bluuebunny/crossref_metadata_2025_split huggingface dataset:
Toxic Leukoencephalopathy Presenting as Lethal Catatonia
Authors: van Esch Anouk M.J. , Fest Antine , Hoffland Britt S. , Janzing Joost G.E. , Steens Stefan C.A. , Esselink Rianne A.J. , Schellekens Arnt F.A. 
Published: November 2018

Introduction:
Catatonia is a syndrome that can present in different forms and can occur in multiple psychiatric and somatic conditions. This case report describes lethal catatonia caused by delayed toxic leukoencephalopathy after excessive use of cocaine and methadone. The characteristic radiographic imaging and biphasic course are discussed.

Case report:
A 54-year-old woman was presented unconsciously at the emergency department after intoxication with methadone and cocaine. After initial recovery, her condition deteriorated unexpectedly, resulting in lethal catatonia. Magnetic resonance imaging (MRI) showed hyperintense white matter abnormalities and diffusion restriction, evident for leukoencephalopathy.

Discussion:
Catatonia can develop in multiple psychiatric and somatic diseases, including toxic leukoencephalopathy. A biphasic course and specific MRI findings are characteristics for delayed toxic leukoencephalopathy, due to intoxication with drugs.
Pregnancy Intention, Risk Perception, and Contraceptive Use in Pregnant Women Who Use Drugs
Authors: MacAfee Lauren K. , Dalton Vanessa , Terplan Mishka 
Published: November 2018

Objectives:
The aim of the study was to evaluate pregnancy intention, risk perception, and contraceptive utilization among women reporting substance use during pregnancy.

Methods:
Data were obtained from the 2009 to 2011 Tennessee Pregnancy Risk Assessment Monitoring System (PRAMS), an annual cross-sectional survey which assesses behaviors before, during and after pregnancy. Substance use during pregnancy and contraceptive use at the time of conception and after delivery were captured by self-report in the postpartum period. Pregnancy intention was categorized as intended (pregnancy desired then or earlier) or unintended (pregnancy desired later or not at all). Weighted descriptive and multivariable analyses were performed.

Results:
A total of 3042 women completed the PRAMS survey, with 168 (5.4%) reporting substance use during pregnancy. Compared with women who did not report drug use, women who used drugs were more likely to have an unintended pregnancy (65.6% vs 48.4%, P = 0.003), were more ambivalent towards pregnancy planning or prevention (69.7% vs 46.2%, P < 0.001) and were less likely to report contraceptive use before pregnancy (31.3% vs 46.8%, P = 0.022) or in the postpartum period (79.6% vs 88.1%, P = 0.019). Finally, women reporting substance use in pregnancy had 2 times higher odds of reporting that they did not think they could get pregnant at the time of conception after adjusting for age, race, income, education, insurance, and smoking status (adjusted OR 2.18, 95% confidence interval 1.07–4.49, P = 0.033).

Conclusions:
Women who report substance use in pregnancy have unique reproductive health needs and would benefit from additional education and counseling concerning their pregnancy intention, contraceptive use, and ability to conceive.
Sex bias in autoimmunity
Authors: Billi Allison C. , Kahlenberg J. Michelle , Gudjonsson Johann E. 
Published: November 2018

Purpose of review
To give an overview of recently published articles addressing the mechanisms underlying sex bias in autoimmune disease.

Recent findings
Recent studies investigating the origins of sex bias in autoimmune disease have revealed an extensive and interconnected network of genetic, hormonal, microbial, and environmental influences. Investigation of sex hormones has moved beyond profiling the effects of hormones on activity and prevalence of immune cell types to defining the specific immunity-related genes driving these changes. Deeper examination of the genetic content of the X and Y chromosomes and genetic escapees of X chromosome inactivation has revealed some key drivers of female-biased autoimmunity. Animal studies are offering further insights into the connections among microbiota, particularly that of the gut, and the immune system.

