bluuebunny/crossref_metadata_2025_split huggingface dataset:
Zika Risk and Pregnancy in Clinical Practice
Authors: Rao Rashmi , Gaw Stephanie L. , Han Christina S. , Platt Lawrence D. , Silverman Neil S. 
Published: May 2017

OBJECTIVE:
To describe a single U.S. perinatal center's ongoing experience with evaluating pregnant patients with potential exposure to Zika virus infection.

METHODS:
This is an institutional review board-approved longitudinal observational study from January to August 2016 from a single perinatal referral center. Patients who had traveled to or had sexual contact with a person who traveled to a region with documented local Zika virus transmission were included in the study. The aim of the study was to identify the rate of confirmed infection among pregnant women referred to our center with established risk factors for Zika virus acquisition. We also sought to characterize travel patterns that constituted risk, to identify rates of symptoms suggesting infection, and to potentially describe findings suggestive of congenital Zika virus infection in prenatal ultrasound evaluations.

RESULTS:
We evaluated 185 pregnant women with potential Zika virus exposure. Testing was offered in accordance with the version of the Centers for Disease Control and Prevention guidelines in place at the time of the consultation visit. Geographic exposure data showed Mexico (44%), the Caribbean (17%), North America (16%), South America (13%), and Central America (9%) to be the most common areas in which potential exposure occurred. One hundred twenty-three (67%) patients reported insect bites and 19 (10%) patients reported symptoms. Overall, five (3% of all) patients had prenatal ultrasound findings suggestive of possible fetal Zika virus infection; all their Zika virus test results returned negative. These findings included microcephaly, echogenic intracardiac foci, and ventricular calcifications. Of the 153 Zika virus screening tests ordered, eight (5%) immunoglobulin M results returned positive or equivocal with only one positive through confirmatory testing. Overall, 1 of 185 (0.5%) of all those consulted and 1 of 153 (0.7%) of those tested had a confirmed Zika virus infection with no confirmed fetal or neonatal infections.

CONCLUSION:
We identified low rates of confirmed maternal Zika virus infection in our cohort, but the number of patients described here demonstrates the magnitude of concern existing among both patients and physicians regarding possible perinatal Zika virus infection. It also underscores the need for health care providers to be prepared to answer questions, explain laboratory and ultrasound results, and describe testing options for concerned patients and their families.
Practical Aspects of Posttrauma Reconstruction With an Intramedullary Lengthening Nail
Authors: Bernstein Mitchell 
Published: May 2017

Summary:
Limb equalization using the Ilizarov method has evolved and adapted the use of internal lengthening devices. One of the newest devices, termed “PRECICE,” is a magnetically controlled telescoping nail. Complications such as pin site infection and skin irritation are eliminated. Despite trauma surgeons’ familiarity with intramedullary nailing, the Ilizarov method requires sound knowledge of deformity analysis and awareness of specific complications associated with distraction osteogenesis. This manuscript discusses some of the practical preoperative and intraoperative components of limb lengthening.
Biomechanical and Histopathologic Effects of Pulsed-Light Accelerated Epithelium-On/-Off Corneal Collagen Cross-Linking
Authors: Zhang Xiaoyu , Sun Ling , Shen Yang , Tian Mi , Zhao Jing , Zhao Yu , Li Meiyan , Zhou Xingtao 
Published: May 2017

Purpose:
This study aimed to compare the biomechanical and histopathologic effects of transepithelial and accelerated epithelium-off pulsed-light accelerated corneal collagen cross-linking (CXL).

Methods:
A total of 24 New Zealand rabbits were analyzed after sham operation (control) or transepithelial or epithelium-off operation (45 mW/cm2 for both). The transepithelial group was treated with pulsed-light ultraviolet A for 5 minutes 20 seconds, and the epithelium-off group was treated for 90 seconds. Biomechanical testing, including ultimate stress, Young modulus, and the physiological modulus, was analyzed. Histological changes were evaluated by light microscopy and transmission electron microscopy.

Results:
The stress–strain curve was nonlinear in both accelerated transepithelial and epithelium-off CXL groups. The stress and elastic moduli were all significantly higher in both experimental groups compared with the control group (P < 0.05), whereas there were no significant differences between the 2 treatment groups (P > 0.05). Six months after the operation, hematoxylin and eosin staining and transmission electron microscopy showed that the subcutaneous collagen fibers were arranged in a regular pattern, and the fiber density was higher in the experimental groups.

