bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Weekend Presentation on Short-Term Outcomes and Choice of Clipping vs Coiling in Subarachnoid Hemorrhage
Authors: Pandey Aditya S. , Wilkinson D. Andrew , Gemmete Joseph J. , Chaudhary Neeraj , Thompson B. Gregory , Burke James F. 
Published: April 2017

Abstract

BACKGROUND: Presentation on a weekend is commonly associated with higher mortality and a decreased likelihood of receiving invasive procedures.

OBJECTIVE: To determine whether weekend presentation influences mortality, discharge destination, or type of treatment received (clip vs coil) in subarachnoid hemorrhage (SAH).

METHODS: We performed a serial cross-sectional retrospective study using the Nationwide Inpatient Sample. All adult discharges with a primary diagnosis of SAH (ICD-9-CM 435) from 2005 to 2010 were included, and records with trauma or arteriovenous malformation were excluded. Unadjusted and adjusted associations between weekend presentation and 3 outcomes (in-hospital mortality, discharge destination, and treatment with clip vs coil) were estimated using chi-square tests and multilevel logistic regression.

RESULTS: A total of 46 093 admissions for nontraumatic SAH were included in the sample; 24.6% presented on a weekend, 68.9% on a weekday, and 6.5% had unknown day of presentation. Weekend admission was not a significant predictor of inpatient mortality (25.4% weekend vs 24.9% weekday; P = .44), or a combined poor outcome measure of mortality or discharge to long-term acute care or hospice (30.3% weekend vs 29.4% weekday; P = .23). Among those treated for aneurysm obliteration, the proportion of clipped vs coiled did not change with weekend vs weekday presentation (21.5% clipped with weekend presentation vs 21.6% weekday, P = .95; 21.5% coiled with weekend presentation vs 22.4% weekday, P = .19).

CONCLUSION: Presentation with nontraumatic SAH on a weekend did not influence mortality, discharge destination, or type of treatment received (clip vs coil) compared with weekday presentation.
Recent advances on the total synthesis of alkaloids in mainland China
Authors: Li Yong , Li Jian , Ding Hanfeng , Li Ang 
Published: April 2017

AbstractAlkaloids are a large family of natural products that mostly contain basic nitrogen atoms. Because of their intriguing structures and important functions, they have long been popular targets for synthetic organic chemists. China's chemists have made significant progress in the area of alkaloid synthesis over past decades. In this article, selected total syntheses of alkaloids from research groups in mainland China during the period 2011–16 are highlighted.
The Hip Fracture Patient on Warfarin: Evaluating Blood Loss and Time to Surgery
Authors: Cohn Matthew R. , Levack Ashley E. , Trivedi Nikunj N. , Villa Jordan C. , Wellman David S. , Lyden John P. , Lorich Dean G. , Lane Joseph M. 
Published: April 2017

Objectives:
To compare blood loss, delay of surgery, and short-term adverse events in (1) patients admitted on warfarin versus nonanticoagulated controls and (2) warfarin patients with day of surgery (DOS) international normalized ratio (INR) of 1.5 or greater versus below 1.5.

Design:
Retrospective cohort.

Setting:
Academic Level I trauma center.

Patients/Participants:
One hundred twenty four patients treated surgically for hip fractures including patients presenting on warfarin (n = 62) and matched controls (n = 62).

Intervention:
Cephalomedullary nailing (CMN), hemiarthroplasty, or total hip arthroplasty.

Main Outcome Measures:
The primary outcome was transfusion rate. Secondary outcomes included calculated blood loss, 30-day complication rate, and hours from emergency department presentation to surgery.

Results:
There was no significant difference in blood transfusion rates between the warfarin and control groups (P = 0.86). Blood transfusion was required in 58.1% of patients in the warfarin group (48.3% of arthroplasties and 65.5% of CMNs) compared with 56.6% of controls (41.9% of arthroplasties and 73.3% of CMNs). There were also no significant differences in calculated blood loss or in complication rates. Patients on warfarin had significantly longer time to surgery (P < 0.01). Subanalysis of the warfarin group showed that patients with DOS INR at or above 1.5 had similar transfusion rates, blood loss, and complications compared with patients with INR below 1.5. Treatment with CMN was the only covariate that was found to be a significant independent predictor of transfusion on multivariable analysis (P = 0.048).

