bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aberrant MUC1 accumulation in salivary glands of Sjögren’s syndrome patients is reversed by TUDCA in vitro
Authors: Castro Isabel , Albornoz Nicolás , Aguilera Sergio , Barrera María-José , González Sergio , Núñez Matilde , Carvajal Patricia , Jara Daniela , Lagos Carolina , Molina Claudio , Urzúa Ulises , Hermoso Marcela A , González María-Julieta 
Published: July 2019

Abstract

Objectives
Xerostomia in SS patients has been associated with low quality and quantity of salivary mucins, which are fundamental for the hydration and protection of the oral mucosa. The aim of this study was to evaluate if cytokines induce aberrant mucin expression and whether tauroursodeoxycholic acid (TUDCA) is able to counteract such an anomaly.

Methods
Labial salivary glands from 16 SS patients and 15 control subjects, as well as 3D acini or human submandibular gland cells stimulated with TNF-α or IFN-γ and co-incubated with TUDCA, were analysed. mRNA and protein levels of Mucin 1 (MUC1) and MUC7 were determined by RT-qPCR and western blot, respectively. Co-immunoprecipitation and immunofluorescence assays for mucins and GRP78 [an endoplasmic reticulum (ER)-resident protein] were also performed. mRNA levels of RelA/p65 (nuclear factor-κB subunit), TNF-α, IL-1β, IL-6, SEL1L and EDEM1 were determined by RT-qPCR, and RelA/p65 localization was evaluated by immunofluorescence.

Results
MUC1 is overexpressed and accumulated in the ER of labial salivary gland from SS patients, while MUC7 accumulates throughout the cytoplasm of acinar cells; however, MUC1, but not MUC7, co-precipitated with GRP78. TUDCA diminished the overexpression and aberrant accumulation of MUC1 induced by TNF-α and IFN-γ, as well as the nuclear translocation of RelA/p65, together with the expression of inflammatory and ER stress markers in 3D acini.

Conclusion
Chronic inflammation alters the secretory process of MUC1, inducing ER stress and affecting the quality of saliva in SS patients. TUDCA showed anti-inflammatory properties decreasing aberrant MUC1 accumulation. Further studies are necessary to evaluate the potential therapeutic effect of TUDCA in restoring glandular homeostasis in SS patients.
Analysis of primitive genetic interactions for the design of a genetic signal differentiator
Authors: Halter Wolfgang , Murray Richard M , Allgöwer Frank 
Published: July 2019

AbstractWe study the dynamic and static input–output behavior of several primitive genetic interactions and their effect on the performance of a genetic signal differentiator. In a simplified design, several requirements for the linearity and time-scales of processes like transcription, translation and competitive promoter binding were introduced. By experimentally probing simple genetic constructs in a cell-free experimental environment and fitting semi-mechanistic models to these data, we show that some of these requirements can be verified, while others are only met with reservations in certain operational regimes. Analyzing the linearized model of the resulting genetic network, we conclude that it approximates a differentiator with relative degree one. Taking also the discovered nonlinearities into account and using a describing function approach, we further determine the particular frequency and amplitude ranges where the genetic differentiator can be expected to behave as such.
Low-income workers’ perceptions of wages, food acquisition, and well-being
Authors: Beck Lindsay , Quinn Emilee L , Hill Heather D , Wolf Jessica , Buszkiewicz James , Otten Jennifer J 
Published: July 2019

Abstract
Although studies have demonstrated an association between increased economic resources and improvements in food security and health, there is a paucity of qualitative research regarding the relationships between household resources, food security, and health. Policy changes related to increasing low wages are potential opportunities to understand changes to material resources. The aims of this analysis were to describe how low-wage workers perceive household resources in relation to food acquisition and to explore how workers in low-wage jobs connect food and diet to perceptions of health and well-being. We analyzed 190 transcripts from 55 workers in low-wage jobs who were living in households with children who were part of the Seattle Minimum Wage Study (up to three in-depth qualitative interviews and one phone survey per participant, conducted between 2015 and 2017). We coded and analyzed interviews using Campbell’s food acquisition framework and best practices for qualitative research. Participants relied on a combination of wages, government assistance, and private assistance from community or family resources to maintain an adequate food supply. Strategies tended to focus more on maintaining food quality than food quantity. Restricted resources also limited food-related leisure activities, which many participants considered important to quality of life. Although many low-wage workers would like to use additional income to purchase higher quality foods or increase food-related leisure activities, they often perceive trade-offs that limit income-based adjustments to food-spending patterns. Future studies should be specifically designed to examine food choices in response to changes in income.
Financial and Clinical Impact of Transfer Patients at Major Teaching Hospitals
Authors: Baker Matthew C. , Koopman Christopher J. , Landman James H. , Alsdurf Charles R. , Gundling Richard L. , Haberman Merle , Horvath Keith A. , Orlowski Janis M. 
Published: July 2019

