bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative Immunonutrition and Elective Colorectal Resection Outcomes
Authors: Thornblade Lucas W. , Varghese Thomas K. , Shi Xu , Johnson Eric K. , Bastawrous Amir , Billingham Richard P. , Thirlby Richard , Fichera Alessandro , Flum David R. 
Published: December 2016

BACKGROUND:
Randomized controlled trials demonstrate the efficacy of arginine-enriched nutritional supplements (immunonutrition) in reducing complications after surgery. The effectiveness of preoperative immunonutrition has not been evaluated in a community setting.

OBJECTIVE:
This study aims to determine whether immunonutrition before elective colorectal surgery improves outcomes in the community at large.

DESIGN:
This is a prospective cohort study with a propensity score–matched comparative effectiveness evaluation.

SETTINGS:
This study was conducted in Washington State hospitals in the Surgical Care Outcomes Assessment Program from 2012 to 2015.

PATIENTS:
Adults undergoing elective colorectal surgery were selected.

INTERVENTIONS:
Surgeons used a preoperative checklist that recommended that patients take oral immunonutrition (237 mL, 3 times daily) for 5 days before elective colorectal resection.

MAIN OUTCOME MEASURES:
Serious adverse events (infection, anastomotic leak, reoperation, and death) and prolonged length of stay were the primary outcomes measured.

RESULTS:
Three thousand three hundred seventy-five patients (mean age 59.9 ± 15.2 years, 56% female) underwent elective colorectal surgery. Patients receiving immunonutrition more commonly were in a higher ASA class (III–V, 44% vs 38%; p = 0.01) or required an ostomy (18% vs 14%; p = 0.02). The rate of serious adverse events was 6.8% vs 8.3% (p = 0.25) and the rate of prolonged length of stay was 13.8% vs 17.3% (p = 0.04) in those who did and did not receive immunonutrition. After propensity score matching, covariates were similar among 960 patients. Although differences in serious adverse events were nonsignificant (relative risk, 0.76; 95% CI, 0.49–1.16), prolonged length of stay (relative risk, 0.77; 95% CI, 0.58–1.01 p = 0.05) was lower in those receiving immunonutrition.

LIMITATIONS:
Patient compliance with the intervention was not measured. Residual confounding, including surgeon-level heterogeneity, may influence estimates of the effect of immunonutrition.

CONCLUSIONS:
Reductions in prolonged length of stay, likely related to fewer complications, support the use of immunonutrition in quality improvement initiatives related to elective colorectal surgery. This population-based study supports previous trials of immunonutrition, but shows a lower magnitude of benefit, perhaps related to compliance or a lower rate of adverse events, highlighting the value of community-based assessments of comparative effectiveness.
Periorbital Syringomas Treated With an Externally Used 1,444 nm Neodymium-Doped Yttrium Aluminum Garnet Laser
Authors: Kim Jun Young , Lee Jae Won , Chung Kee Yang 
Published: December 2016

BACKGROUND
The 1,444 nm wavelength is also well absorbed in water making it a possible setting for treatment of cystic lesions such as eccrine hydrocystomas and syringomas.

OBJECTIVE
The authors aimed to investigate the efficacy of an externally used 1,444 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser for the treatment of periorbital syringomas.

METHODS AND MATERIALS
Nineteen patients with periorbital syringomas were treated twice with the externally used 1,444 nm Nd:YAG laser at 2-month intervals. Laser fluences were delivered to each papule with pulse energy of 160 mJ, 1.6 W of power, and at a 10 Hz pulse rate. Clinical improvement and patient satisfaction were assessed at 2 and 6 months after each treatment. Side effects were also examined.

RESULTS
Clinical improvement of >50% was observed in 68.4% of individuals at 2 months after first treatment (2FT) and in all patients at 6 months after second treatment (6ST). Patient satisfaction of no less than “satisfied” was recorded for 63.2% of patients at 2FT, and in 89.5% of patients at 6ST. Erythema was observed in 63.2% of patients but only at 2FT.

