bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Etiology of Male Urethral Discharge in Zimbabwe: Results from the Zimbabwe STI Etiology Study
Authors: Rietmeijer Cornelis A. , Mungati More , Machiha Anna , Mugurungi Owen , Kupara Vitalis , Rodgers Luanne , Kilmarx Peter H. , Roloff Amy Herman , Gonese Elizabeth , Tippett-Barr Beth A. , Shambira Gerald , Lewis David A. , Handsfield H. Hunter , Tshimanga Mufuta 
Published: September 2017

Introduction
Sexually transmitted infections (STIs) are managed syndromically in most developing countries. In Zimbabwe, men presenting with urethral discharge are treated with a single intramuscular dose of kanamycin or ceftriaxone in combination with a week’s course of oral doxycycline. This study was designed to assess the current etiology of urethral discharge and other STIs to inform current syndromic management regimens.

Methods
We conducted a study among 200 men with urethral discharge presenting at 6 regionally diverse STI clinics in Zimbabwe. Urethral specimens were tested by multiplex polymerase chain reaction testing for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis. In addition, serologic testing for syphilis and HIV was performed.

Results
Among the 200 studied men, one or more pathogens were identified in 163 (81.5%) men, including N. gonorrhoeae in 147 (73.5%), C. trachomatis in 45 (22.5%), T. vaginalis in 8 (4.0%), and M. genitalium in 7 (3.5%). Among all men, 121 (60%) had a single infection, 40 (20%) had dual infections, and 2 (1%) had 3 infections. Among the 45 men with C. trachomatis, 36 (80%) were coinfected with N. gonorrhoeae. Overall, 156 (78%) men had either N. gonorrhoeae or C. trachomatis identified. Of 151 men who consented to HIV testing, 43 (28.5%) tested positive. There were no differences in HIV status by study site or by urethral pathogen detected.

Conclusions
Among men presenting at Zimbabwe STI clinics with urethral discharge, N. gonorrhoeae and C. trachomatis are the most commonly associated pathogens. Current syndromic management guidelines seem to be adequate for the treatment for symptomatic men, but future guidelines must be informed by ongoing monitoring of gonococcal resistance.
The Significance of Arachnoid Granulation in Patients With Idiopathic Intracranial Hypertension
Authors: Watane Gaurav Vishwasrao , Patel Bhumi , Brown Derek , Taheri M. Reza 
Published: September 2017

Purpose
The aim of this article was to study the significance of arachnoid granulations (AGs) in patients with idiopathic intracranial hypertension (IIH).

Methods
In an institutional review board–approved retrospective chart review study, 79 patients with clinical diagnosis of idiopathic increased intracranial pressure were compared with 63 patients with a diagnosis of multiple sclerosis. Inclusion criteria also included available magnetic resonance imaging (MRI) of the brain, older than 18 years, and female sex. Patients with elevated intracranial pressure due to other causes were excluded. The electronic medical records were mined for presence of the following: body mass index, age, headache, vision changes, tinnitus, and vertigo. The MRI of the brain was reviewed for the presence of the following features: empty sella, prominent cerebrospinal fluid space in the optic sheaths, tortuosity of the optic nerves and enlarged Meckel cave. In addition, the number, size, and location of AGs associated with major venous drainage sinuses were documented in all patients. Using statistical analysis, association between various imaging and clinical signs were evaluated.

Results
The association between AG and various imaging and clinical signs were evaluated. The percentage of patients with AG were significantly higher in patients with IIH. Patients with IIH tended to have 0 to 3 AG. The most common imaging findings observed in MRI of the brain of patients with IIH were empty sella and prominent cerebrospinal fluid space in the optic sheaths. The prevalence of these MRI findings in patients with IIH was inversely proportional to the number of AG. A similar inverse trend was also noted with the opening pressure of patients with IIH and number of AG.

Conclusions
The study establishes that there is a relationship between presence of AG and IIH. Arachnoid granulation seems to act in a compensatory mechanism in patients with IIH.
Iterative Metallic Artifact Reduction for In-Plane Gonadal Shielding During Computed Tomographic Venography of Young Males
Authors: Choi Jin Woo , Lee Sang Yub , Kim Jong Hyo , Jin Hyeongmin , Lee Jaewon , Choi Young Hun , Lee Hyeon-Kyeong , Park Jae Hyung 
Published: September 2017

Objective
The purpose of this study was to evaluate a gonadal shield (GS) and iterative metallic artifact reduction (IMAR) during computed tomography scans, regarding the image quality and radiation dose.