Summary
Sex bias in autoimmune disease is the manifestation of a complex interplay of the sex chromosomes, sex hormones, the microbiota, and additional environmental and sociological factors.
Osteoarthritis following meniscus and ligament injury: insights from translational studies and animal models
Authors: Rai Muhammad Farooq , Brophy Robert H. , Sandell Linda J. 
Published: November 2018

Purpose of review
The interaction between joint injuries and posttraumatic osteoarthritis (PTOA) is generally thought to be mechanical in nature, however, surgical intervention has little effect on the development of PTOA. Little is known about the biological underpinning of how meniscus and anterior cruciate ligament (ACL) tears lead to cartilage degeneration. This review summarizes the latest findings regarding biological factors that influence how the knee responds to meniscus and ligament injuries, how meniscus and/or ACL tears turn the joint in the direction of PTOA and whether patient risk for PTOA after meniscus/ACL injury can be predicted.

Recent findings
Literature indicates that numerous intrinsic and extrinsic factors are associated with the biological response of the knee to injuries associated with PTOA. Gene/protein biomarkers provide insight into the biologic response of the knee to meniscus/ACL tears and the relationship to osteoarthritis in at-risk patients. Animal studies detail the time-course of disease pathogenesis and inform about the molecules that potentially alter the course of disease.

Summary
The molecular metabolic state of the meniscus/ACL after injury is associated with several biological factors. The limited studies to date provide initial evidence on the early molecular manifestations of injury, suggesting possible mechanisms for further study.
Treatment of anaplastic lymphoma kinase-positive non-small cell lung cancer: update and perspectives
Authors: Ryser Christoph Oliver , Diebold Joachim , Gautschi Oliver 
Published: November 2018

Purpose of review
We describe recent developments in the rapidly evolving field of anaplastic lymphoma kinase-targeting agents.

Recent findings
Five targeted drugs are currently available in the clinic via regular approval or named patient programs, including crizotinib, ceritinib, alectinib, brigatinib and lorlatinib. Further drugs are tested in clinical trials. This review summarizes published data, together with drug-specific information on dosing and toxicity. Moreover, we discuss different clinical scenarios and potential treatment options in patients with tumor progression, based on current literature and our own experience.

Summary
Patients with metastatic, anaplastic lymphoma kinase-rearranged nonsmall cell lung cancer should be managed by interdisciplinary expert teams. New drugs with enhanced brain activity are available, and some patients may benefit from local therapies.
Physicians as Teachers and Lifelong Learners
Authors: Ding Mao , Babenko Oksana , Koppula Sudha , Oswald Anna , White Jonathan 
Published: November 2018

Introduction:
Lifelong learning requires sustained motivation for learning. Employing a motivational theory framework, we investigated the relationships of psychological need satisfaction, clinical teaching involvement, and lifelong learning of physicians at different career stages and in various medical specialties. We also examined the associations of physician lifelong learning with stress, burnout, teaching enjoyment, and life satisfaction, all of which are essential for physician well-being and, ultimately, for the provision of quality patient care.

Methods:
This was a cross-sectional study. Using survey methodology, quantitative data were collected from 202 practicing physicians in Canada. The questionnaire contained validated scales of physician lifelong learning and psychological need satisfaction, measures of clinical teaching (involvement and enjoyment), stress level, burnout frequency, and life satisfaction. Analysis of covariance and correlational analysis were performed.

Results:
On average, participants reported moderate to moderately high levels of lifelong learning, psychological need satisfaction, teaching enjoyment, and life satisfaction. Irrespective of career stage and specialty, physicians' psychological need satisfaction and involvement in clinical teaching were significant in relation to lifelong learning. That is, physicians who experienced greater psychological need satisfaction at work and those who were involved in clinical teaching had, on average, higher lifelong learning scores. Physician lifelong learning had significant associations with life satisfaction and teaching enjoyment but not with stress level and burnout frequency.

Discussion:
Fulfilling physicians' basic psychological needs at work and supporting them in their teaching roles is likely to enhance physician lifelong learning and, ultimately, quality of patient care.
An Evaluation of the Eighth Edition of the American Joint Committee on Cancer (AJCC) Staging System for Retroperitoneal Sarcomas Using the National Cancer Data Base (NCDB)
Authors: Fisher Sarah B. , Chiang Yi-Ju , Feig Barry W. , Cormier Janice N. , Hunt Kelly K. , Torres Keila E. , Roland Christina L. 
Published: November 2018

