bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bone remodeling effect of a chitosan and calcium phosphate-based composite
Authors: Kjalarsdóttir Lilja , Dýrfjörd Arna , Dagbjartsson Atli , Laxdal Elín H , Örlygsson Gissur , Gíslason Jóhannes , Einarsson Jón M , Ng Chuen-How , Jónsson Halldór 
Published: March 2019

Abstract
Chitosan is a biocompatible polymer that has been widely studied for tissue engineering purposes. The aim of this research was to assess bone regenerative properties of an injectable chitosan and calcium phosphate-based composite and identify optimal degree of deacetylation (%DDA) of the chitosan polymer. Drill holes were generated on the left side of a mandible in Sprague-Dawley rats, and the hole was either left empty or filled with the implant. The animals were sacrificed at several time points after surgery (7–22 days) and bone was investigated using micro-CT and histology. No significant new bone formation was observed in the implants themselves at any time points. However, substantial new bone formation was observed in the rat mandible further away from the drill hole. Morphological changes indicating bone formation were found in specimens explanted on Day 7 in animals that received implant. Similar bone formation pattern was seen in control animals with an empty drill hole at later time points but not to the same extent. A second experiment was performed to examine if the %DDA of the chitosan polymer influenced the bone remodeling response. The results suggest that chitosan polymers with %DDA between 50 and 70% enhance the natural bone remodeling mechanism.
Narrow Incumbent Victories and Post-Election Conflict: Evidence from the Philippines
Authors: Crost Benjamin , Felter Joseph H , Mansour Hani , Rees Daniel I 
Published: March 2019

Abstract
Post-election violence is a common form of conflict, but its underlying mechanisms are not well understood. Using data from the 2007 Philippine mayoral elections, this paper provides evidence that post-election violence is particularly intense after narrow victories by incumbents. Using a density test, the study shows that incumbents were substantially more likely to win narrow victories than their challengers, a pattern consistent with electoral manipulation. There is no evidence that the increase in post-election violence is related to the incumbents’ political platform or their performance in past elections. These results provide support for the notion that post-election violence is triggered by election fraud or by the failure of democratic ways of removing unpopular incumbents from office.
Disruption of Rapid Eye Movement Sleep Homeostasis in Adolescent Rats after Neonatal Anesthesia
Authors: Lunardi Nadia , Sica Ryan , Atluri Navya , Salvati Kathryn A. , Keller Caroline , Beenhakker Mark P. , Goodkin Howard P. , Zuo Zhiyi 
Published: March 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Previous studies suggest that rapid eye movement sleep rebound and disruption of rapid eye movement sleep architecture occur during the first 24 h after general anesthesia with volatile anesthetics in adult rats. However, it is unknown whether rapid eye movement sleep alterations persist beyond the anesthetic recovery phase in neonatal rats. This study tested the hypothesis that rapid eye movement sleep disturbances would be present in adolescent rats treated with anesthesia on postnatal day 7.

Methods
Forty-four neonatal rats were randomly allocated to treatment with anesthesia consisting of midazolam, nitrous oxide, and isoflurane or control conditions for 2 h or 6 h. Electroencephalographic and electromyographic electrodes were implanted and recordings obtained between postnatal days 26 and 34. The primary outcome was time spent in rapid eye movement sleep. Data were analyzed using two-tailed unpaired t tests and two-way repeated measures analysis of variance.

Results
Rats treated with midazolam, nitrous oxide, and isoflurane exhibited a significant increase in rapid eye movement sleep three weeks later when compared with control rats, regardless of whether they were treated for 2 h (174.0 ± 7.2 min in anesthetized, 108.6 ± 5.3 in controls, P < 0.0001) or 6 h (151.6 ± 9.9 min in anesthetized, 108.8 ± 7.1 in controls, P = 0.002).

