bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identification of optimal reference genes for transcriptomic analyses in normal and diseased human heart
Authors: Molina Cristina E , Jacquet Eric , Ponien Prishila , Muñoz-Guijosa Christian , Baczkó Istvan , Maier Lars S , Donzeau-Gouge Patrick , Dobrev Dobromir , Fischmeister Rodolphe , Garnier Anne 
Published: September 2017

AbstractAimsQuantitative real-time RT-PCR (RT-qPCR) has become the method of choice for mRNA quantification, but requires an accurate normalization based on the use of reference genes showing invariant expression across various pathological conditions. Only few data exist on appropriate reference genes for the human heart. The objective of this study was to determine a set of suitable reference genes in human atrial and ventricular tissues, from right and left cavities in control and in cardiac diseases.Methods and resultsWe assessed the expression of 16 reference genes (ACTB, B2M, GAPDH, GUSB, HMBS, HPRT1, IPO8, PGK1, POLR2A, PPIA, RPLP0, TBP, TFRC, UBC, YWHAZ, 18S) in tissues from: right and left ventricles from healthy controls and heart failure (HF) patients; right-atrial tissue from patients in sinus rhythm with (SRd) or without (SRnd) atrial dilatation, patients with paroxysmal (pAF) or chronic (cAF) atrial fibrillation or with HF; and left-atrial tissue from patients in SR or cAF. Consensual analysis (by geNorm and Normfinder algorithms, BestKeeper software tool and comparative delta-Ct method) of the variability scores obtained for each reference gene expression shows that the most stably expressed genes are: GAPDH, GUSB, IPO8, POLR2A, and YWHAZ when comparing either right and left ventricle or ventricle from healthy controls and HF patients; GAPDH, IPO8, POLR2A, PPIA, and RPLP0 when comparing either right and left atrium or right atria from all pathological groups. ACTB, TBP, TFRC, and 18S genes were identified as the least stable.ConclusionsThe overall most stable reference genes across different heart cavities and disease conditions were GAPDH, IPO8, POLR2A and PPIA. YWHAZ or GUSB could be added to this set for some specific experiments. This study should provide useful guidelines for reference gene selection in RT-qPCR studies in human heart.
A Case of Opioid Overdose and Subsequent Death After Medically Supervised Withdrawal: The Problematic Role of Rapid Tapers for Opioid Use Disorder
Authors: Chang Derek C. , Klimas Jan , Wood Evan , Fairbairn Nadia 
Published: September 2017

Background:
Relapse to opioid use is common after rapid opioid withdrawal. As a result, short-term tapers of opioid agonist/partial agonist medications, such as methadone and buprenorphine/naloxone, are no longer recommended by recent clinical care guidelines for the management of opioid use disorder. Nonetheless, rapid tapers are still commonplace in medically supervised withdrawal settings.

Case summary:
We report a case of an individual with opioid use disorder who was prescribed a rapid buprenorphine/naloxone taper in a medically supervised withdrawal facility and who had a subsequent opioid overdose and death after discharge.

Discussion:
The fatal outcome in this case study underscores the potential severe harms associated with use of rapid tapers. Given the increased overdose risk, tapers should be avoided and continuing care strategies, such as maintenance pharmacotherapy, should be initiated in medically supervised withdrawal settings.
Recovery after Nulliparous Birth
Authors: Komatsu Ryu , Carvalho Brendan , Flood Pamela D. 
Published: September 2017

Abstract

Background
The majority of parturients in the United States first return for evaluation by their obstetric practitioner 6 weeks after delivery. As such, there is little granular data on the pain experience, analgesic requirements, and functional recovery during the postpartum period. This prospective observational study was performed to evaluate these factors to provide expectations for patients.

Methods
A total of 213 nulliparous women were enrolled and assessed daily until they completed 3 outcomes: (1) pain resolution; (2) opioid cessation; and (3) self-assessed functional recovery from delivery. The primary endpoint, pain- and opioid-free functional recovery, was the time required to reach all three of the endpoints. Pain burden was assessed as the area under the curve created by plotting the daily numerical pain rating scale against the days required to attain pain resolution. Times to attain study endpoints after cesarean delivery and vaginal delivery were compared using survival analysis.