CONCLUSION
Externally used 1,444 nm Nd:YAG laser treatment may represent an effective and safe approach for the treatment of periorbital syringomas, resulting in good satisfaction and minimal side effects.
An Automated Expanded Polytetrafluoroethylene Suturing and Coaxial Fastener System for Mitral Chordae Replacement: Strength, Feasibility, and Healing
Authors: Lee Candice Y. , Wong Joshua K. , Sauer Jude S. , Gorea Heather R. , Martellaro Angelo J. , Sifain Andrew R. , Knight Peter A. 
Published: December 2016

Objective Mitral valve (MV) chordae replacements can be technically challenging. Technology that remotely delivers and accurately secures artificial chordae may reduce the learning curve and improve the reliability of MV repairs. Methods The technology involved two devices: a remote suturing device for delivery of expanded polytetrafluoroethylene (ePTFE) suture to the papillary muscle and a Coaxial titanium suture fastener (TF) device with integrated saline infusion for real-time determination of chordae length during fixation. A mechanical model simulating MV chordae tension in a beating heart quantified the durability of 120 coaxially fastened ePTFE sutures using TF over time. Investigation of the technology was performed in ex vivo porcine, ovine, and in situ cadaver hearts, whereas live-tissue testing was conducted in a survivor ovine model. Mitral valve repair procedures involved the iatrogenic induction of mitral regurgitation by the resection of one to two native MV chordae, followed by implantation of ePTFE suture using the technology. Epicardial echocardiography, saline infusion testing, and histologic analysis evaluated MV competence, repair integrity, and long-term healing. Results Durability testing of ePTFE suture secured with TF demonstrated no degradation of TF pull-apart forces of for 440 million cycles. Mitral valve repairs using the technology were performed in eight sheep; four demonstrating proof of concept and four survived for an average of 6.5 months after completion of the procedure. At reoperation, echocardiography demonstrated trace to no mitral regurgitation with near complete endothelialization of the TF and artificial chordae. Conclusions This technology successfully enabled the implantation of artificial chordae while providing real-time adjustment of chordae length during MV repair. These results encourage further investigation of its use clinically.
Strategies to Improve the Efficacy of Epicardial Linear Ablation on the Beating Heart
Authors: Watanabe Yoshiyuki , Schill Matthew R. , Kazui Toshinobu , Melby Spencer J. , Schuessler Richard B. , Damiano Ralph J. 
Published: December 2016

Objective Creating transmural linear lesions on the beating heart is an important component of minimally invasive surgical ablation for atrial fibrillation. Animal studies have shown poor efficacy for surface bipolar radiofrequency ablation (RFA). Clinicians have developed strategies including multiple device applications and vena caval occlusion (VCO) to improve ablation efficacy. These techniques were evaluated in an acute porcine model. Methods In the first experiment, an RFA device was used to perform two 40-second epicardial ablations on the right atrium of six pigs. Ablations were performed with and without VCO. Ultrasonic flow probes were used to verify VCO. In the second experiment, an RFA device was used to perform two 40-second epicardial ablations at six locations on the left and right atria of six pigs. All animals were sacrificed. The hearts were removed and stained with 2,3,5-triphenyltetrazolium chloride. Sections were examined using digital photography. Results With VCO, 42 (81%) of 52 sections were transmural; without VCO on the RA, only 12 (24%) of 50 sections were transmural (P < 0.01). In thick (>2 mm) tissue, 10 (59%) of 17 VCO sections were transmural compared with only two (8%) of 24 with normal caval blood flow. Compared with a single ablation, multiple device applications improved transmurality on the LA but not the RA (92% vs 71%, P < 0.05). Conclusions In an acute animal model, VCO improved the efficacy of beating-heart RFA on the RA. Multiple device applications improved the efficacy of RFA on the LA.
An Early Canadian Experience with the Correx Automated Coring and Apical Connector Device for Aortic Valve Bypass
Authors: Al-Amodi Hussein A. , Tarola Christopher L. , Alhabib Hamad F. , Adams Corey , Guo Linrui Ray , Kiaii Bob B. 
Published: December 2016

