published: February 2018

Purpose:
In granular corneal dystrophy type 2 (GCD2), corneal deposits containing fragments of transforming growth factor-β–induced protein appear in sequence as granular lesions (GLs), linear lesions (LLs), and diffuse haze (DH). We aimed to investigate the association between visual acuity and age-related changes in lesion types in patients with GCD2.

Methods:
We retrospectively evaluated the medical records and slit-lamp photographs of 533 patients (1066 eyes) with genetically confirmed GCD2 (heterozygous). Deposits were classified into GLs, LLs, and DH, after which the area occupied by each lesion type was measured. The associations between visual acuity and each lesion area were also evaluated using univariable and multivariable models.

Results:
The area occupied by GLs increased beginning in the teen years, whereas the area occupied by DH began to increase after age 40. However, the area occupied by LLs increased until patients had reached their 40s, after which no further increases occurred. Multivariable analyses revealed no association between GLs and low visual acuity after adjusting for age and sex. Increases in the LL area were associated with lower odds for low visual acuity (adjusted odds ratio = 0.4 for the third tertile, 95% confidence interval, 0.2–0.97), whereas increases in the DH area were positively associated with low visual acuity (adjusted odds ratio = 3.3 for the third tertile of the DH area, 95% confidence interval, 1.3–8.3).

Conclusions:
Our findings indicated that LLs associated with GCD2 do not produce significant decreases in visual acuity, whereas DH exerts the most significant negative impact on visual acuity. Late-onset DH may be associated with the termination of LL formation.
Human Immunodeficiency Virus Partner Notification Services Among a Representative Sample of Young Black Men Who Have Sex With Men Demonstrates Limited Service Offering and Potential Benefits of Clinic Involvement
Authors: Gore Daniel , Ferreira Matthew , Khanna Aditya S. , Schneider John 
Published: February 2018

Background
Partner notification (PN) is commonly offered to persons recently diagnosed with human immunodeficiency virus (HIV) to improve linkage to care and prevent onward transmission. Yet, much remains unknown about the factors associated with successful PN participation in populations at highest risk.

Methods
Data were collected during the first 2 waves (2013–2015) of “uConnect,” a population-based cohort study of young black men who have sex with men in Chicago (N = 618). Participants completed a biobehavioral survey and were tested for HIV. Among HIV-infected participants (N = 187), weighted logistic regression models examined the relationship between participant characteristics and being offered PN and providing partner names.

Results
30.3% (n = 187) of the sample was HIV-positive, of which 71.7% (n = 134) were offered PN, including: 8.2% (n = 11) by the city health department; 51.5% (n = 69) by health care providers; and 40.3% (n = 54) by both. Being offered PN was significantly associated with criminal justice involvement history (adjusted odds ratio [aOR], 2.49; 95% confidence interval [CI], 1.38–4.49), volatile nitrates usage (aOR, 2.88; 95% CI, 1.20–6.94), and recent conversations with HIV outreach workers (aOR, 2.68; 95% CI, 1.25–5.77). Providing partner names was significantly associated with intermittent (aOR, 7.26; 95% CI, 1.75–30.07) and heavy (aOR, 11.47; 95% CI, 2.57–51.22) marijuana use, and being offered PN by both the city health department and health care provider (aOR, 8.36; 95% CI, 2.73–25.62).

Conclusions
A substantial proportion of HIV-diagnosed individuals were never offered PN. Being offered PN by multiple sources is associated with participation, and improved collaboration within health systems may improve participation rates.
Spontaneous Clearance of Pharyngeal Gonococcal Infections: A Retrospective Study in Patients of the Sexually Transmitted Infections Clinic; Amsterdam, the Netherlands; 2012 to 2015
Authors: Hananta I Putu Yuda , de Vries Henry John Christiaan , van Dam Alje Pieter , van Rooijen Martijn Sebastiaan , Soebono Hardyanto , Schim van der Loeff Maarten Franciscus 
Published: February 2018

Introduction
Pharyngeal Neisseria gonorrhoeae infections are mostly asymptomatic, yet sustain ongoing gonococcal transmission. We assessed the proportion of pharyngeal gonorrhea that spontaneously clears and identified determinants of clearance.