Results
After vaginal delivery, days required for pain and opioid-free functional recovery (median [interquartile range (IQR)]) were 19 [11 to 26], for opioid cessation 0 [0 to 2], termination of all analgesic (including nonsteroidal antiinflammatories and acetaminophen) 11 [5 to 17], and pain resolution 14 [7 to 24]. Achievement of these endpoints after cesarean delivery required 27 [19 to 40], 9 [5 to 12], 16 [11 to 24], and 21 [14 to 27] days, respectively.

Conclusions
There is clinically significant variability between healthy nulliparous parturients in the pain experience, opioid use, and functional recovery after childbirth following vaginal and cesarean delivery. Recovery to predelivery function is similar after vaginal and cesarean delivery, and approximately half of the variance was explained by pain burden.
Epidural Labor Analgesia—Fentanyl Dose and Breastfeeding Success
Authors: Lee Amy I. , McCarthy Robert J. , Toledo Paloma , Jones Mary Jane , White Nancy , Wong Cynthia A. 
Published: September 2017

Abstract

Background
Breastfeeding is an important public health concern. High cumulative doses of epidural fentanyl administered for labor analgesia have been reported to be associated with early termination of breastfeeding. We tested the hypothesis that breastfeeding success is adversely influenced by the cumulative epidural fentanyl dose administered for labor analgesia.

Methods
The study was a randomized, double-blind, controlled trial of parous women at greater than 38 weeks gestation who planned to breastfeed, had successfully breastfed a prior infant, and who received neuraxial labor analgesia. Participants were randomized to receive one of three epidural maintenance solutions for labor analgesia (bupivacaine 1 mg/ml, bupivacaine 0.8 mg/ml with fentanyl 1 μg/ml, or bupivacaine 0.625 mg/ml with fentanyl 2 μg/ml). The primary outcome was the proportion of women breastfeeding at 6 weeks postpartum. Maternal and umbilical venous blood fentanyl and bupivacaine concentration at delivery were measured.

Results
A total of 345 women were randomized and 305 had complete data for analysis. The frequency of breastfeeding at 6 weeks was 97, 98, and 94% in the groups receiving epidural fentanyl 0, 1, and 2 μg/ml, respectively (P = 0.34). The cumulative fentanyl dose (difference: 37 μg [95% CI of the difference, −58 to 79 μg], P = 0.28) and maternal and umbilical cord venous fentanyl and bupivacaine concentrations did not differ between women who discontinued breastfeeding and those who were still breastfeeding at 6 weeks postpartum.

Conclusions
Labor epidural solutions containing fentanyl concentrations as high as 2 μg/ml do not appear to influence breastfeeding rates at 6 weeks postpartum.
Prevalence, Risk Factors, and Characteristics of the “Adding-On” Phenomenon in Idiopathic Scoliosis After Correction Surgery
Authors: Yang Mingyuan , Zhao Yuechao , Yin Xin , Chen Ziqiang , Yang Changwei , Li Li , Li Ming 
Published: September 2017

Study Design.
A systematic review and meta-analysis.

Objective.
To discuss the prevalence, risk factors, and characteristics of the “adding-on” phenomenon in idiopathic scoliosis (IS).

Summary of Background Data.
There are controversies on the prevalence and risk factors of the “adding-on” phenomenon. In addition, there is no comprehensive study to describe the characteristics of “adding-on” in IS patients.

Methods.
We performed a systematic online search using PubMed, EMBASE, Web of Science, the Cochrane Library, and China WeiPu Library to identify eligible studies. Effect size (ES), odds ratios (OR), and weight mean difference (WMD) with 95% confidence interval (CI) were used to evaluate the incidence, characteristics, and risk factors for “adding-on,” respectively.

Results.
The overall pooled prevalence of “adding-on” was 14%. Subgroup analysis showed that the prevalence of “adding-on” in Lenke 1A adolescent idiopathic scoliosis (AIS), Lenke 2 AIS, Lenke 5 AIS, and mixed AIS was 15%, 12%, 9%, and 16%, respectively. AIS patients with the “adding-on” phenomenon had smaller proximal thoracic curve (PTC), main thoracic curve (MTC), clavicle angle, T1 tilt angle and radiographic shoulder height (RSH), and larger correction of PTC. Age, Risser sign, preoperative PTC, preoperative MTC, preoperative lumbar curve (LC), preoperative coronal balance and sagittal balance, and T4 tile were identified as risk factors of “adding-on.” Selection of lower instrumented vertebra (LIV) was also an important risk factor as LIV–Center Sacral Vertical Line (CSVL), LIV–end vertebra, LIV–Stable Vertebra, and LIV–Neutral vertebra, and deviation of LIV+1 was found to be significantly associated with “adding-on.” Besides, postoperative MTC was also significantly different between patients with and without “adding-on.”