Objective Aortic valve replacement is the standard of care for severe, symptomatic aortic valve stenosis (AS); however, anatomy or preexisting comorbidities may preclude conventional or alternative transcatheter approaches. Aortic valve bypass (AVB) may be performed as a salvage procedure for the relief of symptomatic aortic stenosis in patients who are not suitable candidates for aortic valve replacement. Methods At our institution, seven patients underwent AVB using the Correx automated coring and apical connector system. All patients had severe AS with New York Heart Association functional class 3 symptoms and were not candidates for conventional or transcatheter approaches. Via a left anterolateral thoracotomy to access the descending aorta and left ventricular apex, we used the Correx system (Correx, Waltham, MA USA) to anastomose a valve conduit to the left ventricular apex proximally and the descending aorta distally. Three patients required cardiopulmonary bypass. Results In all seven patients, the automated coring and apical connector was successfully deployed. There were two in-hospital deaths in this series. Immediately postoperatively and at 3 months, there was a significant reduction in mean and peak valve gradients, and all surviving patients performed at New York Heart Association functional class 1. Conclusions Aortic valve bypass seems to be an acceptable alternative for the treatment of severe AS in high-risk patients who are not candidates for aortic valve replacement. The Correx automated system may improve the clinical applicability and surgical repro-ducibility of AVB in appropriately selected patients in which conventional or transcatheter aortic valve replacement is not a feasible options.
Risk of Gambling Disorder and Impulse Control Disorder With Aripiprazole, Pramipexole, and Ropinirole
Authors: Etminan Mahyar , Sodhi Mohit , Samii Ali , Procyshyn Ric M. , Guo Michael , Carleton Bruce C. 
Published: December 2016

Abstract

Background
Recently, the US Food and Drug Administration issued a warning regarding the potential risk of gambling disorder, but large epidemiologic studies are lacking.

Methods
We used a large health claims database from the United States and conducted a nested case-control study. Cases were defined as subjects newly diagnosed with gambling disorder or impulse control disorder. For each case, 10 controls were selected and matched to cases by age and follow-up time and calendar time. Adjusted rate ratios were computed with conditional logistic regression.

Results
There are 355 cases of gambling disorder and 3550 controls along with 4341 cases of impulse control disorder and 43,410 corresponding controls. After adjusting for confounders, users of aripiprazole demonstrated an increased risk of pathologic gambling (rate ratio [RR], 5.23; 95% confidence interval [CI], 1.78–15.38) and impulse control disorder (RR, 7.71; 95% CI, 5.81–10.34). The risk was also elevated for pramipexole or ropinirole for both gambling disorder and impulse control disorder (RR, 7.61; 95% CI, 2.75–21.07; RR, 3.28; 95% CI, 2.31–4.66, respectively).

Conclusions
Our study confirms an association between aripiprazole, pramipexole, or ropinirole and impulse control disorder and gambling disorder.
Analysis and Management of Complications in a Cohort of 1,065 Minimally Invasive Cochlear Implantations
Authors: Jiang Yi , Gu Ping , Li Beicheng , Gao Xue , Sun Baochun , Song Yueshuai , Wang Guojian , Yuan Yongyi , Wang Cuicui , Liu Miao , Han Dongyi , Dai Pu 
Published: December 2016

Objectives:
To analyze complications associated with minimally invasive cochlear implantation by comparing data from different centers, to discuss major reasons for complications, and to refine implantation techniques to decrease them.

Patients:
Patients who underwent cochlear implantation at our center by the same surgeon (the corresponding author of this article) from March 2006 to March 2015 were enrolled.

Intervention:
First, a retrospective analysis of the complications associated with minimally invasive cochlear implantation at our center was performed. Second, published reports from other centers that describe complications were reviewed. Differences between complications in our cohort and other studies were evaluated.

Main Outcome Measure:
Strategies for reducing complications were assessed and modifications in surgical protocol proposed accordingly.

