bluuebunny/crossref_metadata_2025_split huggingface dataset:
Internal Validation of the Sepsis in Obstetrics Score to Identify Risk of Morbidity From Sepsis in Pregnancy
Authors: Albright Catherine M. , Has Phinnara , Rouse Dwight J. , Hughes Brenna L. 
Published: September 2017

OBJECTIVE:
To prospectively validate the Sepsis in Obstetrics Score, a pregnancy-specific sepsis scoring system, to identify risk for intensive care unit (ICU) admission for sepsis in pregnancy.

METHODS:
This is a prospective validation study of the Sepsis in Obstetrics Score. The primary outcome was admission to the ICU for sepsis. Secondary outcomes included admission to a telemetry unit and time to administration of antibiotic therapy. We evaluated test characteristics of a predetermined score of 6 or greater.

RESULTS:
Between March 2012 and May 2015, 1,250 pregnant or postpartum women presented to the emergency department and met systemic inflammatory response syndrome criteria. Of those, 425 (34%) had a clinical suspicion or diagnosis of an infection, 14 of whom (3.3%) were admitted to the ICU. The Sepsis in Obstetrics Score had an area under the curve of 0.85 (95% CI 0.76–0.95) for prediction of ICU admission for sepsis. This is within the prespecified 15% margin of the area under the curve of 0.97 found in the derivation cohort. A score of 6 or greater had a sensitivity of 64%, specificity of 88%, positive predictive value of 15%, and negative predictive value of 98.6%. Women with a score 6 or greater were more likely to be admitted to the ICU (15% compared with 1.4%, P<.01), admitted to a telemetry unit (37.3% compared with 7.2%, P<.01), and have antibiotic therapy initiated (90% compared with 72.9%, P<.01), initiated more quickly (3.2 compared with 3.7 hours, P=.03), although not within 1 hour (5.6 compared with 3.4%, P=.44).

CONCLUSION:
The Sepsis in Obstetrics Score is a validated pregnancy-specific score to identify risk of ICU admission for sepsis with the threshold score of 6 having a negative predictive value of 98.6%. Adherence to antibiotic administration guidelines is poor.
Accuracy of Endometrial Sampling in Endometrial Carcinoma
Authors: Visser Nicole C. M. , Reijnen Casper , Massuger Leon F. A. G. , Nagtegaal Iris D. , Bulten Johan , Pijnenborg Johanna M. A. 
Published: September 2017

OBJECTIVE:
To assess the agreement between preoperative endometrial sampling and final diagnosis for tumor grade and subtype in patients with endometrial carcinoma.

DATA SOURCES:
MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane library were searched from inception to January 1, 2017, for studies that compared tumor grade and histologic subtype in preoperative endometrial samples and hysterectomy specimens.

METHODS OF STUDY SELECTION:
In eligible studies, the index test included office endometrial biopsy, hysteroscopic biopsy, or dilatation and curettage; the reference standard was hysterectomy. Outcome measures included tumor grade, histologic subtype, or both.

TABULATION, INTEGRATION, AND RESULTS:
Two independent reviewers assessed the eligibility of the studies. Risk of bias was assessed (Quality Assessment of Diagnostic Accuracy Studies). A total of 45 studies (12,459 patients) met the inclusion criteria. The pooled agreement rate on tumor grade was 0.67 (95% CI 0.60–0.75) and Cohen's κ was 0.45 (95% CI 0.34–0.55). Agreement between hysteroscopic biopsy and final diagnosis was higher (0.89, 95% CI 0.80–0.98) than for dilatation and curettage (0.70, 95% CI 0.60–0.79; P=.02); however, it was not significantly higher than for office endometrial biopsy (0.73, 95% CI 0.60–0.86; P=.08). The lowest agreement rate was found for grade 2 carcinomas (0.61, 95% CI 0.53–0.69). Downgrading was found in 25% and upgrading was found in 21% of the endometrial samples. Agreement on histologic subtypes was 0.95 (95% CI 0.94–0.97) and 0.81 (95% CI 0.69–0.92) for preoperative endometrioid and nonendometrioid carcinomas, respectively.

CONCLUSION:
Overall there is only moderate agreement on tumor grade between preoperative endometrial sampling and final diagnosis with the lowest agreement for grade 2 carcinomas.
How Common Is the Ponticulus Posticus?
Authors: Saleh Ahmed , Gruber Jilian , Bakhsh Wajeeh , Rubery Paul T. , Mesfin Addisu 
Published: September 2017

Study Design.
A computed tomography (CT) study of the morphology of the C1 vertebra.

