bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management and Outcomes of Spontaneous Pneumomediastinum in Children
Authors: Noorbakhsh Kathleen A. , Williams Allison E. , Langham Joseph J.W. , Wu Liwen , Krafty Robert T. , Furtado Andre D. , Zuckerbraun Noel S. , Manole Mioara D. 
Published: August 2019

Objectives
Management of spontaneous pneumomediastinum in the pediatric population is highly variable. There are limited data on the use of diagnostic tests and the need for admission. Our objectives were to characterize the management of pediatric spontaneous pneumomediastinum, determine the diagnostic yield of advanced imaging, and describe the patients' outcomes.

Methods
This is a retrospective cohort study of all patients presenting to a single tertiary pediatric emergency department between January 2008 and February 2015 diagnosed with pneumomediastinum. Patients were identified using 2 complementary strategies: International Classification of Diseases, Ninth Revision billing codes and a keyword search of the hospital radiology database.

Results
We identified 183 patients with spontaneous pneumomediastinum. The mean age was 12.8 ± 4.8 years. Diagnosis was established by chest radiograph (CXR) in 165 (90%) patients, chest computed tomography in 15 (8%), neck imaging in 2 (1%), and abdominal imaging in 1. After diagnosis, many patients underwent additional studies: repeat CXR (99, 54%), chest computed tomography (53, 29%), esophagram (45, 25%), and laryngoscopy (15, 8%). Seventy-eight percent of patients (n = 142) were admitted with a median length of stay of 27 hours (18.4–45.6 hours). Six patients returned to the emergency department within 96 hours for persistent chest pain; 2 were admitted, and 1 was found to have worsening pneumomediastinum on CXR. We performed a secondary analysis on 3 key subgroups: primary spontaneous pneumomediastinum (64, 35%), secondary gastrointestinal-associated pneumomediastinum (31, 17%), and secondary respiratory-associated pneumomediastinum (88, 48%). No patients in the study received an invasive intervention for pneumomediastinum. In all patients, further studies did not yield additional diagnostic information.

Conclusions
Our data suggest that patients with spontaneous pneumomediastinum who are clinically well appearing can be managed conservatively with clinical observation, avoiding exposure to radiation and invasive procedures.
A Pediatric Patient With Ascites, Proteinuria, and Thrombocytopenia
Authors: Simpson Samantha L. , Clarkston Kathryn , Wurster Ovalle Victoria M. , Reed Jennifer L. 
Published: August 2019

Abstract
A 7-year-old female patient presented to our pediatric emergency department with 5 days of fever, sore throat, abdominal pain, vomiting, headache, and 2 days of periorbital swelling. Her initial laboratory evaluation revealed a negative monospot test, neutropenia, atypical lymphocytosis, and thrombocytopenia in addition to transaminitis and proteinuria. An abdominal ultrasound obtained identified hepatosplenomegaly, moderate ascites, acalculous cholecystitis, and a distended appendix with periappendiceal fluid. She was admitted to gastroenterology for further management with antibiotics and surgery and hematology consults. Ultimately, Epstein-Barr virus polymerase chain reaction was positive. This case highlights an atypical presentation of Epstein-Barr virus and the collaborative approach to diagnosis.
A Clinical Vignette of Insidious Shoulder Pain and Weakness
Authors: Wong Ashley , Cleland Travis 
Published: August 2019

Abstract
We present a case of a 53-yr-old woman presenting with insidious shoulder pain and weakness. This case will go through the physical examination of the shoulder, a broad differential diagnosis, and analysis of appropriate imaging and tests to culminate in determining the final diagnosis. The objective of this clinical vignette was to highlight the importance of obtaining an extensive differential for shoulder pain and give readers a chance to critically analyze the case findings through electromyography interpretation, evaluating neurological signs and identifying key points in history taking. In addition, readers will also learn the evidence behind the available treatment options.
Patient-Reported Satisfaction and Quality of Life in Obese Patients: A Comparison between Microsurgical and Prosthetic Implant Recipients
Authors: Kamel George N. , Mehta Karan , Nash David , Jacobson Joshua , Berk Robin , Rizzo Amanda M. , Greige Nicolas , Benacquista Teresa , Garfein Evan S. , Weichman Katie E. 
Published: August 2019

Background:
Patients undergoing autologous breast reconstruction have higher rates of patient-reported satisfaction compared to patients undergoing prosthetic reconstruction. Obesity has been shown to increase postoperative complications in both microsurgical and implant reconstructions. The authors evaluated the effects of microsurgical breast reconstruction and prosthetic breast reconstruction on patient-reported outcomes and quality of life in obese patients.