Conclusion.
The pooled prevalence varied differently in different types of IS. Patients with “adding-on” had smaller PTC, MTC, angle, T1 tilt angle and RSH, and larger correction of PTC. Younger age, less skeletal maturity, smaller preoperative PTC, smaller preoperative MTC, smaller preoperative LC, larger preoperative coronal, sagittal imbalance, selection of LIV, and overcorrection of coronal and sagittal alignment were risk factors for “adding-on.”

Level of Evidence: 4
Th17 Response of Borderline-Lepromatous Leprosy Inhibits Rash Manifestation of Dapsone Hypersensitivity Syndrome: Case Report
Authors: de Nardo Vanzela Tamara , Bernardes Filho Fred , Wambier Carlos Gustavo , Faria Francesca Maia , Foss Norma Tiraboschi , Frade Marco Andrey Cipriani 
Published: September 2017

Background:
Dapsone hypersensitivity syndrome (DHS) is a rare, but potentially life-threatening reaction to dapsone.

Objective:
Evaluation of immunological factors involved in the sparing of borderline-lepromatous (BL) leprosy patches by the severe exanthema related to DHS.

Methods:
The authors describe a 19-year-old man with borderline-lepromatous leprosy with a recent diffuse rash, sparing only the hypochromic patches of leprosy, generalized lymphadenopathy, hepatomegaly, and jaundice 25 days after the start of multibacillary multidrug therapy.

Results:
Laboratory testing was remarkable for leukocytosis with eosinophilia, atypical lymphocytosis, and elevated liver and canalicular enzymes. Immunohistopathology of the rash showed stronger expression of Th1 cytokines (IL1β, TNFα, IFNγ, and iNOS), and limited expression of IL17, TGFb, IL4, and IL10. Whereas the hypochromic leprosy patches showed high expression of inflammatory cytokines IL1β, TNFα, IFNγ, iNOS, and TGFβ (Th1), and presented strong expression of IL17 and TGFβ with no IL4 and IL10 expression, by the inflammatory infiltrate, characterizing a participation of Th17 response.

Conclusion:
Th17 response, coupled with the presence of subepidermal collagen band, seems to be directly related to the absence of DHS rash in these hypochromic leprosy patches.
Spectrum of Hybrid Cysts and Their Clinical Significance
Authors: Chang Ray-San , Yao Xiao-Feng , Wu Yu-Hung 
Published: September 2017

Abstract:
A hybrid cyst is a cutaneous cyst combining different types of keratinization of those seen in the folliculo-sebaceous-apocrine unit. Previous reports found that it may be occasionally associated with Gardner syndrome. This study aimed to clarify the pathologic findings and clinical significance of hybrid cyst based on case series observations. We retrospectively reviewed patients who fulfilled the pathological criteria of hybrid cyst from 2001 to 2015. The patient profiles, clinical presentations, pathological findings, and associated diseases were analyzed by reviewing the medical records and slides. A total of 71 hybrid cysts were confirmed over the study period. There were 12 pathologic variants. The most frequent variant was combined infundibular cyst and tricholemmal cyst (22 in 71 cases, 30%), followed by infundibular cyst and pilomatricoma (14 in 71 cases, 19%). There was no significant association between sex, age, or site and the pathological type of hybrid cyst. Neither extra-intestinal manifestation nor a family history of Gardner syndrome was found in any case. Hybrid cysts could contain a variety of combinations of components from the folliculo-sebaceous-apocrine unit. No clinical significance was found between demographics and the type of hybrid cyst. No association with Gardner syndrome was identified in this case series.
LONG-TERM FOLLOW-UP OF PATIENTS WITH CHOROIDEREMIA WITH SCLERAL PITS AND TUNNELS AS A NOVEL OBSERVATION
Authors: van Schuppen Sanne M. , Talib Mays , Bergen Arthur A. , ten Brink Jacoline B. , Florijn Ralph J. , Boon Camiel J. F. , van Schooneveld Mary J. 
Published: September 2017

Purpose:
To evaluate the long-term clinical course and visual outcome of patients with choroideremia.

Methods:
Clinical examination, a social questionnaire, and medical records review of 21 patients with choroideremia from 14 families.

