bluuebunny/crossref_metadata_2025_split huggingface dataset:
Invasive Fungal Infections in Neonates in Canada
Authors: Ting Joseph Y. , Roberts Ashley , Synnes Anne , Canning Roderick , Bodani Jaya , Monterossa Luis , Shah Prakesh S. 
Published: March 2018

Background:
Neonatal fungemia is associated with adverse neonatal outcomes and higher overall healthcare expenditure. Our objective is to review the epidemiology of invasive fungal infections (IFIs) in neonates in Canada.

Methods:
A retrospective cohort study using data collected by the Canadian Neonatal Network (CNN) was conducted. Using a nested matched cohort study design, risk factors and outcomes of neonates born <33 weeks gestation (n = 39,305) during 2003–2013 were compared between neonates diagnosed with an IFI during their stay to infection-free controls.

Results:
Overall incidence of IFI among all admitted neonates was 0.22% (n = 286), while the incidence of IFI in the group of neonates born <33 weeks gestation was 0.64%. Of the isolates, 170 (59%) had Candida albicans and 59 (21%) had Candida parapsilosis. Risk factors for IFI were lower gestation, male sex, Apgar score <7 at 5 minutes, higher severity of illness score, maternal diabetes and vaginal birth. Neonates with IFI had higher odds of mortality [adjusted odds ratio (aOR): 1.60; 95% confidence interval (CI): 1.06–2.43], necrotizing enterocolitis (aOR: 2.97; 95% CI: 1.76–5.01) and severe retinopathy of prematurity (aOR: 2.15; 95% CI: 1.26–3.67).

Conclusions:
The overall incidence of IFI in neonates was low in Canada in comparison to other large population cohort studies; however, the mortality and morbidity remained high.
To intubate or not to intubate?
Authors: Gough Christopher J.R. , Nolan Jerry P. 
Published: March 2018

Purpose of review
Cardiac arrest mortality remains high, and the impact on outcome of most advanced life support interventions is unclear. The optimal method for managing the airway during cardiac arrest remains unknown. This review will summarize and critique recently published evidence comparing basic airway management with the use of more advanced airway interventions [insertion of supraglottic airway (SGA) devices and tracheal intubation].

Recent findings
Systematic reviews generally document an association between advanced airway management and worse neurological outcome but they are subject to considerable bias. A recent observational study of tracheal intubation for in-hospital cardiac arrest that used time-dependent propensity matching showed an association between tracheal intubation during the first 15 min of cardiac arrest and a worse a neurological outcome compared with no intubation in the first 15 min. In a recent randomized clinical trial, tracheal intubation was compared with bag-mask ventilation (with intubation only after return of spontaneous circulation) in 2043 patients with out-of-hospital cardiac arrest. There was no difference in favorable neurological outcome at 28 days.

Summary
Most of the available evidence about airway management during cardiac arrest comes from observational studies. The best option for airway management is likely to be different for different rescuers, and at different time points of the resuscitation process. Thus, it is common for a single patient to receive multiple ‘stepwise’ airway interventions. The only reliable way to determine the optimal airway management strategy is to undertake properly designed, prospective, randomized trials. One randomized clinical trial has been published recently and two others have completed enrollment but have yet to be published.
The Development of the Working Alliance and Its Ability to Predict Outcome in Emotion-Focused Therapy for Social Anxiety Disorder
Authors: Adler Gilad , Shahar Ben , Dolev Tohar , Zilcha-Mano Sigal 
Published: March 2018

AbstractThe study focuses on the alliance of 12 patients receiving emotion-focused therapy for social anxiety. Anxiety symptoms and patient perception of the working alliance were examined weekly. The first eight sessions of each patient were coded for within- and between-sessions alliance levels (1008 segments were coded). At the sample level, the alliance shows linear development over time but high variability between individuals. More than half the patients showed alliance development consistent with the rupture-resolution pattern. Without accounting for the temporal relationship between alliance and symptoms, alliance significantly predicted symptoms across treatment. When we accounted for the temporal relationship between alliance and symptoms, we found that symptoms can predict alliance but alliance cannot predict symptoms. We obtained the same findings using patient-rated and coded alliance.
Meibomian Gland Dysfunction in a Youthful Clinical Sample in Ghana
Authors: Asiedu Kofi , Kyei Samuel , Dzasimatu Selassie K. , Morny Enyam K. A. 
Published: March 2018

SIGNIFICANCE
This study showed a high frequency of nonobvious obstructive meibomian gland dysfunction, which can be detected only via the expression of the meibomian glands. The study advocates that meibomian gland expressibility should be a routine part of the clinical examination of patients especially those with dry eyes to avoid missing meibomian gland dysfunction among a youthful population.