Objective.
Is to determine the prevalence of ponticulus posticus (PP) by analyzing CT scans performed on a large, diverse population in the northeast United States. This study also proposes a CT-based classification system both to aid in unifying the description of PP, and to aid in future research.

Summary of Background Data.
The prevalence of PP varies from 5% to 68% in published studies. There may be geographic variation in the prevalence of PP. Our objective was to establish the prevalence of PP in the general population, and to develop a comprehensive classification system to describe PP.

Methods.
We evaluated cervical spine CT scans performed on patients in the emergency room of a level I trauma center over a 1-year period (January 1, 2014–December 31, 2014). The CT images were evaluated for the presence of a PP, and if present the following demographic data were collected: age, sex, race/ethnicity, and body mass index (BMI). We propose a novel classification system to standardize the description of PP identified on CT scan.

Results.
Two thousand, nine hundred and seventeen cervical spine CT scans were reviewed in this study. The prevalence of PP was 22.5%. Men had a higher prevalence of PP than women (53.5% male vs. 46.5% female P ≤ 0.01). When compared with the overall population, African–Americans were more likely to have a PP (P ≤ 0.01), while Caucasian patients were less likely (P ≤ 0.01). The novel classification consisted of a two letter designation for each patient, with the first letter denoting the right sided arch and the second letter the left sided arch. Each side of the arch described as an A, B, or C type. The A type had no presence of a PP, B type had in incomplete PP, and C type had a complete PP. The most common type of a PP was CC encompassing 25% of the patients. The presence of a PP was more common in the left sided arch than the right side (B and C type Left 89.2% vs. B and C type Right 84.7%, P = 0.02).

Conclusion.
We found a 22.5% prevalence of PP in 2917 patients undergoing a cervical spine CT. This is the largest study to evaluating the prevalence of PP.

Level of Evidence: 4
Advances in immunotherapy in multiple myeloma
Authors: Boussi Leora , Niesvizky Ruben 
Published: September 2017

Purpose of review
Here, we explore the significant progress made in the treatment of multiple myeloma, focusing on immunotherapy and the promise it has offered to patients suffering from advanced disease.

Recent findings
Multiple myeloma, a B-cell malignancy, is characterized by unregulated plasma cell growth in the bone marrow as well as strong immunosuppression in the tumor microenvironment. mAbs targeting tumor antigens overcome this, increasing T-cell activation, multiple myeloma cell death, and depth of response. Similarly, adoptive T-cell therapy aims to engineer or isolate tumor-specific T cells for a targeted approach. Finally, peptide and dendritic cell/tumor fusion vaccines reeducate the immune system, expanding the immune response and generating long-term memory to prevent relapse of disease. Many of these approaches have been combined with existing therapies to enhance antitumor immunity.

Summary
Immunotherapeutic approaches have remarkably changed the treatment paradigm for multiple myeloma, and encouraging patient responses have warranted further investigation into mAbs, adoptive T-cell therapy, vaccines, and combination therapy.
Successful Esophageal Dilation of Eosinophilic Esophagitis (EoE) Patients With a Previous Postdilation Complication
Authors: Lipka Seth , Kumar Ambuj , Richter Joel E. 
Published: September 2017

Introduction:
Esophageal dilation is an effective and safe treatment option for fibrostenotic eosinophilic esophagitis (EoE). Despite the safety, adverse events occur, yet there is scarce literature on the best treatment postcomplications.

Methods:
Patients with diagnosis of EoE (≥15 eosinophils per high-power field) from 2011 to 2015 treated at our center were included. Thirty patients with fibrostenotic disease had records available regarding serial dilation therapy. Eight patients previously experienced complications by outside providers. Groups were created based on history of complication before our dilation versus a group without. Mean difference and odds ratio with 95% confidence interval (CI) were calculated.

