bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cutaneous Angiosarcoma of the Eyelid Mimicking Morbihan Disease
Authors: Ferguson Donna C. , Mawn Louise A. , Al-Rohil Rami N. 
Published: January 2018

Background:
Cutaneous angiosarcoma presents clinically in numerous ways, and can be mistaken for a different clinical entity, particularly when arising at unusual anatomic locations such as the eyelid.

Case Presentation:
A 57-year-old woman presented with a 1-year history of eyelid swelling. Concurrent imaging was also suggestive of an edematous process. Multiple superficial biopsies showed nonspecific dermal inflammation and interstitial edema. A diagnosis of Morbihan disease (chronic and idiopathic lymphedema of the eyelid) was rendered, and the patient was treated with compression and local therapy without clinical improvement. Three years after initial presentation, a diagnostic blepharoplasty was performed revealing a deep dermal vascular proliferation composed of anastomosing vascular channels with an atypical endothelial lining. A diagnosis of cutaneous angiosarcoma was ultimately made.

Conclusions:
This case illustrates a unique presentation of cutaneous angiosarcoma and the implications of different biopsy techniques in acquiring the correct diagnosis.
Single-Stage Breast Reconstruction Using an All-In-One Adjustable Expander/Implant
Authors: Azzi Alain J. , Zammit Dino , Lessard Lucie 
Published: January 2018

Background:
When tissue expansion is necessary in breast reconstruction, a single-stage approach is possible using adjustable expander/implants, with or without the use of acellular dermal matrix. We aimed to present the senior author’s single-stage experience over a period of 12 years using combined expander/implants in breast reconstruction.

Methods:
This is a Single-institution, retrospective review of breast reconstruction with combined expander/implants from 2002 to 2014. Logistic regression was performed to evaluate the impact of multiple variables on long-term outcomes.

Results:
A total of 162 implants in 105 patients were included in this study. Mean follow-up time was 81.7 months (SD, ± 39.2; range, 15–151). Complication rates were as follows: 0.62% extrusion, 1.2% mastectomy flap necrosis, 1.2% hematoma, 1.9% dehiscence, 2.5% seroma, 4.9% infection, and 15.4% deflation. The following associations were identified by logistic regression: adjuvant radiotherapy and capsular contracture (P = 0.034), tumor size and deflation (P = 0014), and smoking history and infection (P = 0.013).

Conclusions:
Overall, 81% of breasts were successfully reconstructed in a single stage. Single-stage reconstruction using all-in-one expander/implants reduces costs by eliminating the need for a second procedure under general anesthesia and can achieve results comparable with other alloplastic reconstructions reported in the literature.
Technique for Preparing Ultrathin and Nanothin Descemet Stripping Automated Endothelial Keratoplasty Tissue
Authors: Cheung Albert Y. , Hou Joshua H. , Bedard Peter , Grimes Veronique , Buckman Natalie , Eslani Medi , Holland Edward J. 
Published: January 2018

Purpose:
To describe and report outcomes of our single-pass microkeratome technique for preparation of ultrathin (UT, ≤100 μm) and nanothin (NT, ≤50 μm) Descemet stripping automated endothelial keratoplasty (DSAEK) grafts.

Methods:
To prepare NT-DSAEK grafts, a pachymetry nomogram specific to each technician and individual microkeratome head was developed based on accumulated precut and postcut pachymetry data from previous DSAEK grafts. Mean graft thickness as well as precut and postcut endothelial cell counts (ECCs) of NT-DSAEK, UT-DSAEK, and Descemet membrane endothelial keratoplasty (DMEK) grafts between July 2015 and July 2017 were calculated and compared statistically. Endothelial cell loss was evaluated using calcein AM stains and ImageJ analysis. Postcut graft thickness and rates of perforation/tissue loss for NT-DSAEK grafts between May and July 2017 were calculated to determine overall graft preparation success rates.

