bluuebunny/crossref_metadata_2025_split huggingface dataset:
New-Onset Refractory Status Epilepticus in Children: Etiologies, Treatments, and Outcomes*
Authors: Husari Khalil S. , Labiner Katherine , Huang Rong , Said Rana R. 
Published: September 2019

Objectives:
To elucidate etiologies, treatment, functional and neurocognitive outcomes of children with new-onset refractory status epilepticus.

Design:
A single-center retrospective study.

Setting:
A tertiary care children’s hospital.

Patients:
All patients between 1 month and 21 years old admitted with new-onset refractory status epilepticus between January 2004 and July 2017.

Interventions:
None.

Measurements and Main Results:
Clinical presentation, laboratory data, imaging studies, and treatments were collected during hospitalization. Outcomes were assessed at hospital discharge and follow-up in the outpatient neurology clinic based on functional and neurocognitive outcomes as well as development of epilepsy. A total of 674 unique patients presented with status epilepticus of which 40 had new-onset refractory status epilepticus. Patients were classified into either refractory status epilepticus or super-refractory status epilepticus. The etiology of most children with new-onset refractory status epilepticus remained cryptogenic. The most common identified etiology was viral (20%). None of the patients had a contributory positive neuronal antibody test. Several treatments were tried including immunotherapy which was used in half of the patients. Five patients died (12.5%) during the acute phase of their disease, with four lost to follow-up. Twenty out of the remaining 31 patients (65%) developed epilepsy and 18 (58%) had persistent neurocognitive impairment. There was no statistical significant difference in various outcome measures and various etiologies, patients’ characteristics, and treatments.

Conclusions:
In this single-center cohort, more than half of the children with new-onset refractory status epilepticus did not have an identifiable etiology. Unlike adult patients, the presence of positive neuronal antibody syndrome was rare. There was no difference in outcome between those with or without an identifiable etiology. As expected, patients with super-refractory status epilepticus had worse functional and neurocognitive outcomes. More standardized diagnostic and treatment algorithms are needed along with prospective multicenter studies.
Prioritizing a sequence of short-duration groups as the standardized pathway for chronic noncancer pain at an Australian tertiary multidisciplinary pain service: preliminary outcomes
Authors: Rajappa Hema , Wilson Michelle , White Ruth , Blanchard Megan , Tardif Hilarie , Hayes Chris 
Published: September 2019

Abstract

Objective:
To describe implementation and report preliminary outcomes of a resource-efficient, standardized group pathway for chronic noncancer pain.

Design:
Descriptive cross-sectional study of a group-based pain management pathway in comparison with an Australasian benchmarking data set.

Setting:
An Australian tertiary multidisciplinary pain service.

Subjects:
Patients with chronic noncancer pain actively participating in the group pathway in 2016.

Methods:
Referred patients were prioritized to a short-duration group–based standardized pain management pathway linking education, assessment, and treatment groups. Measures of pain, mood, self-efficacy, and catastrophizing and reduction in daily opioid use were collated from the Australasian data set.

Results:
In 2016, 928 patients were actively engaged with the pain service. More patients were prioritized to receive treatment in a group format in comparison with other Australasian services (68.4% vs 22%). A greater percentage of patients attended their first clinical contact within 3 months of referral (81.4%) compared with the Australasian average (68.6%). Comparable improvements in average pain intensity, pain interference, depression, anxiety, stress, pain catastrophizing, and self-efficacy were observed. There was significantly greater reduction in opioid use, including for those taking more than 40 mg of oral morphine equivalent daily dose.

Conclusion:
Implementation of a sequence of short-duration groups as the default clinical pathway resulted in shorter waiting times and noninferior outcomes in key areas for patients completing the program, compared with Australasian averages. Given the resource efficiencies of the group process, this finding has implications for service design.
Comparing Glycaemic Benefits of Active Versus Passive Lifestyle Intervention in Kidney Allograft Recipients: A Randomized Controlled Trial
Authors: Kuningas Kulli , Driscoll Joanne , Mair Reena , Smith Helen , Dutton Mary , Day Edward , Sharif and Adnan 
Published: September 2019

Background.
New-onset diabetes is common after kidney transplantation, but the benefit of lifestyle intervention to improve glucose metabolism posttransplantation is unproven.