Methods
A phantom was imaged with and without a GS. Prospectively enrolled, young male patients underwent lower extremity computed tomography venography (precontrast imaging without the GS and postcontrast imaging with the GS). Radiation dose was measured each time, and the GS-applied images were reconstructed by weighted filtered back projection and IMAR.

Results
In the phantom study, image artifacts were significantly reduced by using IMAR (P = 0.031), whereas the GS reduced the radiation dose by 61.3%. In the clinical study (n = 29), IMAR mitigated artifacts from the GS, thus 96.6% of the IMAR image sets were clinically usable. Gonadal shielding reduced the radiation dose to the testes by 69.0%.

Conclusions
The GS in conjunction with IMAR significantly reduced the radiation dose to the testes while maintaining the image quality.
Magnetic Resonance Imaging of the Soft Tissue Vascular Anomalies in Torso and Extremities in Children: An Update With 2014 International Society for the Study of Vascular Anomalies Classification
Authors: Snyder Elizabeth , Puttgen Kate , Mitchell Sally , Ahlawat Shivani , Tekes Aylin 
Published: September 2017

Abstract
Vascular anomalies can occur anywhere in the body, and the majority present in the pediatric population. Accurate classification is essential for proper clinical evaluation, particularly because multidisciplinary care is often required. The International Society for the Study of Vascular Anomalies classification offers a comprehensive classification for all subspecialties. In this review article, we present a magnetic resonance imaging protocol with exemplary cases of the most common types of vascular anomalies in the pediatric trunk and extremities using the current International Society for the Study of Vascular Anomalies classification.
Improved Calcium Scoring at Dual-Energy Computed Tomography Angiography Using a High-Z Contrast Element and Novel Material Separation Technique
Authors: Lambert Jack W. , Sun Yuxin , Ordovas Karen G. , Gould Robert G. , Wang Sizhe , Yeh Benjamin M. 
Published: September 2017

Objectives
The aim of this study was to compare the accuracy of existing dual-energy computed tomography (CT) angiography coronary artery calcium scoring methods to those obtained using an experimental tungsten-based contrast material and a recently described contrast material extraction process (CMEP).

Methods
Phantom coronary arteries of varied diameters, with different densities and arcs of simulated calcified plaque, were sequentially filled with water, iodine, and tungsten contrast materials and scanned within a thorax phantom at rapid-kVp-switching dual-energy CT. Calcium and contrast density images were obtained by material decomposition (MD) and CMEP. Relative calcium scoring errors among the 4 reconstructed datasets were compared with a ground truth, 120-kVp dataset.

Results
Compared with the 120-kVp dataset, tungsten CMEP showed a significantly lower mean absolute error in calcium score (6.2%, P < 0.001) than iodine CMEP, tungsten MD, and iodine MD (9.9%, 15.7%, and 40.8%, respectively).

Conclusions
Novel contrast elements and material separation techniques offer improved coronary artery calcium scoring accuracy and show potential to improve the use of dual-energy CT angiography in a clinical setting.
Patient Burden of Axial Spondyloarthritis
Authors: Strand Vibeke , Singh Jasvinder A. 
Published: September 2017

Abstract
Axial spondyloarthritis (AxSpA) is an inflammatory spondyloarthritis (SpA) that has significant impact on a patient's life. Symptoms, including fatigue, sleep problems, depression, and sexual dysfunction, can profoundly impact health-related quality of life (HRQoL) and limit work, leisure, and daily activities. Available therapies effectively manage pain and inflammation in early-stage disease, but patients often continue to experience impaired HRQoL. Thus, there remains a need for new therapies with novel mechanisms that can stop disease progression, potentially reverse damage caused by AxSpA and improve HRQoL in patients with AxSpA. Newer biologic agents, such as those targeting the interleukin 17–interleukin 23 axis, have promising efficacy and may improve HRQoL for patients with AxSpA. The AxSpA has many negative effects on HRQoL. By targeting disease pathways responsible for the development of AxSpA, approved and emerging therapies potentially reduce disease activity and improve the functional status of patients with AxSpA. This narrative review reflects on the findings of studies evaluating HRQoL of individuals with AxSpA and the role of newer therapies.
Conical Modification of Forearm Free Flaps for Single-Stage Reconstruction After Total Orbital Exenteration
Authors: Purnell Chad A. , Vaca Elbert E. , Ellis Marco F. 
Published: September 2017

