bluuebunny/crossref_metadata_2025_split huggingface dataset:
The first metriorhynchoid crocodyliform from the Aalenian (Middle Jurassic) of Germany, with implications for the evolution of Metriorhynchoidea
Authors: Aiglstorfer Manuela , Havlik Philipe , Herrera Yanina 
Published: July 2019

AbstractThalattosuchia, a clade of Mesozoic aquatic crocodyliforms, were the only archosaurs that ever became fully adapted to marine ecosystems. They are represented by two clades, the semiaquatic teleosauroids and the metriorhynchoids, which include fully pelagic forms. So far, little is known on the early evolutionary history of Metriorhynchoidea and data are sparse, especially from the early Middle Jurassic. Opisuchus meieri gen. et sp. nov. a metriorhynchoid crocodyliform from the early Aalenian (early Middle Jurassic) of southern Germany, is described here. It is one of the most complete specimens of a non-metriorhynchid metriorhynchoid, and the best-preserved thalattosuchian described from the Aalenian. The new taxon is represented by a nearly complete skull, which has a unique combination of characters distinguishing it from other species of Metriorhynchoidea. It displays a mosaic of plesiomorphic and apomorphic morphological features that sheds new light on early metriorhynchoid evolution. This taxon is an important puzzle piece, which will help to better track the mosaic character distribution in Thalattosuchia.
Uterine Cancer Rates Rising, Racial Disparities Found
Authors: Rosenberg Karen 
Published: July 2019

According to this study:

Uterine cancer incidence rates, including for aggressive nonendometrioid subtypes and corrected for hysterectomy prevalence, have been rising significantly in the United States.Higher incidence of nonendometrioid cancers and poorer survival rates among non-Hispanic black women indicate profound racial differences and disparities.
Optimal Arterial Blood Oxygen Tension in the Early Postresuscitation Phase of Extracorporeal Cardiopulmonary Resuscitation: A 15-Year Retrospective Observational Study*
Authors: Chang Wei-Tien , Wang Chih-Hung , Lai Chien-Heng , Yu Hsi-Yu , Chou Nai-Kuan , Wang Chih-Hsien , Huang Shu-Chien , Tsai Pi-Ru , Chou Fang-Ju , Tsai Min-Shan , Huang Chien-Hua , Ko Wen-Je , Chen Wen-Jone , Chen Yih-Sharng 
Published: July 2019

Objectives:
Hyperoxia could lead to a worse outcome after cardiac arrest. Few studies have investigated the impact of oxygenation status on patient outcomes following extracorporeal cardiopulmonary resuscitation. We sought to delineate the association between oxygenation status and neurologic outcomes in patients receiving extracorporeal cardiopulmonary resuscitation.

Design:
Retrospective analysis of a prospective extracorporeal cardiopulmonary resuscitation registry database.

Setting:
An academic tertiary care hospital.

Patients:
Patients receiving extracorporeal cardiopulmonary resuscitation between 2000 and 2014.

Interventions:
None.

Measurements and Main Results:
A total of 291 patients were included, and 80.1% were male. Their mean age was 56.0 years. The arterial blood gas data employed in the primary analysis were recorded from the first sample over the first 24 hours in the ICUs after return of spontaneous circulation. The mean Pao
2 after initiation of venoarterial extracorporeal membrane oxygenation was 178.0 mm Hg, and the mean Pao
2/Fio
2 ratio was 322.0. Only 88 patients (30.2%) demonstrated favorable neurologic status at hospital discharge. Multivariate logistic regression analysis indicated that Pao
2 between 77 and 220 mm Hg (odds ratio, 2.29; 95% CI, 1.01–5.22; p = 0.05) and Pao
2/Fio
2 ratio between 314 and 788 (odds ratio, 5.09; 95% CI, 2.13–12.14; p < 0.001) were both positively associated with favorable neurologic outcomes.

Conclusions:
Oxygenation status during extracorporeal membrane oxygenation affects neurologic outcomes in patients receiving extracorporeal cardiopulmonary resuscitation. The Pao
2 range of 77 to 220 mm Hg, which is slightly narrower than previously defined, seems optimal. The Pao
2/Fio
2 ratio was also associated with outcomes in our analysis, indicating that both Pao
2 and the Pao
2/Fio
2 ratio should be closely monitored during the early postcardiac arrest phase for postextracorporeal cardiopulmonary resuscitation patients.
Antihypertensive and Vasodilatory Effects of Qingda Granules by Suppression of Calcium Influx and the AKT Pathway
Authors: Huang Yue , Wu Xiangyan , Wu Meizhu , Chu Jianfeng , Yu Na , Shen Aling , Shen Zhiqing , Chen Youqin , Peng Jun 
Published: July 2019

