bluuebunny/crossref_metadata_2025_split huggingface dataset:
Important Role of Endothelial Caveolin-1 in the Protective Role of Endothelium-dependent Hyperpolarization Against Nitric Oxide–Mediated Nitrative Stress in Microcirculation in Mice
Authors: Saito Hiroki , Godo Shigeo , Sato Saori , Ito Akiyo , Ikumi Yosuke , Tanaka Shuhei , Ida Tomoaki , Fujii Shigemoto , Akaike Takaaki , Shimokawa Hiroaki 
Published: November 2017

Aims:
Nitric oxide (NO) and endothelium-dependent hyperpolarization (EDH) play important roles in maintaining cardiovascular homeostasis. We have previously demonstrated that endothelial NO synthase (eNOS) plays diverse roles depending on vessel size, as a NO generating system in conduit arteries and an EDH-mediated system in resistance arteries, for which caveolin-1 (Cav-1) is involved. However, the physiological role of endothelial Cav-1 in microvessels remains to be elucidated.

Methods and Results:
We newly generated endothelium-specific Cav-1-knockout (eCav-1-KO) mice. eCav-1-KO mice showed loss of endothelial Cav-1/eNOS complex and had cardiac hypertrophy despite normal blood pressure. In eCav-1-KO mice, as compared to wild-type controls, the extent of eNOS phosphorylation at inhibitory Thr495 was significantly reduced in mesenteric arteries and the heart. Isometric tension and Langendorff-perfused heart experiments showed that NO-mediated responses were enhanced, whereas EDH-mediated responses were reduced in coronary microcirculation in eCav-1-KO mice. Immunohistochemistry showed increased level of 8-nitroguanosine 3′,5′-cyclic monophosphate (8-nitro-cGMP), a marker of nitrative stress, in the heart from eCav-1-KO mice. S-guanylation of cardiac H-Ras in eCav-1-KO mice was also significantly increased compared with wild-type controls.

Conclusions:
These results suggest that eCav-1 is involved in the protective role of EDH against nitrative stress caused by excessive NO to maintain cardiac microvascular homeostasis.
A population ecology perspective on the functioning and future of health information organizations
Authors: Vest Joshua R. , Menachemi Nir 
Published: November 2017

Background:
Increasingly, health care providers need to exchange information to meet policy expectations and business needs. A variety of health information organizations (HIOs) provide services to facilitate health information exchange (HIE). However, the future of these organizations is unclear.

Purpose:
The aim of this study was to explore the environmental context, potential futures, and survivability of community HIOs, enterprise HIEs, and electronic health record vendor-mediated exchange using the population ecology theory.

Approach:
Qualitative interviews with 33 key informants representing each type of HIE organization were analyzed using template analysis.

Results:
Community HIOs, enterprise HIEs, and electronic health record vendors exhibited a high degree of competition for resources, especially in the area of exchange infrastructure services. Competition resulted in closures in some areas. In response to environmental pressures, each organizational type was endeavoring to differentiate its services and unique use case, as well as pursing symbiotic relationships or attempting resource partitioning.

Conclusion:
HIOs compete for similar resources and are reacting to environmental pressures to better position themselves for continued survival and success. Our ecological research perspective helps move the discourse away from situation of a single exchange organization type toward a view of the broader dynamics and relationships of all organizations involved in facilitating HIE activities.

Practice Implications:
HIOs are attempting to partition the environment and differentiate services. HIE options should not be construed as an “either/or” decision, but one where multiple and complementary participation may be required.
CHARACTERISTICS OF PIGMENTED LESIONS IN TYPE 2 IDIOPATHIC MACULAR TELANGIECTASIA
Authors: Leung Irene , Sallo Ferenc B. , Bonelli Roberto , Clemons Traci E. , Pauleikhoff Daniel , Chew Emily Y. , Bird Alan C. , Peto Tunde ,   the MacTel Study Group
Published: November 2017

Purpose:
Pigment in the midretina is a characteristic sign in Type 2 idiopathic macular telangiectasia (MacTel) and is considered to characterize the late stage of the disease. Our aim was to investigate its incidence, and relationship with risk factors for MacTel, including outer retinal vascularization and subretinal neovascular proliferation (SRNV).