Results:
The mean follow-up time was 25.2 years (SD: 13.3; range 2–57 years). The mean age at symptom onset was 15.1 years (SD: 10.1; range 5–40 years). Best-corrected visual acuity was stable until the age of 35 (P = 0.96), but declined significantly faster after the age of 35 (11%/year, P = 0.001), with a high variability between individual patients. The mean age at which patients discontinued working was 48.1 years (SD: 11.7, range 25–65 years). The reason for work discontinuation was vision related in 60% of cases. Most patients (70%) reported visual field constriction as the most debilitating symptom. The authors report scleral pits and tunnels as a novel finding visible on spectral domain optical coherence tomography and ophthalmoscopy.

Conclusion:
Choroideremia is a severely debilitating disease showing a rapid decline of visual acuity generally after the age of 35, but a more gradual decline for other abnormalities.
Chronic pain in families: a cross-sectional study of shared social, behavioural, and environmental influences
Authors: Campbell Paul , Jordan Kelvin P. , Smith Blair H. , Scotland Generation , Dunn Kate M. 
Published: September 2017

Abstract
Chronic pain is common and creates a significant burden to the individual and society. Emerging research has shown the influence of the family environment on pain outcomes. However, it is not clear what shared factors between family members associate with chronic pain. This study aimed to investigate the family-level contribution to an individual's chronic pain status. This was a cross-sectional study using the Generation Scotland: Scottish Family Health Study data set. This study focused on a nested cohort of dyads (only 2 relatives per family, n = 2714). Multi-level modelling was first performed to estimate the extent of variance in chronic pain at the family level. Then each member of the dyad was randomly assigned as either the exposure or outcome family member, and logistic regression was used to identify shared factors associated with the outcome of chronic pain status. Multi-level modelling showed just under 10% of variation in chronic pain status was at a family level. There was an increase in odds of chronic pain if exposure family member had chronic pain (odds ratio [OR]: 1.30, 95% confidence interval [CI]: 1.02-1.65), if both were women (OR: 1.39, 95% CI: 0.99-1.94), if both were older in age (OR: 1.80, 95% CI: 1.31-2.48), and if both had low household income (OR: 3.27, 95% CI: 1.72-6.21). These findings show that most explanation for chronic pain is still at the individual level. However, some significant shared effects between family members associate with chronic pain, and this highlights the influence of the family context.
Self-care Moderates the Relationship Between Symptoms and Health-Related Quality of Life in Heart Failure
Authors: Auld Jonathan P. , Mudd James O. , Gelow Jill M. , Hiatt Shirin O. , Lee Christopher S. 
Published: September 2017

Background:
Physical symptoms and depression in heart failure (HF) are key drivers of health-related quality of life (HRQOL). Heart failure self-care behaviors are believed to influence how symptoms affect HRQOL.

Objective:
The goal of this study was to determine if HF self-care behaviors moderate the relationships between physical and depressive symptoms and HRQOL.

Methods:
In a cohort of adults with moderate to advanced HF, multivariate linear regression was used to evaluate the interaction between self-care behaviors (Self-care of HF index maintenance and management scales) and physical HF symptoms (HF Somatic Perception Scale) on emotional HRQOL (emotional dimension of Minnesota Living With HF Questionnaire). The interaction between self-care behaviors and depression (9-item Patient Health Questionnaire) was evaluated on physical HRQOL (physical dimension of Minnesota Living With HF Questionnaire).

Results:
The mean age of the sample (N = 202) was 57 ± 13 years, 50% were women, and 61% had New York Heart Association class III or IV HF. Controlling for age, Seattle HF score, functional ability, and comorbidities, self-care maintenance and management moderated the relationship between physical HF symptoms and emotional HRQOL. Only self-care maintenance moderated the relationship between depression and physical HRQOL.

Conclusion:
In HF, HRQOL is dependent on both the severity of physical and depressive symptoms and the level of engagement in HF self-care behaviors. Future research should consider both self-care behaviors and symptoms when examining patient HRQOL.
A 6-Month Prospective Trial of a Personalized Behavioral Intervention + Long-Acting Injectable Antipsychotic in Individuals With Schizophrenia at Risk of Treatment Nonadherence and Homelessness
Authors: Sajatovic Martha , Ramirez Luis F. , Fuentes-Casiano Edna , Cage Jamie , Tatsuoka Curtis , Aebi Michelle E. , Bukach Ashley , Cassidy Kristin A. , Levin Jennifer B. 
Published: September 2017

Abstract

Purpose
Long-acting injectable antipsychotics (LAI) can optimize adherence for high-risk serious mental illness (SMI). This customized adherence-enhancement approach delivered by social worker interventionists was combined with LAI (CAE-L) of paliperidone palmitate for homeless, poorly adherent individuals with SMI.