Methods:
A retrospective review of obese patients who underwent breast reconstruction from January of 2009 to December of 2017 was conducted. Patients were divided into two cohorts: microsurgical and two-stage tissue expander/implant-based reconstruction. BREAST-Q survey response, demographic information, complications, and need for revision procedures were analyzed.

Results:
One hundred fifty-five patients met the inclusion criteria: 75 (48.4 percent) underwent microsurgical breast reconstruction and 80 (51.6 percent) underwent implant-based reconstruction. Cohorts were similar in body mass index, mean mastectomy specimen weight, laterality, indication for surgery, smoking status, and postoperative complications. Microsurgical reconstruction patients were younger (49.0 years versus 53.0 years; p = 0.02) and more likely to have delayed reconstruction [n = 70 (64.2 percent) versus n = 0 (0.0 percent); p = 0.0001]. BREAST-Q responses showed that microsurgery patients were more satisfied with their breasts (Q-Score of 63.4 ± 6.9 versus 50.8 ± 12.8; p = 0.0001), overall outcome (Q-Score 70.5 ± 13.0 versus 60.3 ± 10.8; p = 0.0001), and chest physical well-being (Q-Score of 69.1 ± 10.9 versus 63.8 ± 8.2; p = 0.01).

Conclusions:
Microsurgical breast reconstruction in obese patients yields higher satisfaction with breasts, overall outcomes, and chest physical well-being than implant-based reconstruction. Despite increased postoperative complications associated with obesity, microsurgical breast reconstruction appears to be a good choice for women who understand its risks and benefits and choose to proceed with it.
Infections following Immediate Implant-Based Breast Reconstruction: A Case-Control Study over 11 Years
Authors: Banuelos Joseph , Sabbagh M. Diya , Roh Si-Gyun , Nguyen Minh-Doan T. , Lemaine Valerie , Tran Nho V. , Jacobson Steven R. , Boughey Judy C. , Jakub James W. , Hieken Tina J. , Degnim Amy C. , Mandrekar Jay , Berbari Elie , Sharaf Basel 
Published: August 2019

Background:
Surgical-site infection after implant-based breast reconstruction adversely affects surgical outcomes and increases health care costs. This 11-year case-control study examines risk factors specific for surgical-site infection after immediate tissue expander/implant-based breast reconstruction.

Methods:
The authors performed a retrospective review to identify all consecutive patients with breast implant infections between 2006 and 2016. Patients who developed surgical-site infection after immediate tissue expander/implant-based breast reconstruction were included. Surgical-site infection was defined using the Centers for Disease Control and Prevention criteria; specifically, infections requiring hospital admission, intravenous antibiotics, or surgical intervention were included. The authors matched a control patient to each infection case by patient age and date of surgery. Patient demographics, medical comorbidities, and perioperative surgical variables were examined. Univariate and multivariable conditional logistic regression models were constructed.

Results:
A total of 270 breasts in 252 patients were evaluated. On multivariate analysis, patients with a higher body mass index (OR, 1.1 per 1 body mass index point increase; 95 percent CI, 1.0 to 1.2; p = 0.02), hypertension (OR, 6.5; 95 percent CI, 1.9 to 22.3; p = 0.002), neoadjuvant chemotherapy (OR, 2.6; 95 percent CI, 1.0 to 6.3; p = 0.04), axillary lymph node dissection (OR, 7.1; 95 percent CI, 1.7 to 29.2; p = 0.006), seroma formation (OR, 15.34; 95 percent CI, 3.7 to 62.5; p = 0.0001), and wound healing complications (OR, 23.91; 95 percent CI, 6.1 to 93.4; p < 0.0001) were significantly associated with surgical-site infection.

