bluuebunny/crossref_metadata_2025_split huggingface dataset:
The association of nonalcoholic steatohepatitis and obstructive sleep apnea
Authors: Asfari Mohammad M. , Niyazi Fadi , Lopez Rocio , Dasarathy Srinivasan , McCullough Arthur J. 
Published: September 2017

Background and aim
The association between obstructive sleep apnea (OSA) and abnormal liver enzymes has been reported in multiple studies. The existing literature regarding the relationship between OSA and nonalcoholic steatohepatitis (NASH) is conflicting. Thus we aimed to determine the relationship between OSA and NASH from a large database.

Patients and methods
A cross-sectional study was performed using the 2012 Nationwide Inpatient Sample. We identified adult patients (18–90 years) who had a diagnosis of OSA using the International Classification of Diseases 9th version codes. The control group was comprised of adult individuals with no discharge records of OSA. NASH diagnosis was also identified using the International Classification of Diseases 9th version codes. The association between OSA and NASH was calculated using univariable and multivariable logistic regression.

Results
A total of 30 712 524 hospitalizations were included. The OSA group included 1 490 150 patients versus 29 222 374 in the control non-OSA group. The OSA group average age was 61.8±0.07 years (44.2% females) compared with 57.0±0.11 years (60.1% females) in the non-OSA group. NASH prevalence was significantly higher in the OSA group compared with the non-OSA group [2% (95% confidence interval (CI): 1.9, 2.1) vs. 0.65% (95% CI: 0.63, 0.66), P<0.001]. After adjusting for obesity, diabetes, hypertension, dyslipidemia, the metabolic syndrome and Charlson comorbidity index, OSA patients were three times more likely to have NASH [adjusted odds ratio: 3.1 (95% CI: 3.0–3.3), P<0.001].

Conclusion
Patients with OSA are three times more likely to have NASH compared with patients without OSA after controlling for other confounders. These data indicate that OSA should be considered as an independent risk factor for developing NASH.
Strategies for the use of nonstatin therapies
Authors: Pirillo Angela , Norata Giuseppe D. , Catapano Alberico L. 
Published: September 2017

Purpose of review
Dyslipidaemias are a major risk factor for cardiovascular disease (CVD); in particular, high levels of low-density lipoprotein cholesterol (LDL-C) have been associated to a higher cardiovascular risk. Reducing LDL-C levels decreases the risk of coronary heart disease (CHD), and the greater the LDL-C reduction, the greater the decrease in cardiovascular risk. Although statins represent the first line lipid-lowering therapy, many patients do not reach the recommended goals or exhibit adverse side effects leading to therapy discontinuation; in addition, a significant percentage of statin-treated patients continue to experience cardiovascular events even in the presence of well controlled LDL-C levels, because of alterations in other lipid/lipoprotein classes, including triglycerides and high-density lipoprotein cholesterol.

Recent findings
These conditions require further therapeutic interventions to achieve the recommended lipid goals. Several drugs have been developed to address these needs. Recent studies have shown that the association of ezetimibe with rosuvastatin or atorvastatin results in a better hypolipidaemic effect; in addition to this, PCSK9 inhibitors significantly reduce LDL-C levels and cardiovascular events.

Summary
For patients who are intolerant to statins or not able to reach the recommended LDL-C levels, despite maximal tolerated dose of statin, or exhibiting additional lipid alterations, several drugs are available that can be used either in monotherapy or on top of the maximally tolerated dose of statins.
Differences in Partner Services Outcomes for Men Who Have Sex With Men Diagnosed With Primary and Secondary Syphilis by HIV Serostatus
Authors: Rowlinson Emily , Goings Samuel , Minnerly Sydney , Surita Karen , Pogosjans Sargis 
Published: September 2017

Background
Differences in partner services outcomes in men who have sex with men (MSM) by HIV serostatus have not been explored as a potential driver of differential early syphilis (ES) burden in this population.

Methods
We compared partner services outcomes (number of partners named, notified, tested, diagnosed, and treated) between HIV-positive and HIV-negative MSM initiated for ES partner services in Texas from 2013 to 2016 using logistic regression and Wilcoxon-Mann-Whitney tests. Logistic regression was used to assess the relationship between HIV serostatus and having a no-partner–initiated (NPI) partner services interview controlling for demographic characteristics, prior partner services interactions, and geosocial phone application use.

