bluuebunny/crossref_metadata_2025_split huggingface dataset:
Morphine Analgesia Pre-PPCI Is Associated with Prothrombotic State, Reduced Spontaneous Reperfusion and Greater Infarct Size
Authors: Farag Mohamed , Spinthakis Nikolaos , Srinivasan Manivannan , Sullivan Keith , Wellsted David , Gorog Diana 
Published: February 2018

AbstractThe emergency management of ST-elevation myocardial infarction (STEMI) involves treatment with dual-antiplatelet therapy (DAPT) and primary percutaneous coronary intervention (PPCI). Pain is generally treated with opiates, which may delay gastric transit and reduce DAPT absorption. We sought to assess the effect of morphine on reperfusion, infarct size and thrombotic status in 300 patients presenting for PPCI. Morphine was given in a non-randomized fashion as required by emergency teams en route to the heart attack centre. All patients received DAPT and PPCI according to standard care, with optional glycoprotein IIb/IIIa inhibitor (GPI) use. Patients were assessed for ST-segment resolution, coronary flow, thrombotic status and peak troponin. Patients receiving morphine (n = 218; 72.7%) experienced less spontaneous ST-segment resolution pre-PPCI, lower rate of TIMI 2/3 flow in the infarct-related artery pre-PPCI and higher peak troponin level post-PPCI (median [interquartile range]; 1,906 [1,002–4,398] vs. 1,268 [249–2,920] ng/L; p = 0.016) than those who did not. Patients receiving morphine exhibited significantly enhanced platelet reactivity and impaired endogenous fibrinolysis on arrival, compared with no-morphine patients. Morphine administration was an independent predictor of failure of spontaneous ST-segment resolution after adjustment for other variables (odds ratio: 0.26; confidence interval: 0.08–0.84; p = 0.025). Among patients receiving GPI, there was no difference in pre-PPCI flow or peak troponin according to morphine use, suggesting that the adverse effects of morphine relate to delayed DAPT absorption, which may be overcome by GPI. Our hypothesis-generating data suggest that morphine use in STEMI is associated with enhanced platelet reactivity, reduced spontaneous myocardial reperfusion (pre-PPCI) and larger infarct size, and these adverse effects may be influenced by GPI use.
Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02562690.
TIPS in the Treatment of Variceal Bleeding
Authors: Morrison Joseph , Lipnik Andrew , Gaba Ron 
Published: February 2018

AbstractVariceal bleeding is a life-threatening complication of portal hypertension. In recent years, transjugular intrahepatic portosystemic shunt (TIPS) creation has cemented a role in the management of acute refractory bleeding and recurrent variceal hemorrhage. This article aims to review the use of TIPS in patients with variceal bleeding, with a focus on accepted procedure indications, patient selection criteria, TIPS technique, clinical outcomes, and contemporary issues, such as early TIPS in acute variceal hemorrhage, the role of adjuvant embolotherapy, and TIPS utility for gastric varices.
Early Transjugular Intrahepatic Portosystemic Shunt (TIPS) Placement in Patients with Cirrhosis and Variceal Bleeding
Authors: Fortune Brett , Sands Mark , Bayona-Molano Maria , Kapoor Baljendra , Lang Min 
Published: February 2018

AbstractThe placement of a transjugular intrahepatic portosystemic shunt (TIPS) has been traditionally used as a rescue treatment for uncontrolled or recurrent acute variceal bleeding (AVB) in patients with cirrhosis. However, more contemporary studies are revealing that early or ‘pre-emptive’ TIPS placement (performed within 24–72 h of AVB presentation) significantly controls bleeding, prevents rebleeding, and improves survival in selected patients when compared with standard pharmacological and endoscopic therapies. Furthermore, the use of early TIPS did not translate to an increased risk of hepatic encephalopathy (HE) for this population. Proper patient selection for early TIPS is paramount, as the procedure is unlikely to benefit patients with advanced decompensated cirrhosis (Child–Turcotte–Pugh [CTP] class C, score > 13) or patients who do not carry high risk with only mild hepatic dysfunction (Child-Turcotte-Pugh class A). Finally, while the current results for early TIPS are promising, further prospective studies are needed to confirm these findings before early TIPS can be widely adopted.
Investigation of Parvovirus B19 IgM and IgG Positivity Rates in Pediatric Hematology Patients
Authors: Uğur Ayşe , Özdemir Mehmet , Feyzioğlu Bahadır , Baykan Mahmut , Görkem Aysun 
Published: February 2018