Objectives:Retroperitoneal sarcomas (RPS) are often large at diagnosis calling into question the seventh edition AJCC size classification of <5 cm (T1) or ≥5 cm (T2). The eighth edition expands T stage into 4 categories (T1: ≤5 cm, T2: 5<x≤10 cm, T3: 10<x≤15 cm, T4: >15 cm). We evaluated the prognostic ability of the eighth edition using the National Cancer Database (NCDB).Methods:Patients with RPS treated between 1998 and 2011 were identified from the NCDB; overall survival (OS) was compared.Results:Of the 6427 patients identified, 9% had tumors ≤5 cm (n=580), 19.4% 5<x≤10 cm (n=1246), 20.2% 10<x≤15 cm (n=1298) and 47.4% >15 cm (n=3045). With the eighth edition, stage II patients (G2/3 ≤5 cm) have a similar OS to stage IIIA patients (G2/3 5 cm<x≤10 cm), and patients with larger tumors (stage IIIB, G2/3>10 cm) show a decrease in OS. Tumor size as a continuous variable had a modest effect on survival (HR, 1.004;P=0.04). On multivariate analysis, higher T-stage was associated with decreased OS (T4 HR, 1.3;P<0.001) but high grade and incomplete resection (R2) were stronger prognostic factors. The c-index for both editions were similar (80.13 eighth vs. 80.08 seventh).Conclusions:The eighth edition AJCC staging system for retroperitoneal sarcoma incorporates larger tumor size parameters that better characterize most patients, but tumor size alone is only a modest predictor of outcome.
The Pyramidal Flap: an Innovative Technique for DIEP Flap Refinement
Authors: Leache M. Elena , Lozano Jose Ángel , Rubi Carlos G. , Pérez-Espadero Alberto , Escudero Francisco Jose 
Published: November 2018

Summary:
DIEP flap is considered the gold standard technique for breast reconstruction. One of the most frequent contour deformities after breast reconstruction with DIEP flap is a step-off deformity at the interface between the native chest wall and the reconstructed breast. Different techniques have been used to address this problem. We describe the pyramidal flap as a simple, single stage and low risk procedure, which specifically corrects the step-off or tapering deformity of the reconstructed breast with DIEP flap.
Ocular and Genetic Characteristics Observed in Two Cases of Fish-Eye Disease
Authors: Ustaoglu Melih , Solmaz Nilgun , Baser Burak , Kurtulgan Hande Kucuk , Onder Feyza 
Published: November 2018

Purpose:
To present ocular findings and anterior segment–optical coherence tomography (AS-OCT) imaging findings of 2 cases of fish-eye disease (FED) involving 2 novel genetic variants of the lecithin–cholesterol acyltransferase (LCAT) gene.

Methods:
A case report.

Results:
A 46-year-old woman and 63-year-old man presented with blurred vision, burning sensation, and whitening of both eyes for 2 and 3 years, respectively. Ophthalmologic examination revealed slightly decreased visual acuity, yellowish-white diffuse corneal opacities causing corneal clouding, and dry eye disease bilaterally in both patients. AS-OCT imaging demonstrated diffuse hyperreflective corneal opacities predominantly located in the anterior stroma. On systemic examination, both patients had very low plasma high-density lipoprotein cholesterol levels. However, they did not have any systemic associations with familial LCAT deficiency or Tangier disease, which are differential diagnoses for corneal clouding and low plasma high-density lipoprotein cholesterol. Both patients were diagnosed with FED based on clinical findings. Furthermore, genetic analysis, in which novel variants of c.86A>G (p.Asn29Ser) in the first exon and c.1052A>G (p.Tyr351Cys) in the sixth exon on the LCAT gene were detected, confirmed the diagnosis.

Conclusions:
Although it is a rare genetic disorder, FED should be considered in the differential diagnosis of corneal clouding. Corneal lipid deposits, visible on AS-OCT are suggestive of FED, and genetic analysis can be used to confirm the clinical diagnosis. Finally, there may be a relationship between dry eye disease and LCAT enzyme deficiency disorders, which should be investigated in further studies.
Smaller-incision Revision of Trabeculectomy With Mitomycin: Long-term Outcomes and Complications
Authors: Chen Philip P. , Moeller Kristy L. 
Published: November 2018

Purpose:
The purpose of this study was to assess long-term outcomes and complications of smaller-incision trabeculectomy revision with mitomycin (MMC) in glaucoma patients.

Methods:
Review of patients undergoing trabeculectomy revision with MMC for inadequate intraocular pressure (IOP) control. After dissection of subconjunctival fibrosis through a smaller (median, 5 mm) incision, MMC was topically applied and episcleral fibrosis was incised. Failure was defined as reoperation for glaucoma, or IOP reduction < 20% over 3 follow up visits.