Results
A total of 4161 HIV-positive MSM and 5254 HIV-negative MSM were initiated for ES partner services. HIV-positive MSM named fewer partners than did HIV-negative MSM (mean, 1.2 vs. 1.9; P < 0.001) and had lower indices of partners notified, tested, diagnosed, and treated. HIV seropositivity was significantly associated with NPI. However, this association was not significant when limited to MSM with previous partner services interviews (adjusted risk ratio [aRR] 1.06; P = 0.38); in this subset of MSM, using geosocial phone application was negatively associated with having an NPI interview (aRR, 0.90), and having 1 (aRR, 1.33) or more than 1 previous NPI interview (aRR, 1.57) was associated with an NPI interview during the study period.

Conclusions
Suboptimal outcomes for syphilis partner service may result in missed opportunities for testing and treatment of sexual contacts, which could allow for propagation of syphilis. Implementation of innovative protocols is needed to ensure that partner services continue to be an effective and acceptable method of syphilis disease intervention in MSM.
Inducing Somatic Symptoms in Functional Syndrome Patients: Effects of Manipulating State Negative Affect
Authors: Van Den Houte Maaike , Bogaerts Katleen , Van Diest Ilse , De Bie Jozef , Persoons Philippe , Van Oudenhove Lukas , Van den Bergh Omer 
Published: September 2017

ABSTRACT

Objective
Induction of negative affective states can enhance bodily symptoms in high habitual symptom reporters among healthy persons and in patients with irritable bowel syndrome. The aims of this study were to replicate this effect in patients with fibromyalgia and chronic fatigue syndrome and to investigate the role of moderators, focusing on alexithymia, negative affectivity, and absorption.

Methods
Patients with fibromyalgia and/or chronic fatigue syndrome (n = 81) and HCs (n = 41) viewed series of neutral, positive, and negative affective pictures. After every picture series, participants filled out a somatic symptom checklist and rated emotions experienced during the picture series on valence, arousal, and perceived control.

Results
Patients reported more somatic symptoms after viewing negative pictures (least square mean [LSM] = 19.40, standard error (SE) = 0.50) compared with neutral (LSM = 17.59, SE = 0.42, p < .001) or positive (LSM = 17.04, SE = 0.41, p < .001) pictures, whereas somatic symptom ratings of HCs after viewing negative picture series (LSM = 12.07, SE = 0.71) did not differ from ratings after viewing neutral (LSM = 11.07, SE = 0.59, p = .065) or positive (LSM = 11.10, SE = 0.58, p = .93) pictures. Negative affectivity did not moderate the symptom-enhancing effect of negative affective pictures, whereas the alexithymia factor “difficulty identifying feelings” and absorption did (p = .016 and p = .006, respectively).

Conclusion
Negative affective states elicit elevated somatic symptom reports in patients experiencing fibromyalgia and/or chronic fatigue syndrome. This symptom-enhancing effect is greater in patients having higher difficulty to identify feelings and higher absorption scores. The results are discussed in a predictive coding framework of symptom perception.
Proinflammatory Cytokines, Mood, and Sleep in Interepisode Bipolar Disorder and Insomnia: A Pilot Study With Implications for Psychosocial Interventions
Authors: Dolsen Emily A. , Soehner Adriane M. , Harvey Allison G. 
Published: September 2017

ABSTRACT

Objective
Proinflammatory cytokines are associated with bipolar disorder (BD), but less is known about how cytokines function during the interepisode period. This study examined cytokines, mood symptoms, and sleep in individuals with interepisode BD with complaints of insomnia. We also investigated the effects of a BD-specific modification of cognitive behavior therapy for insomnia (CBTI-BP) on cytokine levels.

Methods
Twenty-two adults with interepisode BD type I and insomnia were drawn from a subset of a National Institute of Mental Health funded study. Participants were randomly allocated to CBTI-BP (n = 11) or psychoeducation (n = 11). Participants completed a sleep diary, rated self-report measures of mania and depression, and provided samples assayed for interleukin (IL)-6 and tumor necrosis factor soluble receptor 2 (sTNF-R2).

Results
IL-6 was associated with mania symptoms (r
s = 0.44, p = .041) and total sleep time (r
s = −0.49, p = .026). IL-6 was related to depression symptoms at the trend level (r
s = 0.43, p = .052). sTNF-R2 was not significantly related to mood or sleep measures. From pretreatment to posttreatment, CBTI-BP compared with psychoeducation was associated with a nonsignificant, large effect size decrease in IL-6 (z = −1.61, p = .13, d = −0.78) and a nonsignificant, small-medium effect size decrease in sTNF-R2 (z = −0.79, p = .44, d = −0.38).

