bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Surgical Clostridium-Associated Risk of Death Score Predicts Mortality After Colectomy for Clostridium difficile
Authors: Kulaylat Audrey S. , Kassam Zain , Hollenbeak Christopher S. , Stewart David B. 
Published: November 2017

BACKGROUND:
A Clostridium difficile-associated risk of death score was recently developed and validated by using a national cohort of both nonsurgical and surgical patients admitted with C difficile infection. However, risk scores specifically derived from surgical cohorts and designed for patients with C difficile infection are currently unavailable.

OBJECTIVE:
The aim of this study was to develop a risk of death score for patients with C difficile infection who are being considered for total abdominal colectomy because of the failure of medical therapy.

DESIGN:
This is a retrospective cohort study.

SETTINGS:
This study was conducted with the use of a national database.

PATIENTS:
All patients undergoing total colectomy for C difficile infection were identified in the National Surgical Quality Improvement Program database from 2005 to 2014.

MAIN OUTCOME MEASURES:
Variables similar to the original scoring system were used in multivariable analyses to determine the risk of 30-day mortality for patients, and a model was constructed to estimate the predicted probability of mortality after surgery.

RESULTS:
Of 532 patients who underwent surgery, 32.7% experienced 30-day postoperative mortality. Patient covariates associated with significantly increased mortality included age greater than 80 years (OR 5.5, p = 0.003), need for preoperative mechanical ventilation (OR 3.1, p < 0.001), chronic steroid use (OR 2.9, p < 0.001), underlying cardiopulmonary disease (OR 2.0, p = 0.001), and acute renal failure (OR=1.7, p = 0.03). These and other comorbidities, including hepatic disease, a cancer diagnosis, and both insulin- and noninsulin-dependent diabetes mellitus, were used to construct a model to estimate the predicted probability of mortality, which ranged from 8.0% to 96.1% based on individual comorbidity profiles. These estimates differed substantially when compared with those obtained using the National Surgical Quality Improvement Program risk calculator, which estimated the risk of mortality among surgical patients as being consistently lower.

LIMITATIONS:
This study was limited by its retrospective design.

CONCLUSIONS:
Our surgical scoring system allows preoperative risk stratification for patients being evaluated for colectomy for C difficile infection, potentially helping to avoid futile surgery. See Video Abstract at http://links.lww.com/DCR/A434.
Effect of Andrographolide on Gene Expression Profile and Intracellular Calcium in Primary Rat Myocardium Microvascular Endothelial Cells
Authors: Feng Bo , Zhang Qian , Wang Xin , Sun Xiangwan , Mu Xiang , Dong Hong 
Published: November 2017

Abstract:
Andrographolide (ANDRO) is a diterpene lactone compound with extensive biological effects, such as antibacterial, antitumor and treatment of cardiovascular diseases. Until now, studies on the pharmacological functions of ANDRO are still in progress. However, little is known about the gene expression profile and calcium response of endothelial cells to ANDRO. In this study, we used a microarray technology to investigate the gene expression responses in primary rat myocardium microvascular endothelial cells treated with 10 μg/mL ANDRO. The expression of caveolin-1 and 1-phosphatidylinositol 4, 5-bisphosphate phosphodiesterase δ3 was verified by RT-PCR and western blot. In addition, we investigated the effect of ANDRO on intracellular calcium induced by exogenous adenosine triphosphate and on inflammatory response induced by lipopolysaccharide. Results showed that ANDRO treatment induced an abundance of differential expressed genes, exhibiting a multitarget regulatory effect. ANDRO significantly decreased caveolin-1 and phosphodiesterase δ3 expression, lipopolysaccharide-induced IL-6 and TNF-α levels and expression of several chemokine genes, which are associated with reducing inflammation response and decreasing calcium release without affecting normal endothelia cell function, suggesting that ANDRO may be a potential candidate to treat cardiovascular diseases with less toxicity.
Androgens Mediate β-adrenergic Vasorelaxation Impairment Using Adenylyl Cyclase
Authors: López-Canales Oscar , Castillo-Hernández Maria del Carmen , Vargas-Robles Hilda , Rios Amelia , López-Canales Jorge , Escalante Bruno 
Published: November 2017

