bluuebunny/crossref_metadata_2025_split huggingface dataset:
Discrepancies in the Definition of “Outpatient” Surgeries and Their Effect on Study Outcomes Related to ACDF and Lumbar Discectomy Procedures
Authors: Bovonratwet Patawut , Webb Matthew L. , Ondeck Nathaniel T. , Gala Raj J. , Nelson Stephen J. , McLynn Ryan P. , Cui Jonathan J. , Grauer Jonathan N. 
Published: March 2018

Study Design:
This is a retrospective study.

Objective:
To study the differences in definition of “inpatient” and “outpatient” [stated status vs. actual length of stay (LOS)], and the effect of defining populations based on the different definitions, for anterior cervical discectomy and fusion (ACDF) and lumbar discectomy procedures in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.

Summary of Background Data:
There has been an overall trend toward performing ACDF and lumbar discectomy in the outpatient setting. However, with the possibility of patients who underwent outpatient surgery staying overnight or longer at the hospital under “observation” status, the distinction of “inpatient” and “outpatient” is not clear.

Materials and Methods:
Patients who underwent ACDF or lumbar discectomy in the 2005–2014 ACS-NSQIP database were identified. Outpatient procedures were defined in 1 of 2 ways: either as being termed “outpatient” or hospital LOS=0. Differences in definitions were studied. Further, to evaluate the effect of the different definitions, 30-day outcomes were compared between “inpatient” and “outpatient” and between LOS>0 and LOS=0 for ACDF patients.

Results:
Of the 4123 “outpatient” ACDF patients, 919 had LOS=0, whereas 3204 had LOS>0. Of the 13,210 “inpatient” ACDF patients, 337 had LOS=0, whereas 12,873 had LOS>0. Of the 15,166 “outpatient” lumbar discectomy patients, 8968 had LOS=0, whereas 6198 had LOS>0. Of the 12,705 “inpatient” lumbar discectomy patients, 814 had LOS=0, whereas 11,891 had LOS>0. On multivariate analysis of ACDF patients, when comparing “inpatient” with “outpatient” and “LOS>0” with “LOS=0” there were differences in risks for adverse outcomes based on the definition of outpatient status.

Conclusions:
When evaluating the ACS-NSQIP population, ACDF and lumbar discectomy procedures recorded as “outpatient” can be misleading and often did not correlate with same day discharge. These findings have significant impact on the interpretation of existing studies and define an area that needs clarification for future studies.

Level of Evidence:
Level 3.
Long Fusion Arthrodesis Stopping at L5 for Adult Scoliosis
Authors: Gao Xianda , Wang Linfeng , Zhang Jingtao , Wang Peng , Shen Yong 
Published: March 2018

Study Design:
This is retrospective study.

Objective:
Our purpose is to examine the state of the L5–S1 disk after long fusion arthrodesis stopping at L5 in adult scoliosis, and to identify the risk factors for disk degeneration.

Summary of Background Data:
The long fusion arthrodesis surgery for adult scoliosis has shown to have good clinical results. However, there is still some controversy with reference to the potential caudal extents of the fusion, that is, L5 or S1. One of the most common problems related to the L5 fusion is whether subsequent L5–S1 disk degenerations occurs because of stress concentration. In this study, 1.5-T MRI was used to evaluate the L5–S1 disk degeneration according to Pfirrmann classification.

Materials and Methods:
In total, 43 patients with adult scoliosis after posterior long fusions arthrodesis surgery were reviewed retrospectively with the average follow-up period of 4.17±1.55 years (range, 2–9 y). The 1.5 T MRI and standing long x-ray were performed preoperatively and at last follow-up visit. Clinical outcomes were evaluated according to Japanese Orthopedic Association (JOA) scores and Oswestry Disability Index (ODI).

Results:
Subsequent L5–S1 disk degeneration was observed in 33 patients (51.56%). Preoperative average Pfirrmann grade was 1.98±0.58, whereas during last follow-up average Pfirrmann grade was 2.63±0.83 (P<0.001). Preoperative Pfirrmann grade in patients with subsequent disk degeneration was 1.94±0.66, and in patients without subsequent disk degeneration was 2.06±0.51 (P=0.278). Greater ODI showed in patients with subsequent degeneration (P=0.008). Multivariate logistic regression analysis revealed that long follow-up period, heavy labor, and preoperative imbalance were the risk factors.