Results:
Forty eyes (40 patients; mean age, 67±13 y) underwent revision; 9 revisions were combined with other surgery. Mean baseline IOP was 20.6±6.2 mm Hg on 2.6±1.4 glaucoma medications after 2.4±1.3 incisional ocular surgeries. At final follow-up (70±34 mo), 27 successful eyes (67.5%) had IOP of 9.2±2.4 mm Hg on 0.6±0.9 medications. Eleven eyes (27.5%) required reoperation for glaucoma, 7 (63%) within 7 months after revision. The Kaplan-Meier estimate of success at years 1, 2, 3, and 5 postoperatively was 77.5%, 72.2%, 69.5%, and 69.5%, respectively. Recovery of visual acuity to within 2 lines of baseline was 1.7±2.4 weeks (median 1). Complications included sustained hypotony (IOP, ≤5 mm Hg) in 2 eyes (1 also with corneal decompensation), 1 eye with wound leak, and 2 eyes with bleb leak (1 requiring surgical repair).

Conclusions:
Smaller-incision trabeculectomy revision with MMC resulted in substantial, sustained IOP reduction in most eyes with poorly functioning filtering blebs, with few serious complications and rapid recovery of baseline visual acuity in most eyes.
Melatonin Levels in Patients With Primary Open-angle Glaucoma With High or Low Intraocular Pressure
Authors: Kim Jung Yong , Jeong Ah Reum , Chin Hee Seung , Kim Na Rae 
Published: November 2018

Purpose:
To evaluate circulatory melatonin levels by assessing nocturnal urinary excretion of 6-sulfatoxymelatonin (aMT6s) in patients with primary open-angle glaucoma (POAG) and to compare the high-tension group and the low-tension group.

Methods:
This study included 80 eyes of 41 POAG patients and 87 eyes of 44 control subjects. POAG group was further classified into high-tension group and low-tension group according to the pretreatment intraocular pressure (IOP). The first urine in the morning was collected and aMT6s were measured using a commercial ELISA kit. Urinary aMT6s levels were expressed as ng aMT6s/mg creatinine. Differences in melatonin levels among the control and POAG subgroups were evaluated by generalized estimating equation adjusting age, sex, sleep duration, and intereye correlation.

Results:
Urinary aMT6s/creatinine ratio did not differ between POAG and control group (P=0.097). The difference in the aMT6s/creatinine ratio between the 3 groups—high-tension group with baseline IOP≥21 mm Hg (19.74±3.12 ng/mg), low-tension glaucoma group with baseline IOP<21 mm Hg (26.71±3.47 ng/mg), and control group (30.35±3.05 ng/mg)—was statistically significant (P=0.046). Post hoc analysis revealed that the difference between the control and high-tension glaucoma groups was significant (P=0.014), whereas the difference between the control and low-tension glaucoma groups was not (P=0.436).

Conclusions:
This study found low melatonin levels in high-tension glaucoma compared with the control.
Evaluation of Conduction Disorders after Aortic Valve Replacement with Rapid Deployment Bioprostheses
Authors: D'Onofrio Augusto , Bagozzi Lorenzo , Tessari Chiara , Francescato Annalisa , Cibin Giorgia , Besola Laura , Pesce Rita , Toscano Giuseppe , Gerosa Gino 
Published: November 2018