PURPOSE
The aim of this study was to estimate the frequency of meibomian gland dysfunction including asymptomatic and symptomatic meibomian gland dysfunction and obvious and nonobvious obstructive meibomian gland dysfunction among a youthful population in Ghana.

METHODS
This was a clinic-based prospective cross-sectional study of consecutive patients visiting the University of Cape Coast Optometric clinic for comprehensive eye examination.

RESULTS
Two hundred fifteen clinical subjects consented to participate in the study. Mean age of the entire sample was 21.9 (±3.8) years with an age range of 17 to 40 years. One hundred five males and 107 females participated. Frequency of meibomian gland dysfunction among the sample was 25.5% (95% confidence interval [CI], 19.8 to 31.6%). Frequencies of asymptomatic and symptomatic meibomian gland dysfunction were 10.1% and 15.4%, respectively. Frequencies of obvious and nonobvious obstructive meibomian gland dysfunction were 0.9% and 24.6%, respectively. In univariate logistic regression analysis, age (odds ratio, 1.246; 95% CI, 1.037 to 1.496; P = .019) was significantly associated, but sex (odds ratio, 1.315; 95% CI, 0.707 to 2.446; P = .387) was not significantly associated, with meibomian gland dysfunction. There was a statistically significant difference in the mean corneal staining scores between meibomian gland dysfunction subjects and non–meibomian gland dysfunction subjects (t = 3.51, P = .01). There was also a statistically significant difference in the mean tear breakup time between meibomian gland dysfunction subjects and non–meibomian gland dysfunction subjects (t = 4.44, P < .001).

CONCLUSIONS
Because of the high frequency of nonobvious obstructive meibomian gland dysfunction, reliance on overt posterior lid margin abnormalities for the diagnosis of meibomian gland dysfunction may lead to underdiagnosis of meibomian gland dysfunction among clinicians in a youthful population.
Saccades under Mental Load in Infantile Nystagmus Syndrome and Controls
Authors: Salehi Fadardi Marzieh , Abel Larry Allen 
Published: March 2018

SIGNIFICANCE
This study compares saccades and visual task performance in patients with infantile nystagmus syndrome (INS) with that in normally sighted individuals under mental load. The results highlighted that to more completely evaluate INS therapies recognition time should also be measured with mental load, resembling real-world conditions.

PURPOSE
Patients with INS may complain of “being slow to see.” Stress is reported to worsen nystagmus and to prolong visual recognition time. We hypothesized that the effects of mental load on timing indices of visual recognition, for example, saccade latency, target acquisition time, target viewing time, and subjects' reaction time, differ between the INS and control groups.

METHODS
Eye movements were recorded when participants (INS group, n = 15; controls, n = 25) reported the direction of tumbling-E targets presented randomly across ±25°. The task was repeated with both mental arithmetic and time restriction to impose high mental load, confirmed through subjective ratings and heart rate measurement.

RESULTS
Mental load increased saccade latency (mean, 32.69 milliseconds; 95% confidence interval [CI], 21.17 to 44.20 milliseconds; P < .001) and target acquisition time (57.00 milliseconds; 95% CI, 34 to 81 milliseconds; P < .001). Patients with INS showed longer saccade latency (39.79 milliseconds; 95% CI, 23.98 to 55.62 milliseconds; P < .001) and target acquisition time (134.00 milliseconds; 95% CI, 96 to 172 milliseconds; P < .001) compared with controls. The interaction between task and group was significant for saccade gain (0.11; 95% CI, 0.02 to 0.19; P = .015), target acquisition time (37.93 milliseconds; 95% CI, 36.91 to 38.96 milliseconds; P = .011), and subjects' reaction time (95.37 milliseconds; 95% CI, 65.91 to 124.84 milliseconds; P = .043). There was an inverse correlation between the changes in subjects' response errors and target viewing time with mental load only for controls (r = −0.484, P = .014). Total foveation exposure time and target viewing time remained unchanged.