Results:
There were 8 complications, 7 occurred during dilation and 1 during passage of the endoscope. Esophageal diameter at initial dilation was lower in patients with prior complications 9.0±1.51 versus 11.73±2.98 mm (95% CI: −4.44, −1.02; P=0.003). However, end-esophageal diameter was similar across both groups 15.8±1.8 versus 16.1±2.0 mm. Total number of dilation sessions: 4.0±1.8 versus 2.32±1.0 (95% CI: 0.17, 3.19; P=0.03), as well as sessions to reach 17 mm diameter 3.8±1.0 versus 2.3±1.0 (95% CI: −0.08, 2.89; P=0.04), were higher in the patients with complications. The length of time in months to reach an esophageal diameter of 17 mm was longer in patients with complications, but the difference was not statistically significant 3.50±0.6 versus 2.3±2.3 months (P=0.09).

Conclusions:
Esophageal dilation is a safe and effective modality to treat severe fibrostenotic EoE in patients with prior history of complications. The keys to success are: (1) start with lower diameter bougies and (2) dilate slowly over a longer time course to reach targeted diameter and symptom resolution.
Is Orbital Floor Reconstruction With Titanium Mesh Safe?
Authors: Al-Khdhairi Omar Bakr Hazm , Abdulrazaq Saif Saadedeen 
Published: September 2017

Abstract
To reconstruct the orbital floor defects there are a lot of reconstruction materials, the surgeon must choose one of them. The authors share their experience with 10 patients suffering from orbital trauma causing orbital floor fracture; those fractures were reconstructed using titanium mesh. No complications were encountered postoperatively apart from 1 patient with ectropion. Titanium mesh is a perfect material for the reconstruction of the orbital fractures, eliminating the need for autogenous bone graft.
Evidence for Persistent Immune Suppression in Patients Who Develop Chronic Critical Illness After Sepsis
Authors: Stortz Julie A. , Murphy Tyler J. , Raymond Steven L. , Mira Juan C. , Ungaro Ricardo , Dirain Marvin L. , Nacionales Dina C. , Loftus Tyler J. , Wang Zhongkai , Ozrazgat-Baslanti Tezcan , Ghita Gabriela L. , Brumback Babette A. , Mohr Alicia M. , Bihorac Azra , Efron Philip A. , Moldawer Lyle L. , Moore Frederick A. , Brakenridge Scott C. 
Published: September 2017

ABSTRACT

Background:
Many sepsis survivors develop chronic critical illness (CCI) and are assumed to be immunosuppressed, but there is limited clinical evidence to support this. We sought to determine whether the incidence of secondary infections and immunosuppressive biomarker profiles of patients with CCI differ from those with rapid recovery (RAP) after sepsis.

Methods:
This prospective observational study evaluated 88 critically ill patients with sepsis and 20 healthy controls. Cohorts were defined based on clinical trajectory (early death, RAP, or CCI), whereas immunosuppression was clinically determined by the presence of a postsepsis secondary infection. Serial blood samples were collected for absolute lymphocyte counts (ALCs), monocytic human leukocyte antigen-DR (mHLA-DR) expression, and plasma-soluble programmed death-ligand 1 (sPD-L1) concentrations.

Results:
Of the 88 patients with sepsis, 3 (3%) died within 14 days of sepsis onset, 50 (57%) experienced RAP, and 35 (40%) developed CCI. Compared with RAP patients, CCI patients exhibited a higher incidence and overall number of infections adjusted for hospital length of stay. ALC and mHLA-DR levels were dramatically reduced at the time of sepsis diagnosis when compared with healthy controls, whereas sPD-L1 concentrations were significantly elevated. There were no differences between RAP and CCI patients in ALC, sPD-L1, or mHLA-DR at the time of diagnosis or within 24 h after sepsis diagnosis. However, in contrast to the RAP group, CCI patients failed to exhibit any trend toward restoration of normal values of ALC, HLA-DR, and sPD-L1.

Conclusions:
Septic patients demonstrate clinical and biological evidence to suggest they are immunosuppressed at the time of sepsis diagnosis. Those who develop CCI have a greater incidence of secondary infections and persistently aberrant markers of impaired host immunity, although measurements at the time of sepsis onset did not distinguish between subjects with RAP and CCI.
Modeling Surgical Technical Skill Using Expert Assessment for Automated Computer Rating
Authors: Azari David P. , Frasier Lane L. , Quamme Sudha R. Pavuluri , Greenberg Caprice C. , Pugh Carla M. , Greenberg Jacob A. , Radwin Robert G. 
Published: September 2017

Objective:
Computer vision was used to predict expert performance ratings from surgeon hand motions for tying and suturing tasks.