Conclusions:
Patients with hip fractures admitted on warfarin seem to be at similar risk of transfusion or adverse events compared with nonanticoagulated patients. Awaiting normalization of INR delayed surgery without reducing bleeding or preventing complications. Within reason, surgeons may consider proceeding with surgery in patients with INR above 1.5 if patients are otherwise medically optimized. The upper limit above which surgery causes increased blood loss is currently unknown.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Clinical Utility of Flexion-extension Cervical Spine MRI in 22q11.2 Deletion Syndrome
Authors: Kolman Samuel E. , Ohara Stephanie Y. , Bhatia Aashim , Feygin Tamara , Colo Dino , Baldwin Keith D. , Mcdonald-Mcginn Donna , Spiegel David A. 
Published: April 2017

Background:
Our goal is to correlate the findings on flexion and extension radiographs with dynamic magnetic resonance imaging (MRI), and the clinical history, in a nonrandomly selected cohort of patients with 22q11.2 deletion syndrome (22q).

Methods:
All patients with the 22q who had a dynamic MRI from January 2004 to March 2015 were included. We analyzed multiple radiographic measurements on both the dynamic plain films and the MRIs, and correlated these findings with a review of each patient’s medical record.

Results:
Multiple congenital anomalies were identified as noted in previous studies, and 61% of the patients had a failure of fusion of the anterior (n=2, 9%), posterior (n=2, 9%), or anterior and posterior arches (n=10, 43%). Quantitative measurements were impossible to report with certainty because of the upper cervical anomalies, and no cases of instability were identified using a qualitative assessment. We identified spinal cord encroachment (30%) and impingement (18%); however, none of the patients had any signal change in their spinal cord. None of these findings could be definitively correlated with any clinical symptoms. A single patient was diagnosed with a Chiari I malformation, while another had cerebellar ectopia.

Conclusions:
Although the upper cervical anomalies are extremely common in 22q, we did not identify cases of instability on dynamic plain radiographs and MRI. Although our findings do not support routine screening with flexion and extension MRI, this study may be required in patients with neurological symptoms and/or findings or abnormalities on dynamic plain radiographs.

Level of Evidence:
Level III.
Hemolysis Following Intraoperative Cell Salvage Replacement in a Scoliosis Patient With Sickle Cell Trait
Authors: You Daniel , Peiro-Garcia Alejandro , Ferri-de-Barros Fabio , Parsons David 
Published: April 2017

Study Design.
Case report.

Objective.
To describe a novel presentation of acute renal failure associated with hemolysis after intraoperative cell salvage (ICS) in a neuromuscular scoliosis patient with sickle cell trait (SCT).

Summary of Background Data.
Hemolysis-associated acute renal failure after ICS in patients with SCT has not been previously reported. Sickle cell disease is regarded as a relative contraindication for ICS due to the risk of red blood cell sickling in the hypoxic cell saver reservoir. A previous case series demonstrated successful ICS reinfusion after elective caesarean section in two patients with SCT. However, a decision to not reinfuse ICS collected blood due to increased sickling after blood processing was reported in general surgery.

Methods.
A 14-year-old female with Group I neuromuscular scoliosis underwent a navigated T3-S1posterior spinal instrumentation fusion. Three hundred milliliters of blood collected by ICS was reinfused intraoperatively along with two units of packed red blood cells.

Results.
Postoperatively, the patient had delayed emergence from the general anesthetic and gross hematuria was observed in the urinary catheter bag. The patient was transferred to the intensive care unit and was treated successfully for hemolysis-induced renal failure.

Conclusion.
Given the potential seriousness of hemolysis-associated acute renal failure associated with ICS, we recommend against the use of ICS in patients with SCT.

Level of Evidence: 5
Clinical Evidence for Spinal Cord Stimulation for Failed Back Surgery Syndrome (FBSS)
Authors: Kapural Leonardo , Peterson Erika , Provenzano David A. , Staats Peter 
Published: April 2017

Study Design.
A systematic review.

Objective.
A systematic literature review of the clinical data from prospective studies was undertaken to assess the efficacy of spinal cord stimulation (SCS) in the treatment of failed back surgery syndrome (FBSS) in adults.