Conclusions:
Women with obesity, women with hypertension, and those treated with neoadjuvant chemotherapy are at increased risk of surgical-site infection. Further risks are also associated with postoperative seroma and wound complications. This may help patient selection and counseling, adjusted based on risk factors regarding complications of immediate implant-based breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Systematic Review of the Impact of Acellular Dermal Matrix on Aesthetics and Patient Satisfaction in Tissue Expander-to-Implant Breast Reconstructions
Authors: DeLong Michael R. , Tandon Vickram J. , Farajzadeh Matthew , Berlin Nicholas L. , MacEachern Mark P. , Rudkin George H. , Da Lio Andrew L. , Cederna Paul S. 
Published: August 2019

Background:
Acellular dermal matrix is used in most postmastectomy implant-based breast reconstructions in the United States. It is believed to be safe, despite a slightly increased complication rate. Although never established in a unifying study, the primary advantage of acellular dermal matrix is believed to be an enhanced aesthetic result, thus justifying the added expense. The purpose of this study was to assess the aesthetic benefits of acellular dermal matrix in expander-to-implant breast reconstruction.

Methods:
A systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology was performed including all original studies examining aesthetic outcomes of expander-to-implant breast reconstructions with acellular dermal matrix compared to muscular coverage. Direct-to-implant and prepectoral studies were excluded from the evaluation. The results were aggregated and reported as a summary.

Results:
Among 883 studies identified, 49 full-text articles were reviewed and nine articles ultimately met inclusion criteria. All nine studies were not randomized. Of these, three articles (1448 total patients) evaluated reconstruction aesthetic outcomes by patient satisfaction, whereas six articles evaluated the aesthetic outcomes by external observer (504 total patients). None of the articles evaluating patient satisfaction reported a difference between acellular dermal matrix and muscular reconstruction. Five of the six articles using objective outcomes demonstrated significant improvement in aesthetic outcome in the acellular dermal matrix group.

Conclusions:
Although little evidence exists evaluating the aesthetic benefits of acellular dermal matrix for expander-to-implant breast reconstruction, the data suggest that objective observers consider acellular dermal matrix–assisted expander-to-implant breast reconstructions aesthetically superior to reconstruction with only muscular coverage, but patients appear to be equally satisfied with both reconstructive options.
Preliminary Results Supporting the Bacterial Hypothesis in Red Breast Syndrome following Postmastectomy Acellular Dermal Matrix– and Implant-Based Reconstructions
Authors: Danino Michel A. , El Khatib Arij M. , Doucet Ophélie , Dao Lan , Efanov Johnny I. , Bou-Merhi Joseph S. , Iliescu-Nelea Monica 
Published: August 2019

Summary:
Acellular dermal matrices have become a mandatory tool in reconstructive breast surgery. Since their introduction, they have been considered to be nonreactive and nonimmunogenic scaffolds. However, some patients who undergo implant-based breast reconstruction with acellular dermal matrices develop postoperative cutaneous erythema overlying their matrices, a condition commonly referred to as red breast syndrome. The aim of this study was to gain a better understanding of this phenomenon. An analysis was conducted on consecutive patients who underwent acellular dermal matrix– and implant-based breast reconstructions and developed red breast syndrome that was treated surgically between April of 2017 and June of 2018 at the authors’ institution. During surgery, 1-cm2 specimens of acellular dermal matrix were sampled and analyzed by scanning electron microscopy. Observations were charted to score and record the presence and thickness of biofilm, and for identification of bacteria. These measurements were performed using Adobe Photoshop CS6 Extended software. Six postmastectomy breast reconstruction patients were included, all with AlloDerm Ready-to-Use–based reconstructions. All specimens were colonized by various bacteria ranging from Gram-negative bacilli to Gram-positive microorganisms. Biofilm was present in all studied specimens. The cause of skin erythema overlying acellular dermal matrix grafts, and the so-called red breast syndrome, may be related to contamination with various bacteria. Although contamination was omnipresent in analyzed samples, its clinical significance is variable. Even if acellular dermal matrix–based reconstructions are salvaged, this could come at the price of chronic local inflammation.
Morphological Characteristics and Individual Differences of Palatal Rugae
Authors: Gezer Rabia , Deniz Mustafa , Uslu Ayşe Imge 
Published: August 2019

Purpose:
This study aims to determine the number, symmetry, shape and individual characteristic of palatal rugae.