Conclusions
Treatment with midazolam, nitrous oxide, and isoflurane on postnatal day 7 increases rapid eye movement sleep three weeks later in rats.
Effect of Documenting Prognosis on the Information Provided to ICU Proxies: A Randomized Trial*
Authors: Turnbull Alison E. , Hayes Margaret M. , Brower Roy G. , Colantuoni Elizabeth , Basyal Pragyashree Sharma , White Douglas B. , Curtis J. Randall , Needham Dale M. 
Published: March 2019

Objectives:
The Critical Care Choosing Wisely Task Force recommends that intensivists offer patients at high risk for death or severe functional impairment the option of pursuing care focused on comfort. We tested the a priori hypothesis that intensivists who are prompted to document patient prognosis are more likely to disclose prognosis and offer comfort-focused care.

Design:
Randomized controlled trial (clinicaltrials.gov: NCT02721810).

Setting:
High-fidelity Simulation Center in Baltimore, MD.

Participants:
One hundred sixteen intensivists from 17 states.

Intervention:
All intensivists reviewed a paper-based medical record for a hypothetical patient on ICU day 3 and answered four survey questions about the patient’s medical management. Intensivists randomized to the intervention group answered three additional questions about patient prognosis. Thereafter, each intensivist participated in a standardized, video-recorded, simulated family meeting with an actor performing a standardized portrayal of the patient’s daughter.

Measurements and Main Results:
Two blinded intensivists reviewed deidentified written transcripts of all simulated family meetings. The primary outcome was the blinded reviewers’ assessment that the intensivist had presented the option of care focused entirely on comfort. Secondary outcomes included disclosing risk of death. All outcomes were planned prior to data collection. Among the 63 intensivists randomized to the intervention, 50 (79%) expected the patient to die during the hospitalization and 58 (92%) expected the patient to have new functional impairments preventing independent living. Intensivists in the intervention versus control group were no more likely to offer the option of care focused on comfort (13% vs 13%; 95% CI, –13% to 12%; p = 1.0) but were more likely to inform the daughter that her father was sick enough to die (68% vs 43%; 95% CI, 5–44%; p = 0.01).

Conclusions:
Documenting prognosis may help intensivists disclose prognosis to ICU proxies, but in isolation, it is unlikely to change the treatment options offered during initial family meetings.
Quality of Life After Curative Resection for Rectal Cancer in Patients Treated With Adjuvant Chemotherapy Compared With Observation: Results of the Randomized Phase III SCRIPT Trial
Authors: van der Valk Maxime J.M. , Hilling Denise E. , Meershoek-Klein Kranenbarg Elma , Peeters Koen C.M.J. , Kapiteijn Ellen , Tsonaka Roula , van de Velde Cornelis J.H. , Marang-van de Mheen Perla J. 
Published: March 2019

BACKGROUND:
Adjuvant chemotherapy after curative resection for rectal cancer is the standard of care in several American and European guidelines.

OBJECTIVE:
The aim of this study was to examine the differences in health-related quality of life over time between patients with rectal cancer who were treated with adjuvant chemotherapy or observation.

DESIGN:
This is a randomized controlled phase III trial.

SETTINGS:
Health-related quality-of-life assessments were conducted in Dutch patients from 43 institutes.

PATIENTS:
Patients with stage II or III rectal cancer who underwent preoperative (chemo)radiotherapy followed by curative surgery (the SCRIPT trial) were included.

INTERVENTIONS:
Patients were randomly assigned to adjuvant capecitabine monotherapy for 8 cycles or observation. Health-related quality of life was assessed using the European Organization for Research and Treatment of Cancer C30 and CR38 questionnaires at 1 month after surgery (before the start of chemotherapy), and 3, 6, and 12 months after surgery.

MAIN OUTCOME MEASURES:
The primary outcome measure was the difference in quality of life at 6 months after surgery, just after completion of adjuvant chemotherapy for patients in the treatment group. Second, the difference in health-related quality of life at 12 months after surgery was examined. A statistically significant difference of 5 points was considered clinically relevant.

RESULTS:
Health-related quality-of-life results of 226 of 233 patients were available. At T3, overall quality of life (C30 summary score) was worse for patients treated with chemotherapy compared with observation (mean 82.3 versus 86.9, p = 0.006), but the difference was not clinically relevant. Patients treated with adjuvant chemotherapy reported clinically relevant worse physical functioning (mean 78.3 versus 87.0, p < 0.001) and more reports of fatigue and dyspnea (35.7 versus 21.0 and 17.1 versus 6.7, p < 0.001). All differences were resolved at 12 months postsurgery.