CONCLUSIONS
Mental load worsens “being slow to see” in INS because of delayed target acquisition and possibly because efficiency of visual processing decreases more in patients with INS compared with controls. To investigate outcomes of INS therapies, visual recognition time should be also measured with mental load.
Contrast Sensitivity in Eyes with Central Scotoma: Effect of Stimulus Drift
Authors: Lewis Peter , Venkataraman Abinaya Priya , Lundström Linda 
Published: March 2018

SIGNIFICANCEIn the field of visual rehabilitation of patients with central visual field loss (CFL), knowledge on how peripheral visual function can be improved is essential. This study presents measurements of peripheral dynamic contrast sensitivity (with optical correction) for off-axis viewing angles in subjects with CFL.PURPOSESubjects with CFL rely on a peripheral preferred retinal locus (PRL) for many visual tasks. It is therefore important to ascertain that contrast sensitivity (CS) is maximized in the PRL. This study evaluates the effect of stimulus motion, in combination with optical correction, on CS in subjects with CFL.METHODSThe off-axis refractive errors in the PRL of five young CFL subjects were measured with a COAS open-view Hartmann-Shack aberrometer. Low-contrast (25% and 10%) and high-contrast resolution acuity for stationary gratings was assessed with and without optical correction. High-contrast resolution was also measured for gratings drifting at 7.5 Hz (within a fixed Gaussian window). Furthermore, resolution CS was evaluated for both stationary and moving gratings with optical correction for a total of two to three spatial frequencies per subject.RESULTSHigh-contrast resolution acuity was relatively insensitive to stimulus drift motion of 7.5 Hz, whereas CS for gratings of 0.5 cycles per degree improved with drift for all subjects. Furthermore, both high- and low-contrast static resolution improved with optical correction.CONCLUSIONSJust as for healthy eyes, stimulus motion of 7.5 Hz enhances CS for gratings of low spatial frequency also in the PRL of eyes with CFL. Concurrently, high-contrast resolution is unaffected by the 7.5-Hz drift but improves with off-axis optical correction. This highlights the importance of providing optimal refractive correction for subjects with CFL and that stimulus motion can be used to further enhance CS at low spatial frequencies.
Novel Technique for Quantifying Retinal Nerve Fiber Bundle Abnormality in the Temporal Raphe
Authors: Ashimatey Bright S. , King Brett J. , Malinovsky Victor E. , Swanson William H. 
Published: March 2018

SIGNIFICANCE
Glaucomatous nasal visual field abnormalities correspond to damage in the temporal raphe—where individual nerve bundles can be visualized. The ability to quantify structural abnormality in the raphe, with a clinically applicable protocol, sets the stage for investigating the raphe as a potential site for assessing early glaucoma.

PURPOSE
To develop a clinically applicable imaging and analysis technique for identifying retinal nerve fiber bundle abnormalities in the temporal raphe.

METHODS
Spectralis optical coherence tomography scans customized for the temporal raphe were gathered from 30 younger controls, 30 older controls, and 29 patients with glaucoma. An analysis technique was developed based on the reflectance of the nerve fiber bundles. The technique was first developed in the younger controls, and then applied to the older controls to generate normative data for quantifying nerve fiber bundle reflectance abnormalities in the patients with glaucoma. Matrix perimetric data were gathered in the patients with glaucoma to evaluate the reflectance technique’s findings. Reflectance abnormality in the patients was defined when the fraction of enface area showing reflectance abnormality was greater than the 95th percentile estimated from controls. Spearman’s rho was used to quantify the relation between the total deviation at the perimetric testing locations and the fraction of corresponding enface area showing reflectance abnormality.

RESULTS
Twenty-five of the 29 patients had reflectance abnormalities. Eight of these had mild to no perimetric mean deviation abnormality. Similar results were found when perimetric total deviations were compared to reflectance abnormalities in the corresponding enface locations. Spearman’s rho comparing the total deviations to reflectance abnormalities found rs(174) = −0.72, P < .001.

