bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variation of Gut Mucosal Microbiome With Anti‐Saccharomyces cerevisiae Antibody Status in Pediatric Crohn Disease
Authors: Kansal Shivani , Catto‐Smith Anthony G. , Boniface Karen , Thomas Sarah , Cameron Donald J. , Oliver Mark , Alex George , Kirkwood Carl D. , Wagner Josef 
Published: August 2019

ABSTRACTObjectives:Crohn disease (CD) is a chronic relapsing condition possibly caused by a dysbiotic microbiome. Approximately 30% to 60% of patients with CD have anti‐Saccharomyces cerevisiae antibody (ASCA), but any association with gut microbiota is unexplored. We hypothesized that ASCA positivity would predict a signature microbial status and clinical phenotype.Methods:Ileocolonic mucosal biopsies were obtained from children with CD (n = 135), and controls without inflammatory bowel disease (n = 45). Comparison was made between ASCA status, microbial diversity, and clinical characteristics.Results:ASCA was highly specific but poorly sensitive for the diagnosis of CD. In patients with CD, ASCA positivity was associated with older age (≥10 years), ileocolonic disease, and long‐term risk of surgery. Microbial alpha and beta diversity were similar in patients with CD with or without ASCA, but significantly less when compared to noninflammatory bowel disease controls. Microbial richness was similar across all 3 groups. Fourteen bacterial species were associated with ASCA‐positive patients with CD and 14 species with ASCA‐negative patients (P < 0.05). After using a false discovery rate correction Ruminococcus torques and bacterium Yersinia enterocolitica 61 remained significantly associated with CD ASCA positivity (P = 0.0178), whereas Enterobacter cloacae and Faecalibacterium prausnitzii were significantly associated with CD ASCA negativity (P = 0.0178 and 0.0342).Conclusion:ASCA‐positive and ASCA‐negative patients with CD have significant differences in gut microbiome composition, which could possibly be influencing the phenotype of the disease.
Pilot Study of the Mastery Lifestyle Intervention
Authors: Ruiz R. Jeanne , Newman Matt , Records Kathie , Wommack Joel C. , Stowe Raymond P. , Pasillas Rebecca M. 
Published: August 2019

Background
Recognizing the effects of acculturation on quality of life and emotional health, especially during pregnancy, we developed an intervention that would target these factors in order to improve maternal well-being during the prenatal period and potentially improve infant outcomes, particularly preterm birth for Mexican-American women (Latinas).

Objective
The purpose of these pilot studies was to test the acceptability, feasibility, and preliminary efficacy of the mastery lifestyle intervention (MLI) to decrease depressive and anxiety symptoms and improve coping as implemented in prenatal clinics with culturally homogenous groups of Latinas.

Methods
The MLI was tested in three small pilot studies (n = 15), one in El Paso, Texas (an urban area), and two in Bastrop, Texas (a rural area outside Austin), for acceptability and feasibility. A pretest/posttest, quasi-experimental design was used with pregnant self-identified Mexican-American Latinas at 14–20 weeks' gestation. Measures of anxiety, depressive symptoms, and positive and negative coping were used.

Results
Feasibility was a success in terms of implementation of the MLI in an active prenatal clinic setting and the use of electronic tablets for data collection and entry of data into REDcap. Satisfaction was high, with the location of the MLI being at their primary OB/GYN clinic. Participants reported that six intervention sessions appear to be ideal as was the class length of 1.5 to 2 hours. On Cohen's d, there were medium to large effect size decreases in depressive and anxiety symptoms and small to medium effect size decreases in the use of negative coping strategies and small effect sizes for increases in positive coping strategies.