Conclusions:
Both transepithelial and accelerated epithelium-off CXL produced biomechanical and histopathologic improvements, which were not significantly different between the 2 pulsed-light accelerated CXL treatments.
Free-Living Amoebae Keratitis
Authors: Pinna Antonio , Porcu Tiziana , Boscia Francesco , Cano Antonella , Erre Giuseppe , Mattana Antonella 
Published: May 2017

Purpose:
To describe the diagnostic and clinical features and treatment results in 43 consecutive patients with microbiologically proven free-living amoebae (FLA) keratitis.

Methods:
In this hospital-based, prospective case series, corneal scrapings from 43 patients with presumed amoebic keratitis were plated on nonnutrient agar. Amoebic isolates were identified morphologically and by the polymerase chain reaction. All patients with culture-proven FLA keratitis were treated with polyhexamethylene biguanide (PHMB) 0.02% eye drops.

Results:
Forty-three corneal scrapings from 43 patients were found to be culture positive for FLA; 41 (95%) were from contact lens wearers and 2 (5%) were from noncontact lens wearers. Microscopic examination identified 4 Acanthamoeba spp, 24 Hartmannella spp, 12 vahlkampfiid amoebae, and 3 mixed infections with Hartmannella/vahlkampfiid amoebae. Morphological results were confirmed by the polymerase chain reaction. Patients with Acanthamoeba, Hartmannella, and vahlkampfiid keratitis had indistinguishable clinical features. In 38 eyes with keratitis at an early stage, treatment with PHMB 0.02% eye drops was fully successful. In 5 patients with advanced keratitis, topical PHMB 0.02% controlled the infection, but all of them developed a central corneal scar with visual deterioration.

Conclusions:

Acanthamoeba is not the only cause of amoebic keratitis, because this condition may also be caused by other FLA, such as Hartmannella and vahlkampfiid amoebae. This finding is epidemiologically interesting, suggesting a possible different geographical prevalence of the different FLA responsible for keratitis. Early diagnosis and proper antiamoebic treatment are crucial to yielding a cure.
Comparison of 2 Different Methods of Transepithelial Corneal Collagen Cross-Linking: Analysis of Corneal Histology and Hysteresis
Authors: Park Young Min , Kim Ho Yoon , Lee Jong Soo 
Published: May 2017

Purpose:
To compare the effect of 2 different methods of transepithelial corneal collagen cross-linking (CXL) on corneal histology and hysteresis.

Methods:
The right eyes of New Zealand white rabbits (n = 50) were treated using one of the 2 transepithelial CXL methods. The eyes were then divided into 2 groups: group 1, transepithelial CXL using continuous ultraviolet A (UVA); group 2, accelerated transepithelial CXL using pulsed UVA.

Results:
Both groups showed a postoperative increase in central corneal thickness. In both groups, an increase in corneal hysteresis was found after CXL, but the changes were not significant when compared with the baseline value. The corneal resistance factor and corneal-compensated intraocular pressure also remained unchanged in both groups after treatment. In both groups, the CXL effect reached the anterior–mid part of the corneal stroma. In group 1, CXL mostly affected the anterior–mid part stroma, whereas group 2 showed stromal keratocyte loss, and an acellular zone, in the deep stroma. More signs of keratocyte apoptosis were observed in group 2 than in group 1.

Conclusions:
Accelerated transepithelial CXL using pulsed UVA showed considerably deeper effect in the stroma with keratocyte loss than transepithelial CXL using continuous UVA.
Validation of the Vasoactive-Inotropic Score in Pediatric Sepsis*
Authors: McIntosh Amanda M. , Tong Suhong , Deakyne Sara J. , Davidson Jesse A. , Scott Halden F. 
Published: May 2017

Objectives:
To assess the validity of Vasoactive-Inotropic Score as a scoring system for cardiovascular support and surrogate outcome in pediatric sepsis.

Design:
Secondary retrospective analysis of a single-center sepsis registry.

Setting:
Freestanding children’s hospital and tertiary referral center.

Patients:
Children greater than 60 days and less than 18 years with sepsis identified in the emergency department between January 2012 and June 2015 treated with at least one vasoactive medication within 48 hours of admission to the PICU.

Interventions:
None.