Methods.
We conducted a single-center, randomized controlled trial involving 130 nondiabetic kidney transplant recipients with stable function between 3 and 24 months post-transplantation. Participants were randomly assigned in a 1:1 ratio to receive active intervention (lifestyle advice delivered by renal dietitians using behavior change techniques) versus passive intervention (leaflet advice alone). Primary outcome was 6-month change in insulin secretion, insulin sensitivity, and disposition index. Secondary outcomes included patient-reported outcomes, cardiometabolic parameters, clinical outcomes, and safety endpoints.

Results.
Between August 17, 2015 and December 18, 2017, 130 individuals were recruited, of whom 103 completed the study (drop-out rate 20.8%). Active versus passive intervention was not associated with any change in glucose metabolism: insulin secretion (mean difference, −446; 95% confidence interval [CI], −3184 to 2292; P = 0.748), insulin sensitivity (mean difference, −0.45; 95% CI, −1.34 to 0.44; P = 0.319), or disposition index (mean difference, −940; 95% CI, −5655 to 3775; P = 0.693). Clinically, active versus passive lifestyle intervention resulted in reduced incidence of posttransplantation diabetes (7.6% versus 15.6%, respectively, P = 0.123), reduction in fat mass (mean difference, −1.537 kg; 95% CI, −2.947 to −0.127; P = 0.033), and improvement in weight (mean difference, −2.47 kg; 95% CI, −4.01 to −0.92; P = 0.002). No serious adverse events were noted.

Conclusions.
Active lifestyle intervention led by renal dietitians did not improve surrogate markers of glucose metabolism. Further investigation is warranted to determine if clinical outcomes can be improved using this methodology.
Prospective metrological validation of multifrequency bioelectrical impedance analysis against volumetric imaging to identify sarcopenia in head and neck cancer patients undergoing radiation therapy
Authors: Grossberg Aaron J. , Rock Crosby D. , Edwards Jared , Mohamed Abdallah S.R. , Ruzensky Debra , Currie Angela , Rosemond Patricia , Phan Jack , Gunn G. Brandon , Frank Steven J. , Morrison William H. , Garden Adam S. , Fuller Clifton D. , Rosenthal David I. 
Published: September 2019

AbstractImportanceDepleted skeletal muscle mass (sarcopenia) is associated with decreased survival and cancer control in head and neck cancer patients treated with radiotherapy. There is a need for validated measures of body composition that can be implemented in routine clinical workflow.ObjectiveTo validate the use of bioelectrical impedance analysis (BIA) for body composition analysis and diagnosis of sarcopenia in head and neck cancer patients.DesignIn this prospective observational cohort study, baseline 50 patients with head and neck cancer undergoing radiation therapy (RT) were enrolled between February 2016 and March 2017. Baseline BIA measures of skeletal muscle (SM) mass, fat-free mass (FMM), and fat mass (FM) were compared to CT-based estimates of body composition using linear regression. Sex-specific BIA-derived thresholds for sarcopenia were defined by the maximum Youden Index on receiver operator characteristic (ROC) curves of BIA against CT-defined sarcopenia. Changes in body composition across treatment were compared against changes in body weight using linear regression.ParticipantsIn total, 50 patients with pathologically confirmed stage I to IVB non-metastatic head and neck cancer treated with definitive radiation therapy were enrolled.SettingSingle academic referral center.Main Outcome and MeasureThe primary outcome was relative agreement between baseline lean body mass and fat body mass predicted from BIA measurement and CT imaging.ResultsOf the 48 evaluable patients 16 (33.3%) were sarcopenic at baseline based on CT analysis. BIA measures of body composition were strongly correlated with CT measures: SM mass (r = 0.97; R2 = 0.94; p < 0.0001), FFM (r = 0.97; R2 = 0.94; p < 0.0001) and FM (r = 0.95; R2 = 0.90; p < 0.0001). Relationship with normalized indices of SM mass, FFM, and FM was similar between BIA and CT, but not BIA and body mass index (BMI). Patients lost a mean of 5.7 ± 5.8 kg during treatment, of which 1.5 ± 1.9 kg was SM, 2.6 ± 3.3 kg was FFM, and 2.2 ± 2.6 kg was FM. Eight additional patients developed sarcopenia by the end of RT.ConclusionsBIA provides accurate estimates of body composition in head and neck cancer patients. Implementation of BIA in clinical practice may identify patients with sarcopenia.Trial RegistrationClinicalTrials.gov identifier: NCT02615275
STOP-Bang questionnaire should be used in all adults with Down Syndrome to screen for moderate to severe obstructive sleep apnea
Authors: de Carvalho Anderson Albuquerque , Amorim Fábio Ferreira , Santana Levy Aniceto , de Almeida Karlo Josefo Quadros , da Cruz Santana Alfredo Nicodemos , Rocha Neves Francisco de Assis 
Published: September 2019