Discussion
Pilot testing of the MLI indicated that it was well accepted from the participants and feasible as a culturally tailored behavioral therapy administered in a group setting by nurse practitioners. Our initial pilot results also suggest preliminary efficacy as indicated by moderate to large Cohen's d effect sizes for depression and anxiety.
Immune Thrombocytopenic Purpura in Pregnancy
Authors: Baucom Amanda M. , Kuller Jeffrey A. , Dotters-Katz Sarah 
Published: August 2019

Importance
Immune thrombocytopenia purpura (ITP), an autoimmune disease characterized by destruction of platelets, is a hematological disorder that can present in both pregnant and nonpregnant patients. Although thrombocytopenia in pregnancy can be caused by more common pathologies such as gestational thrombocytopenia and preeclampsia, ITP can present initially during pregnancy, further complicating diagnosis. Management must be considerate of both the pregnancy itself and the fetus.

Objective
Review the diagnosis, treatment, and management of ITP in pregnancy based on current recommendations.

Evidence Acquisition
Review articles, original research, and case studies were utilized.

Results
Throughout pregnancy, patients are screened for a variety of conditions or disorders of pregnancy. Thrombocytopenia is a common pathology of pregnancy, but ITP is a rare condition that a provider needs to be aware of. After ruling out secondary causes of thrombocytopenia or more common causes such as gestational thrombocytopenia or preeclampsia, ITP should be considered. After diagnosis, treatment options should be discussed and initiated to provide safety for both the mother and fetus.

Conclusions
After reading this article, the reader will understand the current recommendations regarding the diagnosis, treatment, and management of ITP in pregnancy.

Relevance
The practitioner will be comfortable treating this condition during pregnancy.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completing this activity, the obstetrician/gynecologist should be better able to describe thrombocytopenia in pregnancy and identify common manifestations; select appropriate tests for evaluation of thrombocytopenia; and explain treatment options for management of ITP during pregnancy and delivery considerations for women with this condition.
The Effect of Body Mass Index on Retropubic Midurethral Slings
Authors: Bach Fiona , Hill Simon , Toozs-Hobson Philip 
Published: August 2019

(Abstracted from Am J Obstet Gynecol 2019;220:371.e1–371.e9)
The prevalence of obesity during the past 2 decades in England has risen by approximately 40% and is continuing to rise as it has in other developed countries. There is a well-recognized association between stress urinary incontinence (SUI) and increasing body mass index (BMI).
Prenatal Diagnosis of Vasa Previa: Outpatient Versus Inpatient Management
Authors: Bartal Michal Fishel , Sibai Baha M. , Ilan Hadas , Katz Sharon , Eisen Irit Schushan , Kassif Eran , Yoeli Rakefet , Yinon Yoav , Mazaki-Tovi Shali 
Published: August 2019

(Abstracted from Am J Perinatol 2019;36:422–427)
Vasa previa is defined as fetal vessels that run through the fetal membranes, over or within 2-cm distance from the endocervical os and unprotected by the placenta or umbilical cord. Vasa previa is associated with a high fetal or neonatal mortality rate due to risk of fetal exsanguination resulting from the fetal vessels tearing when rupture of membranes occurs.
Prediction of Nonelective Central Venous Catheter Removal in Medically Complex Neonates
Authors: Beard Lauren , Levek Claire , Hwang Sunah , Grover Theresa 
Published: August 2019

Introduction:
Central venous catheters (CVCs) are essential to neonatal care but associated with significant morbidity. Nonelective CVC removal (NER) is an inadequately studied outcome associated with increased morbidity, infant and family stress, and cost. This study describes prevalence and predictors of NER in infants admitted to a level IV neonatal intensive care unit and NER variation between peripherally inserted central catheters (PICCs), cutdown PICCs, and surgical CVCs.

Methods:
In this study, we include patient and catheter data for infants admitted to a level IV neonatal intensive care unit (2010–2015). Demographic and clinical characteristics were compared using 1-way analysis of variance (ANOVA), Kruskal-Wallis, and chi-square tests for continuous, non-normally distributed continuous, and categorical variables, respectively. The association between NER due to complication and infant and catheter characteristics was assessed using generalized linear mixed models.

Results:
Patient and catheter characteristics vary significantly by catheter type. The overall rate of NER is 15% (17% PICCs, 13% cutdown PICCs, and 19% surgical CVCs). The most common indications for NER are catheter breakage, blood stream infection(BSI)/central line-associated blood stream infection(CLABSI), catheter malposition, mechanical obstruction, and extravasation. Birth weight, patient diagnosis, catheter dwell time, and concurrent catheters are associated with increased odds of NER.