Methods:
Pigment extent was measured in fundus autofluorescence images of 150 eyes of 75 MacTel probands, using the Region Finder tool of Heidelberg Eye Explorer. A linear mixed model was used to analyze the dynamics of pigment and its associations with other features of the phenotype. The relative incidence of pigment and of outer retinal outer retinal vascularization and SRNV was analyzed within the full MacTel Study cohort (1,244 probands).

Results:
Mean pigment area at baseline was 0.157 mm2 (range = 0–1.295 mm2, SD = 0.228 mm2, n = 101). Progression demonstrated a nonlinear pattern (P < 0.001) at an overall rate of 0.0177 mm2/year and was associated with the initial plaque size and with SRNV. There was a strong correlation between fellow eyes (P ≤ 0.0001). In approximately 25% of all SRNV cases, SRNV may coincide with or precede pigment.

Conclusion:
Our data may be useful for refining the current system for staging disease severity in MacTel.
Impact of National Ten-Valent Pneumococcal Conjugate Vaccine Program on Reducing Antimicrobial Use and Tympanostomy Tube Placements in Finland
Authors: Palmu Arto A. , Rinta-Kokko Hanna , Nohynek Hanna , Nuorti J. Pekka , Jokinen Jukka 
Published: October 2017

Background:
Otitis media in young children is associated with major resource use including antimicrobial consumption and tympanostomy tube placements (TTPs). We evaluated the impact of 10-valent pneumococcal conjugate vaccine (PCV10) introduction into the Finnish National Vaccination Programme (NVP) against these outcomes in vaccine-eligible children.

Methods:
PCV10-NVP began September 2010 with a 2 + 1 schedule; uptake in 2012 was estimated at 92%. The relative and absolute reduction in the NVP-eligible target cohort was compared with a season and age-matched (3–54 months) cohort before NVP introduction. Outpatient antimicrobial purchase data were collected from the Social Insurance Institution register. Data on purchases of antimicrobials recommended for treatment of acute otitis media by the Finnish Current Care Guidelines (amoxicillin with/without enzyme inhibitor, cefuroxime, cefaclor, clarithromycin, azithromycin) were collected, but full data on penicillin and sulfadiazine/trimethoprim were not available. Data on all TTP procedures were obtained from national hospital discharge register and Social Insurance Institution benefits register. Generalized Cox regression was used in the analysis.

Results:
The incidence rates of antimicrobial purchases in the reference and target cohorts were 1.09 and 0.89 per person-year, respectively. The relative rate reduction was 17.5% (95% confidence interval: 17.0–18.1) and the absolute rate reduction 0.20 per person-year. The rates of TTP in the reference and target cohorts were 5.41/100 and 4.56/100 person-years, respectively. The relative rate reduction was 14.8% (95% confidence interval: 13.1–16.5) and the absolute rate reduction 0.86/100 person-years.

Conclusions:
Use of antimicrobials and TTPs reduced after PCV10 was introduced into a routine vaccination program. This suggests considerable savings in health care resource use.
Association of Statins With Decreased Acute Pancreatitis Severity
Authors: Lee Peter J. , Modha Kunjam , Chua Tiffany , Chak Amitabh , Jang Daniel , Lopez Rocio , Gougol Amir , Papachristou Georgios I. , Stevens Tyler 
Published: October 2017

Background:
Statins possess anti-inflammatory properties and have a protective effect in certain inflammatory conditions; however, their effect on the natural history of pancreatitis is unknown.

Aim:
The aim of this study is to assess the effect of statin exposure on the severity of pancreatitis and incidence of organ failure using a propensity-matched approach.

Methods:
A historical cohort study was conducted of adult patients with acute pancreatitis (AP) admitted in the Cleveland Clinic Health System between 2007 and 2014. All medication, clinical, and outcomes data were extracted from the electronic medical record. Factors that influence statin use were included in a propensity model to minimize selection bias. Patients on and off statins were matched (1:1) based on the propensity score to simulate a randomized controlled trial. Measured outcomes included pancreatitis severity (Revised Atlanta Classification), incidence of multisystem organ failure (MSOF), new MSOF, acute necrosis, and death. Additional surrogate markers of severity included hospital length of stay, Bedside Index of Severity of Acute Pancreatitis (BISAP), and presence of SIRS.

Results:
A total of 110 subjects taking a statin at admission were matched with 210 subjects not on a statin. Known baseline factors that may influence statin use and severity of pancreatitis were evenly matched between the 2 groups. Patients on a statin were less likely to develop MSOF, severe AP and necrosis. Although less in-hospital death occurred in the statin group when compared to nonusers, the difference was not statistically significant (2% vs. 4%; P=0.38).