Summary of Background Data.
For patients with unrelenting back pain due to mechanical instability of the spine, degenerative disc disease, spinal injury, or deformity, spinal surgery is a well-accepted treatment option; however, even after surgical intervention, many patients continue to experience chronic back pain that can be notoriously difficult to treat. Clinical evidence suggests that for patients with FBSS, repeated surgery will not likely offer relief. Additionally, evidence suggests long-term use of opioid pain medications is not effective in this population, likely presents additional complications, and requires strict management.

Methods.
A systematic literature review was performed using several bibliographic databases, prospective studies in adults using SCS for FBSS were included.

Results and Conclusion.
SCS has been shown to be a safe and efficacious treatment for this patient population. Recent technological developments in SCS offer even greater pain relief to patients’ refractory to other treatment options, allowing patients to regain functionality and improve their quality of life with significant reductions in pain.

Level of Evidence: N/A
Noninvasive iPhone Measurement of Left Ventricular Ejection Fraction Using Intrinsic Frequency Methodology*
Authors: Pahlevan Niema M. , Rinderknecht Derek G. , Tavallali Peyman , Razavi Marianne , Tran Thao T. , Fong Michael W. , Kloner Robert A. , Csete Marie , Gharib Morteza 
Published: April 2017

Objective:
The study is based on previously reported mathematical analysis of arterial waveform that extracts hidden oscillations in the waveform that we called intrinsic frequencies. The goal of this clinical study was to compare the accuracy of left ventricular ejection fraction derived from intrinsic frequencies noninvasively versus left ventricular ejection fraction obtained with cardiac MRI, the most accurate method for left ventricular ejection fraction measurement.

Design:
After informed consent, in one visit, subjects underwent cardiac MRI examination and noninvasive capture of a carotid waveform using an iPhone camera (The waveform is captured using a custom app that constructs the waveform from skin displacement images during the cardiac cycle.). The waveform was analyzed using intrinsic frequency algorithm.

Setting:
Outpatient MRI facility.

Subjects:
Adults able to undergo MRI were referred by local physicians or self-referred in response to local advertisement and included patients with heart failure with reduced ejection fraction diagnosed by a cardiologist.

Interventions:
Standard cardiac MRI sequences were used, with periodic breath holding for image stabilization. To minimize motion artifact, the iPhone camera was held in a cradle over the carotid artery during iPhone measurements.

Measurements and Main Results:
Regardless of neck morphology, carotid waveforms were captured in all subjects, within seconds to minutes. Seventy-two patients were studied, ranging in age from 20 to 92 years old. The main endpoint of analysis was left ventricular ejection fraction; overall, the correlation between ejection fraction–iPhone and ejection fraction–MRI was 0.74 (r = 0.74; p < 0.0001; ejection fraction–MRI = 0.93 × [ejection fraction–iPhone] + 1.9).

Conclusions:
Analysis of carotid waveforms using intrinsic frequency methods can be used to document left ventricular ejection fraction with accuracy comparable with that of MRI. The measurements require no training to perform or interpret, no calibration, and can be repeated at the bedside to generate almost continuous analysis of left ventricular ejection fraction without arterial cannulation.
Preclinical models for translational sarcoma research
Authors: Hamacher Rainer , Bauer Sebastian 
Published: April 2017

Purpose of review
Sarcoma is a basket term for mesenchymal tumors for which more than 75 genetically and histologically distinct subtypes are recognized. Therapeutic progress has largely been achieved with classical chemotherapeutic drugs that were tested in empirical clinical trials. However, outcome in metastatic patients remains poor and with few exceptions numerous trials have failed or only provided limited improvement in recent years.

Recent findings
Given the genomic heterogeneity, preclinical model systems will be indispensable to identify new molecular targets and to prioritize drugs and drug combinations. Cell culture is still widely used in preclinical sarcoma research to identify potential novel therapeutic approaches and resistance mechanisms. New and improved techniques in genome-wide and proteome-wide screens enable a better characterization. In addition to cell line xenograft mouse models, patient-derived xenografts crucially broadened and improved preclinical studies using primary human samples. Finally, novel strategies for genome editing, like CRISPR/Cas and sleeping beauty transposon, lead to development of novel genetically engineered cell lines and mouse models.

