bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neurology
Authors: Wilkinson Ian B. , Raine Tim , Wiles Kate , Goodhart Anna , Hall Catriona , O’Neill Harriet 
Published: September 2017

Abstract
This chapter explores neurology, including lesion location, drugs and the nervous system, cerebral blood supply, testing peripheral nerves, dermatomes and peripheral nerves, headache, migraine, blackouts, vertigo and dizziness, hearing loss and tinnitus, acute bilateral leg weakness, abnormal involuntary movements (dyskinesia), stroke, transient ischaemic attack (TIA), subarachnoid haemorrhage (SAH), intracranial venous thrombosis (IVT), subdural haematoma, extradural (epidural) haematoma, delirium (acute confusional state), dementia, Alzheimer’s disease (AD), epilepsy, Parkinsonism, multiple sclerosis (MS), space-occupying lesions (SOL), idiopathic intracranial hypertension, Bell’s palsy, mononeuropathies, polyneuropathies, autonomic neuropathy, motor neuron disease (MND), bulbar palsy, cervical spondylosis, myopathy, myasthenia gravis (MG), Lambert–Eaton myasthenic syndrome (LEMS), neurofibromatosis, syingomyelia, and retroviruses and neurology.
INDUCIBLE TRANSIENT CENTRAL RETINAL ARTERY VASOSPASM: A CASE REPORT
Authors: Mishulin Aleksey , Gandhi Sachin , Apple Daniel , Lin Xihui , Hu Jonathan , Abrams Gary W. 
Published: September 2017

Purpose:
To report a case of inducible transient central retinal artery vasospasm with associated imaging.

Methods:
Observational case report.

Results:
A 51-year-old man presented for outpatient follow-up for recurrent inducible transient vision loss in his right eye. He experienced an episode during examination and was found to have central retinal artery vasospasm. Fundus photography and fluorescein angiography obtained during his vasospastic attack confirmed retinal arterial vasospasm. Treatment with a calcium-channel blocker (nifedipine) has been effective in preventing recurrent attacks.

Conclusion:
Idiopathic primary vasospasm is a rare cause of transient vision loss that is difficult to confirm because of the transient nature. We obtained imaging showing the initiation and resolution of the vasospastic event. The patient was then successfully treated with a calcium-channel blocker.
Cellular Targets and Receptor of Sexual Transmission of Zika Virus
Authors: Bagasra Omar , Addanki Krishna C. , Goodwin Gregory R. , Hughes Brandon W. , Pandey Pratima , McLean Ewen 
Published: September 2017

Study Question:
What is the mechanism of sexual transmission of Zika virus (ZIKV)?

Summary Answer:
By utilizing exquisite reverse transcriptase–initiated in situ polymerase chain reaction (RT-in situ PCR), which enables an improved visualization of spermatozoa’s subcellular compartment, we precisely localized the mid-piece of sperm that carry receptors for ZIKV.

What is Already Known:
ZIKV is transmitted sexually and recent studies have verified ZIKV presence in semen of previously Zika-infected patients for >6-month postinfection when ZIKV had disappeared from blood, saliva, and urine. Strong serial analyses of various body fluids suggest that ZIKV can be transmitted between sexual partners. Currently, there is limited information on the association of the virus with human semen cell types that may carry the virus.

Study Design, Size, Duration:
Analyses were carried out to localize ZIKV for subcellular localization of ZIKV on cell types. The Tyro3 receptor for ZIKV was colocalized by dual immunocytochemistry with specific monoclonal antibodies.

Participants/Materials, Setting, Methods:
Three semen specimens were purchased from a commercial sperm bank. Motile sperm was separated from nonmotile cells by the “swim-up” technique. Each of the semen fractions was infected with ZIKV at the multiplicity of infection of 0.1.0 and 1.0 and evaluated for the primary targets of ZIKV in the semen cells by RT-in situ PCR and confirmed by real-time RT-PCR.

Main Results and the Role of Chance:
ZIKV was present primarily at the mid-piece of mature spermatozoa in about 30% of the sperm. In addition, we determined that Tyro3 receptors, primarily expressed on mid-piece of human spermatozoa, play a role in ZIKV-binding and entry into spermatozoa. Our data strongly suggest a potential sexual/horizontal route of transmission for ZIKV primarily via infected sperms; most likely ZIKV enters the sperm via the Tyro3 receptor found at the mid-piece of the mature spermatozoa.

Limitations, Reasons for Caution:
We are uncertain as to what phase of spermatogenesis, that in human takes about 120 days, sperms are permissive to ZIKV. If permissiveness was very early during spermatogenesis males could be infectious for ∼120 days after the disappearance of viremia in an infected man.