Results:
Mean postcut graft thickness for all grafts within the NT range was 41.0 ± 6.4 μm (range 26–50 μm). Mean ECC did not differ between NT-DSAEK, UT-DSAEK, and DMEK grafts (P = 0.759 and 0.633, respectively). The overall tissue loss rate from attempted NT-DSAEK was 4.8%. Excluding cases of perforation, the chance of achieving NT thickness was 60% and within the traditional UT range was 100%.

Conclusions:
We propose the term “NT-DSAEK” for grafts ≤50 μm. The described nomogram allows for standardized creation of NT grafts with a low tissue loss rate. This technique is safe and does not result in significant ECC loss compared with UT-DSAEK and DMEK grafts. Further studies are necessary to corroborate the postsurgical results of NT grafts.
Risk of Hepatitis B Virus Reactivation Among Patients Treated With Ledipasvir-Sofosbuvir for Hepatitis C Virus Infection
Authors: Yanny Beshoy T. , Latt Nyan L. , Saab Sammy , Han Steven , Choi Gina , Kramer Jason , Sahota Amandeep K. 
Published: January 2018

Background:
Direct acting antiviral (DAA) agents are the standard of care for treatment of hepatitis C virus (HCV)–infected individuals. Hepatitis B virus (HBV) reactivation during HCV treatment has been reported, the incidence and clinical outcome remains unclear. The aim of our study is to examine the risk of HBV reactivation in actively infected or previously exposed patients during or after HCV treatment with DAAs.

Methods:
Adults with chronic HCV infection previously exposed or actively infected with HBV and treated with DAAs between December 2015 to 2016 were included. Electronic medical records were reviewed for HCV treatment dates, HCV treatment response, DAA used, HBV status, and concurrent HBV treatment. Primary end-point was to determine the risk of HBV reactivation during or up to 3 months after DAA treatment.

Results:
We identified 283 patients, and 100% of patients completed HCV treatment with ledipasvir-sofosbuvir. 93% had HCV genotype-1 of whom 91% achieved sustained viral response at 12 weeks posttreatment (SVR-12). In total, 7% had HCV genotype-4 who achieved SVR-12 of 84%. Mean (±SD) age was 59.7 (±7) years, and 58% were male. A total of 45% of patients had hepatitis B core antibody (HBcAb) positive and hepatitis B surface antigen (HBsAg) negative. In total, 55% of patients had a positive HBsAg before HCV DAA treatment. No HBV reactivation was encountered in the (HBcAb) positive HBsAg-negative cohort nor in the (HBsAg) positive group with 95% confidence interval (0-0.023) and (0-0.019), respectively.

Conclusion:
In our study of patients with HCV and isolated hepatitis B core or HBsAg positivity, no HCV patients treated with DAA experienced HBV reactivation.
Income Disparities in the Prevalence, Severity, and Costs of Co-occurring Chronic and Behavioral Health Conditions
Authors: Cunningham Peter J. , Green Tiffany L. , Braun Robert T. 
Published: January 2018

Background:
Behavioral health problems usually co-occur along with physical health problems, resulting in higher health care costs. These co-occurring conditions are likely to be more prevalent and serious among low income patients, affecting both the quality and costs of care.

Objective:
To examine the prevalence, severity, and health care costs of co-occurring chronic and behavioral health conditions among low income people compared with higher income people.

Methods:
Analysis of the 2011–2014 Medical Expenditure Panel Survey. Sample includes 146,000 persons aged 18–64 years. Regression analysis was used to examine how the combination of behavioral health conditions and chronic health conditions is associated with health care expenditures, and how this association differs by family income.

Results:
(1) Comorbid behavioral health problems are more prevalent and serious among low income people with chronic conditions compared with higher income people; (2) among patients with co-occurring chronic and behavioral problems, average annual spending is greater among the low income patients ($9472) compared with high income patients ($7457); (3) higher costs among low income patients with co-occurring conditions reflects their poorer mental and physical health, relative to higher income patients.