Abstract:
Cardiovascular disease development has been associated with sex differences, suggesting that sex hormones are implicated in vascular function and development of hypertension. Vascular tone comparison at different stages of rat growth represents a good model to study testosterone-related vascular response. We explored the role of testosterone in modulation of age-dependent impaired β-adrenergic vasodilation. The 3-week-old male Sprague–Dawley rats were sorted in 3-week-old rats without any manipulation and 3-week-old rats treated with testosterone. The 9-week-old rats were randomly grouped into 9-week-old rats without any manipulation (sham), 9-week-old rats that underwent gonadectomy (9-week-old castrated), and 9-week-old castrated treated with testosterone replacement therapy (9-week-old castrated + testosterone). Vascular relaxation was evaluated in aortic rings. β-adrenergic receptor protein expression, cyclic adenosine monophosphate production, testosterone levels, and adenylyl cyclase (AC) gene expression were assessed. Testosterone levels were low in 3-week-old and 9-week-old castrated rats compared with 9-week-old sham rats. Testosterone replacement raised these levels in 3-week-old and 9-week-old castrated rats similar to those of 9-week-old sham rats. SQ22536, the AC inhibitor, prevented isoproterenol-induced relaxation in aortic rings from 3-week-old and 9-week-old castrated rats. The β-adrenergic receptor protein expression was similar in all experimental groups. AC mRNA and protein expression and cyclic adenosine monophosphate levels were elevated in 3-week-old and 9-week-old castrated rats compared with 3-week-old + testosterone, 9-week-old sham, and 9-week-old castrated + testosterone rats. In conclusion, we demonstrated that age maturation was associated with vascular relaxation impairment. Variations in testosterone levels and reduced AC expression may be responsible for this altered vascular function.
Depression and Anxiety Screening and Triage Protocol for Cardiac Rehabilitation Programs
Authors: Tulloch Heather , Heenan Adam , Cupper Laura , Pelletier Robert , O'Farrell Pat , Pipe Andrew 
Published: November 2017

Purpose:
Best practice guidelines for cardiac rehabilitation (CR) suggest routine screening for anxiety and depression, yet many patients are not screened nor do they receive mental health treatment. Protocols are required to identify those in need of care and to ensure that appropriate assistance is provided.

Methods:
Consecutive patients entering CR in our setting from May 4, 2012, to May 3, 2013, completed the Hospital Anxiety and Depression Scale (HADS). As per our Screening and Triage protocol for Anxiety and Depression (STAD), patients with high scores (≥16) were referred to a clinical psychologist; those with low scores (<8 for depression and <11 for anxiety) received information about community resources. Patients with moderate scores were reassessed 4 weeks later before triaging to psychosocial services. High, moderate, and low scores were triaged to a clinical psychologist, social worker, or were guided to community resources, respectively.

Results:
A total of 1504 patients (76% men) completed the HADS at intake; 287 (19%) had elevated depression and/or anxiety scores. Of these, 43 (15%) were referred to psychology services and 244 (85%) patients were referred for HADS readministration at 4 weeks. Scores following reassessment resulted in 6 referrals to psychology services (3%) and 62 to social work (36%), whereas 78 (45%) no longer needed care.

Conclusion:
Many cardiac patients experience symptoms of depression and anxiety. The STAD protocol using the HADS was an efficient method to screen for anxiety and depression and appropriately utilize psychosocial treatment resources in the cardiac rehabilitation setting.
Behavioral Genetics in Criminal and Civil Courts
Authors: Sabatello Maya , Appelbaum Paul S. 
Published: November 2017

AbstractAlthough emerging findings in psychiatric and behavioral genetics create hope for improved prevention, diagnosis, and treatment of disorders, the introduction of such data as evidence in criminal and civil proceedings raises a host of ethical, legal, and social issues. Should behavioral and psychiatric genetic data be admissible in judicial proceedings? If so, what are the various means for obtaining such evidence, and for what purposes should its admission be sought and permitted? How could—and should—such evidence affect judicial outcomes in criminal and civil proceedings? And what are the potential implications of using behavioral and psychiatric genetic evidence for individuals and communities, and for societal values of equality and justice? This article provides an overview of the historical and current developments in behavioral genetics. We then explore the extent to which behavioral genetic evidence has—and should—affect determinations of criminal responsibility and sentencing, as well as the possible ramifications of introducing such evidence in civil courts, with a focus on tort litigation and child custody disputes. We also consider two ways in which behavioral genetic evidence may come to court in the future—through genetic theft or the subpoena of a litigant’s biospecimen data that was previously obtained for clinical or research purposes—and the concerns that these possibilities raise. Finally, we highlight the need for caution and for approaches to prevent the misuse of behavioral genetic evidence in courts.
Dementia, Decision Making, and Capacity
Authors: Darby R. Ryan , Dickerson Bradford C. 
Published: November 2017