AbstractStudy ObjectivesTo determine the prevalence of obstructive sleep apnea (OSA) in adults with Down syndrome (DS), to investigate factors related to OSA severity and to identify which sleep questionnaire is the most appropriate for the screening of OSA in this population.MethodsCross-sectional study that consecutively included 60 adults with DS. All patients underwent type III polysomnography and clinical and laboratory data were collected; sleep assessment questionnaires were applied. Multiple linear regression models evaluated the associations between OSA severity (measured by the respiratory event index - REI) and clinical and laboratory data and sleep questionnaires (Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, BERLIN and STOP-Bang questionnaires).ResultsResults show that 60 (100%) adults with DS had OSA, with moderate-severe OSA identified in 49 (81.6%). At the multivariate linear regression, REI significantly correlated with hematocrit levels, BMI and STOP-Bang questionnaire (SBQ) results (P <0.001). The positive STOP-Bang ≥3 points) showed 100% of sensitivity (95%CI: 92.75-100%), 45.45% of specificity (95%CI: 16.75-76.62), positive predictive value of 89.09% (95%CI: 82.64-93.34%), negative predictive value of 100%, accuracy of 90% (95%CI: 79.49-96.24%) and OR of 24.29.ConclusionsAdults with DS have a very high prevalence of OSA. Hematocrit levels, BMI and SBQ showed a strong correlation with OSA severity. The SBQ performed well in identifying moderate to severe OSA in this population. Considered together, these results point to the need to perform OSA screening in all adults with DS, and STOP-Bang may play a role in this screening.
A rapid review of patient and family perspectives on inappropriateness of intensive care treatments at the end of life
Authors: Cardona Magnolia , Shanmugam Shantiban , Lewis Ebony T , Psirides Alex , Anstey Matthew , Hillman Ken 
Published: September 2019

ABSTRACTAimTo understand patient/family perspective of inappropriate intensive care unit (ICU) admissions and treatment.MethodsRapid literature review of English language articles published between 2001 and 2017 in Medline or PsycInfo.ResultsThirteen articles covering 6,194 elderly patients or surrogate decision-makers from four countries were eligible. Perceived inappropriateness of ICU treatments was mainly expressed as dissatisfaction with clinicians’ as surrogate decision-makers, inconsistency with patient/family values, family distrust of physician’s predictions on poor prognosis, and inadequate communication on over-aggressive treatment causing suffering. Consultation on opinion before ICU admission varied from 1% to 53.6%, and treatment goals from 1.4 to 31.7%. Satisfaction with the decision-making process in ICU was higher for those who had certain level of control and involvement in the process.ConclusionsThe patient/family perspective on inappropriateness of ICU treatments involves preferences, values and social constructs beyond medical criteria. Earlier consultation with families before ICU admission, and patient education on outcomes of life-sustaining therapies may help reconcile these provider-patient disagreements.Take-home messageThe patient/family perspective oninappropriatenessof ICU at the end of life often differs from the clinician’s opinion due to the non-medical frame of mind. To improve satisfaction with communication on treatment goals, consultation on patient values and inclusion of social constructs in addition to clinical prediction are a good start to reconcile differences between physician and health service users’ viewpoint.
Global ocean resistome revealed: exploring Antibiotic Resistance Genes (ARGs) abundance and distribution on TARA oceans samples through machine learning tools
Authors: Cuadrat Rafael R. C. , Sorokina Maria , Andrade Bruno G. , Goris Tobias , Dávila Alberto M. R. 
Published: September 2019