CONCLUSIONS
The technique typically identified reflectance abnormality when perimetric abnormality was present. It also identified reflectance abnormalities even when perimetric abnormality was mild or absent. The findings support the potential of raphe imaging in detecting early glaucomatous damage.
ASCA (Anti-Saccharomyces cerevisiae Antibody) in Patients With Scleroderma
Authors: Fedrigo Aiessa , Skare Thelma L. , Bortoluzzi André Luiz , Nisihara Renato 
Published: March 2018

ObjectivesThe majority of scleroderma (SSc) patients present gastrointestinal involvement. Motility is usually compromised but few studies address permeability changes in the intestinal wall. ASCA (anti-Saccharomyces cerevisiaeantibodies) positivity is associated with increased intestinal permeability. In this study we aimed to investigate ASCA positivity in SSc patients and its association with clinical, serological and epidemiological data.MethodsSeventy-four SSc patients and 57 healthy controls were studied for ASCA (IgG and IgA) positivity by ELISA. ASCA positivity was associated with demographic, clinical severity index (by Medsger score) and serological data in SSc patients.ResultsASCA-IgG was positive in 32/74 (43.2%) patients of the SSc group and 1/57 (1.7%) of controls (p< 0.0001); ASCA-IgA was positive in 12/74 (16.2%) of the SSc group and 3/57 (5.2%) of controls (p= 0.05). In univariate analysis, ASCA-IgG presence was associated positively with African ethnic background (p< 0.001) and negatively associated with anticentromere antibodies (p= 0.013); ASCA-IgA had a negative association with Medsger score (p= 0.05). In multivariate analysis ASCA-IgG associated independently only with African ethnic background.ConclusionPositivity for ASCA-IgG and ASCA-IgA is higher among scleroderma patients than controls. African descendants have more positivity for ASCA-IgG. ASCA-IgA is less frequent in patients with a more severe disease.
Assessment of Atlanto-Axial and Mandibular Rotation by Cone Beam Computed Tomography
Authors: Galli Massimo , Papini Andrea , Buffoli Barbara , Ferrari Marco , Labanca Mauro , Rezzani Rita , Migliario Mario , Lucchina Alberta Greco , Rodella Luigi F. 
Published: March 2018

Abstract
The cranial portion of the vertebral segment together with the atlanto-occipital joint represents a very complex area. Since this system could be influenced by different atlas and mandibular position, the aim of this work was to assess atlanto-axial and mandibular rotation. Scanora 3-dimensional cone bean computed tomography images from 205 patients without signs or symptoms of temporomandibular disorder were evaluated. Using a digitalized images analyzer, the axial rotations of atlas and mandible rotation were calculated, measuring the angle with respect to the frontal plane. The same direction for the axial rotation of the mandible and for the atlanto-axial rotation (consistent group) was observed in 80.98% of the patients; opposite directions (inconsistent group) were observed in 19.02%. Among the consistent group, the left rotation was observed in 71.08% of the patients and the right rotation in 28.92%. Absolute values showed a more marked rotation for atlas than mandible and higher values for the left rotation were reported for both.
Taking together these data represents important starting points for the knowledge of atlas and mandible relationship and its functional and clinical implication.
Isolated Post-Shunt Metopic Synostosis and Neural Tube Defects
Authors: Abouhassan William , Chao John An Kuang , Murthy Ananth S. 
Published: March 2018

Background:Craniosynostosis is an uncommon complication after shunting procedures for congenital hydrocephalus. We report a case of a child with myelomeningocele and normocephaly at the time of birth. She underwent ventricular shunting for Chiari malformation and hydrocephalus at 3 days of age. An immediate postoperative CT scan confirmed all sutures were open. Serial CT scans document an open metopic suture at 2 months, closed metopic suture at 5 months, and trigonocephaly at 11 months with concomitant slit ventricle syndrome, and collapsed lateral and third ventricles.Methods:An Ovid MEDLINE search within the dates of 1948 through 2017, using the keywords “synostosis AND shunt” was carried out. A tabulation of all patients and their respective synostosis patterns were recorded.Results:We identified 8 case series and 2 case reports during 43 years (1966–2017). Seventy-eight patients with 79 suture synostosis patterns were identified (one patient underwent a second cranial reconstruction for identification of a separate, newly formed synostosis). Eighteen (30.5%) cases were associated with a neural tube defect (NTD). Patients with NTD and secondary craniosynostosis had on average earlier age of shunt placement (P = 0.001), craniosynostosis presentation (P = 0.146), and cranioplasty (P = 0.325) than secondary craniosynostosis patients without NTD.Conclusions:Ventricular shunt drainage in treating hydrocephalus rarely may lead to early synostosis and cranial deformity, especially in patients with NTDs. Early shunt placement poses significant risk in patients with NTD. Close follow-up may be necessary to evaluate overdrainage and cranial deformity after shunting procedures.
Tacrolimus-Induced Hyponatremia in Lung Transplant Recipients: A Case Series
Authors: Banks Paul N. , Omar Ashraf , Walia Rajat , Bhalla Sarabjit , Chong Yun , Tokman Sofya 
Published: March 2018

