bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ketamine Alters Hippocampal Cell Proliferation and Improves Learning in Mice after Traumatic Brain Injury
Authors: Peters Austin J. , Villasana Laura E. , Schnell Eric 
Published: May 2018

Abstract

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Traumatic brain injury induces cellular proliferation in the hippocampus, which generates new neurons and glial cells during recovery. This process is regulated by N-methyl-d-aspartate–type glutamate receptors, which are inhibited by ketamine. The authors hypothesized that ketamine treatment after traumatic brain injury would reduce hippocampal cell proliferation, leading to worse behavioral outcomes in mice.

Methods
Traumatic brain injury was induced in mice using a controlled cortical impact injury, after which mice (N = 118) received either ketamine or vehicle systemically for 1 week. The authors utilized immunohistochemical assays to evaluate neuronal, astroglial, and microglial cell proliferation and survival 3 days, 2 weeks, and 6 weeks postintervention. The Morris water maze reversal task was used to assess cognitive recovery.

Results
Ketamine dramatically increased microglial proliferation in the granule cell layer of the hippocampus 3 days after injury (injury + vehicle, 2,800 ± 2,700 cells/mm3, n = 4; injury + ketamine, 11,200 ± 6,600 cells/mm3, n = 6; P = 0.012). Ketamine treatment also prevented the production of astrocytes 2 weeks after injury (sham + vehicle, 2,400 ± 3,200 cells/mm3, n = 13; injury + vehicle, 10,500 ± 11,300 cells/mm3, n = 12; P = 0.013 vs. sham + vehicle; sham + ketamine, 3,500 ± 4,900 cells/mm3, n = 14; injury + ketamine, 4,800 ± 3,000 cells/mm3, n = 13; P = 0.955 vs. sham + ketamine). Independent of injury, ketamine temporarily reduced neurogenesis (vehicle-exposed, 105,100 ± 66,700, cells/mm3, n = 25; ketamine-exposed, 74,300 ± 29,200 cells/mm3, n = 27; P = 0.031). Ketamine administration improved performance in the Morris water maze reversal test after injury, but had no effect on performance in sham-treated mice.

Conclusions
Ketamine alters hippocampal cell proliferation after traumatic brain injury. Surprisingly, these changes were associated with improvement in a neurogenesis-related behavioral recall task, suggesting a possible benefit from ketamine administration after traumatic brain injury in mice. Future studies are needed to determine generalizability and mechanism.
Routine Adaptive Replanning of p16-Positive Stage N2b Oropharyngeal Cancer
Authors: Zhu James H. , Amdur Robert J. , Lu Bo , Liu Chihray , Hitchcock Kathryn E. , Mendenhall William M. 
Published: May 2018

Purpose/Objective(s):
To determine if routinely replanning patients treated for oropharyngeal cancer that is p16-positive and clinical neck stage N2b (AJCC 7th edition) is likely to result in dose changes that will improve patient outcomes to a meaningful degree.

Methods:
In 10 consecutive patients treated with primary radiotherapy (RT) and concurrent weekly chemotherapy for p16-positive N2b oropharyngeal carcinoma, we prospectively evaluated dose changes from replanning for the final 4 or 2 weeks of RT of a 7-week RT program.

Results:
Replanning for the final 4 or 2 weeks improved planning target volume coverage by an average of 4 and 2 percentage points, respectively. For all normal structures, the dose change was small (<1 Gy) with replanning.

Conclusions:
In patients with p16-positive N2b oropharynx cancer, the value of replanning RT is a small improvement in target coverage with minimal improvement in normal tissue sparing. In response to our study, some of the physicians in our group replan most node-positive oropharyngeal cancer cases while others think routine replanning is not valuable.
The Use of Temporoparietal Fascia Flap for Surgical Treatment of Traumatic Auricle Defects
Authors: Kurbonov Ubaidullo , Davlatov Abdumalik , Janobilova Sitora , Kurbanov Ziyodullo , Mirshahi Massoud 
Published: May 2018

Background:
Auricular reconstruction is 1 of the biggest challenges of facial plastic surgery. The aim of this study was to evaluate the efficacy of 1-stage reconstruction of an auricle using a temporoparietal fascia flap (TPFF).