AbstractThe rise of antibiotic resistance (AR) in clinical settings is one of the biggest modern global public health concerns. Therefore, the understanding of AR mechanisms, evolution and global distribution is a priority due to its impact on the treatment course and patient survivability. Besides all efforts in the elucidation of AR mechanisms in clinical strains, little is known about its prevalence and evolution in environmental uncultivable microorganisms. In this study, 293 metagenomic from the TARA Oceans project were used to detect and quantify environmental antibiotic resistance genes (ARGs) using machine learning tools. After extensive manual curation, we show the global ocean ARG abundance, distribution, taxonomy, phylogeny and their potential to be horizontally transferred by plasmids or viruses and their correlation with environmental and geographical parameters. A total of 99,205 environmental ORFs were identified as potential ARGs. These ORFs belong to 560 ARG families that confer resistance to 26 antibiotic classes. 24,567 ORFs were found in contigs classified as plasmidial sequences, suggesting the importance of mobile genetic elements in the dynamics of ARGs transmission. Moreover, 4,804 contigs with more than 2 ARGs were found, including 2 plasmid-like contigs with 5 different ARGs, highlighting the potential presence of multi-resistant microorganisms in the natural ocean environment. This also raises the possibility of horizontal gene transfer (HGT) between clinical and natural environments. The abundance of ARGs showed different patterns of distribution, with some classes being significantly more abundant in coastal biomes. Finally, we identified ARGs conferring resistance to some of the most relevant clinical antibiotics, revealing the presence of 15 ARGs from the recently discovered MCR-1 family with high abundance on Polar Biomes. Of these, 5 were assigned to the genus Psychrobacter, an opportunistic pathogen that can cause fatal infections in humans. Our results are available on Zenodo in MySQL database dump format and all the code used for the analyses, including a Jupyter notebook can be accessed on GitHub (https://github.com/rcuadrat/ocean_resistome).
STAT3-dependent systems-level analysis revealsPDK4as an independent predictor of biochemical recurrence in prostate cancer
Authors: Oberhuber Monika , Pecoraro Matteo , Rusz Mate , Oberhuber Georg , Wieselberg Maritta , Haslinger Peter , Gurnhofer Elisabeth , Pencik Jan , Wiebringhaus Robert , Schlederer Michaela , Weiss Theresa , Schmeidl Margit , Haitel Andrea , Brehme Marc , Wadsak Wolfgang , Griss Johannes , Mohr Thomas , Hofer Alexandra , Jäger Anton , Egger Gerda , Pollheimer Jürgen , Koellensperger Gunda , Mann Matthias , Hantusch Brigitte , Kenner Lukas 
Published: September 2019

AbstractProstate cancer (PCa) has a broad spectrum of clinical behaviour, hence biomarkers are urgently needed for risk stratification. We previously described the protective effect of STAT3 in a prostate cancer mouse model. By utilizing a gene co-expression network in addition to laser microdissected proteomics from human and murine prostate FFPE samples, we describe STAT3-induced downregulation of the TCA cycle/OXPHOS in PCa on transcriptomic and proteomic level. We identify pyruvate dehydrogenase kinase 4 (PDK4), a key regulator of the TCA cycle, as a promising independent prognostic marker in PCa.PDK4predicts disease recurrence independent of diagnostic risk factors such as grading, staging and PSA level. Furthermore,PDK4expression is causally linked to type 2 diabetes mellitus, which is known to have a protective effect on PCa. We conclude that this effect is related toPDK4expression and thatPDK4loss could serve as a biomarker for PCa with dismal prognosis.
Delayed suppression normalizes face identity responses in the primate brain
Authors: Koyano Kenji W. , Jones Adam P. , McMahon David B. T. , Waidmann Elena N. , Russ Brian E. , Leopold David A. 
Published: September 2019

SummaryThe primate brain is specialized for social visual perception. Previous work indicates that recognition draws upon an internal comparison between a viewed face and an internally stored average face. Here we demonstrate that this comparison takes the form of a delayed, dynamic suppression of face averageness among single neurons. In three macaque face patches, spiking responses to low-identity morphed faces met with a synchronous attenuation starting approximately 200 ms after onset. Analysis showed that a late-emerging V-shaped identity tuning was sometimes superimposed on linear ramp tuning. This pattern could not be ascribed to repetition suppression within a given session. The results indicate that the brain’s analysis of faces is enhanced through predictive normalization of identity, which increases sensitivity among face-selective neurons to distinctive facial features known to drive recognition.
Diversity analysis and metagenomic insights into the Antibiotic Resistance and Metal Resistances among Hot Spring Bacteriobiome-insinuating inherent environmental baseline levels of Antibiotic and Metal tolerance
Authors: Najar Ishfaq Nabi , Sherpa Mingma Thundu , Das Sayak , Thakur Nagendra 
Published: September 2019