Conclusions:
For many low income people, comorbid behavioral problems need to be understood in the social context in which they live. Simply screening low income people for behavioral health problems may not be sufficient unless there is greater understanding of the mechanisms that both cause and exacerbate chronic and behavioral health problems in the low income population.
Reorganizing Care With the Implementation of Electronic Medical Records: A Time-Motion Study in the PICU*
Authors: Roumeliotis Nadia , Parisien Geneviève , Charette Sylvie , Arpin Elizabeth , Brunet Fabrice , Jouvet Philippe 
Published: January 2018

Objectives:
To assess caregivers’ patient care time before and after the implementation of a reorganization of care plan with electronic medical records.

Design:
A prospective, observational, time-motion study.

Setting:
A level 3 PICU.

Participants:
Nurses and orderlies caring for intubated patients during an 8-hour work shift before (2008–2009) and after (2016) implementation of reorganization of care in 2013.

Interventions:
The reorganization plan included improved telecommunication for healthcare workers, increased tasks delegated to orderlies, and an ICU-specific electronic medical record (Intellispace Critical Care and Anesthesia information system, Philips Healthcare).

Measurements and Main Results:
Time spent completing various work tasks was recorded by direct observation, and proportion of time in tasks was compared for each study period. A total of 153.7 hours was observed from 22 nurses and 14 orderlies. There was no significant difference in the proportion of nursing patient care time before (68.8% [interquartile range, 48–72%]) and after (55% [interquartile range, 51–57%]) (p = 0.11) the reorganization with electronic medical record. Direct patient care task time for nurses was increased from 27.0% (interquartile range, 30–37%) before to 34.7% (interquartile range, 33–75%) (p = 0.336) after, and indirect patient care tasks decreased from 33.6% (interquartile range, 23–41%) to 18.6% (interquartile range, 16–22%) (p = 0.036). Documentation time significantly increased from 14.5% (interquartile range, 12–22%) to 26.2% (interquartile range, 23–28%) (p = 0.032). Nursing productivity ratio improved from 28.3 to 26.0. A survey revealed that nursing staff was satisfied with the electronic medical record, although there was a concern for the maintenance of oral communication in the unit.

Conclusions:
The reorganization of care with the implementation of an ICU-specific electronic medical record in the PICU did not change total patient care provided but improved nursing productivity, resulting in improved efficiency. Documentation time was significantly increased, and concern over reduced oral communication arose, which should be a focus for future electronic improvement strategies.
Repeat Rapid Response Events in Children: Characteristics and Outcomes
Authors: Meulmester Kristen M. , Jaimon Nancy , Bavare Aarti C. 
Published: January 2018

Objective:
We describe the characteristics and outcomes of pediatric repeat rapid response events within a single hospitalization. We hypothesized that triggers for repeat rapid response and initial rapid response events are similar, and repeat rapid response events are associated with high prevalence of medical complexity and worse outcomes.

Design:
A 3-year retrospective study.

Setting:
High-volume tertiary academic pediatric hospital.

Patients:
All rapid response events were reviewed to identify repeat rapid response events.

Intervention:
None.

Measurements and Main Results:
Patient demographics, rapid response triggers, primary clinical diagnoses, illness acuity scores, medical interventions, transfers to ICU, occurrence of critical deterioration, and mortality were reviewed. We reviewed 146 patients with 309 rapid response events (146 initial rapid response and 163 repeat rapid response: 36% < 24 hr, 38% 24 hr to 7 d, and 26% > 7 d after initial rapid response). Median age was 3 years, and 60% were males. Eighty-five percentage of repeat rapid response occurred in medical complexity patients. The triggers for 71% of all repeat rapid response matched with those of initial rapid response. Transfer to ICU occurred in 69 (47%) of initial rapid response and 124 (76%) of repeat rapid response (p < 0.01). The median hospital stay was 11 and 30 days for previously healthy and medical complexity patients, respectively (p = 0.16). ICU readmission at repeat rapid response was associated with longer hospital stay (p < 0.01). Mortality during hospitalization occurred in 14% (all medically complex) of patients after repeat rapid response. Hospital mortality after rapid response is 4.4% per our center’s administrative data and 6.7% according to published multicenter data.