Conclusions:
Subsequent L5–S1 disk degeneration was common after long fusions arthrodesis was stopped at L5. The recovery of neurological status was similar in patients with or without subsequent L5–S1 disk degeneration, whereas patients with subsequent degeneration complained more about low back pain. Patients with long follow-up period, heavy labor, and preoperative imbalance were more likely to suffer subsequent L5–S1 disk degeneration.
Natural History and Prognostic Factors of Cholangiocarcinoma With Spinal Metastasis
Authors: Sangsin Apiruk , Saiudom Dew , Pongmanee Suthipas , Saengsin Jirawat , Leerapun Taninnit , Murakami Hideki 
Published: March 2018

Study Design:
This is a retrospective analysis.

Objective:
The aim of this study was to determine the epidemiology, survival, and prognostic factors for cholangiocarcinoma (CCA) with spinal metastasis.

Summary of Background Data:
CCA is an epithelial cell malignancy of the bile duct, and a frequent site for its metastasis is the spine. Many areas of Asia are endemic for CCAs. To date, there is limited data on the epidemiology, natural history, and prognostic factors of CCA with spinal metastasis, which is crucial for better management and treatment of the disease.

Materials and Methods:
Patients diagnosed with CCA were recruited to our study, in order to identify cases with spinal metastasis. The survival rate was estimated by the Kaplan-Meier method. The univariate and multivariate analyses of tumor-specific and spinal metastatic factors were performed to identify the independent factors that affect survival.

Results:
From 2006 to 2015, 4585 CCA patients were identified and 182 of these patients had spinal metastasis. The overall median survival of patients with spinal metastasis was 88 days. Serum carcinoembryonic antigen <5 ng/mL, carbohydrate antigen 19-9 <39 U/mL, albumin ≥3.5 g/L, and Frankel score D–E were found to be independent factors that resulted in better survival in a multivariate Cox regression analysis. CCA resection or spinal surgery did not prolong the survival of patients with spinal metastasis.

Conclusion:
Spinal surgery should be considered for CCA patients with spinal metastasis, who have a favorable prognosis, and are likely to live long enough to benefit from surgery. The aim is to palliate the symptoms and not as much to improve the survival.
Hidden Blood Loss in Posterior Lumbar Fusion Surgery
Authors: Wen Longfei , Jin Daxiang , Xie Weixing , Li Yue , Chen Weijian , Ding Jinyong , Xu Jixi , Ren Dongcheng 
Published: March 2018

Study Design:
Descriptive study.

Objectives:
This study aimed to evaluate the hidden blood loss (HBL) of patients who underwent lumbar fusion surgery for degenerative spine and to analyze its risk factors.

Summary of Background Data:
When planning transfusion strategies, blood loss calculation is important. However, in clinical practice, spine surgeons usually ignore the possibility that a large amount of HBL may occur after lumbar fusion surgery.

Materials and Methods:
We studied the patients who underwent posterior lumbar fusion (PLF) surgery for degenerative spine from 2014 to 2015 in one institution. The patient’s demographics, comorbid conditions, coagulation panel value, surgical time, number of levels fused, American Society of Anesthesiologists (ASA) classification, cell saver, preoperative hematocrit level, preoperative hemoglobin level, and postoperative complications were collected retrospectively. Pearson correlation analyses were used to find an association between patient characteristics and HBL. Multivariate linear analysis was used to determine independent risk factors of HBL.

Results:
We reviewed 169 consecutive patients who underwent PLF surgery for degenerative spine in one institution. The mean amount of HBL was 588 mL, which was 39% of the total blood loss. On the basis of the model of multiple linear regression analysis, the multilevel fusion (P=0.001), surgical time (P=0.034), and fibrinogen level (P=0.027) were independent risk factors that contributed to HBL, but age of 60 years or above (P=0.110), postoperative complications (P=0.278), and cell saver were not (P=0.739).

Conclusions:
We conclude that a large amount of HBL may occur in patients who underwent PLF surgery for degenerative spine. In addition, significant hidden loss may have a correlation with postoperative mortality. Multilevel fused, surgical time, and fibrinogen level should be paid close attention when considering strategies of fluid infusion and blood transfusion.
Managing the Social Determinants of Health: Part I
Authors: Fink-Samnick Ellen 
Published: March 2018

Objectives:

This article will:

Define the social determinants of health (SDH)Provide industry evidence on the SDH from a population health perspectiveDiscuss current sociopolitical drivers to impact the progression of SDHDiscuss career implications for the professional case management workforce

Primary Practice Setting(s):
Applicable to health and behavioral health settings, wherever case management is practiced.