Abstract:
The Qingda granule (QDG) formulation was simplified from the Qingxuan Jiangya Decoction, which has been used in China to treat hypertension for decades. However, the molecular mechanisms of QDG in antihypertension remain largely unknown. Therefore, we evaluated the therapeutic efficacy of QDG against elevated blood pressure and explored its underlying mechanism. QDG treatment decreased elevated blood pressure and increased the vascular elasticity of thoracic aortic rings to KCl stimulation in spontaneously hypertensive rats. QDG treatment increased the relaxation of isolated thoracic aortic rings precontracted with norepinephrine (NE) or KCl in an endothelium-independent manner, which was attenuated by treatment with verapamil, but not by treatment with TEA, 4-AP, Gli, or BaCl2. Moreover, QDG pretreatment attenuated the CaCl2-induced constriction of isolated thoracic aortic rings in K+- or NE-containing Ca2+-free solutions. In addition, QDG pretreatment significantly inhibited the influx of Ca2+ in A7r5 cells induced by a K+- or NE-containing Ca2+ solution and decreased the levels of p-AKT but had no effect on levels of total AKT protein in isolated thoracic aortic rings. Considering these results, QDG treatment attenuated elevated blood pressure and promoted the vasorelaxation of thoracic aortic rings by inhibiting the influx of Ca2+ and activating the AKT pathway.
Xanthoangelol Prevents Ox-LDL–Induced Endothelial Cell Injury by Activating Nrf2/ARE Signaling
Authors: Yan Rui , Yan Jifeng , Chen Xiaozhen , Yu Yunfu , Sun Tao 
Published: July 2019

Objective:
Atherosclerosis (AS) contributes to the development of several cardiovascular diseases such as myocardial infarction and stroke. Oxidized low-density lipoprotein (Ox-LDL)–induced endothelial cell injury plays a key role in the pathogenesis of AS. Thus, this study was conducted to examine the effects of a naturally occurring flavonoid compound, xanthoangelol (XAG), on Ox-LDL–induced cell injury.

Materials and Methods:
Human umbilical vein endothelial cells (HUVECs) were used as the in vitro cell model. The number of viable cells was determined using CCK-8 assay. Cell apoptosis was detected using Hoechst staining. Percentage of apoptotic cells was quantified by flow cytometry. The cellular levels of malondialdehyde (MDA), superoxide dismutase, catalase (CAT), and glutathione peroxidase were determined using enzyme-linked immunosorbent assays. The cellular reactive oxygen species level was detected by flow cytometry after fluorescence staining. The mRNA expression levels of nuclear factor-E2–related factor-2 (Nrf2), heme oxygenase-1 (HO-1), and NQO-1 were determined using quantitative real-time polymerase chain reaction assay. The protein levels of cleaved caspase-3, cleaved poly ADP-ribose polymerase, Bax, Bcl-2, Nrf2, Keap1, HO-1, and NQO-1 were measured by using Western blot assay. The HUVECs were transfected with Nrf2 siRNA to reduce the expression of Nrf2.

Results:
XAG could effectively protect against Ox-LDL–stimulated cell death in HUVECs. These cytoprotective effects were due to its anti-apoptotic and anti-oxidant activities, as supported by the increase of SOD, CAT, and glutathione peroxidase activities, and the decrease of MDA and reactive oxygen species levels in injured HUVECs induced by Ox-LDL. Moreover, the results showed that XAG activated Nrf2/ARE signaling in a dose-dependent manner. Importantly, blockade of Nrf2 signaling using siRNA or specific inhibitor notably abolished the cytoprotective activities of XAG.

Conclusions:
These data suggest that XAG cytoprotects against Ox-LDL–induced cell injury through activating Nrf2/ARE–mediated antioxidative stress. Cumulatively, these findings show that EX has the potential to prevent and treat AS.
The female adolescent breast: disorders of development
Authors: Khaja Anam , DeSilva Nirupama 
Published: July 2019

Purpose of review
This article will provide an overview on female breast development and focus on common abnormalities of growth, the emerging role of breast self-awareness, and discuss trends in the evaluation and treatment of the breast masses and disorders most often encountered in the female adolescent population.

Recent findings
Although the embryology of breast development is unchanged, data are emerging on the role of environmental factors on the timing of puberty and thelarche. As breast development occurs, the role of breast self-awareness is also a new trend that allows teens to be cognizant of changes in their own breast and to become more comfortable with their own anatomy. Finally, when breast treatments are needed or desired, the timing of breast treatments is a subject that must be individualized.