Summary
The present review gives a non-comprehensive overview on current model systems used in sarcoma research and discusses their translational relevance. Those include cell lines, subtype-specific patient-derived cell lines and xenografts as well as developments in genome editing and genetically engineered cell lines and mouse models.
Protective Effect of Botulinum Toxin Type A Against Atopic Dermatitis–Like Skin Lesions in NC/Nga Mice
Authors: Han Sang Bum , Kim Hyeree , Cho Sang Hyun , Chung Jin Ho , Kim Hei Sung 
Published: April 2017

BACKGROUND
Botulinum neurotoxin (BTX) A possesses various biological activities, including anti-inflammatory and antipruritic actions. Human and animal studies have shown that BTX is effective in treating histamine-induced itch, lichen simplex chronicus, psoriasis, rosacea, allergic rhinitis, and scar prevention. However, its effect on atopic dermatitis (AD) has not been studied yet.

OBJECTIVE
To examine the effect of BTX on AD using a mouse model. The primary outcome was skin thickness and transepidermal water loss (TEWL), and the secondary outcome was the alteration in skin severity scores, histological, and laboratory test results.

METHODS
Forty-two NC/Nga mice (a mouse model for AD) were allocated into 6 groups (the untreated, 2-Chloro-1,3,5-trinitrobenzene [TNCB] alone, TNCB + BTX 30 U/kg, TNCB + BTX 60 U/kg, TNCB + vehicle [0.9% saline], TNCB + 0.03% tacrolimus). Those of the BTX group received intradermal injections of BTX on the rostral back once on the day of TNCB sensitization. The effect of BTX in TNCB-treated NC/Nga mice was assessed by measuring skin thickness, TEWL (primary outcome), the skin severity scores, histological changes of test skin including mast cell count, interleukin (IL)-4 mRNA and protein expression, and total serum IgE (secondary outcome).

RESULTS
A single intradermal injection of BTX significantly suppressed skin thickness and TEWL in the TNCB-applied skin. The clinical severity scores, acanthosis and mast cell infiltration, were less in the BTX groups. BTX injection also inhibited TNCB-induced increase in IL-4 mRNA and protein expression in mice, but its effect on serum IgE level was not significant.

CONCLUSION
The preliminary results suggest that BTX may be a novel approach to the prevention and supplemental treatment of acute AD lesions.
Novel Risk Assessment Tool for Immunoglobulin Resistance in Kawasaki Disease
Authors: Takeuchi Masato , Inuzuka Ryo , Hayashi Taiyu , Shindo Takahiro , Hirata Yoichiro , Shimizu Nobutaka , Inatomi Jun , Yokoyama Yoshiki , Namai Yoshiyuki , Oda Yoichiro , Takamizawa Masaru , Kagawa Jiro , Harita Yutaka , Oka Akira 
Published: April 2017

Background:
Resistance to intravenous immunoglobulin (IVIG) therapy is a risk factor for coronary lesions in patients with Kawasaki disease (KD). Risk-adjusted initial therapy may improve coronary outcome in KD, but identification of high risk patients remains a challenge. This study aimed to develop a new risk assessment tool for IVIG resistance using advanced statistical techniques.

Methods:
Data were retrospectively collected from KD patients receiving IVIG therapy, including demographic characteristics, signs and symptoms of KD and laboratory results. A random forest (RF) classifier, a tree-based machine learning technique, was applied to these data. The correlation between each variable and risk of IVIG resistance was estimated.

Results:
Data were obtained from 767 patients with KD, including 170 (22.1%) who were refractory to initial IVIG therapy. The predictive tool based on the RF algorithm had an area under the receiver operating characteristic curve of 0.916, a sensitivity of 79.7% and a specificity of 87.3%. Its misclassification rate in the general patient population was estimated to be 15.5%. RF also identified markers related to IVIG resistance such as abnormal liver markers and percentage neutrophils, displaying relationships between these markers and predicted risk.

Conclusions:
The RF classifier reliably identified KD patients at high risk for IVIG resistance, presenting clinical markers relevant to treatment failure. Evaluation in other patient populations is required to determine whether this risk assessment tool relying on RF has clinical value.
Lyme disease ecology in a changing world: consensus, uncertainty and critical gaps for improving control
Authors: Kilpatrick A. Marm , Dobson Andrew D. M. , Levi Taal , Salkeld Daniel J. , Swei Andrea , Ginsberg Howard S. , Kjemtrup Anne , Padgett Kerry A. , Jensen Per M. , Fish Durland , Ogden Nick H. , Diuk-Wasser Maria A. 
Published: April 2017

