bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rapidly Progressing Renal Cell Cancer of the Left Native Kidney in a Renal Transplant Recipient With Unusual Sites of Metastasis Demonstrated in Serial 18F-FDG PET/CT
Authors: Rangan B K Kasturi , Ora Manish , Suraj Ajay Singh , Parashar Ashutosh , Gambhir Sanjay 
Published: July 2019

Abstract
An end-stage renal disease patient underwent renal transplantation 18 years back and was on triple immunosuppression for acute rejection. She presented with left-sided abdominal lump and underwent ultrasound and noncontrast CT scan, which revealed an exophytic mass lesion in atrophic left kidney (16.2 × 13.1 × 14 cm). Baseline 18F-FDG PET/CT revealed a large avid exophytic mass (SUVmax 23, 17 × 14 × 13) in atrophic left kidney, with multiple retroperitoneal lymphadenopathies and a suspicious lung nodule. She underwent left open radical nephrectomy. Follow-up PET/CT after 1 month revealed multiple soft tissue deposits in operative bed and other unusual metastatic sites.
Quality and Safety in Healthcare, Part LVI
Authors: Harolds Jay A. 
Published: July 2019

Abstract
All members of the healthcare system should make positive contributions to improve the overall level of wellness. However, leaders should have certain specific responsibilities to prevent burnout and increase happiness and wellness at work. It has been proposed that a chief wellness officer direct the initiatives to improve wellness, in collaboration with many others including those in the executive suite. Part of improving joy in the workplace is improving efficiency, quality care for patients, safety for patients and workers, meaningful work for the workers, and respect and fairness for all.
Leptomeningeal Metastasis in Carotid Body Paraganglioma
Authors: Tripathy Sarthak , Damle Nishikant Avinash , Naranje Priyanka , Shamim Shamim Ahmed , Tripathi Madhavi , Bal Chandrasekhar 
Published: July 2019

Abstract
Carotid body paragangliomas are mostly benign tumors with very rare propensity to metastasize to lymph nodes, bones, liver, and lungs. Leptomeningeal metastasis from a carotid body paraganglioma is a very rare phenomenon. We describe 68Ga-DOTANOC PET-CT findings of a 33-year-old man, a known case of metastatic paraganglioma who underwent scan for response assessment to everolimus therapy.
A Systematic Review of Behavioral Interventions to Decrease Opioid Prescribing After Surgery
Authors: Zhang David D. Q. , Sussman Jess , Dossa Fahima , Jivraj Naheed , Ladha Karim , Brar Sav , Urbach David , Tricco Andrea C. , Wijeysundera Duminda N. , Clarke Hance A. , Baxter Nancy N. 
Published: July 2019

Objective:
The aim of this study was to summarize strategies to reduce postsurgical opioid prescribing at discharge.

Summary Background Data:
Current practices for the prescription of opioids at discharge after surgery are highly variable and often excessive. We conducted a systematic review to identify behavioral interventions designed to improve these practices.

Methods:
We searched MEDLINE, EMBASE, CINAHL, and PsycINFO until December 14, 2018 to identify studies of behavioral interventions designed to decrease opioid prescribing at discharge among adults undergoing surgery. Behavioral interventions were defined according to the Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy. We assessed the risk of bias of included studies using criteria suggested by Cochrane EPOC and the Newcastle-Ottawa scale.

Results:
Of 8048 citations that were screened, 24 studies were included in our review. Six types of behavioral interventions were identified: local consensus-based processes (18 studies), patient-mediated interventions (2 studies), clinical practice guidelines (1 study), educational meetings (1 study), interprofessional education (1 study), and clinician reminder (1 study). All but one study reported a statistically significant decrease in the amount of opioid prescribed at discharge after surgery, and only 2 studies reported evidence of increased pain intensity. Reductions in prescribed opioids ranged from 34.4 to 212.3 mg morphine equivalents. All studies were found to have medium-to-high risks of bias.