Conclusions:
Statin use is associated with decreased severity of AP observed as reduction in both overall MSOF incidence and new MSOF. Prospective randomized controlled trials are needed to determine the efficacy of statin drugs in the treatment of AP.
Improved Identification of Venous Thromboembolism From Electronic Medical Records Using a Novel Information Extraction Software Platform
Authors: Dantes Raymund B. , Zheng Shuai , Lu James J. , Beckman Michele G. , Krishnaswamy Asha , Richardson Lisa C. , Chernetsky-Tejedor Sheri , Wang Fusheng 
Published: October 2017

Introduction:
The United States federally mandated reporting of venous thromboembolism (VTE), defined by Agency for Healthcare Research & Quality Patient Safety Indicator 12 (AHRQ PSI-12), is based on administrative data, the accuracy of which has not been consistently demonstrated. We used IDEAL-X, a novel information extraction software system, to identify VTE from electronic medical records and evaluated its accuracy.

Methods:
Medical records for 13,248 patients admitted to an orthopedic specialty hospital from 2009 to 2014 were reviewed. Patient encounters were defined as a hospital admission where both surgery (of the spine, hip, or knee) and a radiology diagnostic study that could detect VTE was performed. Radiology reports were both manually reviewed by a physician and analyzed by IDEAL-X.

Results:
Among 2083 radiology reports, IDEAL-X correctly identified 176/181 VTE events, achieving a sensitivity of 97.2% [95% confidence interval (CI), 93.7%–99.1%] and specificity of 99.3% (95% CI, 98.9%–99.7%) when compared with manual review. Among 422 surgical encounters with diagnostic radiographic studies for VTE, IDEAL-X correctly identified 41 of 42 VTE events, achieving a sensitivity of 97.6% (95% CI, 87.4%–99.6%) and specificity of 99.8% (95% CI, 98.7%–100.0%). The performance surpassed that of AHRQ PSI-12, which had a sensitivity of 92.9% (95% CI, 80.5%–98.4%) and specificity of 92.9% (95% CI, 89.8%–95.3%), though only the difference in specificity was statistically significant (P<0.01).

Conclusion:
IDEAL-X, a novel information extraction software system, identified VTE from radiology reports with high accuracy, with specificity surpassing AHRQ PSI-12. IDEAL-X could potentially improve detection and surveillance of many medical conditions from free text of electronic medical records.
Randomized Trial of a Yogurt‐type Amino Acid−based Formula in Infants and Children With Severe Cow's Milk Allergy
Authors: Payot François , Lachaux Alain , Lalanne Florent , Kalach Nicolas 
Published: November 2017

ABSTRACTObjectives:Evaluation of a spoon‐fed amino acid−based formula (AAF) with a yogurt‐type texture compared to the reference oral liquid formula (Neocate).Methods:Phase III/IV, prospective, randomized (1:1), open‐label, multicenter study in infants/young children (6–36 months) with severe cow's milk protein allergy (CMA) who had consumed AAF for ≥1 month before the study. Patients received reference+test formula (Neocate with a yogurt‐type texture for spoon‐feeding: group 1) or reference formula (group 2) for 28 days. The study formulae were integrated into the patients’ usual daily diet. Efficacy on Day 0, 14, and 28 was assessed primarily in terms of symptoms associated with CMA. The evolution of symptoms, amount of formula consumed, nutritional and energy intake, anthropometric data, and tolerability were also assessed.Results:The incidence of CMA symptoms was similar in each group (P > 0.05) on day 0, 14, and 28. For specific symptoms, there was little change from day 0 and no significant difference between groups for incidence on day 0 or evolution at day 14 or 28. There was no difference in formula consumption (day 0–day 28) between groups (P = 0.90), but nutritional value was generally higher for group 1 and calcium intake was statistically higher for group 1 (P < 0.05). Weight‐for‐height, weight‐for age, and body mass index‐for‐age z scores were higher for group 1 than group 2 (P < 0.05). Both formulae were well tolerated.Conclusions:There was no difference in efficacy, formula consumption, and tolerability between the new spoon‐fed yogurt‐type AAF formula and the reference formula, whereas significantly higher calcium intake was achieved with the new formula.
Prediction of Poor Prognosis After Severe Head Injury in Children Using Logistic Regression
Authors: Ichikawa Rie , Maeda Yukihiro , Shibuya Akiko , Umesato Yoshimasa , Kondo Yoshiaki , Maeda Takeshi , Yoshino Atsuo , Takahashi Shori 
Published: November 2017

Objectives
Head trauma is one of the main causes of death in childhood and often leaves severe disability with serious neurological damage. Appropriate treatment must be provided immediately to improve outcomes. This study was performed to identify factors associated with a poor prognosis at an early stage of severe head injury in children.