Methods:
In our study, we performed on subjects ages 16 to 57 (23.01 ± 7.12), ranging from a total of 230 (108 female and 122 male). Alginant impression material from each took dimensions of the upper jaw. Then casts were obtained by pouring hard casts. The shapes, lengths, and directions of rugae measured on these casts. The palatine photos were taken by using a mobile phone-Samsung brand with 12 MP camera and an orthodontic mirror. The casts and photographs were selected at random belonging to 100 subjects. Selected at random 10 photographs were matched among 100 casts. The ratios of correct matches were determined.

Results:
In our study, the total number of palatal rugae was found as 9.49 ± 1.87 in females and 9.42 ± 1.92 in males. The most detected rugae pattern was wavy on both females and males. The most rarely seen rugae pattern was converged in the males and circular in the females. Regarding lengths of rugae, the most detected rugae pattern was the primary one. Regarding the direction of rugae pattern, positive-sided one was the most dominant in both genders. We determined the ratio of matching the casts belonging to Palatine with the photos as 63.5%. The number of rugae aged under 18 and above 41 was found to be statistically significant (P = 0.003), but the number of curved and positive-sided rugae in older ages was not found to be statistically significant.

Conclusions:
Compared with data from earlier studies, the shapes, length, and direction of palatal rugae were seen specific in every individual, and it was seen to have discriminating characteristics among different populations. The possible differences in individual specific palatal rugae require further studies involving larger samples.
Variability of Consecutive Lumbar Puncture Opening Pressures
Authors: Kilgore Khin P. , Bhatti M. Tariq , Cutsforth-Gregory Jeremy K. , Hodge David O. , Chen John J. 
Published: August 2019

Background:
Lumbar puncture (LP) opening pressures (OPs) are known to fluctuate based on diurnal, environmental, and pathologic conditions. Despite their dynamic nature, single OPs are often deemed sufficient for diagnosis of elevated intracranial pressures (ICPs) in nonspecialists' hands. The purpose of this study was to determine the variability of consecutive LP OPs at a large referral center to determine the potential range of variability for a given LP OP.

Methods:
In this retrospective cohort study, medical records of all patients seen at Mayo Clinic, Rochester, MN, from January 1, 2001, through June 1, 2016, were screened for ≥2 LP OPs within 30 days of each other. Patients with pathologic conditions known to influence ICP were excluded.

Results:
There were 148 eligible patients (39.2% female) with mean age of 63.5 ± 15.5 years and mean body mass index (BMI) 28.0 ± 6.0. The LPs were a mean of 10 ± 9 days apart. Mean OP for the first and second LP was 149 ± 51 mm H2O and 148 ± 48 mm H2O (P = 0.78), respectively, with a mean difference of 1 mm H2O, providing an overall coefficient of repeatability (CR) of 86.4 between consecutive LPs. There was a significant correlation between initial OP and BMI (r = 0.39, P < 0.001). OP >200 mm H2O had a significantly higher CR of 111.4, compared to OP <200 mm H2O, with CR 74.6 (P = 0.006). CRs were also higher for patients with diagnoses of headache (P = 0.002) or anxiety (P = 0.03).

Conclusions:
Higher initial LP OP, headache, and anxiety were associated with greater variability on subsequent LPs. OPs that are not consistent with the patients' clinical signs and symptoms should therefore be interpreted with caution.
Motif elucidation in ChIP-seq datasets with a knockout control
Authors: Denisko Danielle , Viner Coby , Hoffman Michael M. 
Published: August 2019

AbstractChromatin immunoprecipitation-sequencing (ChIP-seq) is widely used to find transcription factor binding sites, but suffers from various sources of noise. Knocking out the target factor mitigates noise by acting as a negative control. Paired wild-type and knockout experiments can generate improved motifs but require optimal differential analysis. We introduce peaKO—a computational method to automatically optimize motif analyses with knockout controls, which we compare to two other methods. PeaKO often improves elucidation of the target factor and highlights the benefits of knockout controls, which far outperform input controls. It is freely available at https://peako.hoffmanlab.org.
Shielding working memory from distraction is more effortful than flexible updating
Authors: Papadopetraki Danae , Froböse Monja I. , Westbrook Andrew , Zandbelt Bram B. , Cools Roshan 
Published: August 2019