Conclusions:
We identified 6 types of behavioral strategies to decrease opioid prescription at discharge after surgery. Despite the risk of bias, almost all types of intervention seemed effective in reducing opioid prescriptions at discharge after surgery without negatively impacting pain control.
Management of Pneumoperitoneum
Authors: Udelsman Brooks , Lee Katherine , Qadan Motaz , Lillemoe Keith D. , Chang David , Lindvall Charlotta , Cooper Zara 
Published: July 2019

Objectives:
The aim of this study was to compare morbidity and mortality between nonoperative and operative treatment of pneumoperitoneum.

Background:
Pneumoperitoneum is a potentially life-threatening condition that has been traditionally treated with surgical intervention. Adequately powered studies comparing treatment outcomes are lacking.

Methods:
Chart review and computer-assisted abstraction were used to identify patients with pneumoperitoneum at 5 hospitals from 2010 to 2015. Patients with recent abdominal procedures or contained perforation were excluded. Patients were grouped by treatment modality: comfort measures only (CMO), nonoperative treatment, or operative intervention. CMO included only symptom-palliation, whereas nonoperative therapy included all interventions (antibiotics, peritoneal drains, resuscitation) excluding surgery. Outcomes were mortality, discharge disposition, and 30-day complications. Covariates included demographics, comorbidities, and acuity at presentation.

Results:
Forty patients received CMO, 202 underwent nonoperative treatment, and 199 underwent operative intervention. CMO patients had 98% 30-day mortality. There was no difference in 30-day (P = 0.64) or 2-year mortality (P = 0.53) between patients treated nonoperatively and operatively. Compared with patients treated operatively, patients treated nonoperatively were more likely to have a colorectal source of pneumoperitoneum (37% vs 31%; P = 0.03). Using logistic regression, operative treatment was associated with increased dependence on enteral tube feeding or total parenteral nutrition [odds ratio (OR) 4.30, 95% confidence interval (CI), 1.99–9.29] and nonhome discharge (OR 3.61, 95% CI, 1.81–7.17). Among patients with clinical peritonitis, operative treatment was associated with reduced mortality (OR 0.17, 95% CI, 0.04–0.80).

Conclusions:
Operative intervention is associated with reduced mortality in patients with pneumoperitoneum and peritonitis. In the absence of peritonitis, operative treatment is associated with increased morbidity and nonhome discharge.
Living with cancer and multimorbidity: the role of primary care
Authors: Blane David N. , Lewandowska Marta 
Published: July 2019

Purpose of review
As more people live longer with cancer, the number of patients with cancer and multiple other chronic conditions (multimorbidity) has increased. The presence of multimorbidity impacts on all stages of cancer care, from prevention and early detection through to end of life care, but research into cancer and multimorbidity is in its infancy. This review explores the impact of multimorbidity on adults living with (and beyond) cancer, with particular attention paid to the role of primary care in supporting patients in this situation.

Recent findings
Patterns of multimorbidity vary depending on cancer type and stage, as well as population characteristics and available data (e.g. number of conditions assessed). Cancer survivors are at increased risk of developing other chronic conditions, due to a combination of shared risk factors (e.g. smoking and obesity), effects of cancer treatments and psychosocial effects.

Summary
Primary care has a central role to play in supporting multimorbid adults living with cancer, providing holistic care of physical and mental well being, while taking treatment burden and social circumstances into account. New models of person-centred and personalized cancer care include holistic needs assessments, care planning, treatment summaries and cancer care reviews, and depend on improved communication between oncologists and primary care colleagues.
Hypothermia Associated With Melatonin Ingestion in a Child With Autism
Authors: Erden Semih 
Published: July 2019

Abstract
Autism spectrum disorder is a neurodevelopmental disorder characterized by social interaction and communication disorder and restrictive and repetitive behaviors. Sleep disorders are frequently observed in children with autism spectrum disorder. We present a case of hypothermia in an autistic child with a sleep disorder whose body temperature decreased to 34°C after a single dose of melatonin. Hypothermia continued for 2 more days, but her nighttime sleeping problems decreased. This case is important because it demonstrates the possible risk of hypothermia with melatonin use in children with autism with a sleep disorder.
Risk Factors of Relapse After Successful Electroconvulsive Therapy for Taiwanese Patients With Major Depression
Authors: Yang Wei-Cheng , Lin Ching-Hua , Chen Cheng-Chung 
Published: July 2019

Objectives
Major depressive disorder is a recurrent illness. Treatment strategies are generally focused on achieving remission and preventing relapse/recurrence. The aim of this study was to explore the risk factors associated with relapse for remitted patients during the 12-week follow-up.