Methods
The subjects were registered in the Japan Neurotrauma Data Bank. They were 119 children (mean age, 8 years; male, 67.2%) with severe head injury registered during a period of 4 years (from July 1, 2004 to June 30, 2006 and from July 1, 2009 to June 30, 2011). Univariate and multivariate analyses were performed to examine relationships among factors and outcome 6 months after discharge. Logistic regression analysis was performed to develop models for poor prognosis and death.

Results
Outcome was evaluated based on the Glasgow Outcome Scale: 73 children (61.3%) had good recovery, 11 (9.2%) had moderate disability, 8 (6.7%) had severe disability, 4 (3.3%) were in a vegetative state, and 23 (19.3%) had died. Four factors were identified as predictors of a poor prognosis: serum glucose level greater than or equal to 200 mg/dL, Glasgow Coma Scale score on admission less than or equal to 5, presence of mydriasis, and presence of traumatic subarachnoid hemorrhage. Three factors were identified as predictors of death: serum glucose level greater than or equal to 200 mg/dL, Glasgow Coma Scale score on admission less than or equal to 5, and presence of mydriasis.

Conclusions
Using these predictors, subsequent exacerbation may be predicted just after arrival at the hospital and appropriate treatment can be provided immediately.
Paroxysmal Tonic Upgaze in Children
Authors: Kartal Ayse 
Published: November 2017

BackgroundIn clinical practice, nonepileptic paroxysmal events during infancy and childhood are common reasons for parents and caregivers to seek for medical advice. These events are mostly unrecognized and considered as an epileptic seizure because of the clinical features resembling an epileptic seizure. Paroxysmal tonic upgaze, which consists of recurrent episodes of sustained upward deviation of the eyes and incomplete downward saccades, and normal horizontal eye movements without impairment of consciousness, is a diagnostic challenge for the pediatrician and pediatric neurologist. In general, the entity was defined as an apparently benign phenomenon with normal investigations and eventual complete resolution of the symptoms, although some authors reported on patients with associated neurologic signs, such as ataxia, developmental delay, and abnormal brain magnetic resonance imaging finding.MethodsThe patients were 3 children (1 boy and 2 girls) who were between 5 and 18 months old experiencing rapid ocular movements with sustained conjugate upward deviation of the eyes. Their attacks, which were recorded using a video or electroencephalogram system, were also investigated comprehensively, including neurologic examination, electroencephalograms, brain magnetic resonance imaging, and metabolic tests. Paroxysmal tonic upgaze attacks have decreased in number or disappeared in 2 patients, but 1 patient exhibited mild abnormalities on magnetic resonance imaging and had relatives with epilepsy.ConclusionsIn conclusion, paroxysmal tonic upgaze is an apparently benign phenomenon with unclear pathophysiology of various proposed mechanisms such as genetic predisposition, immaturity of the brain stem, neurotransmitter depletion, or immune dysregulation. It is important to recognize the clinical presentation of paroxysmal tonic upgaze and distinguish the disorders from epilepsy for deciding the treatment and prognosis of the patients.
Ultrasound-Guided Popliteal Sciatic Nerve Block for an Ankle Laceration in a Pediatric Emergency Department
Authors: Mori Takaaki , Hagiwara Yusuke 
Published: November 2017

Abstract
Although ultrasound-guided peripheral nerve block has recently been introduced into pediatric emergency departments, knowledge of its use is limited. We present here a case demonstrating the safety and effectiveness of ultrasound-guided popliteal sciatic nerve block for a pediatric spoke injury in a pediatric emergency department setting.
Novel and preclinical treatment strategies in pneumococcal meningitis
Authors: Bewersdorf Jan P. , Grandgirard Denis , Koedel Uwe , Leib Stephen L. 
Published: November 2017

Purpose of review
Pneumococcal meningitis is the most frequent form of bacterial meningitis in Europe and the United States. Although early antimicrobial and adjuvant therapy with dexamethasone have helped to improve disease outcome in adults, mortality and morbidity rates remain unsatisfactorily high, emphasizing the need for additional treatment options. Promising targets for adjuvant therapy have been identified recently and will be the focus of this review.