Background:
Orbital exenteration is a significant reconstructive challenge for plastic surgeons. Options described for these defects range from healing by secondary intention to free tissue transfer. The authors present our preferred reconstruction of orbital defects with free forearm-based flaps, which provides quality soft tissue and orbital contouring in 1 stage to consistently allow placement of bone-anchored implants for eventual orbital prosthesis.

Methods:
This conical shape of the orbit is deconstructed into a “Pac-Man” type shaped flap that leaves adequate depth for a prosthesis. A retrospective chart review was performed of 2 separate patients receiving orbital exenteration reconstruction by the senior author (MFE).

Results:
Two patients presented with adenoid cystic carcinoma of the orbit. Both patients underwent nonlid sparing orbital exenteration with adjuvant chemotherapy and radiation. Each patient subsequently developed delayed wound healing after prior local flap reconstruction. Vascularized radial forearm flaps in a Pac-Man shape were used in both patients. Both patients were discharged from the hospital on postoperative day 3. No partial or total flap loss was encountered. To date, each patient has undergone planning for osseointegrated implants.

Conclusion:
The authors present a simplified method of orbital reconstruction that provides high-quality vascularized tissue for resurfacing in 1 stage. This type of open-cavity flap reconstruction avoids the need for flap debulking procedures and facilitates 2-stage placement of osseointegrated implants.
Thoracic irrigation prevents retained hemothorax: A prospective propensity scored analysis
Authors: Kugler Nathan W. , Carver Thomas W. , Milia David , Paul Jasmeet S. 
Published: September 2017

BACKGROUND
Thoracic trauma resulting in hemothorax (HTx) is typically managed with thoracostomy tube (TT) placement; however, up to 20% of patients develop retained HTx which may necessitate further intervention for definitive management. Although optimal management of retained HTx has been extensively researched, little is known about prevention of this complication. We hypothesized that thoracic irrigation at the time of TT placement would significantly decrease the rate of retained HTx necessitating secondary intervention.

METHODS
A prospective, comparative study of patients with traumatic HTx who underwent bedside TT placement was conducted. The control group consisted of patients who underwent standard TT placement, whereas the irrigation group underwent standard TT placement with immediate irrigation using 1 L of warmed sterile 0.9% saline. Patients who underwent emergency thoracotomy, those with TTs removed within 24 hours, or those who died within 30 days of discharge were excluded. The primary end point was secondary intervention defined by additional TT placement or operative management for retained HTx. A propensity-matched analysis was performed with scores estimated using a logistic regression model based on age, sex, mechanism of injury, Abbreviated Injury Scale chest score, and TT size.

RESULTS
In over a 30-month period, a total of 296 patients underwent TT placement for the management of traumatic HTx. Patients were predominantly male (79.6%) at a median age of 40 years and were evenly split between blunt (48.8%) and penetrating (51.2%) mechanisms. Sixty (20%) patients underwent thoracic irrigation at time of initial TT placement. The secondary intervention rate was significantly lower within the study group (5.6% vs. 21.8%; OR, 0.16; p < 0.001). No significant differences in TT duration, ventilator days, or length of stay were noted between the irrigation and control cohort.

CONCLUSION
Thoracic irrigation at the time of initial TT placement for traumatic HTx significantly reduced the need for secondary intervention for retained HTx.

LEVEL OF EVIDENCE
Therapeutic Study, Level III.
Electroconvulsive Therapy for Super Refractory Status Epilepticus
Authors: Ahmed Jayme , Metrick Michael , Gilbert Anne , Glasson Anita , Singh Ranjeet , Ambrous Wayne , Brown Lori , Aykroyd Laura , Bobel Karen 
Published: September 2017

Objectives
Super refractory status epilepticus (SRSE) is a stage beyond refractory status that requires general anesthesia as management. Electroconvulsive therapy (ECT) is recommended only as a potential treatment option beyond general anesthesia and after all other options have been exhausted. Its effect on aborting status has been minimally researched. We present the largest case series to our knowledge exploring the effect of ECT on SRSE.