Methods
At the sexually transmitted infections clinic Amsterdam, at-risk women and men who have sex with men were routinely screened for pharyngeal N. gonorrhoeae using an RNA-based nucleic acid amplification test (NAAT; Aptima Combo 2).
We retrospectively examined medical records of pharyngeal gonorrhea patients (January 2012–August 2015). We included patients who returned for antibiotic treatment and had a new sample taken for NAAT before treatment. Spontaneous clearance was defined as a negative NAAT result at the follow-up visit.

Results
During the study period, 1266 cases with a pharyngeal gonorrhea were not treated at the first consultation and returned for a follow-up visit. Median (interquartile range) time between the first consultation and follow-up was 10 (7–14) days. Spontaneous clearance was found in 139 cases (11.0%) and was associated with age at least 45 years (vs. 16–24 years; adjusted odds ratio, 2.02 [95% confidence interval, 1.09–3.75]) and with time from the first consultation to follow-up (adjusted odds ratio, 1.08 [1.06–1.10], per extra day).

Conclusions
Eleven percent of pharyngeal gonorrhea cases cleared spontaneously. Spontaneous clearance of pharyngeal gonorrhea was more often seen among older patients.
Trauma-induced insurance instability: Variation in insurance coverage for patients who experience readmission after injury
Authors: Rajasingh Charlotte Mary , Weiser Thomas G. , Knowlton Lisa M. , Tennakoon Lakshika , Spain David A. , Staudenmayer Kristan L. 
Published: February 2018

BACKGROUND
Traumatic injuries result in a significant disruption to patients' lives, including their ability to work, which may place patients at risk of losing insurance coverage. Our objective was to evaluate the impact of injury on insurance status. We hypothesized that trauma patients with ongoing health needs experience changes in coverage.

METHODS
We used the Nationwide Readmission Database (2013–2014), a nationally representative sample of readmissions in the United States. We included patients aged 27 years to 64 years admitted with any diagnosis of trauma with at least one readmission within 6 months. Patients on Medicare and with missing payer information were excluded. The primary outcome was payer status.

RESULTS
57,281 patients met inclusion criteria, 11,006 (19%) changed insurance payer at readmission. Of these, 21% (n = 2,288) became uninsured, 25% (n = 2,773) gained coverage, and 54% (n = 5,945) switched insurance. Medicaid and Medicare gained the largest fraction of patients (from 16% to 30% and 0% to 18%, respectively), with a decrease in private payer coverage (37% to 17%). In multivariate analysis, patients who were younger (27–35 years vs. 56–64 years; odds ratio [OR], 1.30; p < 0.001); lived in a zip code with average income in the lowest quartile (vs. the highest quartile; OR, 1.37; p < 0.001); and had three or more comorbidities (vs. none; OR, 1.61; p < 0.001) were more likely to experience a change in insurance.

CONCLUSION
Approximately one fifth of trauma patients who are readmitted within 6 months of their injury experience a change in insurance coverage. Most switch between insurers, but nearly a quarter lose their insurance. The government adopts a large fraction of these patients, indicating a growing reliance on government programs like Medicaid. Trauma patients face challenges after injury, and a change in insurance may add to this burden. Future policy and quality improvement initiatives should consider addressing this challenge.

LEVEL OF EVIDENCE
Epidemiologic, level III.
Continuous remote ischemic conditioning attenuates cognitive and motor deficits from moderate traumatic brain injury
Authors: Pandit Viraj , Khan Muhammad , Zakaria El Rasheid , Largent-Milnes Tally M. , Hamidi Mohammad , O’Keeffe Terence , Vanderah Todd W. , Joseph Bellal 
Published: February 2018

BACKGROUND
While studies show that single-dose remote ischemic conditioning (RIC) improves outcomes, the effect of continuous (daily) RIC is unknown. Thus, we aimed to investigate the role of continuous RIC on cognitive and motor function following traumatic brain injury (TBI).

METHODS
We subjected 24 male C57BL mice to a cortical-controlled TBI. Two hours after TBI, the animals were randomly allocated to the RIC group (n = 12) or the sham group (n = 12). Remote ischemic conditioning was induced by noninvasive external compression of the hind limb using an occlusive band (six 4-minute cycles/24 hours) for six consecutive days. Before TBI, a baseline rotarod test and novel object recognition were performed. Post-TBI rotarod and novel object recognition tests were performed on Days 1 to 5, 7, 14, and 21. After the animals were sacrificed on Day 21, brain sections were analyzed using hematoxylin and eosin and glial fibrillary acidic protein staining to evaluate the hippocampal CA1 area for neuronal injury.