Summary
There are numerous conditions that can result from disruption of normal breast development. These resultant breast disorders are generally benign but can still cause emotional distress to both the patient and family. It is thus imperative that healthcare providers be educated on breast development, the common breast masses that occur in the adolescent population and be prepared to discuss breast self-awareness and shared decision-making in this population.
Evaluation of Current Perioperative Antimicrobial Regimens for the Prevention of Surgical Site Infections in Breast Implant-based Reconstructive Surgeries
Authors: Viola George M. , Rolston Kenneth V. , Butler Charles , Selber Jesse , Reece Gregory , Clemens Mark , Villa Mark , Raad Issam I. , Baumann Donald 
Published: July 2019

Background:
Several steps to reduce the rate of postoperative surgical site infections (SSIs) have been implemented. The use of prophylactic antimicrobials targeting patient’s microbial flora has been associated with a decrease in postoperative infections. We evaluated the relationship between perioperative antimicrobials, baseline microbial flora, and occurrence of SSIs.

Methods:
We prospectively enrolled 241 patients scheduled to receive a postmastectomy implant-based reconstructive procedure between September 2015 and January 2018. Axillary swab cultures were obtained preoperatively, and all recovered bacteria were identified. Surgeons were blinded to these results. The use of prophylactic perioperative antimicrobials was defined as concordant if the baseline axillary flora were susceptible to the given antibiotic and discordant if not. As Staphylococcus species are the most common pathogen causative for breast implant-related infections, patients colonized with these organisms were analyzed in detail. All patients were followed up for at least 6 months postoperatively and evaluated for SSIs.

Results:
A total of 238 patients (99%) received both perioperative and postoperative oral antimicrobials. The most common preoperative staphylococci axillary flora recovered were methicillin-sensitive coagulase-negative Staphylococcus (67%), methicillin-resistant coagulase-negative Staphylococcus (35%), with only 1 case of methicillin-sensitive Staphylococcus aureus (0.4%). Thirty-three patients (14%) developed an SSI. Of those with a positive Staphylococcus culture, only 54% received a concordant antimicrobial regimen, but this was not associated with an increased risk for infection (P > 0.72).

Conclusions:
The use of perioperative antimicrobials whether concordant or discordant with the preoperative axillary microbial flora, specifically Staphylococci species, did not provide a significant impact on the risk of SSI.
ABSENCE OF MACULAR DEGENERATION IN A PATIENT WITH ACERULOPLASMINEMIA
Authors: Ronquillo Cecinio C. , Sauer Lydia , Morgan Denise , Heckzo Josh B. , Creel Donnell J. , Mamalis Nick , DeAngelis Margaret M. , Hagemann Gregory S. , Bernstein Paul S. 
Published: July 2019

Purpose:
To describe the clinical, histological, electrophysiologic, and multimodal imaging findings in a 76-year-old patient with aceruloplasminemia with low genetic risk of age-related macular degeneration (AMD).

Methods:
Clinical examination as well as multimodal imaging including fundus photography, optical coherence tomography, fluorescence lifetime imaging ophthalmoscopy imaging, and full-field and multifocal electroretinography were performed on one patient with aceruloplasminemia. The ceruloplasmin gene was sequenced to confirm a known mutation. Single nucleotide polymorphism genotyping of known AMD risk alleles was performed to characterize the AMD risk profile of the patient. Prussian blue staining in postmortem retinal sections was used to confirm iron accumulation.

Results:
A homozygous mutation in the ceruloplasmin gene was detected at position c.395-1 G>A. The clinical assessment and imaging of the patient did not show any findings of AMD. Fundus examination revealed yellow flecks in the midperiphery with notable absence of macular drusen or geographic atrophy. Genotyping for AMD risk alleles revealed a low AMD risk profile. Histopathologic analysis confirms iron accumulation in retinal pigment epithelial cells.

Conclusion:
In contrast to a previous report, these findings suggest that neither aceruloplasminemia nor iron accumulation was sufficient to cause AMD in this patient.
ACUTE SYPHILITIC POSTERIOR PLACOID CHORIORETINITIS: MULTIMODAL IMAGING AND ELECTROPHYSIOLOGIC FINDINGS BEFORE AND AFTER TREATMENT
Authors: Wong Wendy , Naing Thet , Bhargava Mayuri , Chee Caroline , Lingam Gopal , Holder Graham E. 
Published: July 2019

Purpose:
To describe the clinical course of acute syphilitic posterior placoid chorioretinitis (ASPPC) in the preplacoid stage, placoid stage, and after treatment with penicillin.