Methods:
In this nonrandomized study, autologous auricle bodies with emergency condition and cartilaginous graft from projection of a costal arch from the VI–VII ribs were used. Temporal fascia sample with vascular pedicle (a temporal artery with the accompanying veins) by the Z-shaped incision of skin in temporal area for auricular reconstruction was extracted. Skin grafts were taken from the supraclavicular area or from the left or right flank. Grafts of partial auricle bodies (n = 8) along with cartilaginous framework from a costal arch (n = 21) were used for auricle reconstruction. The follow-up period studied after 6 months in 29 operated patients.

Results:
The graft of partial auricle bodies or the graft of a cartilaginous framework from a costal arch presented a perfect auricular reconstruction. By avoiding a difficult microsurgery and its possible complications, the use of TPFF led to beneficial results in 75% and 90.4% of cases, respectively. Overall, no major complication (alopecia, hematoma, or necrosis) occurred, and further surgery was not required.

Conclusion:
TPFF is a technique of choice for surgical treatment of traumatic auricle defects.
Perforator Propeller Flaps for the Coverage of Middle and Distal Leg Soft-tissue Defects
Authors: Mendieta Mauricio , Cabrera Rodrigo , Siu Armando , Altamirano Roderick , Gutierrez Sandra 
Published: May 2018

Background:
Local propeller flaps preserve the main vascular arteries of the lower extremity and muscle function, avoiding the need for a microsurgical anastomosis and the benefit of providing a “like with like” coverage. Our goal in this study was to demonstrate the versatility, safety, and complications of the local propeller flaps for lower extremity reconstruction.

Methods:
We present a series of 28 patients in whom we used local propeller flaps to restore small-to-medium soft-tissue defects of the lower limb in different hospitals of Managua, Nicaragua.

Results:
Flap average dimensions were of 48 cm2. Flap rotation was performed in 180 degrees in 85% of the cases. The propeller flaps were based on a single perforator, from the posterior tibial artery in 50%, anterior tibial artery in 39.3%, and peroneal artery in 10.7% of the cases. Complications occurred in 14% of the propeller flaps performed, with 3 partial necrosis of less than 15% of the flap transposed. Complications of the patients occurred in both sex groups; however, for the female group, there was a 75% of complications with a tendency toward statistical significance of P = 0.038. Donor site of the flap was closed primarily in 85.7% (24) of the cases.

Conclusions:
In our opinion, the availability and safety of local propeller flaps, justifies its use in cases where microsurgical techniques are not an option for the reconstruction of the middle and distal extremity, in small-to-medium defects of soft-tissue coverage of the lower limb.
Physician Assistant Student Perceptions of “Muddiest Point” Classroom Assessment Technique Implementation
Authors: Aycock Mallory M. , Sikes Martha L. , Stevens Gregg A. 
Published: May 2018

Purpose
To assess student perceptions of the use of the “Muddiest Point” as a type of formative classroom assessment technique (CAT) in a clinical skills laboratory course.

Methods
Physician assistant (PA) students enrolled in a private university were invited to complete a perception survey regarding the use of the Muddiest Point at the conclusion of the course.

Results
Survey results showed positive overall student perceptions of the Muddiest Point and desire for broader use of this CAT in other courses.

Conclusions
The Muddiest Point is a CAT that is simple for the instructor to implement and showed overall perceived benefit to the PA student. The Muddiest Point is an effective method to gauge student learning and allows students to be active participants in their education.
Quality and Importance of Health Policy, Reform, and Public Health Topics: A Study in Physician Assistant Education
Authors: Angerer-Fuenzalida Frances M. 
Published: May 2018

Purpose
As key players in a changing US health care system, physician assistants (PAs) must be prepared to act with a clear understanding of health policy as reform changes are enacted. The purpose of this study was to assess the perceptions of graduating PA students about the importance of health policy, reform, and public health and their perception of their preparedness in these areas. The research question was: Do PA students identify these topic areas as important, and, for each topic area, do they feel adequately prepared with sufficient knowledge for clinical practice?