RESULTS
Both the RIC and sham groups had lower latency to fall compared with the baseline post-TBI. The RIC animals had a higher latency to fall compared with the sham animals at all time points, statistically significant after Day 3, until Day 21 post-TBI. Both the RIC and sham groups had lower recognition index compared with the baseline post-TBI. The RIC animals had a significantly higher recognition index than the sham animals after Day 1, until Day 21 post-TBI. Hematoxylin and eosin and glial fibrillary acidic protein staining of the brain samples of the sham group revealed that more neurons in the hippocampal CA1 area appeared shrunken with eosinophilic cytoplasm and pyknotic nuclei compared with the brain samples of the RIC group.

CONCLUSION
Postinjury continuous RIC resulted in improved cognitive functions and motor coordination in a mouse model of moderate TBI. Further studies are required to determine optimum dosage and frequency of this novel therapy to maximize its beneficial effects following TBI.
Overresuscitation with plasma is associated with sustained fibrinolysis shutdown and death in pediatric traumatic brain injury
Authors: Leeper Christine M. , Neal Matthew D. , Billiar Timothy R. , Sperry Jason L. , Gaines Barbara A. 
Published: February 2018

BACKGROUND
Elevated International Normalized Ratio (INR) is a marker of poor outcome but not necessarily bleeding or clinical coagulopathy in injured children. Conversely, children with traumatic brain injury (TBI) tend to be hypercoagulable based on rapid thromboelastography (rTEG) parameters. Many clinicians continue to utilize INR as a treatment target.

METHODS
Prospective observational study of severely injured children age < 18 with rTEG on arrival and daily thereafter for up to 7 days. Standard rTEG definitions of hyperfibrinolysis (LY30 ≥ 3), fibrinolysis shutdown (SD) (LY30 ≤ 0.8), and normal (LY30 = 0.9-2.9) were applied. The first 24-hour blood product transfusion volumes were documented. Abbreviated Injury Scale score ≥ 3 defined severe TBI. Sustained SD was defined as two consecutive rTEG with SD and no subsequent normalization. Primary outcomes were death and functional disability, based on functional independence measure score assessed at discharge.

RESULTS
One hundred one patients were included: median age, 8 years (interquartile range, 4–12 years); Injury Severity Score, 25 (16–30); 72% blunt mechanism; 47% severe TBI; 16% mortality; 45% discharge disability. Neither total volume nor any single product volume transfused (mL/kg; all p > 0.1) differed between TBI and non-TBI groups. On univariate analysis, transfusion of packed red blood cells (p = 0.016), plasma (p < 0.001), and platelets (p = 0.006) were associated with sustained SD; however, in a regression model that included all products (mL/kg) and controlled for severe TBI (head Abbreviated Injury Scale score ≥ 3), admission INR, polytrauma, and clinical bleeding, only plasma remained an independent predictor of sustained SD (odds ratio, 1.17; p = 0.031). Patients with both severe TBI and plasma transfusion had 100% sustained SD, 75% mortality, and 100% disability in survivors. Admission INR was elevated in TBI patients, but did not correlate with rTEG activated clotting time (p = NS) and was associated with sustained SD (p = 0.006).

CONCLUSION
Plasma transfusion is independently associated with sustained fibrinolysis SD. Severe TBI is also associated with sustained SD; the combined effect of plasma transfusion and severe TBI is associated with extremely poor prognosis. Plasma transfusion should not be targeted to INR thresholds but rather to rTEG activated clotting time and clinical bleeding.

LEVEL OF EVIDENCE
Prognostic and epidemiological study, level III.
Ian William Murison Smith. 15 June 1937—8 November 2016
Authors: Hancock Gus 
Published: February 2018

