bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the Clavicle Hook Plate for Treatment of Acromioclavicular Joint Dislocation: A Cadaveric Study
Authors: Vajapey Sravya P. , Bong Matthew R. , Peindl Richard D. , Bosse Michael J. , Ly Thuan V. 
Published: September 2019

Objectives:
To describe surgical technique for proper placement of the clavicle hook plate, determine whether there is subacromial impingement caused by hook plate fixation, and evaluate the mechanical strength of the clavicle hook plate construct.

Methods:
Eight fresh-frozen cadaveric shoulders with a mean age of 48 years (range, 37–69) were used. Open reduction and internal fixation of simulated Rockwood type V AC joint dislocation was performed with the clavicle hook plate. Three-dimensional computed tomography studies and arthroscopic evaluation were performed with the glenohumeral joint in different orientations to assess the position of the hook plate relative to relevant joint structures. The clavicle was then superiorly loaded to mechanical failure.

Results:
Computed tomography evaluations showed no contact between the humerus and the hook plate. Distance between the greater tuberosity and hook plate ranged from 14 to 31 mm with maximal shoulder forward flexion and 8.1–25.4 mm with maximal shoulder abduction. Arthroscopic evaluation of the subacromial space demonstrated that with maximal abduction/forward flexion, there was abutment of the rotator cuff with the hook plate in 6 of 8 specimens. In mechanical testing, mean failure load was determined to be 1011 N (range, 380–1563 N). Failure mechanisms included acromion fracture (4), slippage of the hook under acromion (3), and distal clavicle fracture (1).

Conclusions:
This study demonstrates that the clavicle hook plate reduces AC joint dislocation or distal clavicle fractures anatomically, has supra-physiologic mechanical strength, does not cause bony impingement, and exhibits rotator cuff impingement only with maximal abduction/forward flexion of the shoulder.
Cardiac organ damage in patients with Parkinson's disease and reverse dipping
Authors: Di Stefano Cristina , Sobrero Gabriele , Milazzo Valeria , Vallelonga Fabrizio , Romagnolo Alberto , Zibetti Maurizio , Milan Alberto , Veglio Franco , Maule Simona 
Published: September 2019

Objective:
Patients with autonomic neuropathy associated with Parkinson's disease often show reverse dipping pattern/nocturnal hypertension at 24-h ambulatory blood pressure (BP) monitoring (24-h ABPM) and diurnal orthostatic hypotension. The aim of the study was to evaluate cardiac alterations in Parkinson's disease patients with reverse dipping, in comparison with non-reverse dippers Parkinson's disease and essential hypertensive patients.

Methods:
A total of 26 consecutive Parkinson's disease patients with reverse dipping at 24-h ABPM and no previous history of hypertension were compared with 26 non-reverse Parkinson's disease patients matched for age, sex and 24-h mean BP, and 26 essential hypertensive patients matched for nighttime mean BP. None of the Parkinson's disease patients suffered from cardiovascular diseases or were treated with antihypertensive or antihypotensive drugs. Reverse dipping was defined by a systolic day-night BP difference less than 0% at 24-h ABPM. Left ventricular (LV) hypertrophy was defined by a LV mass index at least 115 g/m2 in men and at least 95 g/m2 in women.

Results:
LV mass, indexed for BSA, was significantly higher in reverse dipping than non-reverse Parkinson's disease patients (respectively 90.2 ± 25.3 vs. 77.4 ± 13.3 g/m2, P = 0.04), and was similar to essential hypertensive patients (91.6 ± 24.8, P = 0.92). LV hypertrophy was detected in five reverse dipping Parkinson's disease patients and four hypertensive patients, but was not present in non-reverse Parkinson's disease patients (P = 0.046). Nocturnal BP values, nocturnal BP load, weighted BP variability and age were found to correlate with the increased LV mass index.

Conclusion:
Reverse dipping and nocturnal hypertension are related to higher LV mass and increased prevalence of LV hypertrophy in Parkinson's disease patients.
Multiplex Polymerase Chain Reaction Panel for Suspected Pertussis
Authors: Desjardins Michaël , Doyon-Plourde Paméla , Mousseau Sarah , Iachimov Daniela , Rallu Fabien , Quach Caroline 
Published: September 2019

Background:
The use of bacterial multiplex polymerase chain reaction (PCR) in children with suspected pertussis sometimes yields unexpected positive results for Mycoplasma pneumoniae. We aimed to evaluate the clinical significance of positive M. pneumoniae results in this population.