AbstractHuman parvovirus B19 is a frequent etiologic agent causing erythema infectiosum in children. It has recently been suggested that parvovirus B19 may be latent after infection and cause reactive infections especially in immunosuppressed patients with hematological problems. In this study, we aimed to investigate the parvovirus B19 immunoglobulin M (IgM) and immunoglobulin G (IgG) seropositivity rates of patients evaluated in a pediatric hematology clinic. We retrospectively screened the laboratory results of parvovirus B19 IgM and IgG antibody assays of children less than 18 years, who consulted pediatric in-and-outpatient clinics between 2013 and 2016. Parvovirus B19 IgM and IgG antibodies were investigated in serum samples by using enzyme-linked immunosorbent assay method in the Medical Microbiology Laboratory. Parvovirus B19 IgM antibodies were detected in 109 of 602 patients attending pediatric hematology clinics (18.1%). Parvovirus B19 IgG antibody was detected in 244 of 952 patients attending pediatric hematology clinics (25.6%). Parvovirus B19 IgM and IgG positivity in samples from pediatric in-and-outpatient clinics other than pediatric hematology were 2.8% and 35.7%, respectively. Parvovirus IgM and IgG positivity in serum samples sent from the pediatric hematology clinic and outpatients was statistically significant compared with those sent from pediatric clinics other than pediatric hematology (p = 0.0001 and p = 0.0008, respectively). The higher detection rate of serum parvovirus B19 IgM positivity in patients under the follow-up of pediatric hematology clinics suggests that immune suppression-related viral reinfection or persistence may occur in these patients.
‘The Great Blow’ and the Politics of Popular Royalism in Civil War Norwich
Authors: Hopper Andrew 
Published: February 2018

Abstract
This article explores popular politics and royalism during the English Civil Wars through the reaction of magistrates to the riot in Norwich on 24 April 1648 that was referred to by contemporaries as the ‘mutiny’ or the ‘Great Blow’. On the eve of the Second Civil War, this confrontation between urban rioters and New Model Army troopers led to the largest explosion of gunpowder in seventeenth-century England, when ninety-eight barrels were ignited at the Committee House. The article analyses the 278 witness statements that were produced as part of the judicial inquest, making this the best documented provincial riot of the early modern period. These previously neglected proceedings can do much to advance our understanding of popular politics, royalism and urban culture. Therefore the article focuses on how the rioters mobilised and generated crowds through petitioning, subscription, print, preaching, rumour, health-drinking, seditious words, and gestures. It assesses participants’ social origins and places them within contrasting local religious and political cultures in a battle for control of the key public spaces of the city. The seditious words revealed in the testimonies cannot be dismissed as merely anti-parliamentarian, and in many cases illuminate how a politics of popular royalism was revived in the city. The episode highlights how both national and local, and elite and popular politics overlapped and were entwined by civil war.
Danger Signals in the ICU
Authors: Schenck Edward J. , Ma Kevin C. , Murthy Santosh B. , Choi Augustine M. K. 
Published: February 2018

Objectives:
Sterile and infectious critical illnesses often result in vasoplegic shock and a robust systemic inflammatory response that are similar in presentation. The innate immune system is at the center of the response to both infectious and traumatic insults. Damage-associated molecular patterns are small molecules that are released from stressed or dying cells. Damage-associated molecular patterns activate pattern recognition receptors and coordinate the leading edge of the innate immune response. This review introduces the concept of damage-associated molecular patterns and how they activate a systemic inflammatory response, specifically in trauma, neurologic injury, and infection. It also explores how, when carried to extremes, damage-associated molecular patterns may even perpetuate multisystem organ failure.

Data Sources:
Basic and clinical studies were obtained from a PubMed search through August 2017.