Ian Smith was one of the world-wide leading researchers into reaction kinetics, energy transfer and molecular dynamics in gas phase systems. He was able to span all of these aspects of collisional behaviour, and to form connections and insights that allowed him to make advances in all of them, advances which have stood the tests of time. His graduate work at the University of Cambridge was followed by academic positions in Cambridge and in Birmingham. He provided new insights into molecular energy transfer by systematically measuring how vibrational frequencies and multipole moments influenced the magnitude of the energy transfer cross sections. In reaction kinetics his detailed work on the OH radical has led to an understanding of the importance of its reactions not only in applied areas such as atmospheric and combustion chemistry, but also in fundamental dynamical studies of radical recombination and the effect of reagent energies on reactive processes. Of particular significance has been his development of both cryogenic and nozzle expansion methods of studying collisional processes at temperatures down to 10 K, with the discovery that reactions without activation barriers can get faster as the temperature decreases. The impact of this work upon astrochemistry has been profound, and has stimulated theoretical explanations of the effect. He was one of the first pioneers in the UK of the use of laser techniques to study collisional processes, using laser-induced fluorescence as a sensitive detection tool, UV laser photolysis to form reactive species and laser pumping to create excited state populations in order to observe their effect upon reaction pathways and vibrational relaxation.
Ian was devoted to his family—his wife Sue, their four children and 11 grandchildren. His research collaborators will always remember his scholarship, his unending suggestions of interesting problems to study, his deep integrity and humanity. His legacy lives on with his personal and academic families.
Implementing Parrondo’s paradox with two-coin quantum walks
Authors: Rajendran Jishnu , Benjamin Colin 
Published: February 2018

Parrondo’s paradox is ubiquitous in games, ratchets and random walks. The apparent paradox, devised by J. M. R. Parrondo, that two losing games
A
and
B
can produce a winning outcome has been adapted in many physical and biological systems to explain their working. However, proposals on demonstrating Parrondo’s paradox using quantum walks failed for a large number of steps. In this work, we show that instead of a single coin if we consider a two-coin initial state which may or may not be entangled, we can observe a genuine Parrondo’s paradox with quantum walks. Furthermore, we focus on reasons for this and pin down the asymmetry in initial two-coin state or asymmetry in shift operator, either of which is necessary for observing a genuine Parrondo’s paradox. We extend our work to a three-coin initial state too with similar results. The implications of our work for observing quantum ratchet-like behaviour using quantum walks are also discussed.
Markov chain models of cancer metastasis
Authors: Mason Jeremy , Newton Paul K. 
Published: February 2018

Abstract.We describe the use of Markov chain models for the purpose of quantitative forecasting of metastatic cancer progression. Each site (node) in the Markov network (directed graph) is an organ site where a secondary tumor could develop with some probability. The Markov matrix is an N x N matrix where each entry represents a transition probability of the disease progressing from one site to another during the course of the disease. The initial state-vector has a 1 at the position corresponding to the primary tumor, and 0s elsewhere (no initial metastases). The spread of the disease to other sites (metastases) is modeled as a directed random walk on the Markov network, moving from site to site with the estimated transition probabilities obtained from longitudinal data. The stochastic model produces probabilistic predictions of the likelihood of each metastatic pathway and corresponding time sequences obtained from computer Monte Carlo simulations. The main challenge is to empirically estimate the N^2 transition probabilities in the Markov matrix using appropriate longitudinal data.
Targeting redox regulatory site of protein kinase B impedes neutrophilic inflammation in lung injury
Authors: Chen Po-Jen , Ko I-Ling , Lee Chia-Lin , Hu Hao-Chun , Chang Fang-Rong , Wu Yang-Chang , Leu Yann-Lii , Wu Chih-Ching , Lin Cheng-Yu , Pan Chang-Yu , Tsai Yung-Fong , Hwang Tsong-Long 
Published: February 2018

AbstractNeutrophil activation has a pathogenic effect in inflammatory diseases. Protein kinase B (PKB)/AKT regulates diverse cellular responses. However, the significance of AKT in neutrophilic inflammation is still not well understood. Here, we identified CLLV-1 as a novel AKT inhibitor. CLLV-1 inhibited respiratory burst, degranulation, chemotaxis, and AKT phosphorylation in activated human neutrophils and dHL-60 cells. Significantly, CLLV-1 blocked AKT activity and covalently reacted with AKT Cys310 in vitro. The AKT309-313 peptide-CLLV-1 adducts were determined by NMR or mass spectrometry assay. The alkylation agent-conjugated AKT (reduced form) level was also inhibited by CLLV-1. Additionally, CLLV-1 ameliorated lipopolysaccharide (LPS)-induced acute lung injury (ALI) in mice. CLLV-1 acts as a covalent allosteric AKT inhibitor by targeting AKT Cys310 to restrain inflammatory responses in human neutrophils and LPS-induced ALI in vivo. Our findings provide a mechanistic framework for redox modification of AKT that may serve as a novel pharmacological target to alleviate neutrophilic inflammation.