Methods
Participants in the study included 352 PA students from 14 PA programs randomly selected from 4 geographic regions of the continental United States. A 20-item instrument, the Health Policy Perception Tool, was developed and validated for data collection.

Results
Physician assistant students rated content items high on the importance scale and displayed a wide range of ratings on their perceived preparedness in each content area. Health policy/reform items demonstrated the highest disparity, with students indicating that they were least prepared in content areas relating to the Affordable Care Act, such as patient-centered medical home and accountable care organizations. They also rated health system structure/function items as moderately important, but indicated that they were ill prepared on this topic. Public health topics were rated highly on both scales.

Conclusions
Physician assistant programs appear to be addressing public health issues well; however, PA education leaders must address the low levels of preparedness in the other areas of health care, specifically those related to health structure/function and health reform.
Applying Intelligent Algorithms to Automate the Identification of Error Factors
Authors: Jin Haizhe , Qu Qingxing , Munechika Masahiko , Sano Masataka , Kajihara Chisato , Duffy Vincent G. , Chen Han 
Published: May 2018

Objectives
Medical errors are the manifestation of the defects occurring in medical processes. Extracting and identifying defects as medical error factors from these processes are an effective approach to prevent medical errors. However, it is a difficult and time-consuming task and requires an analyst with a professional medical background. The issues of identifying a method to extract medical error factors and reduce the extraction difficulty need to be resolved.

Methods
In this research, a systematic methodology to extract and identify error factors in the medical administration process was proposed. The design of the error report, extraction of the error factors, and identification of the error factors were analyzed.

Results
Based on 624 medical error cases across four medical institutes in both Japan and China, 19 error-related items and their levels were extracted. After which, they were closely related to 12 error factors. The relational model between the error-related items and error factors was established based on a genetic algorithm (GA)–back-propagation neural network (BPNN) model. Additionally, compared to GA-BPNN, BPNN, partial least squares regression and support vector regression, GA-BPNN exhibited a higher overall prediction accuracy, being able to promptly identify the error factors from the error-related items.

Conclusions
The combination of “error-related items, their different levels, and the GA-BPNN model” was proposed as an error-factor identification technology, which could automatically identify medical error factors.
Perfect Registration Leads to Imperfect Performance
Authors: Dilley James W. R. , Hughes-Hallett Archie , Pratt Philip J. , Pucher Philip H. , Camara Mafalda , Darzi Ara W. , Mayer Erik K. 
Published: May 2018

Objective:
To compare surgical safety and efficiency of 2 image guidance modalities, perfect augmented reality (AR) and side-by-side unregistered image guidance (IG), against a no guidance control (NG), when performing a simulated laparoscopic cholecystectomy (LC).

Background:
Image guidance using AR offers the potential to improve understanding of subsurface anatomy, with positive ramifications for surgical safety and efficiency. No intra-abdominal study has demonstrated any advantage for the technology. Perfect AR cannot be provided in the operative setting in a patient; however, it can be generated in the simulated setting.

Methods:
Thirty-six experienced surgeons performed a baseline LC using the LapMentor simulator before randomization to 1 of 3 study arms: AR, IG, or NG. Each performed 3 further LC. Safety and efficiency-related simulator metrics, and task workload (SURG-TLX) were collected.

Results:
The IG group had a shorter total instrument path length and fewer movements than NG and AR groups. Both IG and NG took a significantly shorter time than AR to complete dissection of Calot triangle. Use of IG and AR resulted in significantly fewer perforations and serious complications than the NG group. IG had significantly fewer perforations and serious complications than the AR group. Compared with IG, AR guidance was found to be significantly more distracting.