Methods:
Retrospective cohort of consecutive patients with suspected pertussis tested with a bacterial multiplex PCR (including Bordetella pertussis and M. pneumoniae) between June 2015 and March 2017. Medical records were reviewed to compare demographics, clinical presentations and outcomes of patients positive for M. pneumoniae with those positive for B. pertussis and those with negative results, using multivariable logistic regression.

Results:
A total of 1244 patients were included as follows: 56 (4.5%) with M. pneumoniae, 116 (9.3%) with B. pertussis and 1029 (82.7%) with negative results. Mean age was respectively 4.8 years, 6.5 years and 2.8 years (P < 0.05). Children with M. pneumoniae were less likely to present with cardinal symptoms of pertussis such as paroxysmal cough [adjusted odds ratio (OR): 0.19, 95% confidence interval (CI): 0.08–0.40) but were more likely to have fever (adjusted OR: 10.53, 95% CI: 3.54–39.49) and other nonspecific respiratory symptoms compared with children with B. pertussis. Children with M. pneumoniae had very similar clinical presentations to those with a negative PCR, but were more likely to have radiologically confirmed pneumonia (adjusted OR: 5.48, 95% CI: 2.96–9.99) and were less likely to be diagnosed with a concomitant viral infection (adjusted OR: 0.32, 95% CI: 0.07–0.99).

Conclusions:
In children with suspected pertussis, the detection of M. pneumoniae is clinically relevant. However, the impact of this finding on patients’ outcome is still unclear.
A high-dose rapamycin treatment alleviates hepatopulmonary syndrome in cirrhotic rats
Authors: Chang Ching-Chih , Chuang Chiao-Lin , Hsin I-Fang , Hsu Shao-Jung , Huang Hui-Chun , Lee Fa-Yauh , Lee Shou-Dong 
Published: September 2019

Background:
Rapamycin is a type of immunosuppressive agent that acts through inhibition of mammalian target of rapamycin (mTOR). Hepatopulmonary syndrome (HPS) is a lethal complication in cirrhotic patients. It is characterized by hypoxia and increased intrapulmonary shunts, in which pulmonary inflammation and angiogenesis play important roles. The current study aimed to evaluate the effect of rapamycin on HPS using the experimental model of common bile duct ligation (CBDL)-induced cirrhosis in rats.

Methods:
The rats received low-dose (0.5 mg/kg), high-dose (2 mg/kg) rapamycin, or vehicle from the 15th to the 28th day post CBDL. Then the mortality rate, hemodynamics, biochemistry parameters, arterial blood gas and plasma levels of vascular endothelial growth factor (VEGF) and tumor necrosis factor (TNF)-α were evaluated on the 28th day post CBDL. Pulmonary histopathological stains were performed, and protein expression was examined. In parallel groups, the intrapulmonary shunts of CBDL rats were measured.

Results:
Compared with the control, a high-dose rapamycin treatment decreased portal pressure and improved hypoxia in CBDL rats. It also reduced the plasma level of VEGF and TNF-α and decreased intrapulmonary shunts. Meanwhile, it ameliorated pulmonary inflammation and angiogenesis and downregulated the protein expression of mTOR, P70S6K, nuclear factor kappa B (NFκB), VEGF, and VEGF receptor 2. In contrast, low-dose rapamycin did not attenuate intrapulmonary shunts despite ameliorating portal hypertension.

Conclusion:
High-dose rapamycin ameliorates HPS in cirrhotic rats as evidenced by the alleviated hypoxia and decreased intrapulmonary shunts. Downregulation of the mTOR/P70S6K, NFκB, and VEGF signaling pathways might play a key role.
Small intestinal bacterial overgrowth and nonalcoholic fatty liver disease: a systematic review and meta-analysis
Authors: Wijarnpreecha Karn , Lou Susan , Watthanasuntorn Kanramon , Kroner Paul T. , Cheungpasitporn Wisit , Lukens Frank J. , Pungpapong Surakit , Keaveny Andrew P. , Ungprasert Patompong 
Published: September 2019

Objectives
Recent studies have suggested that small intestinal bacterial overgrowth (SIBO) could be a predisposing factor for nonalcoholic fatty liver disease (NAFLD) although the results were inconsistent. This systematic review and meta-analysis was conducted with the aim to summarize all available data.

Methods
A comprehensive literature review was conducted utilizing MEDLINE and EMBASE databases through September 2018 to identify all studies that compared the risk of NAFLD among patients with SIBO versus those without SIBO. Effect estimates from each study were extracted and combined together using the random effect, generic inverse variance method of DerSimonian and Laird.