Objective The aim of this retrospective, single-center study was to evaluate the occurrence of conduction disorders after rapid deployment aortic bioprosthesis implantation. Methods Electrocardiograms of patients undergoing INTUITY (Edwards Lifesciences, Irvine, CA USA) bioprosthesis implantation were collected at admission, during postoperative course, and at discharge. Primary end point was the occurrence of new-onset conduction disorders, defined as complete left bundle branch block, complete right bundle branch block, permanent pacemaker implantation, and worsening of pre-existing rhythm abnormalities. Secondary end points were the assessment of preoperative and postoperative QRS duration and the identification of transitory conduction disorders. Results Forty-four patients (July 2015–December 2016) were included in the analysis. Preoperatively, patients with normal conduction and with already existing disorders were 25 (56.8%) and 19 (43.2%), respectively. Primary end point occurred in 14 patients (31.8%). Two patients (4.5%) received pacemaker implantation. In patients with normal preoperative conduction, new abnormalities were found in eight cases (32%): all left bundle branch blocks with one pacemaker implantation. Worsening of pre-existing conduction disorders was found in six patients (31.6%) with one pacemaker implantation. QRS duration increased in 20 patients (45.4%), and average increase was 37 milliseconds. Overall, we observed a significant increase of QRS (96 ± 21 milliseconds vs. 111 ± 28 milliseconds, P < 0.001). Three patients experienced a new-onset temporary left bundle branch block. Conclusions New-onset conduction disorders or worsening of pre-existing rhythm abnormalities occur in one third of patients after rapid deployment aortic bioprosthesis implantation. Although the incidence of postoperative pacemaker implantation before discharge is low, strict follow-up is mandatory to identify a potential need for pacemaker implantation in a timely manner.
Titanium Fastener Utilization during HeartMate 3 Left Ventricular Assist Device Implantation
Authors: Johnson Carl A. , Melvin Amber L. , Robinson Davida A. , Amirjamshidi Hossein , Knight Peter A. , Gosev Igor 
Published: November 2018

Objective The objective of this study was to investigate the feasibility of using titanium fasteners for securement of the inflow sewing ring during HeartMate 3 implantation. The secondary objective was to compare cardiopulmonary bypass and total operative times between the titanium fastener and hand-tied knot groups. Methods Clearance between the sewing ring and the HeartMate 3 device was assessed in vitro. Thirty-one patients undergoing HeartMate 3 implantation via median sternotomy at a single center from April 2017 to February 2018 were reviewed. The sewing ring was secured with hand-tied knots (n = 18) or titanium fasteners (n = 13). Cannulation strategy and implantation technique were otherwise identical between groups. Central arterial and venous cannulation was performed for cardiopulmonary bypass. The left ventricular apex was cored, and the sewing ring was attached with hand-tied knots or titanium fasteners. Results There was adequate clearance for the titanium fastener to secure the inflow sewing ring and then connect to the HeartMate 3 in vitro. The inflow sewing ring was successfully secured during HeartMate 3 implantation in the titanium fastener group. Cardiopulmonary bypass time was 75 and 92 minutes for the titanium fastener and hand-tied groups, respectively ( P < 0.03). Total operative time was 177 and 193 minutes for the titanium fastener and hand-tied groups, respectively ( P = 0.513). Conclusions The inflow sewing ring of the HeartMate 3 was efficiently secured using titanium fasteners. Titanium fasteners resulted in shorter cardiopulmonary bypass times compared with the hand-tied group. There was no difference in total operative time.
Safety and Immunogenicity of a Full-dose, Split-virion, Inactivated, Quadrivalent Influenza Vaccine in Healthy Children 6-35 Months of Age
Authors: Robertson Corwin A. , Mercer Monica , Selmani Alexandre , Klein Nicola P. , Jeanfreau Robert , Greenberg David P. 
Published: November 2018

Background:
For children <3 years of age, a half dose of inactivated influenza vaccine (7.5 μg hemagglutinin per strain) has been used for more than 30 years, but several studies indicate that a full dose (15 μg hemagglutinin per strain) can be used in this population without increasing the rate of fever or other reactions. Here, we compare the safety and immunogenicity of full and half doses of quadrivalent, split-virion, inactivated influenza vaccine (IIV4) in children 6–35 months of age.

Methods:
In this phase IV, randomized, observer-blinded, multi-center study, healthy children 6–35 months of age were randomized 1:1 to be vaccinated with a half or full dose of IIV4 (NCT02915302). The primary objective was to demonstrate that the rate of any fever (≥38.0°C) up to 7 days after a full dose of IIV4 was noninferior to the rate of fever after a half dose.

Results:
The study included 1950 children. Noninferiority in the rate of fever was demonstrated for the full dose versus the half dose of IIV4 (difference in rate = 0.84%; 95% confidence interval, −2.13% to 3.80%). Solicited reactions and unsolicited adverse events were similar between the dose groups. No vaccine-related serious adverse events were reported. Noninferiority of both hemagglutination inhibition geometric mean titers and seroconversion rates was demonstrated for all 4 vaccine strains for the full dose versus the half dose.

Conclusions:
In children 6–35 months of age, a full dose of IIV4 was immunogenic and had a safety profile comparable to that of a half dose, with no new safety concerns observed.