Finding/Conclusion:
The SDH pose major challenges to the health care workforce in terms of effective resource provision, health and behavioral health treatment planning plus adherence, and overall coordination of care. Obstacles and variances to needed interventions easily lead to less than optimal outcomes for case managers and their health care organizations. Possessing sound knowledge and clear understanding of each SDH, the historical perspectives, main theories, and integral dynamics, as well as creative resource solutions, all support a higher level of intentional and effective professional case management practice.

Implications for Case Management Practice:
Those persons and communities impacted most by the SDH comprise every case management practice setting. These clients can be among the most vulnerable and disenfranchised members of society, which can easily engender biases on the part of the interprofessional workforce. They are also among the costliest to care for with 50% of costs for only 5% of the population. Critical attention to knowledge about managing the SDH leverages and informs case management practice, evolves more effective programming, and enhances operational outcomes across practice settings.
Twice-Daily Enoxaparin among Plastic Surgery Inpatients: An Examination of Pharmacodynamics, 90-Day Venous Thromboembolism, and 90-Day Bleeding
Authors: Pannucci Christopher J. , Fleming Kory I. , Momeni Arash , Prazak Ann Marie , Agarwal Jayant , Rockwell W. Bradford 
Published: March 2018

Background:
Low anti–factor Xa level, indicative of inadequate enoxaparin dosing, has a significant association with 90-day venous thromboembolism events. The authors examined the pharmacodynamics of enoxaparin 40 mg twice daily and its correlation with anti–factor Xa level, postoperative venous thromboembolism, and bleeding.

Methods:
Adult patients were admitted after plastic and reconstructive surgery and received enoxaparin 40 mg twice daily. Peak anti–factor Xa levels, which quantify enoxaparin’s antithrombotic effect, were drawn, with a goal level of 0.2 to 0.4 IU/ml. Ninety-day symptomatic venous thromboembolism and clinically relevant bleeding were identified.

Results:
The authors enrolled 118 patients who received enoxaparin 40 mg twice daily. Of these patients, 9.6 percent had low peak anti–factor Xa levels (<0.2 IU/ml), 62.6 percent had in-range peak anti–factor Xa levels (0.2 to 0.4 IU/ml), and 27.8 percent had high anti–factor Xa levels (>0.4 IU/ml). With enoxaparin 40 mg twice daily, 90.4 percent of patients received at least adequate prophylaxis. Patient weight predicted the rapidity of enoxaparin metabolism. Zero acute 90-day venous thromboembolism occurred. Eight patients (6.8 percent) had clinically relevant 90-day bleeding: clinical consequences ranged from cessation of enoxaparin prophylaxis to transfusion to operative hematoma evacuation.

Conclusions:
When enoxaparin 40 mg twice daily is provided, 90 percent of patients receive at least adequate venous thromboembolism prophylaxis (anti–factor Xa level >0.2 IU/ml). However, 27 percent of the overall population is overtreated (anti–factor Xa level >0.4 IU/ml). These pharmacodynamics data likely explain the low rate of 90-day acute venous thromboembolism (0 percent) and the high rate of clinically relevant bleeding (6.8 percent) observed. Future studies are needed to better optimize the risks and benefits of enoxaparin prophylaxis in plastic and reconstructive surgery patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
BEL Commons: an environment for exploration and analysis of networks encoded in Biological Expression Language
Authors: Hoyt Charles Tapley , Domingo-Fernández Daniel , Hofmann-Apitius Martin 
Published: March 2018