Conclusions:
Prevalence of medical complexity was high in patients with repeat rapid response compared with that reported for pediatric hospitalizations. Triggers between initial and repeat rapid response events correlated. Transfer to ICU was more likely after repeat rapid response and among repeat rapid response, events with ICU readmissions had a longer length of ICU and hospital stay. Mortality for the repeat rapid response cohort was higher than that for overall rapid responses in our center and per published reports from other centers.
Comparison of Laparoscopic and Open Pancreaticoduodenectomy for the Treatment of Nonpancreatic Periampullary Adenocarcinomas
Authors: Meng Ling-Wei , Cai Yun-Qiang , Li Yong-Bin , Cai He , Peng Bing 
Published: January 2018

Background:
Laparoscopic pancreaticoduodenectomy (LPD), a surgical option for nonpancreatic periampullary adenocarcinoma (NPPA), is a complex procedure that has become increasing popular. However, there is no consensus as to whether this technique should be performed routinely. Our aim was to evaluate the outcomes of LPD compared with open pancreaticoduodenectomy (OPD).

Materials and Methods:
From October 2010 to September 2015, 58 LPDs were performed to treat NPPA and were compared with 58 OPDs, which can theoretically be carried out by laparoscopic approach. Patients were also matched based on their demographic data and pathologic diagnosis. Demographic information, intraoperative and postoperative data, pathologic data, and follow-up evaluation data were collected at our center.

Results:
All patients had a median follow-up of 34 months (range, 8 to 60 mo). Overall median survival during the study between the groups was not different (P=0.760). No significant differences between the 2 groups were found in terms of patient demographics, short-term complications, pathologic outcomes, or tumor-node-metastasis stage. With regard to operative time, the LPD group was slightly longer than the OPD group (P<0.001). There were significant differences between groups in the time to the first passage of flatus and the time to oral intake (P<0.001). However, no differences were seen in blood loss, length of intensive care unit stay, node positive, or R0 resection between the laparoscopic and open groups.

Conclusions:
This study found that LPD is a feasible, safe, and effective method for the treatment of NPPA compared with OPD and may be a preferred method for surgeons to choose.
Signatures of host specialization and a recent transposable element burst in the dynamic one-speed genome of the fungal barley powdery mildew pathogen
Authors: Frantzeskakis Lamprinos , Kracher Barbara , Kusch Stefan , Yoshikawa-Maekawa Makoto , Bauer Saskia , Pedersen Carsten , Spanu Pietro D , Maekawa Takaki , Schulze-Lefert Paul , Panstruga Ralph 
Published: January 2018

ABSTRACTPowdery mildews are biotrophic pathogenic fungi infecting a number of economically important plants. The grass powdery mildew,Blumeria graminis,has become a model organism to study host specialization of obligate biotrophic fungal pathogens. We resolved the large-scale genomic architecture ofB. graminis forma specialis hordei (Bgh)to explore the potential influence of its genome organization on the co-evolutionary process with its host plant, barley(Hordeum vulgare).The near-chromosome level assemblies of theBghreference isolate DH14 and one of the most diversified isolates, RACE1, enabled a comparative analysis of these haploid genomes, which are highly enriched with transposable elements (TEs). We found largely retained genome synteny and gene repertoires, yet detected copy number variation (CNV) of secretion signal peptide-containing protein-coding genes (SPs) and locally disrupted synteny blocks. Genes coding for sequence-related SPs are often locally clustered, but neither theSPclusters nor TEs are enriched in specific genomic regions. Extended comparative analysis with different host-specificB. graminis formae specialesrevealed the existence of a core suite ofSPs,but also isolate-specificSPsets as well as congruence ofSPCNV and phylogenetic relationship. We further detected evidence for a recent, lineage-specific expansion of TEs in theBghgenome. The characteristics of theBghgenome (largely retained synteny, CNV ofSPgenes, recently proliferated TEs and a lack of compartmentalization) are consistent with a “one-speed” genome that differs in its architecture and (co-)evolutionary pattern from the “two-speed” genomes reported for several other filamentous phytopathogens.
Identification of an immune gene expression signature associated with favorable clinical features in Treg-enriched patient tumor samples
Authors: Givechian Kevin B. , Wnuk Kamil , Garner Chad , Benz Stephen , Garban Hermes , Rabizadeh Shahrooz , Niazi Kayvan , Soon-Shiong Patrick 
Published: January 2018