Study Selection:
Articles considered include original articles, review articles, and conference proceedings.

Data Extraction:
An analysis of scientific, peer-reviewed data was performed. High quality preclinical and clinical studies adjudicated by the authors were included and summarized.

Data Synthesis:
Pattern recognition receptors respond to damage-associated molecular patterns and then activate inflammatory pathways. Damage-associated molecular patterns have been linked to the recruitment of sentinel leukocytes and the initiation of the inflammatory cascade. Damage-associated molecular patterns have been linked to many conditions in critical care illnesses. Preclinical models have added insight into how they may mediate distant organ dysfunction.

Conclusions:
Damage-associated molecular pattern activation and release is an important research for intensive care practitioners. It will add to our understanding of the phase and state of the innate immune response to an insult. Early work is encouraging. However, only with improved understanding of damage-associated molecular pattern activation and function, we can perhaps hope to target damage-associated molecular patterns as diagnostic and/or therapeutic modalities in the future.
NEWLY DIAGNOSED ASYMPTOMATIC RETINAL ASTROCYTIC HAMARTOMA IN AN OLDER ADULT
Authors: Gündüz A. Kaan , Shields Carol L. , Çöndü Gökçen , Gürsel Ragip 
Published: February 2018

Background:
To report a coincidentally discovered retinal astrocytic hamartoma in an asymptomatic older woman with no history of tuberous sclerosis or neurofibromatosis.

Methods:
A 63-year-old Turkish woman underwent routine ophthalmic examination.

Results:
Visual acuity was 20/25 in each eye. On fundus examination, the right eye showed a flat yellow-white superficial retinal lesion in the inferotemporal macula and measuring 1 mm in diameter. The lesion was unmeasurable using B-mode ultrasonography. Spectral domain optical coherence tomography revealed the mass with thickening in the retinal nerve fiber layer, with minor disorganization of the underlying retina and no retinal or vitreoretinal traction. Fluorescein angiography disclosed the mass as early isofluorescence with late mild hyperfluorescence, without leakage. Findings in the left eye were normal. Based on the clinical and imaging results, a diagnosis of noncalcified small retinal astrocytic hamartoma was rendered. The lesion remained unchanged at 1-year follow-up.

Conclusion:
Small coincidentally discovered retinal astrocytic hamartomas in older patients can be difficult to diagnose and possibly cause diagnostic confusion with other conditions including myelinated nerve fiber and cotton wool spot. Retinal astrocytic hamartoma is characterized by thickening of the retinal nerve fiber layer and mild compression and disorganization of the underlying retinal layers on spectral domain optical coherence tomography.
PROGRESSION OF RETINAL ISCHEMIA IN A CASE OF MACULAR TELANGIECTASIA TYPE 1 AFTER RANIBIZUMAB INJECTION: OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS
Authors: Lorusso Massimo , Zito Roberta , Nikolopoulou Eleni , Micelli Ferrari Luisa , Cicinelli Maria Vittoria , Querques Giuseppe , Micelli Ferrari Tommaso 
Published: February 2018

Purpose:
To describe a case of a 68-year-old man with macular telangiectasia (MacTel) Type 1 in the right eye, showing an increase in capillary ischemia after intravitreal ranibizumab.

Methods:
The patient underwent complete ophthalmologic evaluation, including best-corrected visual acuity, intraocular pressure, anterior segment and fundus examination, optical coherence tomography (OCT), and OCT angiography at baseline and on each visit. Fluorescein angiography was performed at baseline. The patient was followed up on monthly bases for 22 months.

Results:
The patient presented a best-corrected visual acuity of 20/80 in the right eye and of 20/25 in the left eye at baseline. In the right eye, the fluorescein angiography images showed perifoveal capillary ectasia, late-frames dye leakage, and enlargement of the foveal avascular zone. The OCT showed intraretinal pseudocysts and microaneurysms, and the OCT angiography showed vascular rarefaction, capillary dropout, and capillary ectasia of the superficial plexus. After 16 months of follow-up and four ranibizumab injections, the best-corrected visual acuity was 20/60, and the OCT angiography disclosed a further enlargement of the foveal avascular zone area and increased capillary obliteration in the perifoveal nasal area.