AbstractThe rapid accumulation of knowledge in the field of systems and networks biology during recent years requires complex, but user-friendly and accessible web applications that allow from visualization to complex algorithmic analysis. While several web applications exist with various focuses on creation, revision, curation, storage, integration, collaboration, exploration, visualization, and analysis, many of these services remain disjoint and have yet to be packaged into a cohesive environment.Here, we present BEL Commons; an integrative knowledge discovery environment for networks encoded in the Biological Expression Language (BEL). Users can upload files in BEL to be parsed, validated, compiled, and stored with fine-granular permissions. After, users can summarize, explore, and optionally shared their networks with the scientific community. We have implemented a query builder wizard to help users find the relevant portions of increasingly large and complex networks and a visualization interface that allows them to explore their resulting networks. Finally, we have included a dedicated analytical service for performing data-driven analysis of knowledge networks to support hypothesis generation.This web application can be freely accessed athttps://bel-commons.scai.fraunhofer.de.
Leaps and bounds: geographical and ecological distance constrained the colonisation of the Afrotemperate by Erica
Authors: Pirie M.D. , Kandziora M. , Nürk N.M. , Le Maitre N.C. , Mugrabi de Kuppler A. , Gehrke B. , Oliver E.G.H. , Bellstedt D.U. 
Published: March 2018

AbstractThe coincidence of long distance dispersal and biome shift is assumed to be the result of a multifaceted interplay between geographical distance and ecological suitability of source and sink areas. Here, we test the influence of these factors on the dispersal history of the flowering plant genus Erica (Ericaceae) across the Afrotemperate. We quantify similarity of Erica climate niches per biogeographic area using direct observations of species, and test various colonisation scenarios while estimating ancestral areas for the Erica clade using parametric biogeographic model testing. We infer that the overall dispersal history of Erica across the Afrotemperate is the result of infrequent colonisation limited by geographic proximity and niche similarity. However, the Drakensberg Mountains represent a colonisation sink, rather than acting as a “stepping stone” between more distant and ecologically dissimilar Cape and Tropical African regions. Strikingly, the most dramatic examples of species radiations in Erica were the result of single unique dispersals over longer distances between ecologically dissimilar areas, contradicting the rule of phylogenetic biome conservatism. These results highlight the importance of rare biome shifts, in which a unique dispersal event fuels evolutionary radiation.
Rapid Turnover of Life-Cycle-Related Genes in the Brown Algae
Authors: Lipinska A.P. , Serrano-Serrano M.L. , Peters Akira F. , Kogame K. , Cock J Mark , Coelho Susana M. 
Published: March 2018

ABSTRACTBackgroundSexual life cycles in eukaryotes involve a cyclic alternation between haploid and diploid phases. While most animals possess a diploid life cycle, plants and algae alternate between multicellular haploid (gametophyte) and diploid (sporophyte) generations. In many algae, gametophytes and sporophytes are independent and free living, and may present dramatic phenotypic differences. The same shared genome can therefore be subject to different, even conflicting, selection pressures in each of the life cycle generations. Here, we have analysed the nature and extent of genome-wide generation-biased gene expression in four species of brown algae with contrasting levels of dimorphism between life cycle generations, in order to assess the potential role of generation-specific selection in shaping patterns of gene expression and divergence.ResultsWe show that the proportion of the transcriptome that is generation-biased is associated with the level of phenotypic dimorphism between the life cycle stages. Importantly, our data reveals a remarkably high turnover rate for life-cycle-related gene sets across the brown algae and highlights the importance not only of co-option of regulatory programs from one generation to the other but also a key role for newly emerged, lineage-specific genes in the evolution of the gametophyte and sporophyte developmental programs in this major eukaryotic group. Moreover, we show that generation-biased genes display distinct evolutionary modes, with gametophyte-biased genes evolving rapidly at the coding sequence level whereas sporophyte-biased genes exhibit changes in their patterns of expression.ConclusionOur analysis uncovers the characteristics, expression patterns and evolution of generation-biased genes and underline the selective forces that shape this previously underappreciated source of phenotypic diversity.
Combining high resolution and exact calibration to boost statistical power: A well-calibrated score function for high-resolution MS2 data
Authors: Lin Andy , Howbert J. Jeffry , Noble William Stafford 
Published: March 2018