Measurements and Main Results:
Vasoactive-Inotropic Score was abstracted at 6, 12, 24, and 48 hours post ICU admission. Primary outcomes were ventilator days and ICU length of stay. The secondary outcome was a composite outcome of cardiac arrest/extracorporeal membrane oxygenation/in-hospital mortality. One hundred thirty-eight patients met inclusion criteria. Most common infectious sources were pneumonia (32%) and bacteremia (23%). Thirty-three percent were intubated and mortality was 6%. Of the time points assessed, Vasoactive-Inotropic Score at 48 hours showed the strongest correlation with ICU length of stay (r = 0.53; p < 0.0001) and ventilator days (r = 0.52; p < 0.0001). On multivariable analysis, Vasoactive-Inotropic Score at 48 hours was a strong independent predictor of primary outcomes and intubation. For every unit increase in Vasoactive-Inotropic Score at 48 hours, there was a 13% increase in ICU length of stay (p < 0.001) and 8% increase in ventilator days (p < 0.01). For every unit increase in Vasoactive-Inotropic Score at 12 hours, there was a 14% increase in odds of having the composite outcome (p < 0.01).

Conclusions:
Vasoactive-Inotropic Score in pediatric sepsis patients is independently associated with important clinically relevant outcomes including ICU length of stay, ventilator days, and cardiac arrest/extracorporeal membrane oxygenation/mortality. Vasoactive-Inotropic Score may be a useful surrogate outcome in pediatric sepsis.
Predicting Thoracic Injury in Children With Multitrauma
Authors: Weerdenburg Kirstin D. , Wales Paul W. , Stephens Derek , Beno Suzanne , Gantz Jessica , Alsop Jessie , Schuh Suzanne 
Published: May 2017

Objectives
Previous pediatric trauma studies focused on predictors of abnormal chest radiographs or included patients with low injury severity. This study identified predictors of thoracic injury (TI) diagnoses in a high-risk population and determined TI rate without predictors.

Methods
This study was a retrospective trauma registry analysis of previously healthy children aged 0 to 17 years with multisystem blunt trauma requiring trauma team activation and chest radiography who were divided into those with and without TI. Plausible TI predictors included Glasgow Coma Scale score of 13 or less, abnormal thoracic symptoms/signs, abnormal chest auscultation, respiratory distress/ rate higher than the 95th percentile, oxygen saturation less than 95%, abnormal abdominal signs/symptoms, tachycardia higher than the 95th percentile, blood pressure lower than the 5th percentile, and femur fracture.

Results
One hundred forty-one (29%) of 493 eligible patients had TI. Independent TI predictors include thoracic symptoms/signs (odds ratio [OR], 6.0; 95% confidence interval [CI], 3.6–10.1), abnormal chest auscultation (OR, 3.5; 95% CI, 2.0–6.2), saturation less than 95% (OR, 3.1; 95% CI, 1.8–5.5), blood pressure lower than the 5th percentile (OR, 3.7; 95% CI, 1.1–12.2), and femur fracture (OR, 2.5; 95% CI, 1.2–5.4). Six (5%) of 119 children (95% CI, 0.01–0.09) without predictors had TI.

Conclusions
Predictors of TI include thoracic symptoms/signs, abnormal chest auscultation, saturation less than 95%, blood pressure lower than the 5th percentile, and femur fracture. Because an important portion of children without predictors had TI, chest radiography should remain part of pediatric trauma resuscitation.
HIV and Obesity Comorbidity Increase Interleukin 6 but Not Soluble CD14 or D-Dimer
Authors: Taylor Barbara S. , So-Armah Kaku , Tate Janet P. , Marconi Vincent C. , Koethe John R. , Bedimo Roger J. , Butt Adeel A. , Gibert Cynthia L. , Goetz Matthew B. , Rodriguez-Barradas Maria C. , Womack Julie A. , Gerschenson Mariana , Lo Re Vincent , Rimland David , Yin Michael T. , Leaf David , Tracy Russell P. , Justice Amy C. , Freiberg Matthew S. 
Published: May 2017

Objectives:
Obesity prevalence among people living with HIV (HIV+) is rising. HIV and obesity are proinflammatory states, but their combined effect on inflammation (measured by interleukin 6, IL-6), altered coagulation (D-dimer), and monocyte activation (soluble CD14, sCD14) is unknown. We hypothesized inflammation increases when obesity and HIV infection co-occur.