Conclusion:
Side-by-side unregistered image guidance (IG) improved safety and surgical efficiency in a simulated setting when compared with AR or NG. IG provides a more tangible opportunity for integrating image guidance into existing surgical workflow as well as delivering the safety and efficiency benefits desired.
10th Anniversary of ALPPS—Lessons Learned and quo Vadis
Authors: Lang Hauke , de Santibañes Eduardo , Schlitt Hans J. , Malagó Massimo , van Gulik Thomas , Machado Marcel A. , Jovine Elio , Heinrich Stefan , Ettorre Giuseppe Maria , Chan Albert , Hernandez-Alejandro Roberto , Robles Campos Ricardo , Sandström Per , Linecker Michael , Clavien Pierre-Alain 
Published: May 2018

Objective:
Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) has been tested in various indications and clinical scenarios, leading to steady improvements in safety. This report presents the current status of ALPPS.

Summary Background Data:
ALPPS offers improved resectability, but drawbacks are regularly pointed out regarding safety and oncologic benefits.

Methods:
During the 12th biennial congress of the European African-Hepato-Pancreato-Biliary Association (Mainz, Germany, May 23–26, 2017) an expert meeting “10th anniversary of ALPP” was held to discuss indications, management, mechanisms of regeneration, as well as pitfalls of this novel technique. The aim of the meeting was to make an inventory of what has been achieved and what remains unclear in ALPPS.

Results:
Precise knowledge of liver anatomy and its variations is paramount for success in ALPPS. Technical modifications, mainly less invasive approaches like partial, mini- or laparoscopic ALPPS, mostly aiming at minimizing the extensiveness of the first-stage procedure, are associated with improved safety. In fibrotic/cirrhotic livers the degree of future liver remnant hypertrophy after ALPPS appears some less than that in noncirrhotic. Recent data from the only prospective randomized controlled trial confirmed significant higher resection rates in ALPPS with similar peri-operative morbidity and mortality rates compared with conventional 2-stage hepatectomy including portal vein embolization. ALPPS is effective reliably even after failure of portal vein embolization.

Conclusions:
Although ALPPS is now an established 2-stage hepatectomy additional data are warranted to further refine indication and technical aspects. Long-term oncological outcome results are needed to establish the place of ALPPS in patients with initially nonresectable liver tumors.
Pursuing Excellence
Authors: Gardner Aimee K. , Dunkin Brian J. 
Published: May 2018

Introduction:
As current screening methods for selecting surgical trainees are receiving increasing scrutiny, development of a more efficient and effective selection system is needed. We describe the process of creating an evidence-based selection system and examine its impact on screening efficiency, faculty perceptions, and improving representation of underrepresented minorities.

Methods:
The program partnered with an expert in organizational science to identify fellowship position requirements and associated competencies. Situational judgment tests, personality profiles, structured interviews, and technical skills assessments were used to measure these competencies. The situational judgment test and personality profiles were administered online and used to identify candidates to invite for on-site structured interviews and skills testing. A final rank list was created based on all data points and their respective importance. All faculty completed follow-up surveys regarding their perceptions of the process. Candidate demographic and experience data were pulled from the application website.

Results:
Fifty-five of 72 applicants met eligibility requirements and were invited to take the online assessment, with 50 (91%) completing it. Average time to complete was 42 ± 12 minutes. Eighteen applicants (35%) were invited for on-site structured interviews and skills testing—a greater than 50% reduction in number of invites compared to prior years. Time estimates reveal that the process will result in a time savings of 68% for future iterations, compared to traditional methodologies. Fellowship faculty (N = 5) agreed on the value and efficiency of the process. Underrepresented minority candidates increased from an initial 70% to 92% being invited for an interview and ranked using the new screening tools.

Discussion:
Applying selection science to the process of choosing surgical trainees is feasible, efficient, and well-received by faculty for making selection decisions.
Metabolic Tumor Volume Change Predicts Long-term Survival and Histological Response to Preoperative Chemotherapy in Locally Advanced Esophageal Cancer
Authors: Makino Tomoki , Yamasaki Makoto , Tanaka Koji , Masuike Yasunori , Tatsumi Mitsuaki , Motoori Masaaki , Kimura Yutaka , Hatazawa Jun , Mori Masaki , Doki Yuichiro 
Published: May 2018

Objective:
Here, we assess the ability of metabolic tumor volume (MTV) as measured by 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG PET/CT) to evaluate neoadjuvant chemotherapy response for patients with locally advanced esophageal cancer (EC).