Methods
Eight adults hospitalized for SRSE received ECT in an attempt to abort status after other treatment modalities were exhausted. Electroconvulsive therapy consisted of a 504-mC (≈99.4 J) stimulus delivered bifrontotemporally with a constant 0.5-millisecond pulse width. Seizure activity during ECT was monitored visually and correlated to the single-channel recording provided by the apparatus.

Results
There was neurotelemetry or clinical evidence of improvement within 24 hours after the full course of ECT treatment in 5 (63%) of the 8 cases. Cases that improved were given an average of 7.8 total ECT stimulations, eliciting an average of 4.2 total seizures.

Conclusions
Although it is difficult to determine the exact role of ECT in the improvement of 63% of our cases, we present a series of patients for whom pharmacotherapy, ketogenic diet, and general anesthesia otherwise did not produce an appreciable effect on status prior to implementation of ECT. These findings suggest that cases of SRSE may benefit from ECT administration.
A Randomized, Nonblind, Naturalistic Comparison of Efficacy and Cognitive Outcomes With Right Unilateral, Bifrontal, and Bitemporal Electroconvulsive Therapy in Schizophrenia
Authors: Bansod Aniket , Sonavane Sushma S. , Shah Nilesh B. , De Sousa Avinash A. , Andrade Chittaranjan 
Published: September 2017

Background
There is little literature on the relative efficacy and cognitive safety of right unilateral (RUL), bifrontal (BF), and bitemporal (BT) electroconvulsive therapy (ECT) in schizophrenia.

Methods
We present a randomized, nonblind, naturalist comparison of a fixed course of 8 moderately high-dose RUL (n = 24), threshold BF (n = 27), and threshold BT (n = 31) ECT in patients with schizophrenia. Assessments included the Positive and Negative Syndrome Scale (PANSS), the Wechsler Memory Scale—Revised, and an autobiographical memory interview. A completer analysis was planned and conducted to capture the cognitive outcomes.

Results
The sample as a whole improved significantly on all efficacy outcomes and deteriorated significantly on all cognitive outcomes. The primary efficacy outcome, improvement in PANSS total scores, did not differ significantly across groups. The PANSS positive score (but no other subscale score) improved significantly less with RUL relative to BF and BT ECT. For autobiographical memory and for almost all Wechsler Memory Scale subtests, including memory quotient (the primary adverse effect outcome), BT ECT was associated with greater impairment than RUL or BF ECT. Importantly, all statistically significant differences between treatments were clinically small in magnitude.

Conclusions
In patients with schizophrenia who receive a fixed course of 8 ECTs, threshold BT ECT is associated with greater cognitive impairment across a range of measures, and moderately high-dose RUL ECT is associated with poorer efficacy against positive symptoms. Threshold BF ECT exhibits the best efficacy-cum-neurocognitive safety profile. All differences between groups, however, are small and perhaps clinically insignificant.
Harnessing the adaptive potential of mechanoresponsive proteins to overwhelm pancreatic cancer dissemination and invasion
Authors: Surcel Alexandra , Schiffhauer Eric , Thomas Dustin , Zhu Qingfeng , DiNapoli Kathleen , Herbig Maik , Otto Oliver , Guck Jochen , Jaffee Elizabeth , Iglesias Pablo , Anders Robert , Robinson Douglas 
Published: September 2017