Methods:
The Veterans Aging Cohort Study survey cohort is a prospective, observational study of predominantly male HIV+ veterans and veterans uninfected with HIV; a subset provided blood samples. Inclusion criteria for this analysis were body mass index ≥ 18.5 kg/m2 and biomarker measurement. Dependent variables were IL-6, sCD14, and D-dimer quartiles. Obesity/HIV status was the primary predictor. Unadjusted and adjusted logistic regression models were constructed.

Results:
Data were analyzed for 1477 HIV+ and 823 uninfected participants. Unadjusted median IL-6 levels were significantly higher and sCD14 levels significantly lower in obese/HIV+ compared with nonobese/uninfected (P <0.01 for both). In adjusted analyses, the odds ratio for increased IL-6 in obese/HIV+ patients was 1.76 (95% confidence interval: 1.18 to 2.47) compared with nonobese/uninfected, and obesity/HIV+ remained associated with lower odds of elevated sCD14. We did not detect a synergistic association of co-occurring HIV and obesity on IL-6 or sCD14 elevation. D-dimer levels did not differ significantly between body mass index/HIV status groups.

Conclusions:
HIV–obesity comorbidity is associated with elevated IL-6, decreases in sCD14, and no significant difference in D-dimer. These findings are clinically significant, as previous studies associated these biomarkers with mortality. Future studies should assess whether other biomarkers show similar trends and potential mechanisms for unanticipated sCD14 and D-dimer findings.
Minimally Invasive Versus Open Pancreaticoduodenectomy
Authors: Nassour Ibrahim , Wang Sam C. , Christie Alana , Augustine Mathew M. , Porembka Matthew R. , Yopp Adam C. , Choti Michael A. , Mansour John C. , Xie Xian-Jin , Polanco Patricio M. , Minter Rebecca M. 
Published: May 2017

Objective:
To compare the perioperative outcomes of minimally invasive pancreaticoduodenectomy (MIPD) in comparison with open pancreaticoduodenectomy (OPD) in a national cohort of patients.

Background:
Limited well-controlled studies exist comparing perioperative outcomes between MIPD and OPD.

Methods:
Patients who underwent MIPD and OPD were abstracted from the 2014 to 2015 pancreas-targeted American College of Surgeons National Surgical Quality Improvement Program. OPD and MIPD patients were matched 3:1 using propensity score, and perioperative outcomes were compared.

Results:
A total of 4484 patients were identified with 334 (7.4%) undergoing MIPD. MIPD patients were younger, more likely to be White, and had a lower rate of weight loss. They were more likely to undergo classic Whipple and to have a drain placed. After 3:1 matching, 1002 OPD patients were compared with 334 MIPD patients. MIPD was associated with longer mean operative time (426.6 vs 359.6 minutes; P < 0.01), higher readmission rate (19.2% vs 14.3%; P = 0.04) and lower rate of prolonged length of stay >14 days (16.5% vs 21.6%; P = 0.047). The 2 groups had a similar rate of 30-day mortality (MIPD 1.8% vs OPD 1.3%; P = 0.51), overall complications, postoperative pancreatic fistula, and delayed gastric emptying. A secondary analysis comparing MIPD without conversion or open assist with OPD showed that MIPD patients had lower rates of overall surgical site infection (13.4% vs 19.6%; P = 0.04) and transfusion (7.9% vs 14.4%; P = 0.02).

Conclusions:
MIPD had an equivalent morbidity and mortality rate to OPD, with the benefit of a decreased rate of prolonged length of stay, though this is partially offset by an increased readmission rate.
Myocardial Injury After Noncardiac Surgery (MINS) in Vascular Surgical Patients
Authors: Biccard Bruce M. , Scott David Julian Ashbridge , Chan Matthew T. V. , Archbold Andrew , Wang Chew-Yin , Sigamani Alben , Urrútia Gerard , Cruz Patricia , Srinathan Sadeesh K. , Szalay David , Harlock John , Tittley Jacques G. , Rapanos Theodore , Elias Fadi , Jacka Michael J. , Malaga German , Abraham Valsa , Berwanger Otavio , Montes Félix R. , Heels-Ansdell Diane M. , Hutcherson Matthew T. , Chow Clara K. , Polanczyk Carisi A. , Szczeklik Wojciech , Ackland Gareth L. , Dubois Luc , Sapsford Robert J. , Williams Colin , Cortés Olga L. , Le Mananch Yannick , Devereaux P. J. 
Published: May 2017

Objective:
To determine the prognostic relevance, clinical characteristics, and 30-day outcomes associated with myocardial injury after noncardiac surgery (MINS) in vascular surgical patients.