Wider Implications of the Findings:
Our findings bring a new focus on the current affords to develop ZIKV vaccine. Why in the presence of anti-ZIKV antibodies infected men are still able to transmit the virus sexually? We suggest that only certain subclass of immunoglobulin (Ig)G (ie, IgG4) can cross the blood-Sertoli barrier therefore, a successful vaccine must provoke a subclass of IgG can quell ZIKV inside the seminiferous tubules.
The Prevalence and Mental and Physical Health Correlates of Posttraumatic Stress Disorder Symptoms in Vulnerable and Underresourced Primary Care Patients Referred to a Behavioral Health Provider
Authors: Langhinrichsen-Rohling Jennifer , Selwyn Candice N. , Jackson Selena , Johns Keri , Wornell Cory , Finnegan Heather , Smith-West Mary B. 
Published: September 2017

Context:
The prevalence of trauma exposure among vulnerable, impoverished patients seeking primary care services is considerable. However, assessment of trauma-related symptoms is rare, even among behavioral health patients receiving primary care services within integrated health care centers.

Objective:
To determine the prevalence of clinically noteworthy trauma-related symptoms and their associations with other co-occurring mental and physical symptoms as well as self-reported resiliency.

Participants:
Primary care patients (n = 120) referred to behavioral health services (76.7% black/African American; 70.8% female).

Setting:
Federally qualified health center.

Main Outcome Measures:
Abbreviated Posttraumatic Stress Disorder Checklist-Civilian, 2-item version; Patient Health Questionnaire (PHQ)-15: physical health symptoms; PHQ-9: depression symptoms; Generalized Anxiety Disorder Scale, 7-item; Connor-Davidson Resilience Scale, 2-items.

Results:
Seventy-three percent (n = 88) of provider-referred behavioral health patients screened positive for potential posttraumatic stress disorder. Patients most likely to meet criteria for posttraumatic stress disorder reported significantly higher levels of stress, depression, anxiety, and suicide ideation as well as more severe headaches, chest pains, dizziness, and poorer health care.

Conclusions:
Results support the need for a trauma-informed integrated approach to health care within primary care settings, particularly those serving vulnerable populations. Integrated health care services foster an environment in which patient access to and satisfaction with services is maximized while overall well-being is enhanced. Adding resiliency-enhancing strategies to patients' integrated health care treatment plans might also be health-promoting. PTSD symptoms can be assessed as part of routine integrated practice via a 2-item screener. Information obtained from trauma screening provides the health care team with useful contextual information about patients' physical and behavioral health symptoms.
Behind the Black Box: The Evidence for the U.S. Food and Drug Administration Warning about the Risk of General Anesthesia in Children Younger than 3 Years
Authors: Derderian Christopher A. , Szmuk Peter , Derderian Courtney K. 
Published: September 2017

Summary:
On December 14, 2016, the U.S. Food and Drug Administration issued a Drug Safety Communication warning “that repeated or lengthy use of general anesthetic and sedation drugs during surgeries or procedures in children younger than 3 years or in pregnant women during their third trimester may affect the development of children’s brains.” Health care professionals were urged to “balance the benefits of appropriate anesthesia in young children and pregnant women against the potential risks, especially for procedures that may last more than 3 hours or if multiple procedures are required in children under 3 years.” Surgeons must have an understanding of the evidence that led to the U.S. Food and Drug Administration warning and recommendations to appropriately weigh these risks and counsel their patients. In this article, the authors summarize the preclinical and clinical data that led to the U.S. Food and Drug Administration warning, discuss ongoing clinical studies, and provide strategies to reduce the risk of general anesthesia in patients younger than 3 years.
Phalloplasty with Urethral Lengthening: Addition of a Vascularized Bulbospongiosus Flap from Vaginectomy Reduces Postoperative Urethral Complications
Authors: Massie Jonathan P. , Morrison Shane D. , Wilson Stelios C. , Crane Curtis N. , Chen Mang L. 
Published: September 2017

Background:
Phalloplasty with urethral lengthening is the procedure of choice for female-to-male transgender patients who desire an aesthetic phallus and standing micturition, but is associated with complications, including urethral stricture and fistula formation. Horizontal urethra construction can be accomplished with labia minora flaps covered with additional vascularized layers of vestibular tissue when vaginectomy is performed concomitantly with phalloplasty. However, vaginectomy is not a requisite step in phalloplasty, and some individuals may choose to retain their vagina. In these cases, extra layers of vascularized vestibular tissue are not used for horizontal urethra coverage. This study examined the effects of vaginectomy and the addition of extra layers of vascularized vestibular tissue on phalloplasty complication rates.