LIMITATIONS:
A selection of relatively fit patients willing to be randomly assigned may limit the generalizability of the results.

CONCLUSIONS:
Although inferior health-related quality of life was reported just after completion of adjuvant chemotherapy, no persistent deterioration in quality of life was detected. See Video Abstract at http://links.lww.com/DCR/A907.
How Reliable Is CT Scan in Staging Right Colon Cancer?
Authors: Fernandez Laura M. , Parlade Albert J. , Wasser Elliot J. , Dasilva Giovanna , de Azevedo Rafael U. , Ortega Cinthia D. , Perez Rodrigo O. , Habr-Gama Angelita , Berho Mariana , Wexner Steven D. 
Published: March 2019

BACKGROUND:
The observation of inferior oncologic outcomes after surgery for proximal colon cancers has led to the investigation of alternative treatment strategies, including surgical procedures and neoadjuvant systemic chemotherapy in selected patients.

OBJECTIVE:
The purpose of this study was to determine the accuracy of CT staging in proximal colon cancer in detecting unfavorable pathologic features that may aid in the selection of ideal candidates alternative treatment strategies, including extended lymph node dissection and/or neoadjuvant chemotherapy.

DESIGN:
This was a retrospective consecutive series.

SETTINGS:
Trained abdominal radiologists from 2 centers performed a blinded review of CT scans obtained to locally stage proximal colon cancer according to previously defined prognostic groups, including T1/2, T3/4, N+, and extramural venous invasion. CT findings were compared with histopathologic results as a reference standard. Unfavorable pathologic findings included pT3/4, pN+, or extramural venous invasion.

PATIENTS:
Consecutive patients undergoing right colectomy in 2 institutions between 2011 and 2016 were retrospectively reviewed from a prospectively collected database.

MAIN OUTCOME MEASURES:
T status, nodal status, and extramural venous invasion status comparing CT with final histologic findings were measured.

RESULTS:
Of 150 CT scans reviewed, CT failed to identify primary cancer in 18%. Overall accuracy of CT to identify unfavorable pathologic features was 63% with sensitivity, specificity, positive predictive value, and negative predictive value of 63% (95% CI, 54%–71%), 63% (95% CI, 46%–81%), 87% (95% CI, 80%–94%) and 30% (95% CI, 18%–41%). Only cT3/4 (55% vs 45%; p = 0.001) and cN+ (42% vs 58%; p = 0.02) were significantly associated with correct identification of unfavorable features at final pathology. CT scans overstaged and understaged cT in 23.7% and 48.3% and cN in 28.7% and 53.0% of cases.

LIMITATIONS:
The study was limited by its retrospective design, relatively small sample size, and heterogeneity of CT images performed in different institutions with variable equipment and technical details.

CONCLUSIONS:
Accuracy of CT scan for identification of pT3/4, pN+, or extramural venous invasion was insufficient to allow for proper identification of patients at high risk for local recurrence and/or in whom to consider alternative treatment strategies. Locoregional overstaging and understaging resulted in inappropriate treatment strategies in <48%. See Video Abstract at http://links.lww.com/DCR/A935.
Emissions From Smart Meters and Other Residential Radiofrequency Sources
Authors: Aerts Sam , Verloock Leen , Van den Bossche Matthias , Martens Luc , Vergara Ximena , Joseph Wout 
Published: March 2019