AbstractExerting cognitive control is known to carry a subjective effort cost and people are generally biased to avoid it. Recent theorizing suggests that the cost of cognitive effort serves as a motivational signal to bias people away from excessive focusing and towards more cognitive flexibility. We asked whether the effort cost of stable distractor resistance is higher than that of flexible updating of working memory representations. We tested this prediction by using (i) a delayed response paradigm in which we manipulate demands for distractor resistance and flexible updating, as well as (ii) a subsequent cognitive effort discounting paradigm that allows us to quantify subjective effort costs. We demonstrate, in two different samples (28 and 62 participants) that participants discount tasks both high in distractor resistance and flexible updating when comparing with taking a break. As predicted, when directly contrasting distractor resistance and flexible updating the subjective cost of performing a task requiring distractor resistance is higher than that requiring flexible updating.
High-performance chemical and light-inducible recombinases in mammalian cells and mice
Authors: Weinberg Benjamin H. , Cho Jang Hwan , Agarwal Yash , Pham N. T. Hang , Caraballo Leidy D. , Walkosz Maciej , Ortega Charina , Trexler Micaela , Tague Nathan , Law Billy , Benman William K. J. , Letendre Justin , Beal Jacob , Wong Wilson W. 
Published: August 2019

ABSTRACTSite-specific DNA recombinases are some of the most powerful genome engineering tools in biology. Chemical and light-inducible recombinases, in particular, enable spatiotemporal control of gene expression. However, the availability of inducible recombinases is scarce due to the challenge of engineering high performance systems with low basal activity and sufficient dynamic range. This limitation constrains the sophistication of genetic circuits and animal models that can be created. To expand the number of available inducible recombinases, here we present a library of >20 orthogonal split recombinases that can be inducibly dimerized and activated by various small molecules, light, and temperature in mammalian cells and mice.Furthermore, we have engineered inducible split Cre systems with better performance than existing inducible Cre systems. Using our orthogonal inducible recombinases, we created a “genetic switchboard” that can independently regulate the expression of 3 different cytokines in the same cell. To demonstrate novel capability with our split recombinases, we created a tripartite inducible Flp and a 4-Input AND gate. We have performed extensive quantitative characterization of the inducible recombinases for benchmarking their performances, including computation of distinguishability of outputs in terms of signal-to-noise ratio (SNR). To facilitate sharing of this set of reagents, we have deposited our library to Addgene. This library thus significantly expands capabilities for precise and multiplexed mammalian gene expression control.
Somatic Mutations in Clonally Expanded T-lymphocytes in Patients with Chronic Graft-Versus-Host Disease
Authors: Park Giljun , Kim Daehong , Huuhtanen Jani , Lundgren Sofie , Khajuria Rajiv K. , Hurtado Ana M. , Muñoz-Calleja Cecilia , Cardeñoso Laura , Gómez-García de Soria Valle , Chen-Liang Tzu Hua , Eldfors Samuli , Ellonen Pekka , Hannula Sari , Bruck Oscar , Kreutzman Anna , Salmenniemi Urpu , Lönnberg Tapio , Jerez Andres , Itälä-Remes Maija , Keränen Mikko A. I. , Mustjoki Satu 
Published: August 2019

ABSTRACTGraft-versus-host-disease (GvHD) is the main complication of allogeneic hematopoietic stem cell transplantation. GvHD patients have aberrant T cell expansions, which are thought to drive pathological immune activation. Here we report mechanistic insights that somatic mutations may account for persistent clonal T cell expansions in chronic GvHD (cGvHD). In an index patient suffering from cGVHD, we discovered persisting somaticMTOR,NFKB2, andTLR2mutations in an expanded CD4+ T clone. In the screening cohort (n=135), theMTOR P2229Rkinase domain mutation was detected in two additional cGvHD patients, but not in controls. Functional analysis of the discoveredMTORmutation indicated a gain-of-function alteration in translational regulation yielding in up-regulation of phosphorylated S6K1, S6, and AKT. Paired single-cell RNA and T cell receptor alpha and beta sequencing strongly supported cytotoxicity and abnormal proliferation of the clonally expanded CD4+ T cells. Real-time impedance measurements indicated increased cytotoxicity of mutated CD4 + T cells against the patient’s fibroblasts. High throughput drug-sensitivity testing suggested that mutations induce resistance to mTOR inhibitors but increase sensitivity for HSP90 inhibitors. Our findings suggest a novel explanation for the aberrant, persistent T cell activation in cGvHD, and pave the way for novel targeted therapies.