Purpose
The authors examined the “hub-and-spoke” health care system in the United States for patients transferred from one hospital (“spoke”) to a major teaching hospital (“hub”) and assessed the financial and clinical impact of this system on major teaching hospitals.

Method
The authors surveyed Council of Teaching Hospitals and Health Systems members to collect detailed financial and clinical data from fiscal year 2015 for transfer cases and nontransfer cases (cases directly admitted to the teaching hospital). Data included computed margins (the difference between revenue received and direct and indirect facility costs as estimated by the hospitals) as well as case severity, average length of stay (ALOS), time of admission, surgical or medical status, and other situational variables for All Patient Refined Diagnosis Related Groups (APR-DRGs). The authors used an ordinary least-squares regression model with fixed effects to analyze the data.

Results
Twenty-six hospitals provided data. The average difference between transfer and nontransfer cases was a 2.18 day longer ALOS and a $1,716 lower computed margin, for a case in the same APR-DRG and hospital (P < .001 for both outcomes). Transfer cases had a 19% higher case severity of illness rating and were disproportionately represented among complex APR-DRGs. Transfer patients were 14% more likely to be Medicaid beneficiaries.

Conclusions
Compared with nontransfer cases, transfer cases at major teaching hospitals were more complex and resulted in greater resource utilization, affecting the financial margins on which teaching hospitals rely to support their multipart mission.
The Empirical Challenge of 21st-Century Medical Education
Authors: Wartman Steven A. 
Published: July 2019

Medical education is at a crossroads. Facing challenges wrought by science and technology as well as societal change, the curriculum is increasingly out of synch with new needs in teaching content and medical practice. The path to significant curricular reform is difficult because of a variety of factors, including deeply entrenched values, the natural resistance to change, and the accreditation process. Indeed, even the very definition of what it means to be a professional is changing with profound implications for the future role of the physician and the sacrosanct doctor–patient relationship.
In this Invited Commentary, the author enumerates challenges facing medical education in the current era. To address these challenges, the author recommends specific curricular emphases for 21st-century medical education: knowledge capture and curation, collaboration with and management of artificial intelligence applications, a deep understanding of probabilistic reasoning, and the cultivation of empathy and compassion in accordance with ethical standards. Given these needs, it is imperative that schools act today to undertake significant curricular reform and, in so doing, strive to make the hard changes necessary to produce optimal practitioners in a rapidly transforming 21st century. The author provides first steps an institution can take to begin to address these challenges.
Brief Cognitive Behavioral Therapy For Chronic Pain
Authors: Beehler Gregory P. , Murphy Jennifer L. , King Paul R. , Dollar Katherine M. , Kearney Lisa K. , Haslam Aaron , Wade Michael , Goldstein Wade R. 
Published: July 2019

Objectives:
Although cognitive behavioral therapy is an effective intervention for chronic pain, it is a lengthy treatment typically applied only in specialty care settings. The aim of this project was to collect preliminary effectiveness data for Brief Cognitive Behavioral Therapy for Chronic Pain (Brief CBT-CP), an abbreviated, modular form of treatment designed for use in primary care.

Methods:
A clinical demonstration project was conducted in which Brief CBT-CP was delivered to primary care patients by 22 integrated care providers practicing in the Primary Care Behavioral Health model of Veterans Health Administration primary care clinics. Brief measures were used at each appointment to collect patient-reported clinical outcomes.

Results:
One hundred eighteen patients provided sufficient data for analysis (male, 75%; mean age, 51.4 y). Multilevel modeling suggested that a composite measure of pain intensity and functional limitations showed statistically significant improvements by the third appointment (Cohen’s d=0.65). Pain-related self-efficacy outcomes showed a similar pattern of results but of smaller effect size (Cohen’s d=0.22). The exploratory analysis identified that Brief CBT-CP modules addressing psychoeducation and goal setting, pacing, and relaxation training were associated with the most significant gains in treatment outcomes.