Abstract
The advent of the Internet of things comes with a huge increase in wirelessly communicating devices in our environment. For example, smart energy-consumption meters are being widely deployed in residences from which they communicate their state using radiofrequency networks. Accurate characterization of the radiofrequency emissions from emerging residential wireless solutions is important to inform the public about the potential impact on their exposure to radiofrequency electromagnetic fields. A new measurement procedure to determine the exposure from residential radiofrequency devices is proposed by assessing the peak emitted fields at various distances and the proportion of time they transmit (duty cycle). Radiofrequency emissions from 55 residential devices were measured in 10 residences (Belgium and France) and compared to environmental levels, emissions from 41 mobile phones, and international standards. Overall, residential levels of radiofrequency electromagnetic field exposure are low. In addition to the continuous environmental exposure, wireless access points (due to frequent use) and especially mobile phones and other personal communication devices (due to their use close to the body) continue to represent the bulk of the radiofrequency electromagnetic field exposure in the smart home. However, some residential devices can significantly increase the exposure if their duty cycles are high enough (>10%), especially when held or used close to the body. Individual smart meters, on the other hand, will contribute only little in general, despite emissions of up to 20 V m−1 at 50 cm, due to their low duty cycles (maximum 1%) and locations.
Clinicopathological study of occult hepatitis B virus infection in hepatitis C virus-associated hepatocellular carcinoma
Authors: El-Maksoud Mohamed A. , Habeeb Maha R. , Ghazy Hayam F. , Nomir Manal M. , Elalfy Hatem , Abed Sally , Zaki Maysaa E.S. 
Published: March 2019

Background
Occult hepatitis B virus infection (OBI) frequently occurs in patients with chronic hepatitis C (CHC) infection, but the influence of OBI on CHC outcome is still uncertain. The aim of the present study was to clarify the clinical and pathological characteristics of OBI in CHC-related hepatocellular carcinoma (HCC).

Patients and methods
DNA was obtained from serum and tumor tissue of patients with hepatitis C virus (HCV)-related HCC with negative HBsAg and from patients with HCV-related liver cirrhosis. HBV-DNA was detected using qPCR. Clinicopathological features were compared between patients with HCC with and without OBI.

Results
On the basis of positive serum and tissue HBV-DNA typing, the overall frequency of OBI was 50% in patients with HCV-related HCC. HBV genotype D was the most dominant, constituting 35.3% of HCC cases. Almost 80% of patients with OBI had anti-HBc, whereas 20% of patients had no serological markers. Tissue HBV-DNA showed significant association with positive serum HBV-DNA, anti-HBc, and genotype D. There were no clinical differences between patients with HCC with and without OBI; however, patients with OBI tended to be younger. HCC cases with positive OBI were significantly associated with positive anti-HBc antibodies and late histological grades (3–4). Multivariate logistic regression analysis revealed that the presence of OBI was a predictor of more advanced HCC histological grades in patients with HCV infection.

Conclusion
OBI was detected in 50% of HCV-infected patients with HCC. OBI was strongly associated with the presence of anti-HBc antibodies. Patients with HCC with positive OBI were younger and had more advanced HCC histological grades.
An update on the medical consequences of anorexia nervosa
Authors: Chidiac Carole Wehbe 
Published: March 2019

Purpose of review
The diagnosis of anorexia nervosa is associated with the highest mortality rate of any psychiatric disorder, mainly caused by medical complications.
The purpose of this article is to review the common medical consequences of anorexia nervosa focusing on the special considerations related to children and adolescents and recent updates on the pathophysiology of these complications and their prognosis significance.

Recent findings
The main findings were related to the diagnostic and prognostic value of hypokalaemia, QTc prolongation, hypoglycaemia and orthostatic changes. A new modality to evaluate the heart in anorexia nervosa was explored (2DSTE) as well. Bone mineral density (BMD) loss is one of the few nonreversible consequences of anorexia nervosa. BMD loss does not seem to be significantly related to sex or to cut-off low-weight parameters in teenagers with anorexia nervosa, but rather to the amount of weight loss they have experienced. Brain volume deficits might be another irreversible complication in adolescents with anorexia nervosa.

Summary
It is crucial for any healthcare provider to be informed about the medical consequences of anorexia nervosa, not only because they can be devastating, but also because they can play an essential role in motivating patients to get treated.
Early Identification of Risk Factors for Mobility Decline Among Hospitalized Older Patients
Authors: Lee Yejin , Lee Hyun-Haeng , Uhm Kyeong Eun , Jung Ho Joong , Kim Yoon-Sook , Shin Jinyoung , Choi Jaekyung , Han Seol-Heui , Lee Jongmin 
Published: March 2019

Objective
The aim of the study was to identify the risk factors for mobility decline among hospitalized older patients early.