Conclusion:
Optical coherence tomography angiography may represent an indispensable diagnostic technique, complementary to traditional imaging, in the evaluation of the effects of anti–vascular endothelial growth factor therapy in patients with MacTel Type 1.
Context-Appropriate Interventions to Prevent Syphilis: A Narrative Review
Authors: Peterman Thomas A. , Cha Susan 
Published: February 2018

Background
The success of an intervention to prevent syphilis will depend on the context and the goal of the intervention. To help programs choose interventions, we reviewed major changes in context and types of interventions that may be effective.

Methods
We reviewed the literature on the changing context of syphilis in the United States and interventions to prevent syphilis, focusing on articles that included evidence of effectiveness.

Results
Populations acquiring syphilis are constantly changing. Currently, incidence is very high among men who have sex with men (MSM). Among adults, late disease caused by syphilis has become rare. Congenital syphilis incidence has been low but is increasing, and morbidity and mortality remain high when babies are infected. Congenital syphilis now causes more deaths than syphilis among adults.
Routine screening of MSM can identify and treat infections before they progress to disease (secondary prevention). Screening rates are highest when done as part of routine standing orders. Partner notification effectiveness has decreased, partly because many partners are anonymous. Most congenital syphilis can be prevented by screening pregnant women; it has been eliminated in areas where intense primary prevention efforts eliminated syphilis among women.

Conclusions
So far, no program has stopped the increasing rates of infection among MSM, but secondary prevention efforts have prevented most disability. Congenital syphilis is increasing, and can be decreased by screening pregnant women and stopped by intensive efforts to prevent infection among women.
Real-time fine aerosol exposures in taconite mining operations
Authors: Huynh Tran , Ramachandran Gurumurthy , Quick Harrison , Hwang Jooyeon , Raynor Peter C , Alexander Bruce H , Mandel Jeff H 
Published: February 2018

AbstractRespiratory health effects such as mesothelioma, silicosis, and lung cancer have been shown to be associated with working in the taconite mining industry. Taconite workers may also have elevated risks from cardiovascular disease (CVD), although the relationship of CVD to dust exposures at these mines has not been well-studied. Motivated by evidence from environmental epidemiological studies and occupational cohorts that have implicated the effects of fine particulates with increased risk of cardiovascular diseases, we conducted an air monitoring campaign to characterize fine aerosol concentrations at 91 locations across six taconite mines using an array of direct-reading instruments to obtain measurements of mass concentrations (PM2.5 or particles with aerodynamic diameter less than 2.5 μm, and respirable particulate matter or RPM), alveolar-deposited surface area concentrations (ADSA), particle number concentrations (PN), and particle size distributions. To analyze these data, we fit a Bayesian hierarchical model with an AR(1) correlation structure to estimate exposure while accounting for temporal correlation. The highest estimated geometric means (GMs) were observed in the pelletizing and concentrating departments (pelletizing maintenance, balling drum operator, and concentrator operator) for PM2.5 and RPM. ADSA and PN generally had highest GMs in the pelletizing department, which processed large amounts of powder-like particles into iron pellets. The within-location variability (GSD_WL) generally ranged from 1 to 3 for all exposure metrics, except for a few locations which indicated changes of activities that caused the exposures to change. Between-location variability (GSD_BL) estimates were generally higher than GSD_WL, indicating larger differences in exposure levels at different locations between mines than at individual locations over the course of several hours. Ranking between PM2.5 and RPM generally agree with each other, whereas ADSA and PN were more consistent with each other, with some overlap with PM2.5and RPM. Differences in ranking these groups may have potential implication for occupational epidemiological studies that rely on exposure information to detect an exposure-response relationship for various job groups. Future epidemiological studies investigating fine aerosol exposures and health risks in occupational settings are encouraged to use multiple metrics to see how they influence health outcomes risk.
Reverse transcriptase fused CRISPR-Cas1 locus with RNA-seq expression necessitates revisiting hypothesis on acquisition of antibiotic resistance genes in multidrug-resistant Enterococcus faecalis V583
Authors: Chakraborty Sandeep 
Published: February 2018