Learning objectives
After participating in this activity, learners should be better able to:
• Assess the neuropsychological literature on decision making and the medical and legal assessment of capacity in patients with dementia
• Identify the limitations of integrating findings from decision-making research into capacity assessments for patients with dementia

Abstract
Medical and legal professionals face the challenge of assessing capacity and competency to make medical, legal, and financial decisions in dementia patients with impaired decision making. While such assessments have classically focused on the capacity for complex reasoning and executive functions, research in decision making has revealed that motivational and metacognitive processes are also important. We first briefly review the neuropsychological literature on decision making and on the medical and legal assessment of capacity. Next, we discuss the limitations of integrating findings from decision-making research into capacity assessments, including the group-to-individual inference problem, the unclear role of neuroimaging in capacity assessments, and the lack of capacity measures that integrate important facets of decision making. Finally, we present several case examples where we attempt to demonstrate the potential benefits and important limitations of using decision-making research to aid in capacity determinations.
Outcomes of Trabeculectomy and Phacotrabeculectomy With Collagen Matrix Implant (Ologen) and Low-dose Mitomycin C: 2-Year Follow-up
Authors: Castejón Miguel A. , Teus Miguel A. , Bolivar Gema , Paz-Moreno-Arrones Javier , Castaño Beatriz 
Published: November 2017

Purpose:
The purpose of this article is to analyze the results achieved in lowering intraocular pressure (IOP) after trabeculectomy or combined surgery (phacotrabeculectomy) with low-dose mitomycin C (MMC) using the Ologen Collagen Matrix (Ologen CM) implant.

Materials and Methods:
This retrospective study included 58 eyes from 47 consecutive patients with glaucoma who underwent filtering surgery alone or combined with cataract surgery. The study group included 29 eyes that underwent trabeculectomy (14 eyes) or phacotrabeculectomy (15 eyes) with low-dose MMC (0.1 mg/mL×1 min) and subconjunctival Ologen CM implant at the end of surgery. The control group included 29 eyes, 12 that underwent trabeculectomy and 17 that underwent phacotrabeculectomy, with the same MMC dose but without the collagen matrix implant. All surgical procedures were performed by the same surgeon. The follow-up period for the patients was 2 years.

Results:
We found statistically significant differences between the 2 groups in the age of the patients (P=0.02). We found no statistically significant differences in the baseline IOP (P=0.37) or preoperative IOP (P=0.5), nor in the visual field damage measured with mean deviation (P=0.2). The number of hypotensive medications used preoperatively was higher in the study group (P=0.0001). At 1 and 2 years after surgery, we only found statistically significant differences in favor of the study group in patients who underwent phacotrabeculectomy (P=0.0008 and 0.02, respectivily).

Conclusion:
The Ologen CM implant can be considered as an adjunct to MMC in patients undergoing filtering surgery combined with phacoemulsification to improve postoperative IOP results over the long term.
Assessing the Methodological Quality of Glaucoma Clinical Practice Guidelines and Their Recommendations on Microinvasive Glaucoma Surgery: A Systematic Review
Authors: Michaelov Evan , Armstrong James J. , Nguyen Mary , Instrum Bridget , Lam Tracey , Denstedt James , Hutnik Cindy M.L. 
Published: November 2017

Introduction:
Clinical practice guidelines (CPG) are regarded by many as critical communications providing guidance within specific medical fields. Over a decade ago, the first microinvasive glaucoma surgical (MIGS) procedures were introduced. Since then, a number of these novel intraocular pressure controlling surgical options have been approved worldwide. Governing bodies and health care administration often utilize CPGs when considering funding for newer technologies. This highlights the importance of well-written, accurate, and up-to-date CPGs in the rapidly evolving field of MIGS. If CPGs are unable to fill this role, their use in treatment decision-making is doing a disservice to patients, who will be denied currently available and potentially superior care. To determine the overall value of a CPG, the methodological quality with which it was developed, in addition to the current relevance and appropriateness of its recommendations, should be evaluated. The objective of the present study was to assess the methodological quality of currently available international glaucoma CPGs, as well as their coverage of MIGS as a surrogate marker of relevance and appropriateness to policy-makers and ophthalmologists alike.