Design
This is a prospective cohort study. A total of 875 older patients were divided into two groups: older patients with and without mobility decline. The mobility level was measured using the item of functional mobility in the Geriatric Screening for Care 10. The change in mobility between admission and discharge was determined as the dependent variable. There were a total of 18 independent variables, which consisted of three demographic variables, 10 most problematic domains of geriatric care, and five other health-related variables. A multivariable logistic regression analysis was conducted to identify the risk factors for mobility decline during hospitalization.

Results
Of the 875 older patients, 135 (15.4%) experienced mobility decline during hospitalization. The multivariable logistic regression analysis revealed female sex, cognitive impairment, and underweight as the risk factors for mobility decline during hospitalization.

Conclusions
The identified risk factors should be considered to identify patients at a risk of mobility decline early and to provide targeted interventions, which can prevent mobility decline.
Infected Lingual Thyroglossal Duct Cyst Mimicking Supraglottitis
Authors: Hsiao Jen-Hao , Chao Wei-Chieh , Lee Yi-Chan 
Published: March 2019

Abstract
A thyroglossal duct cyst (TGDC) is a common embryological remnant that typically presents as an anterior neck mass; however, this malformation can occur in any adjacent area, including the tongue base (lingual type), along the migration path of the thyroid during embryonic development. Lingual TGDC is often quiescent until infection occurs. Supraglottitis or inflammation of the supraglottis, is a potentially life-threatening disease. Because of the anatomical proximity of lingual TGDC to the supraglottis, lingual TGDC infection might be related to a presentation of supraglottitis. A 49-year-old male initially presented with clinical symptoms of acute supraglottitis. After intensive medical treatment resulting in no improvement, a computed tomography scan was performed. The result raised the suspicion of an infected lingual TGDC. Transoral marsupialization using a rigid laryngoscope was performed to drain the abscess inside the cyst. A diagnosis of lingual TGDC was made based on the characteristic histological pattern of the lesion. After treatment, a follow-up computed tomography scan showed no evidence of recurrence. To the authors’ knowledge, only a few reports have pointed out similarities in the clinical and radiological findings between acute supraglottitis and an infected lingual TGDC. Clinicians should consider lingual TGDC during the differential diagnosis of supraglottitis, especially in patients with poor response to medical treatment.
Use of Parotid Gland Fascia in the Prevention of Frey Syndrome After Parotidectomy
Authors: Ogino Akihiro , Onishi Kiyoshi , Nakamichi Miho , Okaneya Tetsuya 
Published: March 2019

Background:Superficial parotidectomy is standard surgical procedure for parotid gland tumor, and Frey syndrome and depressed deformity of the region are often seen as complications. In this study, we performed prevention of Frey syndrome by covering the residual parotid gland defect with the parotid gland fascia flap.Method:The subjects were 5 patients with parotid gland tumor. Tumor was localized in the inferior and superior poles of the parotid gland in 3 and 2 patients, respectively, and it was confirmed on preoperative diagnostic imaging that the tumor and parotid gland fascia were not present in close proximity. Through Lazy-S incision, main trunk of facial nerve was identified and conserved following the surgical procedure of normal superficial parotidectomy, and the superficial parotid gland containing tumor was elevated. A parotid gland fascia flap with a pedicle on the nasal side was prepared and the defect after superficial parotidectomy was covered with it.Results:The facial nerve and resected parotid gland stump could be sufficiently covered with the parotid gland fascia flap in all patients. The mean duration of postoperative follow-up was 36 months (10 months-4 years and 5 months), and there were no complications such as tumor recurrence, Frey syndrome, salivary gland fistula, or severe concavity in the parotid region.Conclusion:Although application of the present procedure is limited to patients in whom the parotid gland fascia and tumor are not located in close proximity, it may be useful to prevent Frey syndrome because extension of incision is not necessary, the surrounding tissue is not sacrificed, the flap can be easily elevated, and the parotid gland stump can be sufficiently covered.