Background
Lung transplant recipients are treated with a 3-drug immunosuppressive regimen that consists of a calcineurin inhibitor, an antiproliferative agent, and a corticosteroid. Calcineurin inhibitors are the backbone of this regimen, and tacrolimus is used more often than cyclosporine, because tacrolimus is the more potent of the two agents. Tacrolimus-induced hyponatremia has been described among kidney transplant recipients, but not among lung transplant recipients.

Methods
We conducted a retrospective chart review of patients who underwent lung transplant at our institution and went on to develop severe hyponatremia.

Results
We identified 5 lung transplant recipients who developed severe hyponatremia after lung transplantation (median nadir, 117 mEq/L; interquartile range, 116-119 mEq/L). Time to development of hyponatremia ranged from 3 to 85 days posttransplant. Hyponatremia persisted in these patients despite fluid restriction, salt tablets, diuretics, and fludrocortisone therapy. Hyponatremia resolved in 3 patients and significantly improved in 2 patients after they were switched from a tacrolimus-based immunosuppressive regimen to a cyclosporine-based regimen.

Conclusion
Transitioning from a tacrolimus- to a cyclosporine-based immunosuppressive regimen may resolve or improve severe hyponatremia in lung transplant recipients.
Neopterygian phylogeny: the merger assay
Authors: López-Arbarello Adriana , Sferco Emilia 
Published: March 2018

The phylogenetic relationships of the recently described genus†Ticinolepisfrom the Middle Triassic of the Monte San Giorgio are explored through cladistic analyses of the so far largest morphological dataset for fossil actinopterygians, including representatives of the crown-neopterygian clades Halecomorphi, Ginglymodi and Teleostei, and merging the characters from previously published systematic studies together with newly proposed characters.†Ticinolepisis retrieved as the most basal Ginglymodi and our results support the monophyly of Teleostei and Holostei, as well as Halecomorphi and Ginglymodi within the latter clade. The patterns of relationships within these clades mostly agree with those of previous studies, although a few important differences require future research. According to our results, ionoscopiforms are not monophyletic, caturids are not amiiforms and leptolepids and luisiellids form a monophyletic clade. Our phylogenetic hypothesis confirms the rapid radiation of the holostean clades Halecomorphi and Ginglymodi during the Early and Middle Triassic and the radiation of pholidophoriform teleosts during the Late Triassic. Crown-group Halecomorphi have an enormous ghost lineage throughout half of the Mesozoic, but ginglymodians and teleosts show a second radiation during the Early Jurassic. The crown-groups of Halecomorphi, Ginglymodi and Teleostei originated within parallel events of radiation during the Late Jurassic.
Three dimensional two-photon imaging of neuronal activity in freely moving mice using a miniature fiber coupled microscope with active axial-scanning
Authors: Ozbay Baris N. , Futia Gregory L. , Ma Ming , Bright Victor M. , Gopinath Juliet T. , Hughes Ethan G. , Restrepo Diego , Gibson Emily A. 
Published: March 2018

AbstractWe present a miniature head mounted two-photon fiber-coupled microscope (2P-FCM) for neuronal imaging with active axial focusing enabled using a miniature electrowetting lens. Full three-dimensional two-photon imaging of GCaMP6s showing individual neuron activity in multiple focal planes was achieved in a freely-moving mouse. Two-color simultaneous imaging of GFP and tdTomato fluorescence is also demonstrated. Additionally, dynamic control of the axial scanning of the electrowetting lens allows tilting of the focal plane enabling cells in multiple focal planes to be imaged simultaneously. Two-photon imaging allows increased penetration depth in tissue yielding a working distance of 450 μm with an additional 180 μm of active axial focusing. The objective NA is 0.45 with a lateral resolution of 1.8 μm, an axial resolution of 10 μm, and a field-of-view of 240 μm diameter. The 2P-FCM has a weight of only ∼2.5 g and is capable of repeatable and stable head-attachment. The 2P-FCM with dynamic axial scanning provides a new capability to record from functionally distinct neuronal layers, opening new opportunities in neuroscience research.