Background:
Optimal methods to evaluate treatment response for EC patients have not yet been established. Although previous studies have reported the value of standardized uptake value (SUV), the accuracy of predicting histological response or long-term survival in EC is limited.

Methods:
In all, 102 EC patients without distant metastasis who underwent 18F-FDG PET/CT both before and after the preoperative chemotherapy series were analyzed.

Results:
The median primary tumor MTV values before and after preoperative chemotherapy were 22.55 (range 0.4–183.1) and 2.75 (0–52.9), respectively, and the median MVT reduction rate was 86.5%. We found the most significant difference in survival between PET responders and nonresponders with a cut-off value of 60% MTV reduction, using a 10% stepwise cut-off analysis [2-year progression-free survival (PFS): 79.2 vs 44.4%; hazard ratio (HR) 3.397; P < 0.0001). With this cut-off value, histological response (P = 0.0091), tumor location (P = 0.0102), pT (P = 0.0011), and pN (P = 0.0110) were significantly associated with PET response. Univariate analysis of PFS indicated a correlation between PFS and tumor size, cT, decrease of primary lesion by CT, SUVmax reduction rate, MTV reduction rate, pT, pN, and pM. Multivariate analysis further identified pM (HR 3.063; P = 0.0279) and MTV reduction rate (HR 2.471; P = 0.0263) to be independent prognostic predictors, but not decrease of primary lesion by CT or SUVmax reduction rate.

Conclusion:
MTV change is clinically useful in predicting both long-term survival and histological response to preoperative chemotherapy in EC patients, after determining the optimal cut-off value based on survival analysis.
Co-expression patterns define epigenetic regulators associated with neurological dysfunction
Authors: Boukas Leandros , Havrilla James M. , Quinlan Aaron R. , Bjornsson Hans T. , Hansen Kasper D. 
Published: May 2018

AbstractCoding variants in genes encoding for epigenetic regulators are an emerging cause of neurological dysfunction and cancer. However, a systematic effort to identify disease candidates within the human epigenetic machinery (EM) has not been performed, and it is unclear whether features exist that distinguish between variation-intolerant and variation-tolerant EM genes, and between EM genes associated with neurological dysfunction versus cancer. Here, we rigorously define a set of 295 human genes with a direct role in epigenetic regulation (writers, erasers, remodelers, readers). Systematic exploration of these genes reveals that while individual enzymatic functions are always mutually exclusive, readers often also exhibit enzymatic activity as well (dual function EM genes). We find that the majority of EM genes are very intolerant to loss-of-function variation, even when compared to the dosage sensitive group of transcription factors. Using this strategy, we identify 103 novel EM disease candidates. We show that the intolerance to loss-of-function variation is driven by the protein domains encoding the epigenetic function, strongly suggesting that disease is caused by a perturbed chromatin state. Unexpectedly, we also describe a large subset of EM genes that are co-expressed within multiple tissues. This subset is almost exclusively populated by extremely variation-intolerant EM genes, and shows enrichment for dual function EM genes. It is also highly enriched for genes associated with neurological dysfunction, even when accounting for dosage sensitivity, but not for cancer-associated EM genes. These findings prioritize novel disease candidate EM genes, and suggest that the co-expression itself may play a functional role in normal neurological homeostasis.
Evaluation of Methods for Cell Nuclear Structure Analysis from Microscopy Data
Authors: Kalinin Alexandr A. , Athey Brian D. , Dinov Ivo D. 
Published: May 2018

AbstractChanges in cell nuclear architecture are regulated by complex biological mechanisms that associated with the altered functional properties of a cell. Quantitative analyses of structural alterations of nuclei and their compartments are important for understanding such mechanisms. In this work we present a comparison of approaches for nuclear structure classification, evaluated on 2D per-channel representations from a 3D microscopy imaging dataset by maximum intensity projection. Specifically, we compare direct classification of pixel data from either raw intensity images or binary masks that contain only information about morphology of the object, but not intensity. We evaluate a number of widely used classification algorithms using 2 different cross-validation schemes to assess batch effects. We compare obtained results with the previously reported baselines and discuss novel findings.