Discussion:
These findings provide early support for the effectiveness of Brief CBT-CP when delivered by providers in every day Primary Care Behavioral Health settings. Results are discussed in relation to the need for additional research regarding the potential value of employing safe, population-based, nonpharmacological approaches to pain management in primary care.
Fractal Deposits of a Hemostatic Hydrophilic Polymer in Mohs Micrographic Surgery Frozen Sections: A Histologic Analysis and Comparison With Sodium Polystyrene Sulfonate (Kayexalate)
Authors: Urman Danielle , Ledon Jennifer , Kolker Steven , Bennett Richard G. 
Published: July 2019

Abstract:
Hydrophilic polymer with potassium ferrate (HPPF) powder is available as an over-the-counter hemostatic agent used by patients to stop superficial bleeding. In dermatology, it is applied to stop bleeding after superficial shave or punch biopsies or in open wounds after Mohs micrographic surgery. Despite its widespread availability, however, HPPF in histopathologic skin sections is highly unusual. We noted HPPF in skin closely resembles sodium polystyrene sulfonate (SPS) seen in colonic necrosis; SPS is a potassium binder given orally or rectally in hyperkalemic patients with end-stage renal disease. We describe the in vivo and in vitro histologic appearance of HPPF, compare HPPF with SPS, and discuss its potential migration into blood or lymph vessels.
Cadaveric Skin Grafts May Greatly Increase the Healing Rate of Recalcitrant Ulcers When Used Both Alone and in Combination With Split-Thickness Skin Grafts
Authors: Mosti Giovanni , Mattaliano Vincenzo , Magliaro Antonio , Picerni Pietro , Bastiani Luca 
Published: July 2019

BACKGROUND
Leg ulcers that do not heal despite appropriate treatment are defined as recalcitrant ulcers. Large surface area, depth, and long duration represent some of most important factors impeding ulcer healing. After sharp debridement, dermal substitutes including skin from cadaver donors may increase the healing rate of recalcitrant ulcers reducing the risk of scar formation and recurrence.

OBJECTIVE
Assessing if, after sharp debridement, dermal substitutes including skin from cadaver donors may increase the healing rate of recalcitrant ulcers reducing the risk of scar formation and recurrence.

PATIENTS AND METHODS
Among patients admitted to our hospital for all types of chronic leg ulcers, we retrospectively reviewed the records of patients affected by recalcitrant ulcers (surface greater than 100 cm2, tissue loss involving epidermis, dermis, and subcutaneous tissue, duration longer than 1 year, and showing no healing tendency). After sharp debridement, the ulcers were covered by allografts with strict follow-up after discharge. Multiple allografts were performed when necessary, and a final autograft was applied in case of incomplete healing.

RESULTS
The records of 414 patients were analyzed. Forty-three patients were lost at follow-up, and the remaining 371 healed after 765 grafting procedures. In 163 patients, the ulcers healed by means of a final autograft. In all the remaining cases, allograft led to ulcer healing.

CONCLUSION
Allografts represent an effective treatment option in case of recalcitrant, large, deep and long-lasting leg ulcers.
Validated Assessment Scales for the Female Asian Calf
Authors: Seo Kyle , Geister Thorin L. , Yu Chao Yates Yen , Chhabra Chiranjiv , Corduff Niamh , Fabi Sabrina G. , Hornfeldt Carl S. , Kerscher Martina , Lam Stephanie , Pavicic Tatjana , Peng Peter H.L. , Rzany Berthold , Suwanchinda Atchima , Tseng Fang-Wen , Pooth Rainer 
Published: July 2019

BACKGROUND
Clinical photonumeric scales have been developed and validated to objectively measure the effectiveness of aesthetic treatments in specific anatomical areas; however, these are based on the typical features of Caucasian patients. No clinical scale for Asian calf appearance currently exists.

OBJECTIVE
To develop and validate a calf assessment scale for use in the female Asian patient population.

METHODS AND MATERIALS
During 2 validation sessions, 13 raters assessed calf images of female Asian subjects (N = 35) viewed from behind with feet flat on the floor (at rest) and on tiptoes (dynamic). Images were rated from 0 (very slim, linear profile) to 4 (very severe convex profile).