Conclusions:
Patient risk factors and potentially modifiable catheter characteristics, including catheter dwell time and concurrent catheters, are associated with increased NER. As NER is associated with a broad spectrum of adverse outcomes, we propose a quality improvement strategy to risk stratify patients and reduce exposure to high-risk, modifiable catheter characteristics.
Differentiating trait pain from state pain: a window into brain mechanisms underlying how we experience and cope with pain
Authors: Davis Karen D. , Cheng Joshua C. 
Published: August 2019

Abstract
Across various biological and psychological attributes, individuals have a set point around which they can fluctuate transiently into various states. However, if one remains in a different state other than their set point for a considerable period (eg, induced by a disease), this different state can be considered to be a new set point that also has associated surrounding states. This concept is instructive for understanding chronic pain, where an individual's set point may maladaptively shift such that they become stuck at a new set point of pain (trait pain), from which pain can fluctuate on different timescales (ie, pain states). Here, we discuss the importance of considering trait and state pains in neuroimaging studies of brain structure and function to gain an understanding of not only an individual's current pain state but also more broadly to their trait pain, which may be more reflective of their general condition.
Brainstem neuroimaging of nociception and pain circuitries
Authors: Napadow Vitaly , Sclocco Roberta , Henderson Luke A. 
Published: August 2019

Abstract
The brainstem is known to be an important brain area for nociception and pain processing, and both relaying and coordinating signaling between the cerebrum, cerebellum, and spinal cord. Although preclinical models of pain have characterized the many roles that brainstem nuclei play in nociceptive processing, the degree to which these circuitries extend to humans is not as well known. Unfortunately, the brainstem is also a very challenging region to evaluate in humans with neuroimaging. The challenges for human brainstem imaging arise from the location of this elongated brain structure, proximity to cardiorespiratory noise sources, and the size of its constituent nuclei. These challenges can require dedicated approaches to brainstem imaging, which should be adopted when study hypotheses are focused on brainstem processing of nociception or modulation of pain perception. In fact, our review will highlight many pain neuroimaging studies that have reported some brainstem involvement in nociceptive processing and chronic pain pathology. However, we note that with recent advances in neuroimaging leading to improved spatial and temporal resolution, more studies are needed that take advantage of data collection and analysis methods focused on the challenges of brainstem neuroimaging.
Imaging clinically relevant pain states using arterial spin labeling
Authors: Loggia Marco Luciano , Segerdahl Andrew Reilly , Howard Matthew Alexander , Tracey Irene 
Published: August 2019

Abstract
Arterial spin labeling (ASL) is a perfusion-based functional magnetic resonance imaging technique that uses water in arterial blood as a freely diffusible tracer to measure regional cerebral blood flow noninvasively. To date, its application to the study of pain has been relatively limited. Yet, ASL possesses key features that make it uniquely positioned to study pain in certain paradigms. For instance, ASL is sensitive to very slowly fluctuating brain signals (in the order of minutes or longer). This characteristic makes ASL particularly suitable for the evaluation of brain mechanisms of tonic experimental, postsurgical, and ongoing/or continuously varying pain in chronic or acute pain conditions (whereas blood-oxygen level–dependent functional magnetic resonance is better suited to detect brain responses to short-lasting or phasic/evoked pain). Unlike positron emission tomography or other perfusion techniques, ASL allows the estimation of regional cerebral blood flow without requiring the administration of radioligands or contrast agents. Thus, ASL is well suited for within-subject longitudinal designs (eg, to study evolution of pain states over time, or of treatment effects in clinical trials). Arterial spin labeling is also highly versatile, allowing for novel paradigms exploring a flexible array of pain states, plus it can be used to simultaneously estimate not only pain-related alterations in perfusion but also functional connectivity. In conclusion, ASL can be successfully applied in pain paradigms that would be either challenging or impossible to implement using other techniques. Particularly when used in concert with other neuroimaging techniques, ASL can be a powerful tool in the pain imager's toolbox.
The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer
Authors: Zeidan Fadel , Baumgartner Jennifer N. , Coghill Robert C. 
Published: August 2019