Results:
In total, 1,014 patients underwent 1,065 cochlear implantations. There were 28 complications (7 major, 21 minor) and only 2 reimplantations for the entire cohort, with no case of severe infection, flap necrosis, or device extrusion. The major complications were electrode misplacement, magnet displacement, implant failure secondary to trauma, and temporary cerebrospinal fluid leakage. The rates of major complications in our cohort were very low (0.6%) compared with those in the literature.

Conclusion:
Preoperative surgical planning based on individual patient anatomy and employment of soft surgical techniques can minimize surgical complications.
The impact of value-based healthcare for inflammatory bowel diseases on healthcare utilization: a pilot study
Authors: van Deen Welmoed K. , Spiro Arlen , Burak Ozbay A. , Skup Martha , Centeno Adriana , Duran Natalie E. , Lacey Precious N. , Jatulis Darius , Esrailian Eric , van Oijen Martijn G.H. , Hommes Daniel W. 
Published: December 2016

Background and objectives
Value-based healthcare (VBHC) is considered to be the solution that will improve quality and decrease costs in healthcare. Many hospitals are implementing programs on the basis of this strategy, but rigorous scientific reports are still lacking. In this pilot study, we present the first-year outcomes of a VBHC program for inflammatory bowel disease (IBD) management that focuses on highly coordinated care, task differentiation of providers, and continuous home monitoring.

Methods
IBD patients treated within the VBHC program were identified in an administrative claims database from a commercial insurer allowing comparisons to matched controls. Only patients for whom data were available the year before and after starting the program were included. Healthcare utilization including visits, hospitalizations, laboratory and imaging tests, and medications were compared between groups.

Results
In total, 60 IBD patients treated at the VBHC Center were identified and were matched to 177 controls. Significantly fewer upper endoscopies were performed (−10%, P=0.012), and numerically fewer surgeries (−25%, P=0.49), hospitalizations (−28%, 0=0.71), emergency department visits (-37%, P=0.44), and imaging studies (−25 to −86%) were observed. In addition, 65% fewer patients (P=0.16) used steroids long term. IBD-related costs were 16% ($771) lower than expected (P=0.24).

Conclusion
These are the first results of a successfully implemented VBHC program for IBD. Encouraging trends toward fewer emergency department visits, hospitalizations, and long-term corticosteroid use were observed. These results will need to be confirmed in a larger sample with more follow-up.
A Phylogenetic Analysis of Shape Covariance Structure in the Anthropoid Skull
Authors: Garcia Guilherme , de Oliveira Felipe Bandoni , Marroig Gabriel 
Published: December 2016

AbstractPhenotypic traits evolve in a coordinated manner due to developmental and functional interactions, mediated by the dynamics of natural selection; the dependence between traits arising from these three factors is captured by genetic (G) and phenotypic (P) covariance matrices. Mammalian skull development produces an intricate pattern of tissue organization and mutual signaling that integrates this structure, although the set of functions it performs is quite disparate. Therefore, the interplay between these interactions, and their relationships with the adaptive landscape may thus influence divergence in covariance structure among sister lineages. Here, we evaluate the stability of phenotypic covariance structure in skull size and shape along the diversification of Anthropoid Primates under a explicit phylogenetic framework. We estimate diversity in covariance structure, testing hypotheses concerning the phylogenetic distribution ofP-matrix variation and pinpoint which traits are associated with this variation. We find that most changes occurred in the basal split between Platyrrhini and Catarrhini, and that these changes occurred within both Orbital and Basicranial trait sets, while Oral, Nasal and Vault trait sets present stable associations along the Anthropoid phylogeny. Therefore, changes inP-matrix structure among Anthropoids are restricted to trait sets whose functional significance is associated with the accommodation of the two precursor tissues that compose the skull, while the stability in the remaining regions hints at the stability of the underlying functional relationships imposed by the adaptive landscape.
Power laws and critical fragmentation in global forests
Authors: Saravia Leonardo A. , Doyle Santiago R. , Bond-Lamberty Ben 
Published: December 2016