Results
A total of 10 studies with 1093 participants fulfilled the eligibility criteria and were included in the meta-analysis. A significant association between NAFLD and SIBO was observed with the pooled odds ratio of 3.82 (95% confidence interval, 1.93–7.59; I
2 65%). Funnel plot is relatively symmetric and is not suggestive of the presence of publication bias.

Conclusion
A significant association between NAFLD and SIBO was observed in this meta-analysis.
Influence of esophageal variceal bleeding on iron status in chronic hepatitis C patients
Authors: Abbas Omaima Mahmoud , Khalifa Khaled Abd Elmoemen , Makhlouf Manal Mohamed , Osman Nahla Fekri , Abdel Razek Wael M. , Atta Asmaa Said 
Published: September 2019

Background
Disorders of serum iron balance are frequently observed in chronic hepatitis C (CHC) patients. Iron overload as well as iron deficiency anemia are common clinical findings in these patients. Variceal bleeding is also a common complication. To date, no study has discussed the influence of esophageal bleeding on iron status in anemic CHC bleeders.

Objective
Was to study reticulocyte hemoglobin content (CHr) and serum hepcidin levels in anemic CHC and to evaluate the influence of variceal bleeding on patients’ iron status.

Methods
Serum hepcidin levels and CHr were assessed in 65 early phase CHC patients (20 nonanemic, 23 anemic nonbleeders, and 22 anemic bleeders), and 20 healthy controls; and were compared with the conventional indices of iron deficiency including mean corpuscular volume, mean corpuscular hemoglobin, red cell distribution width, serum iron, total iron binding capacity, transferrin saturation and ferritin.

Results
Hepcidin levels were comparable in patients groups, but were significantly lower in patients than in controls (P = 0.01). Child-Pugh class B patients showed significantly lower hepcidin levels than class A patients. CHr levels were comparable in all groups as well as all iron deficiency indices. Patients with ferritin values or less 100 ng/ml and CHr or less 29 pg/cell or Tfsat or less 16% are more likely to have iron deficiency [odds ratio (OR = 3.93, 95% confidence interval (CI) = 2.54–6.08; OR  = 10.50, 95% CI = 1.94–56.55, respectively).

Conclusion
Esophageal bleeding has an almost no influence on iron status in CHC patients. Serum hepcidin content is influenced by CHC disease rather than by anemia associated with or without esophageal bleeding and it could be used as a marker of early hepatic insufficiency. Assessing CHr content could add a potential utility in the detection of iron deficiency in CHC patients.
A randomized controlled trial of the effects of local tranexamic acid on mortality, rebleeding, and recurrent endoscopy need in patients with upper gastrointestinal hemorrhage
Authors: Karadaş Adnan , Doğan Nurettin Özgür , Pinar Seda Güney , Yeşil Olcay , Pekdemir Murat , Yilmaz Serkan , Yaka Elif 
Published: September 2019

Objective
Tranexamic acid (TXA) is an antifibrinolytic agent used to control bleeding in different circumstances. We conducted a randomized controlled trial to assess the efficacy and safety of locally administered TXA in upper gastrointestinal hemorrhage.

Methods
This single-center, double-blind, randomized controlled trial was performed in a tertiary emergency department (ED) in patients presenting with upper gastrointestinal bleeding symptoms between 2016 and 2018. The patients received either 2000 mg of 5% TXA in 100 mL of isotonic saline solution or 100 mL isotonic saline (control group) via the nasogastric route. As a composite outcome, recurrent endoscopy need, rebleeding, surgery need, recurrent admission to the ED, and mortality parameters were evaluated at the end of a one-month period.

Results
During the study period, 78 patients were randomized into the TXA group, and 79 patients were randomized into the isotonic saline group. The majority of the bleedings (61%) were in Forrest class 3, and the most frequent cause was peptic ulcer disease. The composite outcome occurred in 25 of the TXA patients (32.1%) and 23 of the isotonic saline patients (29.1%); no statistically significant difference was found between the groups (P = 0.690). In addition, no statistically significant differences were observed between the TXA and control groups regarding mortality (10.3 vs 12.7%; P = 0.637), recurrent ED admission (17.9 vs 12.7%; P = 0.357), or thromboembolic complications (3.8 vs 1.3%; P = 0.367).