RESULTS
Inter-rater and intra-rater reliability were “substantial” (≥0.6, intraclass correlation coefficient [ICC] and weighted kappa) for the calf—at rest, calf—dynamic, and calf summary score. Reliability was “substantial” for calf—at rest and calf–dynamic (≥0.6, ICC and weighted kappa) and “almost perfect” (0.85) for the calf summary score. BMI and calf circumference were highly correlated with scale ratings, and calf circumference was a significant predictor.

CONCLUSION
This new photonumeric assessment scale has value for assessing the female Asian calf, providing a standardized measure of calf appearance in clinical practice and clinical research settings.
Mohs Micrographic Surgery at the Skin and Cancer Foundation Australia, 20 Years Later (1997–2017)
Authors: Stewart Thomas J. , Moreno Bonilla Gilberto , Venning Victoria L. , Lee Simon , Fernandez-Peñas Pablo 
Published: July 2019

BACKGROUND
The availability of Mohs micrographic surgery (MMS) in Australia has increased dramatically since its inception in the 1980s.

OBJECTIVE
This study aimed to describe the evolution of MMS practices at the Skin and Cancer Foundation Australia (SCFA) over the past 20 years (1997–2017).

METHODS
Retrospective analysis of Mohs surgery cases at SCFA in 2017, 2007, and 1997, comparing data on sex, age, tumor type and site, initial tumor and final defect size, number of surgical stages and sections, and closure management. The present study is limited by being a retrospective analysis from a single institution.

RESULTS
There was a 415% increase in the number of Mohs surgery cases from 1997 to 2017, and a significant increase in Mohs surgery-treated squamous cell carcinoma. The preoperative tumor and final defect size have decreased. More side-to-side closures and fewer grafts are being performed over time.

LIMITATIONS
Retrospective analysis from a single institution.

CONCLUSION
Over the last 20 years, MMS has remained appropriate in its application and is being increasingly used for treatment of squamous cell carcinoma suggesting improved access.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS IN TWO CASES OF SOLAR RETINOPATHY
Authors: Padidam Sneha , Burke Marie T. , Apple Daniel B. , Suchomel John R. , Lin Xihui 
Published: July 2019

Purpose:
To report optical coherence tomography angiography findings obtained in two patients with solar retinopathy.

Methods:
Two case reports.

Results:
Two patients presented with blurry vision after sun gazing during the recent solar eclipse and were found to have characteristic foveal lesions on examination and optical coherence tomography consistent with solar retinopathy. Optical coherence tomography angiography showed a focal area of nonperfusion of the choriocapillaris in the affected eyes.

Conclusion:
Changes to the choriocapillaris layer on optical coherence tomography angiography in two patients with solar retinopathy suggest that damage is not limited to the retina.
Donor Diabetes Mellitus Severity and Corneal Transplant Suitability in a US Eye Bank Donor Population
Authors: Rand Gabriel M. , Polla Daniel J. , Patel Sejal H. , Gore Patrick K. , Forest-Smith Lynn , Livesay Tina M. , Chuck Roy S. 
Published: July 2019

Purpose:
To determine whether donor diabetes mellitus (DM) severity is associated with differences in endothelial cell density (ECD) and surgically unsuitable tissue.

Methods:
Raw data were obtained from Saving Sight Eye Bank (Kansas City, MO) including 10,454 donated eyes from 5346 eligible donors from July 2014 through May 2017. Donors were grouped into 5 categories by their insulin use and the presence of microvascular end-organ complications. The categories were non-DM (NDM), noninsulin-dependent DM without complications (NIDDMnc), noninsulin-dependent DM with complication (NIDDMc), insulin-dependent DM without complications, and insulin-dependent DM with complication. Outcome variables included ECD and tissue transplant suitability. Mixed effects models were used to adjust for the random effect of repeated measures and fixed effects of donor age, race, lens status, and death to refrigeration and death to preservation times. Interaction effects of DM severity group and donor age and DM severity group and lens status were included in the models.