Abstract
The advent of neuroimaging methodologies, such as functional magnetic resonance imaging (fMRI), has significantly advanced our understanding of the neurophysiological processes supporting a wide spectrum of mind–body approaches to treat pain. A promising self-regulatory practice, mindfulness meditation, reliably alleviates experimentally induced and clinical pain. Yet, the neural mechanisms supporting mindfulness-based pain relief remain poorly characterized. The present review delineates evidence from a spectrum of fMRI studies showing that the neural mechanisms supporting mindfulness-induced pain attenuation differ across varying levels of meditative experience. After brief mindfulness-based mental training (ie, less than 10 hours of practice), mindfulness-based pain relief is associated with higher order (orbitofrontal cortex and rostral anterior cingulate cortex) regulation of low-level nociceptive neural targets (thalamus and primary somatosensory cortex), suggesting an engagement of unique, reappraisal mechanisms. By contrast, mindfulness-based pain relief after extensive training (greater than 1000 hours of practice) is associated with deactivation of prefrontal and greater activation of somatosensory cortical regions, demonstrating an ability to reduce appraisals of arising sensory events. We also describe recent findings showing that higher levels of dispositional mindfulness, in meditation-naïve individuals, are associated with lower pain and greater deactivation of the posterior cingulate cortex, a neural mechanism implicated in self-referential processes. A brief fMRI primer is presented describing appropriate steps and considerations to conduct studies combining mindfulness, pain, and fMRI. We postulate that the identification of the active analgesic neural substrates involved in mindfulness can be used to inform the development and optimization of behavioral therapies to specifically target pain, an important consideration for the ongoing opioid and chronic pain epidemic.
The “virtual lesion” approach to transcranial magnetic stimulation: studying the brain–behavioral relationships in experimental pain
Authors: Weissman-Fogel Irit , Granovsky Yelena 
Published: August 2019

Abstract
Transcranial magnetic stimulation (TMS) can be used to create a temporary “virtual lesion” (VL) of a target cortical area, disrupting its function and associated behavior. Transcranial magnetic stimulation can therefore test the functional role of specific brain areas. This scoping review aims at investigating the current literature of the “online” TMS-evoked VL approach to studying brain–behavioral relationships during experimental pain in healthy subjects. Ovid-Medline, Embase, and Web of Science electronic databases were searched. Included studies tested different TMS-based VLs of various pain brain areas during continuous experimental pain or when time-locked to a noxious stimulus. Outcome measures assessed different pain measurements. Initial screening resulted in a total of 403 studies, of which 17 studies were included in the review. The VLs were directed to the prefrontal, primary and secondary somatosensory, primary motor, and parietal cortices through single/double/triple/sequence of five-TMS pulses or through repeated TMS during mechanical, electrical contact, radiant heat, or capsaicin-evoked noxious stimulation. Despite a wide variability among the VL protocols, outcome measures, and study designs, a behavioral VL effect (decrease or increase in pain responses) was achieved in the majority of the studies. However, such findings on the relationships between the modified brain activity and the manifested pain characteristics were often mixed. To conclude, TMS–elicited VLs during experimental pain empower our understanding of brain–behavior relationships at specific time points during pain processing. The mixed findings of these relationships call for an obligatory standard of all pain-related TMS protocols for clearly determining the magnitude and direction of TMS-induced behavioral effects.
Osseous Transformation with Facial Feminization Surgery: Improved Anatomical Accuracy with Virtual Planning
Authors: Gray Rachel , Nguyen Khang , Lee Justine C. , Deschamps-Braly Jordan , Bastidas Nicholas , Tanna Neil , Bradley James P. 
Published: August 2019

Background:
Facial feminization surgery entails a series of surgical procedures that help the transwoman pass as their affirmed gender. Although virtual surgical planning, with intraoperative cutting guides, and custom plates have been shown to be helpful for craniomaxillofacial reconstruction, they have not yet been studied for facial feminization surgery. The authors used cadaveric analysis for morphologic typing and to demonstrate the utility of virtual surgical planning in facial feminization surgery procedures.