Conclusion
Locally administered TXA confers no additional benefit over standard care in patients with upper gastrointestinal hemorrhage.
Prediction and Comparison of Fentanyl Infusion Pharmacokinetics in Obese and Nonobese Children
Authors: Lim Sin Yin , Woo Sukyung , Miller Jamie L. , Skrepnek Grant H. , Henry Emilie D. , Johnson Peter N. 
Published: September 2019

Objectives:To compare fentanyl infusion pharmacokinetic variables in obese children and nonobese children.Design:A pharmacokinetic simulation study.Setting:We used a semi-physiologically based pharmacokinetic model to generate fentanyl pharmacokinetic variables.Subjects:Simulations of pharmacokinetic variables were based on historical inpatient demographic data in less than 18-year-olds.Interventions:Obese children were defined as children less than 2 years with weight-for-length greater than or equal to 97.7th percentile or body mass index-for-age greater than or equal to 95th percentile for greater than or equal to 2–17-year-olds.Measurements and Main Results:Overall, 4,376 patients were included, with 807 (18.4%) classified as obese children. The majority (52.9%) were male, with a median age of 8.1 years (interquartile range, 4.3–13.0 yr). The differences in total clearance (CLS), volume of distribution at steady-state values, weight-normalized CLS, and weight-normalized volume of distribution at steady state were assessed in obese children and nonobese children. Multivariable analyses indicated that obesity was significantly associated with a higher CLSin obese children greater than 6-year-olds (p< 0.0375). However, there was an 11–30% decrease in weight-normalized CLSin obese children versus nonobese children in all age groups (p< 0.05). Both volume of distribution at steady state and weight-normalized volume of distribution at steady state increased significantly in obese children compared with nonobese children (p< 0.05). Fentanyl plasma concentration-time profiles of obese children and nonobese children pairs (ages 4, 9, and 15) receiving 1 µg/kg/hr using total body weight were also compared. Steady-state concentrations of the obese children using similar weight-based dosing increased by 25%, 77%, and 44% in comparison to nonobese children 4-, 9-, and 15-year-olds, respectively. Time to steady state and elimination half-lives were two- to four-fold longer in obese children. An additional simulation was conducted for 15-year-old obese children and nonobese children using a fixed dose of 50 µg/hr and it provided similar pharmacokinetic profiles.Conclusions:CLSmay increase less than proportional to weight in obese children greater than 6-year-olds, while volume of distribution at steady state increases more than proportional to weight in all obese children compared with nonobese children. Weight-based dosing in obese children may cause an increase in steady-state concentration while prolonging the time to steady state. Exploring alternative dosing strategies for obese children is warranted.
Multiple Regional Listing Increases Liver Transplant Rates for Those With Model for End-stage Liver Disease Score <15
Authors: Brown Sara , Savva Yulia , Barth Rolf , LaMattina John , Thuluvath Paul J. 
Published: September 2019

Background.
Multiple listing (ML) at >1 transplant center is one mechanism to combat the geographic disparities in liver transplantation (LT) rates. The objective of our study was to determine the impact of multiple listing on LT rates.

Methods.
We examined the United Network of Organ Sharing database from 2002 to 2016 after excluding those listed for multiple organs, hepatocellular carcinoma, or living donor LT. The waitlist mortality and LT rates for the ML groups and the single listed (SL) group were compared after stratifying patients by the Model for End-Stage Liver Disease (MELD) with a cutoff at 15 (<15 and ≥15).

Results.
Of the 83 935 listed during the study period, 80 351 were listed in a single center (SL group), and 3584 were listed in >1 center (ML group). Of the ML groups, 2028 (2.4%) were listed at multiple donor service areas but within the same region (ML-SR) and 1556 (1.9%) listed in different regions (ML-DR). The median MELD at LT was 20, 21, and 24 for ML-DR, ML-SR, and SL groups, respectively (P = 0.001). Although the probability of receiving LT was significantly higher for the ML groups relative to the SL group for both MELD groups (<15 and ≥15), the impact was the highest for ML-DR group. At MELD score <15, the probability of LT was 72% for ML-DR, 38% for ML-SR, and 32% for SL groups. At MELD score ≥15, the probability of LT was 79% for ML-DR, 67% for ML-SR, and 61% for SL groups.