Methods
This 6-month prospective, uncontrolled trial of CAE-L in 30 recently homeless individuals with SMI assessed adherence using the Tablets Routine Questionnaire, injection frequency, and SMI symptoms measured by the Positive and Negative Syndrome Scale, Brief Psychiatric Rating Scale, and Clinical Global Impressions. The Social and Occupational Functioning Assessment Scale measured social function. Standardized scales assessed extrapyramidal effects.

Findings
Patients' mean age was 43.6 (SD, 9.53) years, and they were mainly minorities (86.7% African American) and single/never married (72.4%). Rate of substance abuse within the past year was 40.0%, and rate of incarceration within the past 6 months was 32.1%. Four participants (13.3%) terminated the study prematurely. Customized adherence enhancement + LAI was associated with good adherence to LAI (92.9%) and improved adherence with oral drug as measured by Tablets Routine Questionnaire (P = 0.02). There were significant improvements in Positive and Negative Syndrome Scale (P < 0.01), Brief Psychiatric Rating Scale (P < 0.001), Clinical Global Impressions (P = 0.003), and Social and Occupational Functioning Assessment Scale (P = 0.005). There were no significant extrapyramidal effects.

Implications
While findings must be tempered by the methodological limitations, CAE-L seems associated with multiple domains of improvement in homeless/recently homeless individuals with SMI. Adverse effects limit tolerability in some individuals, and not all will remain engaged. However, LAI combined with a patient-centered behavioral approach can improve outcomes for some high-risk individuals with SMI.
Statewide Longitudinal Progression of the Whole-Patient Measure of Safety in South Carolina
Authors: Turley Christine B. , Brittingham Jordan , Moonan Aunyika , Davis Dianne , Chakraborty Hrishikesh 
Published: September 2017

ABSTRACT
Meaningful improvement in patient safety encompasses a vast number of quality metrics, but a single measure to represent the overall level of safety is challenging to produce. Recently, Perla et al. established the Whole-Person Measure of Safety (WPMoS) to reflect the concept of global risk assessment at the patient level. We evaluated the WPMoS across an entire state to understand the impact of urban/rural setting, academic status, and hospital size on patient safety outcomes. The population included all South Carolina (SC) inpatient discharges from January 1, 2008, through to December 31, 2013, and was evaluated using established definitions of highly undesirable events (HUEs). Over the study period, the proportion of hospital discharges with at least one HUE significantly decreased from 9.7% to 8.8%, including significant reductions in nine of the 14 HUEs. Academic, large, and urban hospitals had a significantly lower proportion of hospital discharges with at least one HUE in 2008, but only urban hospitals remained significantly lower by 2013. Results indicate that there has been a decrease in harm events captured through administrative coded data over this 6-year period. A composite measure, such as the WPMoS, is necessary for hospitals to evaluate their progress toward reducing preventable harm.
Evidence for Misspecification of a Nationally Used Quality Measure for Substance Use Treatment
Authors: Mattke Soeren , Predmore Zachary , Sloss Elizabeth , Wilks Asa , Watkins Katherine E. 
Published: September 2017

Objectives:
The National Committee for Quality Assurance's (NCQA) measure “Initiation and Engagement of Alcohol and Other Drug Dependence Treatment” captures the proportion of substance use patients with (1) treatment initiation within 14 days and (2) treatment engagement within 30 days thereafter. The definition of treatment considers only counseling but not medication-assisted treatment (MAT), although MAT is supported by current guidelines. Our research question is whether this omission results in meaningful measurement error.

Study Design and Methods:
We analyze claims data for members of commercial health plans to investigate whether including MAT would meaningfully change the measure rate and health plan rankings.

Results:
Including MAT increased both the initiation and engagement rates. The initiation and engagement rates increased 2.4% (38.9–39.8%) and 9.9% (12.9–14%), respectively. These differences imply that 19% of health plans would change their ranking by at least one quintile for the initiation measure and 27% for the engagement measure.

Conclusions:
The current specifications result in erroneous conclusions about the quality of care provided by different health plans. Our results suggest that aligning the measure specifications with guideline recommendations, as recently proposed by NCQA, would result in more accurate information.