Summary Background Data:
Existing methods, including the objective structured assessment of technical skills (OSATS), have proven reliable, but do not readily discriminate at the task level. Computer vision may be used for evaluating distinct task performance throughout an operation.

Methods:
Open surgeries was videoed and surgeon hands were tracked without using sensors or markers. An expert panel of 3 attending surgeons rated tying and suturing video clips on continuous scales from 0 to 10 along 3 task measures adapted from the broader OSATS: motion economy, fluidity of motion, and tissue handling. Empirical models were developed to predict the expert consensus ratings based on the hand kinematic data records.

Results:
The predicted versus panel ratings for suturing had slopes from 0.73 to 1, and intercepts from 0.36 to 1.54 (Average R
2 = 0.81). Predicted versus panel ratings for tying had slopes from 0.39 to 0.88, and intercepts from 0.79 to 4.36 (Average R
2 = 0.57). The mean square error among predicted and expert ratings was consistently less than the mean squared difference among individual expert ratings and the eventual consensus ratings.

Conclusions:
The computer algorithm consistently predicted the panel ratings of individual tasks, and were more objective and reliable than individual assessment by surgical experts.
The hominoid-specific gene DSCR4 is involved in regulation of human leukocyte migration
Authors: Saber Morteza Mahmoudi , Karimiavargani Marziyeh , Hettiarachchi Nilmini , Hamada Michiaki , Uzawa Takanori , Ito Yoshihiro , Saitou Naruya 
Published: September 2017

AbstractDSCR4 (Down syndrome critical region 4) is an orphan retrotransposon-derived de-novo originated protein coding gene present only in hominoids (humans and great apes). Despite being located on the medically critical genomic region and abundance of evidences indicating its functionality, the role of this gene in human cells was utterly unknown. Due to absence of any prior knowledge regarding the function of DSCR4, for the first time here we used a gene-overexpression approach to discover biological importance and cellular roles of this gene. Our analysis strongly indicates DSCR4 to be mainly involved in regulation of the interconnected biological pathways related to cell migration, coagulation and immune system. We also showed that the predicted biological functions are consistent with tissue-specific expression of DSCR4 in migratory immune system leukocyte cells and neural crest cells that shape facial morphology of human embryo. Immune system and neural crest cells are also shown to be affected in Down syndrome patients who suffer from the same type of DSCR4 misregulation as in our study which further support our findings. Providing evidence for the critical roles of DSCR4 in human cells, our findings establish the basis for further investigations on the roles of DSCR4 in etiology of Down syndrome and unique characteristics of hominoids.
Synthesis of a eukaryotic chromosome reveals a role for N6-methyladenine in nucleosome organization
Authors: Beh Leslie Y. , Debelouchina Galia T. , Lindblad Kelsi A. , Kulej Katarzyna , Hutton Elizabeth R. , Bracht John R. , Sebra Robert P. , Garcia Benjamin A. , Muir Tom W. , Landweber Laura F. 
Published: September 2017

SummaryBiochemical studies of chromatin have typically used either artificial DNA templates with unnaturally high affinity for histones, or small genomic DNA fragments deprived of their cognate physical environment. It has thus been difficult to dissect chromatin structure and function within fully native DNA substrates. Here, we circumvent these limitations by exploiting the minimalist genome of the eukaryoteOxytricha trifallax, whose notably small ~3kb chromosomes mainly encode single genes. Guided by high-resolution epigenomic maps of nucleosome organization, transcription, and DNA N6-methyladenine (m6dA) locations, we reconstruct full-lengthOxytrichachromosomesin vitroand use these synthetic facsimiles to dissect the influence of m6dA and histone post-translational modifications on nucleosome organization. We show that m6dA directly disfavors nucleosomes in a quantitative manner, leading to local decreases in nucleosome occupancy that are synergistic with histone acetylation. The effect of m6dA can be partially reversed by the action of an ATP-dependent chromatin remodeler. Furthermore, erasing m6dA marks fromOxytrichachromosomes leads to proportional increases in nucleosome occupancy across the genome. This work showcasesOxytrichachromosomes as powerful yet practical models for studying eukaryotic chromatin and transcription in the context of biologically relevant DNA substrates.HighlightsDe novosynthesis of complete, epigenetically definedOxytrichachromosomesEpigenomic profiles of chromatin organization inOxytricha’sminiature chromosomesm6dA directly disfavors nucleosome occupancy in natural and synthetic chromosomesHistone acetylation and chromatin remodelers temper the impact of m6dA on chromatin
Molecular characterization of breast cancer cell response to metabolic drugs
Authors: Trilla-Fuertes Lucía , Gámez-Pozo Angelo , Arevalillo Jorge M , Díaz-Almirón Mariana , Prado-Vázquez Guillermo , Zapater-Moros Andrea , Navarro Hilario , Aras-López Rosa , Dapía Irene , López-Vacas Rocío , Nanni Paolo , Llorente-Armijo Sara , Arias Pedro , Borobia Alberto M. , Maín Paloma , Feliú Jaime , Espinosa Enrique , Vara Juan Ángel Fresno 
Published: September 2017