AbstractMetastatic disease is often characterized by altered cellular contractility and deformability, lending cells and groups of cells the flexibility to navigate through different microenvironments. This ability to change cell shape is driven in large part by the structural elements of the mechanobiome, which includes cytoskeletal proteins that sense and respond to mechanical stimuli. Here, we demonstrate that key mechanoresponsive proteins (those which accumulate in response to mechanical stress), specifically nonmuscle myosin IIA and IIC, α-actinin 4, and filamin B, are highly upregulated in pancreatic ductal adenocarcinoma cancer (PDAC) and in patient-derived pancreatic cancer cell lines. Their less responsive sister paralogs (myosin IIB, α-actinin 1, and filamin A) show a smaller dynamic range or disappear with PDAC progression. We demonstrate that these mechanoresponsive proteins directly impact cell mechanics using knock-down and overexpression cell lines. We further quantify the nonmuscle myosin II family members in patient-derived cell lines and identify a role for myosin IIC in the formation of transverse actin arcs in single cells and cortical actin belts in tissue spheroids. We harness the upregulation of myosin IIC and its impact of cytoskeletal architecture through the use of the mechanical modulator 4-hydroxyacetophenone (4-HAP), which increases myosin IIC assembly and stiffens cells. Here, 4-HAP decreases dissemination, induces cortical actin belts, and slows retrograde actin flow in spheroids. Finally, mice having undergone hemi-splenectomies with PDAC cells and then treated with 4-HAP have a reduction in liver metastases. Thus, increasing the activity of these mechanoresponsive proteins (in this case, by increasing myosin IIC assembly) to overwhelm the ability of cells to polarize and invade may be an effective strategy to improve the five-year survival rate of pancreatic cancer patients, currently hovering around 6%.
The Cell-Cycle Transcriptional Network Generates and Transmits a Pulse of Transcription Once Each Cell Cycle
Authors: Cho Chun-Yi , Kelliher Christina M. , Haase Steven B. 
Published: September 2017

SUMMARYMultiple studies have suggested the critical roles of cyclin-dependent kinases (CDKs) as well as a transcription factor (TF) network in generating the robust cell-cycle transcriptional program. However, the precise mechanisms by which these components function together in the gene regulatory network remain unclear. Here we show that the TF network can generate and transmit a “pulse” of transcription independently of CDK oscillations. The premature firing of the transcriptional pulse is prevented by early G1 inhibitors, including transcriptional corepressors and the E3 ubiquitin ligase complex APCCdh1. We demonstrate that G1 cyclin-CDKs facilitate the activation and accumulation of TF proteins in S/G2/M phases through inhibiting G1 transcriptional corepressors (Whi5 and Stb1) and APCCdh1, thereby promoting the initiation and propagation of the pulse by the TF network. These findings suggest a unique oscillatory mechanism in which global phase-specific transcription emerges from a pulse-generating network that fires once-and-only-once at the start of the cycle.
CXCR4-associated depletion of bone marrow CD34+cells following CCR5-tropic HIV-1 infection of humanized NOD/SCID/JAK3nullmice and partial protection of those cells by a promotor-targeting shRNA
Authors: Tsukamoto Tetsuo 
Published: September 2017

AbstractObjectivesHematological abnormalities that include changes in bone marrow, such as in anemia and pancytopenia, are common among human immunodeficiency virus (HIV)-infected patients, particularly in the advanced stage of disease. This study aimed to provide better experimental evidence of such manifestations in animal models.DesignNOD/SCID/JAK3null(NOJ) mice were transplanted with human cord-derived CD34+cells with or without transduction with a lentiviral vector expressing a promoter-targeting shRNA called PromA.MethodsAt 16 weeks after transplantation, mice engrafted with CD34+cells were infected with CCR5-tropic HIV-1JRFL.ResultsAt week 2 post infection, HIV replication was observed in peripheral blood mononuclear cells and splenocytes. In mice transplanted with unmanipulated CD34+cells, viral replication was accompanied by a loss of peripheral/spleen CD4+CCR5+T cells. Interestingly, bone marrow CD34+cells in HIV-infected mice were also depleted, but in a CXCR4-associated manner. Conversely, the lentiviral transfer of PromA in CD34+cells prior to transplantation rendered the humanized NOJ mice resistant to HIV replication in CD4+T cells, resulting in better preservation of peripheral/spleen CD4+CCR5+T cells and bone marrow CD34+cells at two weeks after infection.ConclusionsThese results implicate the importance of evaluating hematopoietic stem/progenitor cell pools in addition to peripheral CD4+T-cell counts to assess the early stage of HIV infection. Moreover, stable gene transfer of PromA to hematopoietic stem cells not only limited HIV replication but also led to preservation of different subsets of hematopoietic cells, including bone marrow stem/progenitor cells.