Conclusions
These findings provide preliminary evidence that IL-6 is related to mania symptoms and shorter total sleep time in interepisode BD. A treatment that targets sleep in BD could potentially decrease IL-6 although replication is warranted.
Infection Staging and Incidence Surveillance Applications of High Dynamic Range Diagnostic Immuno-Assay Platforms
Authors: Grebe Eduard , Welte Alex , Hall Jake , Keating Sheila M. , Facente Shelley N. , Marson Kara , Martin Jeffrey N. , Little Susan J. , Price Matthew A. , Kallas Esper G. , Busch Michael P. , Pilcher Christopher D. , Murphy Gary ,   on behalf of the Consortium for the Evaluation and Performance of HIV Incidence Assays (CEPHIA)
Published: September 2017

Background:
Custom HIV staging assays, including the Sedia HIV-1 Limiting Antigen (LAg) Avidity EIA and avidity modifications of the Ortho VITROS anti-HIV-1+2 and Abbott ARCHITECT HIV Ag/Ab Combo assays, are used to identify “recent” infections in clinical settings and for cross-sectional HIV incidence estimation. However, the high dynamic range of chemiluminescent platforms allows differentiating recent and long-standing infection on signal intensity, and this raises the prospect of using unmodified diagnostic assays for infection timing and surveillance applications.

Methods:
We tested a panel of 2500 well-characterized specimens with estimable duration of HIV infection with the 3 assays and the unmodified ARCHITECT. Regression models were used to estimate mean durations of recent infection (MDRIs), context-specific false-recent rates (FRRs) and correlation between diagnostic signal intensity and LAg measurements. Hypothetical epidemiological scenarios were constructed to evaluate utility in surveillance applications.

Results:
Over a range of MDRIs (reflecting recency discrimination thresholds), a diluted ARCHITECT-based RITA produced lower FRRs than the VITROS platform (FRR ≈ 0.5% and 1.5%, respectively at MDRI ≈ 200 days), and the unmodified diagnostic ARCHITECT produces incidence estimates with comparable precision to LAg (relative SE ≈ 17.5% and 15%, respectively at MDRI ≈ 200 days). ARCHITECT S/CO measurements were highly correlated with LAg optical density measurements (r = 0.80), and values below 200 are strongly predictive of LAg recency and duration of infection less than 1 year.

Conclusions:
Low quantitative measurements from the unmodified ARCHITECT obviate the need for additional recency testing, and its use is feasible in clinical staging and incidence surveillance applications.
Effectiveness of Bone Suppression Imaging in the Detection of Lung Nodules on Chest Radiographs
Authors: Miyoshi Tomohiro , Yoshida Junji , Aramaki Nao , Matsumura Yuki , Aokage Keiju , Hishida Tomoyuki , Kobayashi Tsuyoshi , Tsubura Shinichi , Katsuhara Shinsuke , Kasai Satoshi , Sasano Yasuhiko , Nagai Kanji , Tsuboi Masahiro 
Published: September 2017

Objective:
To evaluate the effectiveness of bone suppression imaging (BSI) software in lung-nodule detection on chest radiographs (CXRs) in relation to nodule location and observer’s experience.

Materials and Methods:
The CXRs of 80 patients, of which 40 had a lung nodule (8 to 30 mm in diameter) and 40 did not have any nodules, were interpreted by 20 observers comprising of 7 pulmonologists with >10 years of experience and 13 pulmonology residents. Each patient’s image was sequentially read, first using the standard CXR and thereafter with the BSI software. The nodule location and confidence level with regard to the presence of a lung nodule were recorded. Receiver operating characteristic analysis was used to evaluate observer performance.

Results:
The average area under the curve (AUC) for the observers’ receiver operating characteristic significantly improved from 0.867 to 0.900 (P=0.004) with the use of the BSI software. The average AUC for experienced pulmonologists improved from 0.877 to 0.924 (P=0.017) for lung nodules located in the apical and peripheral areas but not for those in the inner area. The average AUC for residents improved regardless of nodule location.

Conclusion:
The use of BSI software improved the performance in lung-nodule detection on CXRs regardless of observer’s experience and was more effective for observers with limited experience.
Cleft Lip and Palate Repair
Authors: Gatti Gian Luca , Freda Nicola , Giacomina Alessandro , Montemagni Marina , Sisti Andrea 
Published: September 2017

Introduction:
Cleft lip and palate is the most frequent congenital craniofacial deformity. In this article, the authors describe their experience with cleft lip and palate repair.