AbstractTo achieve accurate assignment of peptide sequences to observed fragmentation spectra, a shotgun proteomics database search tool must make good use of the very high resolution information produced by state-of-the-art mass spectrometers. However, making use of this information while also ensuring that the search engine’s scores are well calibrated—i.e., that the score assigned to one spectrum can be meaningfully compared to the score assigned to a different spectrum—has proven to be challenging. Here, we describe a database search score function, the “residue evidence” (res-ev) score, that achieves both of these goals simultaneously. We also demonstrate how to combine calibrated res-ev scores with calibrated XCorr scores to produce a “combined p-value” score function. We provide a benchmark consisting of four mass spectrometry data sets, which we use to compare the combined p-value to the score functions used by several existing search engines. Our results suggest that the combined p-value achieves state-of-the-art performance, generally outperforming MS Amanda and Morpheus and performing comparably to MS-GF+. The res-ev and combined p-value score functions are freely available as part of the Tide search engine in the Crux mass spectrometry toolkit (http://crux.ms).
Spatial and Temporal Cortical Variability Track with Age and Affective Experience During Emotion Regulation in Youth
Authors: Moreira João F. Guassi , McLaughlin Katie A. , Silvers Jennifer A. 
Published: March 2018

AbstractVariability is a fundamental feature of human brain activity that is particularly pronounced during development. However, developmental neuroimaging research has only recently begun to move beyond characterizing brain function exclusively in terms of magnitude of neural activation to incorporate estimates of variability. No prior neuroimaging study has done so in the domain of emotion regulation. We investigated how age and affective experiences relate to spatial and temporal variability in neural activity during emotion regulation. In the current study, 70 typically developing youth aged 8-17 years completed a cognitive reappraisal task of emotion regulation while undergoing functional magnetic resonance imaging. Estimates of spatial and temporal variability during regulation were calculated across a network of brain regions, defineda priori, and were then related to age and affective experiences. Results showed that increasing age was associated with reduced spatial and temporal variability in a set of frontoparietal regions (e.g., dorsomedial prefrontal cortex, superior parietal lobule) known to be involved in effortful emotion regulation. In addition, youth who reported less negative affect during regulation had less spatial variability in the ventrolateral prefrontal cortex, which has previously been linked to cognitive reappraisal. We interpret age-related reductions in spatial and temporal variability as implying neural specialization. These results suggest that the development of emotion regulation is undergirded by a process of neural specialization and open up a host of possibilities for incorporating neural variability into the study of emotion regulation development.
Cancer therapy with a CRISPR-assistant telomerase-activating gene expression system
Authors: Dai Wei , Xu Xinhui , Wang Danyang , Wu Jian , Wang Jinke 
Published: March 2018

AbstractTelomerase is silent in most normal somatic cells while active in 90% of tumor cells. Various telomerase activity inhibitors have been developed to treat cancer but all failed due to side effects. Here we acted oppositely to develop a cancer therapy named telomerase-activating gene expression (Tage) by utilizing the telomerase activity in tumor cells. By using CRISPR/Cas9 functions, the Tage system can effectively kill various cancer cells, including HepG2, HeLa, PANC-1, MDA-MB-453, A549, HT-29, SKOV-3, Hepa1-6, and RAW264.7, without effecting normal cells. By using homothallic switching endonuclease and adeno-associated virus, the Tage system realizes its in vivo application. The virus-loaded Tage system can significantly and specifically kill the cancer cells in mice by intravenous drug administration without side effects or toxicity.One Sentence Summary: Killing cancer cells in body with a gene therapy missile detonated by telomerase.
GPRIN1 modulates neuronal signal transduction and affects mouse-learning behavior
Authors: Savoia Claudia , Pujol Julien B , Vaucher Angelique , Marchi Umberto De , Rieker Claus , Heikkilä Eija , Núñez Galindo Antonio , Dayon Loïc , Dioum Elhadji M 
Published: March 2018

ABSTRACTIn the adult and developing brain, G protein-regulated inducer of neurite outgrowth 1 (GPRIN1) is a downstream effector for Gαo/i/z proteins that promotes neurite outgrowth. However, so far, the physiological role of GPRIN1 in brain health has not been reported. We generated a viable GPRIN1 whole-body knockout mouse to assess its physiological role in synaptic function both ex vivo and in vivo. In adult neurons, GPRIN1 is highly localized to the plasma membrane and synapses where it regulates neuronal signal transduction and Ca2+ homeostasis. Our results reveal that GPRIN1 might be a novel protein involved in agonist-stimulated cytoskeletal reorganization, which is crucial for early neuronal network development and in functionally mature neurons. Finally, we show that loss of GPRIN1 leads to a learning deficit in vivo and sensitizes neurons to stress, suggesting a modulatory role in brain health and disease.