AbstractImmune heterogeneity within the tumor microenvironment undoubtedly adds several layers of complexity to our understanding of drug sensitivity and patient prognosis across various cancer types. Within the tumor microenvironment, immunogenicity is a favorable clinical feature in part driven by the antitumor activity of CD8+ T cells. However, tumors often inhibit this antitumor activity by exploiting the suppressive function of Regulatory T cells (Tregs), thus suppressing the adaptive immune response. Despite the seemingly intuitive immunosuppressive biology of Tregs, prognostic studies have produced contradictory results regarding the relationship between Treg enrichment and survival. We therefore analyzed RNA-seq data of Treg-enriched tumor samples to derive a pan-cancer gene signature able to help reconcile the inconsistent results of Treg studies, by better understanding the variable clinical association of Tregs across alternative tumor contexts. We show that increased expression of a 32-gene signature in Treg-enriched tumor samples (n=135) is able to distinguish a cohort of patients associated with chemosensitivity and overall survival This cohort is also enriched for CD8+ T cell abundance, as well as the antitumor M1 macrophage subtype. With a subsequent validation in a larger TCGA pool of Treg-enriched patients (n = 626), our results reveal a gene signature able to produce unsupervised clusters of Treg-enriched patients, with one cluster of patients uniquely representative of an immunogenic tumor microenvironment. Ultimately, these results support the proposed gene signature as a putative biomarker to identify certain Treg-enriched patients with immunogenic tumors that are more likely to be associated with features of favorable clinical outcome.
Efficient production of erythroid, megakaryoid and myeloid cells, using single cell-derived iPSC colony differentiation
Authors: Hansen Marten , Varga Eszter , Aarts Cathelijn , Wust Tatjana , Kuijpers Taco , von Lindern Marieke , van den Akker Emile 
Published: January 2018

AbstractHematopoietic differentiation of human induced pluripotent stem cells (iPSCs) provide opportunities not only for fundamental research and disease modelling/drug testing but also for large-scale production of blood effector cells for future clinical application. Although there are multiple ways to differentiate human iPSCs towards hematopoietic lineages, there is a need to develop reproducible and robust protocols. Here we introduce an efficient way to produce three major blood cell types using a standardized differentiation protocol that starts with a single hematopoietic initiation step. This system is feeder-free, avoids EB-formation, starts with a hematopoietic initiation step based on a novel single cell-derived iPSC colony differentiation and produces multi-potential progenitors within 8-10 days. Followed by lineage-specific growth factor supplementation these cells can be matured into well characterized erythroid, megakaryoid and myeloid cells with high-purity, without transcription factor overexpression or any kind of pre-purification step. This standardized differentiation system provides a simple platform to produce specific blood cells in a reproducible manner for hematopoietic development studies, disease modelling, drug testing and the potential for future therapeutic applications.HighlightsEfficient hematopoietic differentiation from single cell-derived iPSC coloniesReproducible feeder-free, monolayer differentiation system independent of iPSC lineProduction of erythroid, megakaryoid and myeloid cells with high-purityPlatform for hematopoietic developmental research and future clinical application