AbstractMechanisms of occurrence and expressions of antibiotic resistance genes (ARGs) in thermophilic bacteria are still unknown owing to limited research and data. The evolution and proliferation of ARGs in the thermophilic bacteria is unclear and needs a comprehensive study. In this research, comparative profiling of antibiotic resistance genes and metal tolerance genes among the thermophilic bacteria has been done by culture-independent functional metagenomic methods. Metagenomic analysis showed the dominance of Proteobacteria, Actinobacteria. Firmicutes and Bacteroidetes in these hot springs. ARG analysis through shotgun gene sequencing was found to be negative in case of thermophilic bacteria. However, few of genes were detected but they were showing maximum similarity with mesophilic bacteria. Concurrently, metal resistance genes were also detected in the metagenome sequence of hot springs. Detection of metal resistance gene and absence of ARG’s investigated by whole genome sequencing, in the reference genome sequence of thermophilicGeobacillusalso conveyed the same message. This evolutionary selection of metal resistance over antibiotic genes may have been necessary to survive in the geological craters which are full of different metals from earth sediments rather than antibiotics. Furthermore, the selection could be environment driven depending on the susceptibility of ARG’s in thermophilic environment as it reduces the chances of horizontal gene transfer. With these findings this article highlights many theories and culminates different scopes to study these aspects in thermophiles.
KAKU4-mediated deformation of the vegetative nucleus controls its precedent migration over sperm cells in pollen tubes
Authors: Goto Chieko , Tamura Kentaro , Nishimaki Satsuki , Yanagisawa Naoki , Matsuura-Tokita Kumi , Higashiyama Tetsuya , Maruyama Daisuke , Hara-Nishimura Ikuko 
Published: September 2019

AbstractA putative nuclear lamina protein, KAKU4, modulates nuclear morphology inArabidopsis thalianaseedlings but its physiological significance is unknown.KAKU4was strongly expressed in mature pollen grains, each of which has a vegetative cell and two sperm cells. KAKU4 protein was highly abundant on the envelopes of vegetative nuclei (VNs) and less abundant on the envelopes of sperm cell nuclei (SCNs) in pollen grains and elongating pollen tubes. VN is irregularly shaped in wild-type pollen. However,KAKU4deficiency caused it to become more spherical. These results suggest that the dense accumulation of KAKU4 is responsible for the irregular shape of the VNs. After a pollen grain germinates, the VN and SCNs migrate to the tip of the pollen tube. In the wild type, the VN preceded the SCNs in 91–93% of the pollen tubes, whereas inkaku4mutants, the VN trailed the SCNs in 39–58% of the pollen tubes.kaku4pollen was less competitive than wild-type pollen after pollination, although it had an ability to fertilize. Taken together, our results suggest that controlling the nuclear shape in vegetative cells of pollen grains byKAKU4ensures the orderly migration of the VN and sperm cells in pollen tubes.HighlightThe nuclear envelope protein KAKU4 is involved in controlling the migration order of vegetative nuclei and sperm cells in pollen tubes, affecting the competitive ability of pollen for fertilization.
Flagella methylation promotes bacterial adhesion and host cell invasion
Authors: Horstmann Julia A. , Lunelli Michele , Cazzola Hélène , Heidemann Johannes , Kühne Caroline , Steffen Pascal , Szefs Sandra , Rossi Claire , Lokareddy Ravi K. , Wang Chu , Hughes Kelly T. , Uetrecht Charlotte , Schlüter Hartmut , Grassl Guntram A. , Stradal Theresia E.B. , Rossez Yannick , Kolbe Michael , Erhardt Marc 
Published: September 2019

AbstractThe flagellum is the motility device of many bacteria and the long external filament is made of several thousand copies of a single protein, flagellin. While posttranslational modifications of flagellin are common among bacterial pathogens, the role of lysine methylation remained unknown. Here, we show that both flagellins ofSalmonella enterica, FliC and FljB, are methylated at surface-exposed lysine residues. ASalmonellamutant deficient in flagellin methylation was outcompeted for gut colonization in a gastroenteritis mouse model. In support, methylation of flagellin promoted invasion of epithelial cellsin vitro. Lysine methylation increased the surface hydrophobicity of flagellin and enhanced flagella-dependent adhesion ofSalmonellato phosphatidylcholine vesicles and epithelial cells. In summary, posttranslational flagellin methylation constitutes a novel mechanism how flagellated bacteria facilitate adhesion to hydrophobic host cell surfaces and thereby contributes to efficient gut colonization and successful infection of the host.