Background:
MINS has been independently associated with 30-day mortality after noncardiac surgery. The characteristics and prognostic importance of MINS in vascular surgery patients are poorly described.

Methods:
This was an international prospective cohort study of 15,102 noncardiac surgery patients 45 years or older, of whom 502 patients underwent vascular surgery. All patients had fourth-generation plasma troponin T (TnT) concentrations measured during the first 3 postoperative days. MINS was defined as a TnT of 0.03 ng/mL of higher secondary to ischemia. The objectives of the present study were to determine (i) if MINS is prognostically important in vascular surgical patients, (ii) the clinical characteristics of vascular surgery patients with and without MINS, (iii) the 30-day outcomes for vascular surgery patients with and without MINS, and (iv) the proportion of MINS that probably would have gone undetected without routine troponin monitoring.

Results:
The incidence of MINS in the vascular surgery patients was 19.1% (95% confidence interval (CI), 15.7%–22.6%). 30-day all-cause mortality in the vascular cohort was 12.5% (95% CI 7.3%–20.6%) in patients with MINS compared with 1.5% (95% CI 0.7%–3.2%) in patients without MINS (P < 0.001). MINS was independently associated with 30-day mortality in vascular patients (odds ratio, 9.48; 95% CI, 3.46–25.96). The 30-day mortality was similar in MINS patients with (15.0%; 95% CI, 7.1–29.1) and without an ischemic feature (12.2%; 95% CI, 5.3–25.5, P = 0.76). The proportion of vascular surgery patients who suffered MINS without overt evidence of myocardial ischemia was 74.1% (95% CI, 63.6–82.4).

Conclusions:
Approximately 1 in 5 patients experienced MINS after vascular surgery. MINS was independently associated with 30-day mortality. The majority of patients with MINS were asymptomatic and would have gone undetected without routine postoperative troponin measurement.
Behavioural, ecological and evolutionary responses to extreme climatic events: challenges and directions
Authors: van de Pol Martijn , Jenouvrier Stéphanie , Cornelissen Johannes H. C. , Visser Marcel E. 
Published: May 2017

More extreme climatic events (ECEs) are among the most prominent consequences of climate change. Despite a long-standing recognition of the importance of ECEs by paleo-ecologists and macro-evolutionary biologists, ECEs have only recently received a strong interest in the wider ecological and evolutionary community. However, as with many rapidly expanding fields, it lacks structure and cohesiveness, which strongly limits scientific progress. Furthermore, due to the descriptive and anecdotal nature of many ECE studies it is still unclear what the most relevant questions and long-term consequences are of ECEs. To improve synthesis, we first discuss ways to define ECEs that facilitate comparison among studies. We then argue that biologists should adhere to more rigorous attribution and mechanistic methods to assess ECE impacts. Subsequently, we discuss conceptual and methodological links with climatology and disturbance-, tipping point- and paleo-ecology. These research fields have close linkages with ECE research, but differ in the identity and/or the relative severity of environmental factors. By summarizing the contributions to this theme issue we draw parallels between behavioural, ecological and evolutionary ECE studies, and suggest that an overarching challenge is that most empirical and theoretical evidence points towards responses being highly idiosyncratic, and thus predictability being low. Finally, we suggest a roadmap based on the proposition that an increased focus on the mechanisms behind the biological response function will be crucial for increased understanding and predictability of the impacts of ECE.
This article is part of the themed issue ‘Behavioural, ecological and evolutionary responses to extreme climatic events’.
On detecting ecological impacts of extreme climate events and why it matters
Authors: Solow Andrew R. 
Published: May 2017

There is growing interest in identifying the impacts of extreme climate events on natural systems. Two principles of such detection are that it should be based on a scientific understanding of the processes by which climate affects the system of interest and that non-climate factors that also affect the system should be controlled for. Using a simple temperature-dependent predator–prey model, this paper illustrates the importance of these principles in the context of establishing a link between temperature and population extremes. The results suggest that a naive approach based only on the co-occurrence of temperature and population extremes may fail. In the second part of the paper, some reasons for focusing attention on the ecological impacts of extreme climate events are briefly reviewed. It is suggested that, while extreme ecological events may be important for society, this does not imply that an analysis aimed at connecting them to extreme climate events should necessarily be based on extreme events themselves.
This article is part of the themed issue ‘Behavioural, ecological and evolutionary responses to extreme climatic events’.