Methods:
Male cadaveric heads underwent morphologic typing analysis of the frontal brow, lateral brow, mandibular angle, and chin regions (n = 50). Subsequently, the cadavers were split into two groups: (1) virtual surgical planning intraoperative cutting guides and (2) no preoperative planning. Both groups underwent (1) anterior frontal sinus wall setback, (2) lateral supraorbital recontouring, (3) mandibular angle reduction, and (4) osseous genioplasty narrowing. Efficiency (measured as operative time), safety (determined by dural or nerve injury), and accuracy (scored with three-dimensional computed tomographic preoperative plan versus postoperative result) were compared between groups, with significance being p < 0.05.

Results:
For frontal brow and lateral lower face, morphologic type 3 (severe) predominated; for lateral brow and chin, type 2 (moderate) predominated. For frontal sinus wall setback, virtual surgical planning improved efficiency (19 minutes versus 44 minutes; p < 0.05), safety (100 percent versus 88 percent; p < 0.05; less intracranial entry), and accuracy (97 percent versus 79 percent; p < 0.05) compared with no preoperative planning. For mandibular angle reduction, virtual surgical planning improved safety (100 percent versus 88 percent; p < 0.05; less inferior alveolar nerve injury) and accuracy (95 percent versus 58 percent; p < 0.05).

Conclusions:
Preoperative planning for facial feminization surgery is helpful to determine morphologic typing. Virtual surgical planning with the use of cutting guides/custom plates improved efficiency, safety, and accuracy when performing four key craniofacial techniques for facial feminization.
Algorithm for Free Perforator Flap Selection in Lower Extremity Reconstruction Based on 563 Cases
Authors: Abdelfattah Usama , Power Hollie A. , Song Sinyoung , Min Kyunghyun , Suh Hyunsuk Peter , Hong Joon Pio 
Published: August 2019

Background:
Microsurgical lower extremity reconstruction remains a challenge. The use of perforator flaps in lower extremity reconstruction is expanding. The authors present an algorithm to guide in the selection of the ideal free perforator flap that can be tailored to each lower extremity defect.

Methods:
The authors conducted a retrospective review of lower extremity reconstruction using free perforator flaps over a 7-year period. Demographics, comorbidities, defect characteristics, operative details, complications, and secondary procedures were documented. Pairwise comparisons of flap types were performed to differentiate flaps on the basis of flap size, thickness, and pedicle length.

Results:
A total of 563 free perforator flaps were performed. The most common causes were trauma (36.5 percent) and diabetes (24.4 percent). Nine flaps were used, with the most common being superficial circumflex iliac perforator (51.2 percent) and anterolateral thigh (33.2 percent). Size differed significantly between flap types (p < 0.05), with the exception of thoracodorsal artery perforator versus gluteal artery perforator flaps (p = 0.26). The thinnest flaps were posterior interosseous artery perforator (3.7 ± 0.5 mm) and superficial circumflex iliac perforator (5.4 ± 0.8 mm). The thickest flaps were deep inferior epigastric perforator (11.1 ± 3.9 mm) and anterolateral thigh (9.0 ± 1.5 mm). The shortest pedicles were in posterior interosseous artery perforator (3.3 ± 0.3 cm) and superficial circumflex iliac perforator flaps (5.2 ± 0.8 cm). The longest pedicles were in deep inferior epigastric perforator (11.7 ± 1.4 cm), thoracodorsal artery perforator (9.3 ± 1.4 cm), and anterolateral thigh flaps (9.2 ± 0.8 cm).

Conclusions:
Free perforator flaps are reliable in lower extremity reconstruction. The authors believe their algorithm for flap selection helps to optimize form and function, decrease operative time, and minimize donor-site morbidity and secondary procedures.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.