Method:
A retrospective case report of serial multimodal imaging and electrophysiology studies of a patient with ASPPC, with 18 months of follow-up.

Results:
A 47-year-old man presented with bilateral panuveitis. The patient defaulted follow-up and returned when his vision deteriorated. Tests for neurosyphilis and retroviral disease were positive, and treatment was initiated. The earliest change on serial optical coherence tomography was loss of the signal from the reflective band corresponding to the ellipsoid zone. In the placoid stage, there was nodular thickening of the retinal pigment epithelium. The ellipsoid zone signals reappeared after treatment. Fundus fluorescein angiogram at presentation showed peripapillary vasculitis and disk leakage; indocyanine green angiography revealed multiple hypofluorescent spots in the peripapillary region and posterior pole that was not visible clinically. The angiographic abnormalities resolved after treatment. Electrophysiology demonstrated bilateral maculopathy and reduction of both a- and b-waves from dark-adapted and light-adapted responses at presentation. The b-waves (inner retina) recovered partially with treatment.

Conclusion:
To the best of our knowledge, this is the first case report of the multimodal imaging and electrophysiology findings in a patient with acute syphilitic posterior placoid chorioretinitis, before the development of the classic placoid lesion. Improvement of structural and functional pathology after systemic treatment is demonstrated.
The role of the small intestine in modulating metabolism and inflammation in atherosclerosis and cancer
Authors: Mukherjee Pallavi , Chattopadhyay Arnab , Fogelman Alan M. 
Published: July 2019

Purpose of review
To discuss recent findings on the importance of the small intestine in modulating metabolism and inflammation in atherosclerosis and cancer.

Recent findings
Integrin β7+ natural gut intraepithelial T cells modulated metabolism and accelerated atherosclerosis in mice. Reducing the generation of lysophospholipids in the small intestine mimicked bariatric surgery and improved diabetes. Enterocyte-specific knockdown of stearoyl-CoA desaturase-1 significantly improved dyslipidemia in LDL receptor null (Ldlr

−/−
) mice fed a Western diet. Adding a concentrate of tomatoes transgenic for the apolipoprotein A-I mimetic peptide 6F to the chow of wild-type mice altered lipid metabolism in the small intestine, preserved Notch signaling and reduced tumor burden in mouse models. The phospholipid-remodeling enzyme Lpcat3 regulated intestinal stem cells and progenitor cells by stimulating cholesterol biosynthesis; increasing cholesterol in the diet or through genetic manipulation promoted tumorigenesis in Apcmin+ mice.

Summary
The small intestine is important for regulating metabolism and inflammation in animal models of both atherosclerosis and cancer.
Outcomes of Primary Palatoplasty: An Analysis Using the Pediatric Health Information System Database
Authors: Jodeh Diana S. , Nguyen Anh Thy H. , Rottgers S. Alex 
Published: July 2019

Background:
Previous attempts at reporting oronasal fistula development and secondary speech surgery following cleft palate surgery have been limited to single-center case series. This limitation can be overcome by querying large databases created by health care governing bodies or health care alliances. The authors examined the effect of cleft type and demographic variables on the clinical outcomes.

Methods:
Data from the Pediatric Health Information System database were queried for patients, aged 6 to 18 months, who had undergone primary palatoplasty between 2004 and 2009. Subsequent repair of an oronasal fistula and/or secondary speech surgery between 2004 and 2015 was identified by procedure codes. Logistic regression models were used to assess the associations between cleft type with oronasal fistula and with secondary speech surgery.

Results:
Seven thousand three hundred twenty-five patients were identified, and 6.4 percent (n = 468) had a subsequent repair of an oronasal fistula and 18.5 percent (n = 1355) had a secondary speech operation. Adjusted for age, sex, and race, patients with cleft lip and palate have increased odds of oronasal fistula (OR, 5.60; 95 percent CI, 4.44 to 7.07) and secondary speech surgery (OR, 2.32; 95 percent CI, 2.05 to 2.63).