Recent findings
Brain disease in pneumococcal meningitis is caused by direct bacterial toxicity and excessive meningeal inflammation. Accordingly, promising targets for adjuvant therapy comprise limiting the release of toxic bacterial products and suppressing inflammation in a way that maximally protects against tissue injury without hampering pathogen eradication by antibiotics. Among the agents tested so far in experimental models, complement inhibitors, matrix-metalloproteinase inhibitors, and nonbacteriolytic antibiotics or a combination of the above have the potential to more efficiently protect the brain either alone (e.g., in children and outside the high-income settings) or in addition to adjuvant dexamethasone. Additionally, new protein-based pneumococcal vaccines are being developed that promise to improve disease prevention, namely by addressing the increasing problem of serotype replacement seen with pneumococcal conjugate vaccines.

Summary
Pneumococcal meningitis remains a life-threatening disease requiring early antibiotic and targeted anti-inflammatory therapy. New adjuvant therapies showed promising results in animal models but need systematic clinical testing.
Surgeons’ Perceptions Toward Providing Care for Diverse Patients
Authors: Changoor Navin R. , Udyavar Nidhi R. , Morris Megan A. , Torain Maya , Mullen John T. , Kent Tara S. , Smink Douglas S. , Green Alexander , Haider Adil H. 
Published: November 2017

Objective:
We sought to understand the experiences of surgical residents and faculty with treating culturally diverse patients, and identify recommendations for establishing and implementing structured cultural competency training.

Summary Background Data:
Cultural competency training for medical professionals could reduce healthcare disparities, yet is currently not a standard part of surgical residency training. Few studies have explored the perspectives of surgical residents and faculty on the skills needed to provide cross-cultural care.

Study Design:
A purposeful sample of surgical residents and faculty from 4 academic institutions was recruited for semistructured qualitative interviews. We developed an in-depth interview guide and performed interviews to thematic saturation. Interviews were audio-recorded, transcribed, and analyzed using grounded theory methodology.

Results:
We interviewed 16 attending surgeons and 15 surgical residents. Participant demographics were: male (51.6%), White (58.1%), Black (9.7%), Asian (22.5%), and Hispanic (9.7%). Four main themes emerged from the data: 1) aspects of culture that can inform patient care; 2) specific cultural challenges related to surgical care, including informed consent, pain management, difficult diagnoses and refusal of treatment, emergency situations, and end-of-life issues; 3) need for culturally competent care in surgery to navigate cultural differences; 4) perceived challenges and facilitators to incorporating cultural competency into the current training paradigm.

Conclusions:
Surgeons identified the need to provide better cross-cultural care and proposed tenets for training. Based on these findings, we suggest the development and dissemination of a cultural dexterity training program that will provide surgeons with specific knowledge and skills to care for patients from diverse sociocultural backgrounds.
Central control of eye movements
Authors: Baird-Gunning Jonathan J.D. , Lueck Christian J. 
Published: November 2017

Purpose of review
Eye-movement research continues to provide an excellent tool for understanding the central control of motor function, both in health and disease. This article reviews recent findings in relation to saccadic eye movements, particularly antisaccades and microsaccades, with particular emphasis on the control of inaction, something which has recently become topical.

Recent findings
Microsaccades are under the control of the cerebral cortex, particularly the frontal and parietal eye fields. Their frequency and direction alters following presentation of visual stimuli. Spontaneous alterations in their frequency are correlated with alterations in the frequency of the gamma-band activity in the visual cortex as well as, interestingly, the heartbeat. Studies of saccades in Parkinson's disease have demonstrated abnormalities of prosaccade suppression which have variously been shown to correlate with freezing of gait, postural instability, minimal cognitive change and stimulation of the subthalamic nuclei. In stroke patients, abnormal patterns of saccade activity are associated with poor performance on reaching studies when using the weak arm.

Summary
Eye-movement studies continue to provide new insights into the control of movement in general but have been particularly useful in investigating the process of suppressing unwanted movement.