Methods:
Data regarding patients presenting with primary diagnosis of cleft lip and/or palate, between 2009 and 2015, were reviewed. Details including demographics, type of cleft, presence of known risk factors, surgical details, and follow-up visits were collected. Documented complications were reported. Caregivers’ satisfaction was assessed with a survey. The survey used to assess satisfaction with cleft-related features was based on the cleft evaluation profile (CEP). In addition, 4 assessors used visual analog scale (VAS) to assess the aesthetic satisfaction.

Results:
Seven hundred fifty-two patients with primary diagnosis of cleft lip and/or palate underwent surgical correction at ”S. Chiara” Hospital, 432 (57.45%) male and 320 (42.55%) female. The most common cleft types in our study were incomplete cleft palate (152 patients) and left unilateral complete cleft lip and palate (152 patients). Associated syndromes were found in 46 patients (6.12%). Cleft lip was repaired using a modified Tennison–Randall technique when the defect was unilateral, whereas a modified Mulliken technique was used for bilateral cleft lip. Cleft palate was repaired using the Bardach technique or Von Langenbeck technique at 5 to 6 months of age. Cleft lip and palate was repaired in several surgical steps. In total, complications were reported in 81 of 752 patients (14.16%). Average fathers’ satisfaction score assessed using CEP was 4.5 (lip), 4.8 (nose), 4.7 (teeth), 4.8 (bite), 4.2 (breathing), 4.6 (profile). Average mothers’ satisfaction score assessed using CEP was 4.3 (lip), 4.6 (nose), 4.4 (teeth), 4.5 (bite), 4.1 (breathing), 4.4 (profile). Average level of aesthetic satisfaction, assessed using VAS, was 8.7 (fathers), 8.1 (mothers), 7.9 (lay person), and 8.0 (senior cleft surgeon).

Conclusion:
The multidisciplinary management of children with oral cleft determinated good results, in terms of satisfaction and aesthetic appearance. From our experience, periosteoplasty and lip-adhesion are key surgical techniques.
Quality, reliability, repeatability—What about excellence?
Authors: Harrington David T. 
Published: September 2017

ABSTRACT
Today, I will be giving a general overview of the quality question. I will divide quality into four topics: first essential element—data, second essential element—process, third essential element—culture, and hidden dangers. We were fairly “high on the hog” in the House of Surgery in the late 20th century but then came the Institute of Medicine (IOM) reports. Partly in response to the IOM reports, we have discussed incessantly airplanes and aircrews. However, this is not the only challenge for in addition to this quality problem, we have a cost problem. These intersecting challenges appear insurmountable, but there is hope. We need better data, better process, and an evolution of our culture. The easiest type of data to collect is process measure data. We should all be aware of Surgical Care Improvement Project (SCIP), Physician Reporting Quality System (PRQS), and Merit-Based Incentive Payment System (MIPS). On the performance measures side of the house, the National Surgical Quality Incentive Program and the University Health-System Collaborative are major initiatives. There is an abundance of data, but if we are to improve care, we also need a good process. There is increased attention into process such as checklists, bundles, and standard operating procedures. Data and process is important, but we also need to be strategic. For a process to be effective, it needs to be part of a coherent strategy. And once we have data, process, and strategic thinking, we come to the third essential element, which is culture. Are there some dangers in embracing these new approaches? In a word, yes. We cannot abandon the traditional role of surgeons as leaders. We need to think about training the next generation of surgeons and the risk that this over-systemization of care begets. Surgeons have always led change, so though these new challenges seem profoundly disruptive, I am sure that we will again rise to the task.
The hyperfibrinolytic phenotype is the most lethal and resource intense presentation of fibrinolysis in massive transfusion patients
Authors: Taylor John R. , Fox Erin E. , Holcomb John B. , Rizoli Sandro , Inaba Kenji , Schreiber Martin A. , Brasel Karen , Scalea Thomas M. , Wade Charles E. , Bulger Eileen , Cotton Bryan A. 
Published: September 2017

BACKGROUND
Among bleeding patients, we hypothesized that the hyperfibrinolytic (HF) phenotype would be associated with the highest mortality, whereas shutdown (SD) patients would have the greatest complication burden.

METHODS
Severely injured patients predicted to receive a massive transfusion at 12 Level I trauma centers were randomized to one of two transfusion ratios as described in the Pragmatic, Randomized, Optimal Platelet and Plasma Ratio trial. Fibrinolysis phenotypes were determined based on admission clot lysis at 30 minutes (LY30): SD ≤0.8%, physiologic (PHYS) 0.9–2.9%, and HF ≥3%. Univariate and multivariate analysis was performed. Logistic regression was used to adjust for age, gender, arrival physiology, shock, injury severity, center effect, and treatment arm.