Conclusions:
Using a large, multi-institution billing database, the authors were able to estimate the prevalence of oronasal fistula and surgically treated velopharyngeal insufficiency following primary palatoplasty in the United States. In addition, the authors demonstrated that patients with isolated cleft palate develop fewer oronasal fistulas and require less secondary speech surgery than patients with cleft lip and palate.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Predictors for Prolonged Drainage following Tissue Expander–Based Breast Reconstruction
Authors: Lee Kyeong-Tae , Hong Seung Heon , Jeon Byung-Joon , Pyon Jai Kyong , Mun Goo-Hyun , Bang Sa Ik 
Published: July 2019

Background:
A closed-suction drain is usually inserted during tissue expander–based breast reconstruction. Prolonged duration of drain retention can disturb patients’ daily lives and affect overall sociomedical costs. This study aimed to investigate factors that may influence the drainage and to identify predictors of unusually prolonged drain duration.

Methods:
Patients who underwent delayed-immediate, two-stage breast reconstruction using a tissue expander between January of 2013 and July of 2017 were reviewed. Prolonged drain duration was defined as drain duration for longer than the 75th percentile of that for the entire cohort. Effects of patient- and operation-related variables on drainage and prolonged drain duration were evaluated.

Results:
A total of 1056 cases (1002 patients) were analyzed. The median drain duration was 10 days. Drain placement for more than 12 postoperative days was observed in 256 cases (24.2 percent), classified as prolonged drain duration. Multivariate analyses demonstrated that old age, high body mass index, neoadjuvant chemotherapy, insertion of large Siltex textured tissue expanders, and greater volume of initial inflation were independent risk factors of prolonged drain duration. The size and texture of the tissue expanders and initial inflation volume retained their influence, regardless of mastectomy specimen weight. Use of acellular dermal matrix had contradictory effects according to breast size, being protective against prolonged drain duration in cases with mastectomy specimen weight greater than 400 g, and being a significant predictor for it in cases with mastectomy specimen weight less than or equal to 400 g.

Conclusion:
Several factors, including reconstructive operation-related factors, might influence drain duration following tissue expander–based breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Ischemic Preconditioning and Iloprost Reduces Ischemia-Reperfusion Injury in Jejunal Flaps: An Animal Model
Authors: Tuncer Fatma Betul , Durmus Kocaaslan F. Nihal , Yildirim Alper , Sacak Bulent , Arabaci Tamer Sevil , Sahin Hulya , Cinel Leyla , Celebiler Ozhan 
Published: July 2019

Background:
Free jejunal flaps are among the most commonly used flaps for esophageal reconstruction. However, ischemia-reperfusion injury caused by warm ischemia seen during transfer limits their use. Iloprost, a prostacyclin analogue, has been shown to reduce ischemia-reperfusion injury in various organs. The authors investigated tissue damage in jejunal flaps with iloprost and ischemic preconditioning and compared the effectiveness of these two modalities.

Methods:
Thirty-four Sprague-Dawley rats were randomized into five groups: sham, ischemia-reperfusion (control), ischemic preconditioning, iloprost, and ischemic preconditioning plus iloprost. All flaps, except those in the sham group, underwent ischemia for 60 minutes and reperfusion for 2 hours. Flap perfusion was assessed by laser Doppler perfusion monitoring. Histologic sections were scored using the Chiu scoring system. Superoxide dismutase and myeloperoxidase levels were measured spectrophotometrically.

Results:
Animals that were administered iloprost and/or underwent ischemic preconditioning had better postischemic recovery of mesenteric perfusion (ischemic preconditioning, 78 percent; iloprost, 83 percent; ischemic preconditioning plus iloprost, 90 percent; versus ischemia-reperfusion, 50 percent; p < 0.05). All intervention groups showed improved histology of jejunal flaps following ischemia-reperfusion injury (ischemic preconditioning, 3; iloprost, 2.3; ischemic preconditioning plus iloprost, 3.2; versus ischemia-reperfusion, 4.7; p < 0.01, p < 0.001, and p < 0.05, respectively). Superoxide dismutase levels were higher in ischemic preconditioning, iloprost plus ischemic preconditioning, and iloprost groups (ischemic preconditioning, 2.7 ± 0.2; ischemic preconditioning plus iloprost, 2.5 ± 0.3; versus ischemia-reperfusion, 1.2 ± 0.1; p < 0.01; iloprost, 2.4 ± 1.1; versus ischemia-reperfusion, 1.2 ± 0.1; p < 0.05). Myeloperoxidase, a marker for neutrophil infiltration, was lower in the iloprost group (iloprost, 222 ± 5; versus ischemia-reperfusion, 291 ± 25; p < 0.05).

Conclusions:
This study showed that both iloprost and ischemic preconditioning reduced reperfusion injury in jejunal flaps. Based on histologic results, iloprost may be a novel treatment alternative to ischemic preconditioning.