Conclusions.
Multiple listing appeared to considerably improve a patient’s chance of receiving LT and survival with the highest benefit for those with low MELD scores (<15) listed at multiple regions.
Detection and Classification of Cardiac Arrhythmias by a Challenge-Best Deep Learning Neural Network Model
Authors: Chen Tsai-Min , Huang Chih-Han , Shih Edward S. C. , Hu Yu-Feng , Hwang Ming-Jing 
Published: September 2019

AbstractBackgroundElectrocardiogram (ECG) is widely used to detect cardiac arrhythmia (CA) and heart diseases. The development of deep learning modeling tools and publicly available large ECG data in recent years has made accurate machine diagnosis of CA an attractive task to showcase the power of artificial intelligence (AI) in clinical applications.Methods and FindingsWe have developed a convolution neural network (CNN)-based model to detect and classify nine types of heart rhythms using a large 12-lead ECG dataset (6877 recordings) provided by the China Physiological Signal Challenge (CPSC) 2018. Our model achieved a median overall F1-score of 0.84 for the 9-type classification on CPSC2018’s hidden test set (2954 ECG recordings), which ranked first in this latest AI competition of ECG-based CA diagnosis challenge. Further analysis showed that concurrent CAs observed in the same patient were adequately predicted for the 476 patients diagnosed with multiple CA types in the dataset. Analysis also showed that the performances of using only single lead data were only slightly worse than using the full 12 lead data, with leads aVR and V1 being the most prominent. These results are extensively discussed in the context of their agreement with and relevance to clinical observations.ConclusionsAn AI model for automatic CA diagnosis achieving state-of-the-art accuracy was developed as the result of a community-based AI challenge advocating open-source research. In- depth analysis further reveals the model’s ability for concurrent CA diagnosis and potential use of certain single leads such as aVR in clinical applications.AbbreviationsCA, cardiac arrhythmia; AF, Atrial fibrillation; I-AVB, first-degree atrioventricular block; LBBB, left bundle branch block; RBBB, right bundle branch block; PAC, premature atrial contraction; PVC, premature ventricular contraction; STD, ST-segment depression; STE, ST-segment elevation.
End-to-End Boundary Aware Networks for Medical Image Segmentation
Authors: Hatamizadeh Ali , Terzopoulos Demetri , Myronenko Andriy 
Published: September 2019

AbstractFully convolutional neural networks (CNNs) have proven to be effective at representing and classifying textural information, thus transforming image intensity into output class masks that achieve semantic image segmentation. In medical image analysis, however, expert manual segmentation often relies on the boundaries of anatomical structures of interest. We propose boundary aware CNNs for medical image segmentation. Our networks are designed to account for organ boundary information, both by providing a special network edge branch and edge-aware loss terms, and they are trainable end-to-end. We validate their effectiveness on the task of brain tumor segmentation using the BraTS 2018 dataset. Our experiments reveal that our approach yields more accurate segmentation results, which makes it promising for more extensive application to medical image segmentation.
Integrated Low-Energy and Low Carbon Shortcut Nitrogen removal with Biological Phosphorus Removal for Sustainable Mainstream Wastewater Treatment
Authors: Roots Paul , Sabba Fabrizio , Rosenthal Alex F. , Wang Yubo , Yuan Quan , Rieger Leiv , Yang Fenghua , Kozak Joseph A. , Zhang Heng , Wells George F. 
Published: September 2019

AbstractWhile enhanced biological phosphorus removal (EBPR) is widely utilized for phosphorus (P) removal from wastewater, understanding of efficient process alternatives that allow combined biological P removal and shortcut nitrogen (N) removal, such as nitritation-denitritation, is limited. Here, we demonstrate efficient and reliable combined total N, P, and chemical oxygen demand removal (70%, 83%, and 81%, respectively) in a sequencing batch reactor (SBR) treating real mainstream wastewater (primary effluent) at 20°C. Anaerobic – aerobic cycling (with intermittent oxic/anoxic periods during aeration) was used to achieve consistent removal rates, nitrite oxidizing organism (NOO) suppression, and high effluent quality. Importantly, high resolution process monitoring coupled toex situbatch activity assays demonstrated that robust biological P removal was coupled to energy and carbon efficient nitritation-denitritation, not simultaneous nitrification-denitrification, for the last >400 days of 531 total days of operation. Nitrous oxide emissions of 2.2% relative to the influent TKN (or 5.2% relative to total inorganic nitrogen removal) were similar to those measured in other shortcut N bioprocesses. No exogenous chemicals were needed to achieve consistent process stability and high removal rates in the face of frequent wet weather flows and highly variable influent concentrations. Process modeling reproduced the performance observed in the SBR and confirmed that nitrite drawdown via denitritation contributed to suppression of NOO activity.