Methods
This was an open-label trial for major depressive disorder patients receiving acute treatments with electroconvulsive therapy (ECT) and continuation medication in the 12-week follow-up. Symptom severity and psychosocial functioning were assessed using the 17-item Hamilton Rating Scale for Depression (HAMD-17) and the Work and Social Adjustment Scale at each visit. Remission was defined as a HAMD-17 of 7 or less after acute treatment. Relapse was defined as a HAMD-17 of 14 or greater. Subjects achieving remission after acute treatments were included for analysis. Survival analysis was used to investigate the factors associated with relapse.

Results
Sixty patients receiving ECT for acute treatment were enrolled for 12-week follow-up. Using Cox regression analysis, a greater number of previous major depressive episodes and greater baseline Work and Social Adjustment Scale scores were significantly associated with shorter time to relapse.

Conclusions
The goal of acute treatment should focus on functional remission to prevent relapse. Further studies related to more effective treatments to prevent relapse after acute ECT are required in the future.
The development of methodology and techniques for crop disease identification
Authors: Tiwari N. S. , Richmond J. W. 
Published: July 2019

AbstractIn India, an estimated 15-25% of potential crop production is lost due pest and diseases (Roy and Bezbaruah, 2002). The country needs not only to raise production but also ensure food security for its growing consumption needs while curbing excessive pesticide usage. Detection of pests and diseases at an early stage plays a significant role in addressing the above-mentioned concerns and image classification offers a cost-effective and scalable solution to the disease detection problem (A. Ramcharan et al. 2017). Here, the principles of transfer learning are implemented with pretrained model – Resnet34 (K. He et al. 2015), and test its effectiveness in image classification using a dataset of tea leaves. The novelty of this work is that the images used are not curated, individual leaves with controlled backgrounds but of plants in-situ. The effect of the level of zoom and background is examined and class activation maps are used to validate that the basis of classification is indeed the disease and not an artificial bias from factors such as background, lighting etc.
Blood-spinal cord barrier leakage is independent of motor neuron pathology in ALS
Authors: Waters Sarah , Dieriks Birger V. , Swanson Molly E. V. , Zhang Yibin , Grimsey Natasha L. , Murray Helen C. , Turner Clinton , Waldvogel Henry J. , Faull Richard L.M. , An Jiyan , Bowser Robert , Curtis Maurice A. , Dragunow Mike , Scotter Emma L. 
Published: July 2019

AbstractBackgroundAmyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease involving progressive degeneration of upper and lower motor neurons. Both lower motor neuron loss and the deposition of phosphorylated TDP-43 inclusions display regional patterning along the spinal cord. The blood-spinal cord barrier (BSCB) ordinarily restricts entry into the spinal cord parenchyma of blood components that are neurotoxic, but in ALS there is evidence for barrier breakdown. Here we sought to examine whether BSCB breakdown, motor neuron loss, and TDP-43 proteinopathy display the same regional patterning across and along the spinal cord.MethodsWe measured cerebrospinal fluid (CSF) hemoglobin in living ALS patients (n=87 controls, n=236 ALS) as a potential biomarker of BSCB and blood-brain barrier leakage. We then immunostained cervical, thoracic, and lumbar post mortem spinal cord tissue (n=5 controls, n=13 ALS) and employed semi-automated imaging and analysis to quantify and map lower motor neuron loss and phosphorylated TDP-43 inclusion load against hemoglobin leakage.ResultsMotor neuron loss and TDP-43 proteinopathy were seen at all three levels of the ALS spinal cord, with most abundant TDP-43 deposition in the ventral grey (lamina IX) of the cervical and lumbar cord. In contrast, hemoglobin leakage was observed along the ALS spinal cord axis but was most severe in the dorsal grey and white matter in the thoracic spinal cord.ConclusionsOur data show that leakage of the blood-spinal cord barrier occurs during life but at end-stage its distribution is independent from the major motor neuron pathology and is unlikely to be a major contributor to pathogenesis in ALS.
Recommendations for application of the functional evidence PS3/BS3 criterion using the ACMG/AMP sequence variant interpretation framework
Authors: Brnich Sarah E. , Abou Tayoun Ahmad N. , Couch Fergus J. , Cutting Garry R. , Greenblatt Marc S. , Heinen Christopher D. , Kanavy Dona M. , Luo Xi , McNulty Shannon M. , Starita Lea M. , Tavtigian Sean V. , Wright Matt W. , Harrison Steven M. , Biesecker Leslie G. , Berg Jonathan S. ,   On behalf of the Clinical Genome Resource Sequence Variant Interpretation Working Group
Published: July 2019