AbstractMetabolic reprogramming is a hallmark of cancer. We and other authors have previously shown that breast cancer subtypes present metabolism differences. In this study, breast cancer cell lines were treated with metformin and rapamycin. The response was heterogeneous across various breast cancer cells, leading to cell cycle disruption in specific conditions. The molecular effects of these treatments were characterized using sublethal doses, SNP genotyping and mass spectrometry-based proteomics. Protein expression was analyzed using probabilistic graphical models, showing that treatments elicit various responses in some biological processes, providing insights into cell responses to metabolism drugs. Moreover, a flux balance analysis approach using protein expression values was applied, showing that predicted growth rates were comparable with cell viability measurements and suggesting an increase in reactive oxygen species response enzymes due to metformin treatment. In addition, a method to assess flux differences in whole pathways was proposed. Our results show that these various approaches provide complementary information, which can be used to suggest hypotheses about the drugs’ mechanisms of action and the response to drugs that target metabolism.
The challenges of employee resourcing: the perceptions of managers in Nigeria
Authors: Adisa Toyin Ajibade , Osabutey Ellis L.C. , Gbadamosi Gbolahan , Mordi Chima 
Published: September 2017

PurposeThe existing literature on the recruitment and selection process in Sub-Saharan African (SSA) context has not sufficiently revealed inherent challenges. The purpose of this paper is to examine managers’ perceptions of employee resourcing in Nigeria.Design/methodology/approachThis paper uses qualitative data which were generated from the semi-structured interviews of 61 managers across the six geo-political zones of Nigeria.FindingsThe paper finds that in addition to the Federal Character Principle and the Quota System Policy, favouritism, ethnicity, age and gender discrimination, as well as corruption significantly inhibit the recruitment and selection process in Nigeria. Consequently, the ability to hire the best workers to improve competitiveness is also inadvertently hampered.Practical implicationsThe paper shows that the institutional and cultural variations in SSA require a nuanced approach in the recruitment and selection process in order to enhance organisational competitiveness.Originality/valueThe institutional and cultural variations in SSA require a nuanced approach in the recruitment and selection process in order to enhanced organisational competitiveness.
Employment goal commitment moderates the impact of job search goal orientation on the job search process
Authors: Kanar Adam 
Published: September 2017

PurposeThe purpose of this paper is to enhance the understanding of self-regulation during job search by integrating goal-orientation theory with a resource allocation framework.Design/methodology/approachThe author surveyed job searching new labor market entrants at two time points and hypothesized that the effects of job seekers’ state goal orientations on indicators of self-regulation during the job search process (procrastination, anxiety, and guidance-seeking behaviors) depended on levels of employment goal commitment (EGC).FindingsResults indicate that for job seekers with higher levels of EGC, a state learning-approach goal orientation (LGO) was beneficial for the job search process and a state performance-approach goal orientation (PGO) was detrimental. For job seekers with lower levels of EGC, a state LGO was detrimental to the search process, while a state PGO was beneficial.Research limitations/implicationsThis research extends the understanding of state goal orientation in the context of job search. Future research may replicate these findings with different samples of employed and unemployed job seekers and extend this research with additional conceptualizations of resource limitations.Practical implicationsThe present research suggests that the effectiveness of learning-approach goal-orientation training methods in the context of job search must be considered in light of individual differences in resource availability. In particular, individuals with lower resources available for job searching may benefit from interventions focusing on increasing state PGO.Originality/valueThe present results suggest that EGC is an important moderator of the impact of job search goal orientation on indicators of self-regulation during job search, and therefore present important boundary conditions regarding the role of state goal orientation in the job search process.