AbstractThe replacement of forest areas with human-dominated landscapes usually leads to fragmentation, altering the structure and function of the forest. Here we studied the dynamics of forest patch sizes at a global level, examining signals of a critical transition from an unfragmented to a fragmented state, using the MODIS vegetation continuous field. We defined wide regions of connected forest across continents and big islands, and combined five criteria, including the distribution of patch sizes and the fluctuations of the largest patch over the last sixteen years, to evaluate the closeness of each region to a fragmentation threshold. Regions with the highest deforestation rates—South America, Southeast Asia, Africa—all met these criteria and may thus be near a critical fragmentation threshold. This implies that if current forest loss rates are maintained, wide continental areas could suddenly fragment, triggering extensive species loss and degradation of ecosystems services.
OpenMM 7: Rapid Development of High Performance Algorithms for Molecular Dynamics
Authors: Eastman Peter , Swails Jason , Chodera John D. , McGibbon Robert T. , Zhao Yutong , Beauchamp Kyle A. , Wang Lee-Ping , Simmonett Andrew C. , Harrigan Matthew P. , Stern Chaya D. , Wiewiora Rafal P. , Brooks Bernard R. , Pande Vijay S. 
Published: December 2016

AbstractOpenMM is a molecular dynamics simulation toolkit with a unique focus on extensibility. It allows users to easily add new features, including forces with novel functional forms, new integration algorithms, and new simulation protocols. Those features automatically work on all supported hardware types (including both CPUs and GPUs) and perform well on all of them. In many cases they require minimal coding, just a mathematical description of the desired function. They also require no modification to OpenMM itself and can be distributed independently of OpenMM. This makes it an ideal tool for researchers developing new simulation methods, and also allows those new methods to be immediately available to the larger community.
Resource-Driven Encounters and the Induction of Disease Among Consumers
Authors: Borchering Rebecca K. , Bellan Steve E. , Flynn Jason M. , Pulliam Juliet R.C. , McKinley Scott A. 
Published: December 2016

AbstractSubmitted Manuscript 2016.Territorial animals share a variety of common resources, which can be a major driver of conspecific encounter rates. We examine how changes in resource availability influence the rate of encounters among individuals in a consumer population by implementing a spatially explicit model for resource visitation behavior by consumers. Using data from 2009 and 2010 in Etosha National Park, we verify our model's prediction that there is a saturation effect in the expected number of jackals that visit a given carcass site as carcasses become abundant. However, this does not directly imply that the overall resource-driven encounter rate among jackals decreases. This is because the increase in available carcasses is accompanied by an increase in the number of jackals that detect and potentially visit carcasses. Using simulations and mathematical analysis of our consumer-resource interaction model, we characterize key features of the relationship between resource-driven encounter rate and model parameters. These results are used to investigate a standing hypothesis that the outbreak of a fatal disease among zebras can potentially lead to an outbreak of an entirely different disease in the jackal population, a process we refer to as indirect induction of disease.
Rice protein models from the Nutritious Rice for the World Project
Authors: Hung Ling-Hong , Samudrala Ram 
Published: December 2016

AbstractBackgroundMany rice protein sequences are very different from the sequence of proteins with known structures. Homology modeling is not possible for many rice proteins. However, it is possible to use computational intensivede novotechniques to obtain protein models when the protein sequence cannot be mapped to a protein of known structure. The Nutritious Rice for the World project generated 10 billion models encompassing more than 60,000 small proteins and protein domains for the rice strains Oryza sativa and Oryza japonica.FindingsOver a period of 1.5 years, the volunteers of World Community Grid supported by IBM generated 10 billion candidate structures, a task that would have taken a single CPU on the order of 10 millennia. For each protein sequence, 5 top structures were chosen using a novel clustering methodology developed for analyzing large datasets. These are provided along with the entire set of 10 billion conformers.ConclusionsWe anticipate that the centroid models will be of use in visualizing and determining the role of rice proteins where the function is unknown. The entire set of conformers is unique in terms of size and that they were derived from sequences that lack detectable homologs. Large sets ofde novoconformers are rare and we anticipate that this set will be useful for benchmarking and developing new protein structure prediction methodologies.