ABSTRACTBackgroundThe American College of Medical Genetics and Genomics (ACMG)/Association for Molecular Pathology (AMP) clinical variant interpretation guidelines established criteria (PS3/BS3) for functional assays that specified a “strong” level of evidence. However, they did not provide detailed guidance on how functional evidence should be evaluated, and differences in the application of the PS3/BS3 codes is a contributor to variant interpretation discordance between laboratories. This recommendation seeks to provide a more structured approach to the assessment of functional assays for variant interpretation and guidance on the use of various levels of strength based on assay validation.MethodsThe Clinical Genome Resource (ClinGen) Sequence Variant Interpretation (SVI) Working Group used curated functional evidence from ClinGen Variant Curation Expert Panel-developed rule specifications and expert opinions to refine the PS3/BS3 criteria over multiple in-person and virtual meetings. We estimated odds of pathogenicity for assays using various numbers of variant controls to determine the minimum controls required to reach moderate level evidence. Feedback from the ClinGen Steering Committee and outside experts were incorporated into the recommendations at multiple stages of development.ResultsThe SVI Working Group developed recommendations for evaluators regarding the assessment of the clinical validity of functional data and a four-step provisional framework to determine the appropriate strength of evidence that can be applied in clinical variant interpretation. These steps are: 1. Define the disease mechanism; 2. Evaluate applicability of general classes of assays used in the field; 3. Evaluate validity of specific instances of assays; 4. Apply evidence to individual variant interpretation. We found that a minimum of eleven total pathogenic and benign variant controls are required to reach moderate-level evidence in the absence of rigorous statistical analysis.ConclusionsThe recommendations and approach to functional evidence evaluation described here should help clarify the clinical variant interpretation process for functional assays. Further, we hope that these recommendations will help develop productive partnerships with basic scientists who have developed functional assays that are useful for interrogating the function of a variety of genes.
A mini-atlas of gene expression for the domestic goat (Capra hircus) reveals transcriptional differences in immune signatures between sheep and goats
Authors: Muriuki Charity , Bush Stephen J. , Salavati Mazdak , McCulloch Mary E.B. , Lisowski Zofia M. , Agaba Morris , Djikeng Appolinaire , Hume David A. , Clark Emily L. 
Published: July 2019

AbstractGoats (Capra hircus) are an economically important livestock species providing meat and milk across the globe. They are of particular importance in tropical agri-systems contributing to sustainable agriculture, alleviation of poverty, social cohesion and utilisation of marginal grazing. There are excellent genetic and genomic resources available for goats, including a highly contiguous reference genome (ARS1). However, gene expression information is limited in comparison to other ruminants. To support functional annotation of the genome and comparative transcriptomics we created a mini-atlas of gene expression for the domestic goat. RNA-Seq analysis of 22 transcriptionally rich tissues and cell-types detected the majority (90%) of predicted protein-coding transcripts and assigned informative gene names to more than 1000 previously unannotated protein-coding genes in the current reference genome for goat (ARS1). Using network-based cluster analysis we grouped genes according to their expression patterns and assigned those groups of co-expressed genes to specific cell populations or pathways. We describe clusters of genes expressed in the gastro-intestinal tract and provide the expression profiles across tissues of a subset of genes associated with functional traits. Comparative analysis of the goat atlas with the larger sheep gene expression atlas dataset revealed transcriptional differences between the two species in macrophage-associated signatures. The goat transcriptomic resource complements the large gene expression dataset we have generated for sheep and contributes to the available genomic resources for interpretation of the relationship between genotype and phenotype in small ruminants.
Cholesterol and matrisome pathways dysregulated in human APOE ε4 glia
Authors: TCW Julia , Liang Shuang A. , Qian Lu , Pipalia Nina H , Chao Michael J. , Shi Yang , Bertelsen Sarah E. , Kapoor Manav , Marcora Edoardo , Sikora Elizabeth , Holtzman David M. , Maxfield Frederick R. , Zhang Bin , Wang Minghui , Poon Wayne W. , Goate Alison M. 
Published: July 2019