Results:
One thousand six hundred eighty-four (32.1%) donors had a diagnosis of DM. Six hundred fifty-eight donors were in the NIDDMnc group, 225 in the NIDDMc group, 404 in the insulin-dependent DM without complication group, and 397 in the insulin-dependent DM with complication group. Compared with non-DM, donors with DM were older (P < 0.001) and more likely to be pseudophakic (P < 0.001). DM severity groups did not affect adjusted ECD at mean donor age. There was no statistically significant ECD interaction between DM severity group and lens status. There was a statistically significant ECD crossover interaction with NIDDMnc and donor age (P < 0.001). In phakic eyes, NIDDMc was associated with a statistically significantly lower odds of transplant suitability (odds ratio 0.62, P = 0.006).

Conclusions:
DM severity does not affect lowering adjusted ECD at mean donor age. DM severity and pseudophakia were not associated with lower adjusted ECD. NIDDMnc was associated with an attenuation of the age-dependent decrease in ECD. NIDDMc was associated with decreased transplant suitability in phakic eyes. Future studies should include age, lens status, and interaction effects in their models of ECD and transplant suitability.
Technique for Ensuring Type I Bubble Formation for Pre-Descemet Endothelial Keratoplasty Preparation
Authors: Saint-Jean Alejandro , Soper Mark , Den Beste Kyle , Iverson Shawn , Price Marianne O. , Price Francis W. 
Published: July 2019

Purpose:
To describe a technique that ensures the production of a type 1 bubble when preparing pre-Descemet endothelial keratoplasty (PDEK) grafts with a high rate of predictability.

Methods:
Donor corneas were placed on a support disc, and a blunt instrument was used to score 360 degrees of the peripheral Descemet membrane and endothelium just inside the trabecular meshwork. Air was injected in several short bursts and several stages with a 30-gauge needle on a 3-mL syringe 2.0 mm away from the limbus to create a type 1 big bubble. The technique was tested by 2 operators (M.S. and A.S.-J.) in 26 human donor corneas, including 12 for possible transplantation, over a 9-month period. Anterior segment optical coherence tomograph (AS-OCT) was performed in 1 case proving a type 1 bubble.

Results:
A type 1 big bubble was successfully created in 24 of 26 attempted cases (92.3%). The technique was used successfully to obtain PDEK tissue for transplant in 9 eyes. One case was not technically acceptable because of diffuse cell loss (>10%); however, the bubble preparation itself was successful. One case had a mixed bubble because of incomplete scoring, resulting in a Descemet membrane endothelial keratoplasty graft used for transplant. One case failed to form any bubble likely because the scoring was too central. Of a total of 26 cases, 14 cases were for practice.

Conclusions:
The Soper technique significantly improved the success rate of creating a type 1 bubble for PDEK preparation.
Influenza in Children With Special Risk Medical Conditions
Authors: Tuckerman Jane , Misan Siobhan , Crawford Nigel W. , Marshall Helen S. 
Published: July 2019

Background:
Children with special risk medical conditions (SRMC) are over-represented in influenza hospitalizations. A systematic review was undertaken to determine whether children with SRMCs experience greater complications or severity following influenza infection.

Methods:
Bibliographies of pertinent articles were searched in MEDLINE and EMBASE (1990 to March 2018) and contact made with the investigators of unpublished studies containing relevant data. Studies of children (aged ≤18 years) with a SRMC hospitalized with influenza were included. Outcomes were pneumonia, intensive care unit (ICU) admission, mechanical ventilation, neurologic outcomes (seizures, encephalopathy), death and length of stay in hospital or ICU.

Results:
Twenty-two studies met inclusion criteria. Compared with healthy peers, children with SRMC had higher odds of ICU admission [pooled odds ratio (OR) 1.66 (95% confidence interval (CI): 1.25–2.21)], for mechanical ventilation [pooled OR 1.53 (95% CI: 0.93–2.52)] and death [pooled OR 1.34 (95% CI: 0.74–2.41)]. Additionally, children with SRMC were more likely to develop bacterial pneumonia (crude OR 1.7; 95% CI: 1.1–2.6) or experience prolonged hospital length of stay [adjusted rate ratio 1.75 (95% CI: 1.44–2.11)]. The level of GRADE evidence was low for all outcomes considered in this review.

Conclusions:
While there was evidence that ICU management and bacterial pneumonia increases in children with SRMC, evidence showing an increase in the probability of death or need for mechanical ventilation was inconsistent. Further research using large datasets should evaluate the impact of complications and associated morbidity from influenza in SRMC children.