Materials and Methods:
To identify potentially relevant CPGs, a predefined search strategy was used to search the following databases: Medline, EMBASE, BIOSIS, and Web of Science. All CPGs related to adult glaucoma and published in English were included. CPG methodological quality was assessed by 3 individuals using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Studies were then assessed for coverage of MIGS devices and procedures.

Results:
Search strategy and subsequent screening identified 11 CPGs for analysis. Eight were of high quality according to the AGREE II criteria. Three included basic information on MIGS, but none provided specific recommendations regarding their indications or which patient populations would benefit most.

Conclusions:
Many international glaucoma CPGs are of high methodological quality. However, coverage of MIGS is sparse, nonspecific and in many instances, absent. This causes CPGs to be a suboptimal source in guiding physicians and health policy-makers in areas characterized by novel and/or rapidly evolving technologies. Mechanisms to incorporate updated evidence in CPGs would have to be considered before they can be used as a source of contemporary clinical decision-making.
Mrgprs activation is required for chronic itch conditions in mice
Authors: Zhu Yuyan , Hanson Claire E. , Liu Qin , Han Liang 
Published: November 2017

Introduction:
Chronic itch has been drawing much attention due to its clinical significance and the complexity of its mechanisms. To facilitate the development of anti-itch strategies, it is necessary to investigate the key players in itch sensation under chronic itch conditions. Several members of the Mrgpr family were identified as itch receptors that detect cutaneous pruritogens in primary sensory neurons. However, the role of Mrgprs in chronic itch conditions has not been well described.

Methods:
Scratching behaviors of Wildtype and Mrgpr-clusterΔ

−/−
mice were examined in dry skin model and contact dermatitis model to examine the role of Mrgpr genes in mediating chronic itch sensation. Scratching behaviors of the mice were also examined in allergic itch model. Real-time polymerase chain reaction were performed to examine the expression level of MrgprA3 and MrgprC11 under naive and dry skin conditions. The MrgprA3+ itch-sensing fibers were labeled by tdTomato fluorescence in Mrgpra3

GFP-Cre
; ROSA26

tdTomato
mice, and the morphology and density of those fibers in the epidermis were analyzed under dry skin condition.

Results:
We showed that deleting a cluster of Mrgpr genes in mice reduced scratching behavior severely under 2 chronic itch conditions, namely dry skin and contact dermatitis, and the allergic itch condition. Moreover, the gene expressions of itch receptors MrgprA3 and MrgprC11 in dorsal root ganglia were upregulated significantly under dry skin condition. Consistently, the percentage of MrgprA3+ itch-sensing neurons was increased as well. We also observed hyperinnervation of MrgprA3+ itch-sensing fibers in the epidermis of the skin under dry skin condition.

Discussion:
We demonstrate that Mrgprs play important roles in mediating chronic itch and allergic itch. These findings enrich our knowledge of itch mechanism and may lead to the development of novel therapeutic approach to combat itch.
Molecular Characterization of Markers Associated With Antimicrobial Resistance in Neisseria gonorrhoeae Identified From Residual Clinical Samples
Authors: Melendez Johan H. , Hardick Justin , Barnes Mathilda , Barnes Perry , Geddes Christopher D. , Gaydos Charlotte A. 
Published: November 2017

Background
The emergence and spread of antimicrobial-resistant (AMR) Neisseria gonorrhoeae (NG) is a major public health concern. In the era of nucleic acid amplifications tests, rapid and accurate molecular approaches are needed to help increase surveillance, guide antimicrobial stewardship, and prevent outbreaks.