AbstractApolipoprotein E (APOE) ε4 is the strongest genetic risk factor for Alzheimer’s disease (AD). Although its association with AD is well-established, the impact of APOE ε4 on human brain cell function remains unclear. Here we investigated the effects of APOE ε4 on several brain cell types derived from human induced pluripotent stem cells and human APOE targeted replacement mice. Gene set enrichment and pathway analyses of whole transcriptome profiles showed that APOE ε4 is associated with dysregulation of cholesterol homeostasis in human but not mouse astrocytes and microglia. Elevated matrisome signaling associated with chemotaxis, glial activation and lipid biosynthesis in APOE ε4 mixed neuron/astrocyte cultures parallels altered pathways uncovered in cell-type deconvoluted transcriptomic data from APOE ε4 glia and AD post-mortem brains. Experimental validation of the transcriptomic findings showed that isogenic APOE ε4 is associated with increased lysosomal cholesterol levels and decreased cholesterol efflux, demonstrating decoupled lipid metabolism. APOE ε4 glia also secrete higher levels of proinflammatory chemokines, cytokines and growth factors, indicative of glial activation. Thus, APOE ε4 induces human glia-specific dysregulation that may initiate AD risk.
Automating Three-dimensional Osteoarthritis Histopathological Grading of Human Osteochondral Tissue using Machine Learning on Contrast-Enhanced Micro-Computed Tomography
Authors: Rytky S.J.O. , Tiulpin A. , Frondelius T. , Finnilä M.A.J. , Karhula S.S. , Leino J. , Pritzker K.P.H. , Valkealahti M. , Lehenkari P. , Joukainen A. , Kröger H. , Nieminen H.J. , Saarakkala S. 
Published: July 2019

AbstractObjectiveTo develop and validate a machine learning (ML) approach for automatic three-dimensional (3D) histopathological grading of osteochondral samples imaged with contrast-enhanced micro-computed tomography (CEμCT).DesignOsteochondral cores from 24 total knee arthroplasty patients and 2 asymptomatic cadavers (n = 34, Ø = 2 mm; n = 45, Ø = 4 mm) were imaged using CEμCT with phosphotungstic acid-staining. Volumes-of-interest (VOI) in surface (SZ), deep (DZ) and calcified (CZ) zones were extracted depthwise and subjected to dimensionally reduced Local Binary Pattern-textural feature analysis. Regularized Ridge and Logistic regression (LR) models were trained zone-wise against the manually assessed semi-quantitative histopathological CEμCT grades (Ø = 2 mm samples). Models were validated using nested leave-one-out cross-validation and an independent test set (Ø = 4 mm samples). The performance was assessed using Spearman’s correlation, Average Precision (AP) and Area under the Receiver Operating Characteristic Curve (AUC).ResultsHighest performance on cross-validation was observed for SZ, both on Ridge regression (ρ = 0.68, p < 0.0001) and LR (AP = 0.89, AUC = 0.92). The test set evaluations yielded decreased Spearman’s correlations on all zones. For LR, performance was almost similar in SZ (AP = 0.89, AUC = 0.86), decreased in CZ (AP = 0.71→0.62, AUC = 0.77→0.63) and increased in DZ (AP = 0.50→0.83, AUC = 0.72→0.72).ConclusionWe showed that the ML-based automatic 3D histopathological grading of osteochondral samples is feasible from CEμCT. The developed method can be directly applied by OA researchers since the grading software and all source codes are publicly available.