RESULTS
Among the 680 patients randomized, 547(80%) had admission thrombelastography (TEG) values available to determine fibrinolytic phenotypes. Compared to SD and PHYS, HF patients had higher Injury Severity Score (25 vs. 25 vs. 34), greater base deficit (−8 vs. −6 vs. −12) and were more uniformly hypocoagulable on admission by PT, PTT, and TEG values; all p <0.001. HF patients also received more red blood cells, plasma, and platelets (at 3, 6, and 24 hours); had fewer ICU-, ventilator-, and hospital-free days; and had higher 24-hour and 30-day mortality. There were no differences in complications between the three phenotypes. Multivariate logistic regression demonstrated that HF on admission was associated with a threefold higher mortality (OR 3.06, 95% CI 1.57–5.95, p = 0.001).

CONCLUSIONS
Previous data have shown that both the SD and HF phenotypes are associated with increased mortality and complications in the general trauma population. However, in a large cohort of bleeding patients, HF was confirmed to be a much more lethal and resource-intense phenotype. These data suggest that further research into the understanding of SD and HF is warranted to improve outcomes in this patient population.

LEVEL OF EVIDENCE
Prognostic, level II.
In vivo relevance of intercellular calcium signaling inDrosophilawing development
Authors: Wu Qinfeng , Brodskiy Pavel A. , Huizar Francisco , Jangula Jamison J. , Narciso Cody , Levis Megan , Brito-Robinson Teresa , Zartman Jeremiah J. 
Published: September 2017

AbstractRecently, organ-scale intercellular Ca2+transients (ICTs) were reported in the Drosophila wing disc. However, the functional in vivo significance of ICTs remains largely unknown. Here we demonstrate the in vivo relevance of intercellular Ca2+signaling and its impact on wing development. We report that Ca2+signaling in vivo decreases as wing discs mature. Ca2+signaling ex vivo responds to fly extract in a dose-dependent manner. This suggests ICTs occur in vivo due to chemical stimulus that varies in concentration during development. RNAi mediated inhibition of genes required for ICTs results in defects in the size, shape, and vein patterning of adult wings. It also leads to reduction or elimination of in vivo Ca2+transients. Further, perturbations to the extracellular matrix along the basal side of the wing disc stimulates intercellular Ca2+waves. This is the first identified chemically defined, non-wounding stimulus of ICTs. Together, these results point toward specific in vivo functions of intercellular Ca2+signaling to mediate mechanical stress dissipation and ensure robust patterning during development.
Methylation-To-Expression Feature Models of Breast Cancer Accurately Predict Overall Survival, Distant-Recurrence Free Survival, And Pathologic Complete Response in Multiple Cohorts
Authors: Thompson Jeffrey A. , Christensen Brock C. , Marsit Carmen J. 
Published: September 2017

AbstractBackground:Approaches that capitalize on the benefits of multi-omic data integration in invasive breast carcinoma to define prognostic biomarkers for precision medicine have been slow to emerge. In this work, we examined the efficacy of our methylation-to-expression feature model (M2EFM) approach to combining molecular and clinical predictors as part of a single analysis to create prognostic risk scores for overall survival, distant metastasis, and chemosensitivity.Methods:Gene expression and DNA methylation values as well as clinical variables were integrated via M2EFM to build prognostic models of overall survival using 1028 breast tumor samples and further applied to external validation cohorts of 61 and 327 samples. Data-integrated prognostic models of distant recurrence-free survival and pathologic complete response were built using 306 samples and validated on 182 samples of external validation data. Additionally, we compared the discrimination and calibration of M2EFM models to other approaches.Results:Despite different populations and assays, M2EFM models validated with good accuracy (C-index or AUC ≥ .7) for all outcomes in all validation data. M2EFM models had the most consistent performance overall and superior calibration, suggesting a greater likelihood of clinical utility. Finally, we demonstrated that M2EFM identifies functionally relevant genes, which could be useful in translating an M2EFM biomarker to the clinic.Conclusion:M2EFM uses multiple levels of genomic data to infer disrupted regulatory patterns, thus providing a gene signature that connects loss of regulatory control with cancer prognosis.Funding:The analyses described in this report were supported by NIH grants R01ES022222, P30CA138292, P30ES019776, and R01DE022772.Conflicts of Interest:The authors declare no potential conflicts of interest.