Lyme disease is the most common tick-borne disease in temperate regions of North America, Europe and Asia, and the number of reported cases has increased in many regions as landscapes have been altered. Although there has been extensive work on the ecology and epidemiology of this disease in both Europe and North America, substantial uncertainty exists about fundamental aspects that determine spatial and temporal variation in both disease risk and human incidence, which hamper effective and efficient prevention and control. Here we describe areas of consensus that can be built on, identify areas of uncertainty and outline research needed to fill these gaps to facilitate predictive models of disease risk and the development of novel disease control strategies. Key areas of uncertainty include: (i) the precise influence of deer abundance on tick abundance, (ii) how tick populations are regulated, (iii) assembly of host communities and tick-feeding patterns across different habitats, (iv) reservoir competence of host species, and (v) pathogenicity for humans of different genotypes ofBorrelia burgdorferi. Filling these knowledge gaps will improve Lyme disease prevention and control and provide general insights into the drivers and dynamics of this emblematic multi-host–vector-borne zoonotic disease.This article is part of the themed issue ‘Conservation, biodiversity and infectious disease: scientific evidence and policy implications'.
Null expectations for disease dynamics in shrinking habitat: dilution or amplification?
Authors: Faust Christina L. , Dobson Andrew P. , Gottdenker Nicole , Bloomfield Laura S. P. , McCallum Hamish I. , Gillespie Thomas R. , Diuk-Wasser Maria , Plowright Raina K. 
Published: April 2017

As biodiversity declines with anthropogenic land-use change, it is increasingly important to understand how changing biodiversity affects infectious disease risk. The dilution effect hypothesis, which points to decreases in biodiversity as critical to an increase in infection risk, has received considerable attention due to the allure of a win–win scenario for conservation and human well-being. Yet some empirical data suggest that the dilution effect is not a generalizable phenomenon. We explore the response of pathogen transmission dynamics to changes in biodiversity that are driven by habitat loss using an allometrically scaled multi-host model. With this model, we show that declining habitat, and thus declining biodiversity, can lead to either increasing or decreasing infectious-disease risk, measured as endemic prevalence. Whether larger habitats, and thus greater biodiversity, lead to a decrease (dilution effect) or increase (amplification effect) in infection prevalence depends upon the pathogen transmission mode and how host competence scales with body size. Dilution effects were detected for most frequency-transmitted pathogens and amplification effects were detected for density-dependent pathogens. Amplification effects were also observed over a particular range of habitat loss in frequency-dependent pathogens when we assumed that host competence was greatest in large-bodied species. By contrast, only amplification effects were observed for density-dependent pathogens; host competency only affected the magnitude of the effect. These models can be used to guide future empirical studies of biodiversity–disease relationships across gradients of habitat loss. The type of transmission, the relationship between host competence and community assembly, the identity of hosts contributing to transmission, and how transmission scales with area are essential factors to consider when elucidating the mechanisms driving disease risk in shrinking habitat.This article is part of the themed issue ‘Conservation, biodiversity and infectious disease: scientific evidence and policy implications'.
Causal Evidence for Lateral Prefrontal Cortex Dynamics Supporting Cognitive Control
Authors: Nee Derek Evan , D’Esposito Mark 
Published: April 2017

AbstractThe lateral prefrontal cortex (LPFC) is essential for higher-level cognition, but how interactions among LPFC areas support cognitive control has remained elusive. In previous work, dynamic causal modeling (DCM) of fMRI data revealed that demands on cognitive control elicited a convergence of influences towards mid LPFC. We proposed that these findings reflect the integration of abstract, rostral and concrete, caudal influences to inform context-appropriate action. Here, we provide a causal test of this model using continuous theta-burst transcranial magnetic stimulation (cTBS). cTBS was applied to caudal, mid, or rostral LPFC, as well as a control site in counterbalanced sessions. In most cases, behavioral modulations resulting from cTBS could be predicted based upon the direction of influences within the previously estimated DCM. However, inconsistent with our DCM, we found that cTBS to caudal LPFC impaired cognitive control processes presumed to involve rostral LPFC. Revising the original DCM with a pathway from caudal LPFC to rostral LPFC significantly improved the fitted DCM and accounted for the observed behavioral findings. These data provide causal evidence for LPFC dynamics supporting cognitive control and demonstrate the utility of combining DCM with causal manipulations to create, test, and refine models of cognition.