Methods
Residual urethral swabs, collected prospectively in the Baltimore City Health Department during a 6-month period, were analyzed by real-time polymerase chain reaction assays for NG DNA and AMR determinants to fluoroquinolones, penicillin, and extended-spectrum cephalosporins.

Results

N. gonorrhoeae DNA was detected in 34.8% (73/210) of samples, including 67.3% (68/101) of the swabs that had been previously identified as NG positive by culture. Markers associated with decreased susceptibility to fluoroquinolones were detected in 22.4% of the polymerase chain reaction NG-positive samples. The rate of penicillinase-producing NG was very low (1.6%), and no markers associated with decreased susceptibility to extended-spectrum cephalosporins were detected in this cohort of men using the AMR assays herein described.

Conclusions
Detection of molecular markers associated with AMR in NG can be performed directly from residual clinical samples, although the recovery rate of adequate DNA for molecular testing from these samples can be suboptimal. A high number of samples with mutations associated with decreased susceptibility to fluoroquinolones were identified.
Association Between Sensorimotor Impairments and Functional Brain Changes in Patients With Low Back Pain
Authors: Goossens Nina , Rummens Sofie , Janssens Lotte , Caeyenberghs Karen , Brumagne Simon 
Published: November 2017

Abstract
Low back pain (LBP) coincides with sensorimotor impairments, for example, reduced lumbosacral tactile and proprioceptive acuity and postural control deficits. Recent functional magnetic resonance imaging studies suggest that sensorimotor impairments in LBP may be associated with brain changes. However, no consensus exists regarding the relationship between functional brain changes and sensorimotor behavior in LBP. Therefore, this review critically discusses the available functional magnetic resonance imaging studies on brain activation related to nonnociceptive somatosensory stimulation and motor performance in individuals with LBP. Four electronic databases were searched, yielding nine relevant studies. Patients with LBP showed reduced sensorimotor-related brain activation and a reorganized lumbar spine representation in higher-order (multi)sensory processing and motor regions, including primary and secondary somatosensory cortices, supplementary motor area, and superior temporal gyrus. These results may support behavioral findings of sensorimotor impairments in LBP. In addition, patients with LBP displayed widespread increased sensorimotor-evoked brain activation in regions often associated with abnormal pain processing. Overactivation in these regions could indicate an overresponsiveness to sensory inputs that signal potential harm to the spine, thereby inducing overgeneralized protective responses. Hence, functional brain changes could contribute to the development and recurrence of LBP. However, future studies investigating the causality between sensorimotor-related brain function and LBP are imperative.
The Role of Real-Time Sonoelastography in the Differentiation of Benign From Malignant Parotid Gland Tumors
Authors: Cortcu Sumeyra , Elmali Muzaffer , Tanrivermis Sayit Asli , Terzi Yuksel 
Published: November 2017

Objective
The aims of this study are to evaluate the utility of sonoelastography for parotid gland masses and to determine which cutoff strain ratio (SR) would be best for the differentiation between benign and malignant lesions.

Methods
From August 2015 to December 2016, 39 parotid gland masses were examined prospectively by ultrasonography and strain sonoelastography. Elastographic scores were determined by a 4-point scoring method. Interventional procedures were performed on all patients after sonographic examinations. The lesions were divided into groups as benign or malignant according to histopathological findings. The difference in elastographic scores between benign and malignant masses was evaluated.

Results
Among the 39 parotid gland masses, 33 (84.6%) were benign and 6 (15.3%) were malignant tumors with 53.8% (n = 21) of the lesions being on the right side. Pleomorphic adenoma (41%) was the most common neoplasm followed by Warthin tumor (28.2%). The median elastographic score was 2 (range, 1–3) for benign tumors, and it was 3 (range, 2–4) (P = 0.003) for malignant tumors. Median SR was 1.11 (range, 0.26–2.15), and it was 2.75 (range, 1.03–3.54) (P = 0.01) for benign and malignant tumors. In the receiver operating characteristic analysis, the cutoff value of the SR was 2.1, sensitivity was 83.3%, specificity was 97%, positive predictive value was 83.3%, negative predictive value was 97%, and accuracy was 94%.

Conclusions
There was a statistically significant difference between benign lesions and malignant lesions in both elastography score and SR. It is possible that elastography can improve the noninvasive diagnostic accuracy for certain pathological conditions.