AbstractThe emergence of drug-resistance in Enterococcus faecalis V583 through acquisition of resistance genes has been correlated to the absence of CRISPR-loci. Here, the presence of a bona-fide CRISPR locus in E. faecalis V583 (Accid:NC_004668.1) at 2238156 with a single 20 nt repeat is demonstrated. The presence of a putative endonuclease Cas1 13538 nucleotides away from the repeat substantiates this claim. This Cas1 (628 aa) is highly homologous (Eval:5e-34) to a Cas1 from Pseudanabaena biceps (Accid:WP 009625648.1, 697 aa), which belongs to the enigmatic family of RT-CRISPR locus. Such significant similarity to a Cas protein, the presence of a topoisomerase, other DUF (domain of unknown function) proteins as is often seen in CRISPR loci, and other hypothetical proteins indicates that this is a bona-fide CRISPR locus. Further corroboration is provided by expression of both the repeat and the Cas1 gene in existing RNA-seq data (SRX3438611). Since so little is known of even well-studied species like E. faecalis V583 having many hypothetical proteins, computational absence of evidence should not be taken as evidence of absence (both crisprfinder and PILER-CR do not report this as a CRISPR locus). It is unlikely that bacteria would completely give up defense against its primeval enemies (viruses) to bolster its fight against the newly introduced antibiotics.
Enhancer Identification using Transfer and Adversarial Deep Learning of DNA Sequences
Authors: Cohn Dikla , Zuk Or , Kaplan Tommy 
Published: February 2018

AbstractEnhancer sequences regulate the expression of genes from afar by providing a binding platform for transcription factors, often in a tissue-specific or context-specific manner. Despite their importance in health and disease, our understanding of these DNA sequences, and their regulatory grammar, is limited. This impairs our ability to identify new enhancers along the genome, or to understand the effect of enhancer mutations and their role in genetic diseases.We trained deep Convolutional Neural Networks (CNN) to identify enhancer sequences in multiple species. We used multiple biological datasets, including simulated sequences, in vivo binding data of single transcription factors and genome-wide chromatin maps of active enhancers in 17 mammalian species. Our deep networks obtained high classification accuracy by combining two training strategies: First, training on enhancers vs. non-enhancer background sequences, we identified short (1-4bp) low-complexity motifs. Second, by replacing the negative training set by adversarial k-order random shuffles of enhancer sequences (thus maintaining base composition while shuttering longer motifs, including transcription factor binding sites), we identified a set of biologically meaningful motifs, unique to enhancers. In addition, classification performance improved when combining positive data from all species together, showing a shared mammalian regulatory architecture.Our results demonstrate that design of adversarial training data, and transfer of learned parameters between networks trained on different species/datasets improve the overall performance and capture biologically meaningful information in the parameters of the learned network.Contact:or.zuk@mail.huji.ac.il, tommy@cs.huji.ac.il
Steering ecological-evolutionary dynamics during artificial selection of microbial communities
Authors: Xie Li , Shou Wenying 
Published: February 2018

AbstractMicrobial communities often perform important functions that arise from interactions among member species. Community functions can be improved via artificial selection: Many communities are repeatedly grown, mutations arise, and communities with the highest desired function are chosen to reproduce where each is partitioned into multiple offspring communities for the next cycle. Since selection efficacy is often unimpressive in published experiments and since multiple experimental parameters need to be tuned, we sought to use computer simulations to learn how to design effective selection strategies. We simulated community selection to improve a community function that requires two species and imposes a fitness cost on one of the species. This simplified case allowed us to distill community function down to two fundamental and orthogonal components: a heritable determinant and a nonheritable determinant. We then visualize a “community function landscape” relating community function to these two determinants, and demonstrate that the evolutionary trajectory on the landscape is restricted along a path designated by ecological interactions. This path can prevent the attainment of maximal community function, and trap communities in landscape locations where community function has low heritability. Exploiting these observations, we devise a species spiking approach to shift the path to improve community function heritability and consequently selection efficacy. We show that our approach is applicable to communities with complex and unknown function landscapes.