Methods:
A single-center retrospective study of 224 patients who underwent phalloplasty with urethral lengthening was performed. Patients were sorted into vaginectomy and vaginal preservation cohorts and complication rates were assessed.

Results:
Of 224 total phalloplasty patients, 215 underwent vaginectomy and nine underwent vaginal preservation. Urethral complications occurred in 27 percent of patients with vaginectomy and in 67 percent of patients with vaginal preservation (OR, 0.18; p = 0.02). Vaginectomy was associated with decreased urethral stricture (OR, 0.25; p = 0.047) and urethral fistula formation (OR, 0.13; p = 0.004). Non–urethra-related complications occurred in 15 percent of vaginectomy patients but were not statistically significant (OR, 3.37; p = 0.41).

Conclusion:
Vaginectomy is associated with a significant decrease in urethral stricture and fistula formation, most likely because vaginectomy affords additional horizontal urethroplasty suture line coverage of labia minora flaps with vascularized vestibular tissue.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Managing Opioid Addiction Risk in Plastic Surgery during the Perioperative Period
Authors: Demsey Daniel , Carr Nicholas J. , Clarke Hance , Vipler Sharon 
Published: September 2017

Summary:
Opioid addiction is a public health crisis that affects all areas of medicine. Large numbers of the population across all racial and economic demographics misuse prescription opioids and use illicit opioids. The current understanding is that opioid misuse is a disease that requires treatment, and is not an issue of choice or character. Use of opioid medication is a necessary part of postoperative analgesia, but many physicians are unsure of how to do this safely given the risk of patients developing an opioid misuse disorder. This review gives an update of the current state of the opioid crisis, explains how current surgeons’ prescribing practices are contributing to it, and gives recommendations on how to use opioid medication safely in the perioperative period.
Impact of a Cleft and Craniofacial Center on an Academic Health System
Authors: Pourtaheri Navid , Kearney Aaron , Wan Derrick C. , Lakin Gregory 
Published: September 2017

Background:
The contributions of all physician specialties and ancillary services involved in cleft and craniofacial center care must be evaluated to fairly assess the financial impact of a cleft and craniofacial center. The authors hypothesized that the cleft and craniofacial center generates profitable downstream productivity for the academic health system.

Methods:
This was a retrospective cohort study of all patients who presented to a cleft and craniofacial center in the first quarter of 2011. Analysis included all health system encounters for each patient over a 2-year period using the electronic medical record and health system financial database.

Results:
Sixty-two patients were seen (mean age, 11.4 years; 38 boys and 24 girls; 18 new and 44 established patients). Over 2 years, there were 618 health system encounters (599 outpatient and 19 inpatient encounters), 68 hospital days, and 110 procedures. The most common physician specialty was plastic surgery [312 encounters (50.5 percent)] and the most common ancillary service was speech therapy [256 encounters (41.4 percent)]. The overall reimbursement rate was 39.9 percent, with a majority payor-mix of government payors (62.1 percent). The total profit margin percentage from all encounters was 13.7 percent, which was greater for managed care compared with government payor (38.9 percent versus −10.8 percent; p = 0.022), inpatient compared to outpatient (24.5 percent versus −2.8 percent; p < 0.001), and plastic surgery compared to other specialty encounters (19.7 percent versus 8.7 percent; p = 0.003).

Conclusions:
The cleft and craniofacial center generated profitable downstream productivity for the academic health system with referrals to 39 different physician and nonphysician specialties. Health system providers and the business team should align to analyze the center, enhance patient outcomes, and improve specialty care access for patients.
Patient Safety Climate in General Public Hospitals in China: A Multiregion Study
Authors: Zhou Ping , Li Minqi , Wei Xuefeng , Zhu Hongbo , Xue Di 
Published: September 2017

Objective
This study aimed to analyze the potential difference in patient safety climate by region (Shanghai vs Hubei Province vs Gansu Province) and general public hospital level (tertiary vs secondary) in China.

Methods
Using a stratified sampling method, employees from 54 public general hospitals in Shanghai, Hubei Province, and Gansu Province in China were surveyed in 2015. The Patient Safety Climate in Health Care Organizations tool and the percentage of “problematic responses” (PPRs) were used to measure and analyze the patient safety climate. A χ2 test and hierarchical linear modeling were applied for the analysis.

Results
In the study, 4121 valid questionnaires were collected. The psychometric analysis supported the validity and reliability of our Chinese version of the Patient Safety Climate in Health Care Organizations. The overall patient safety climate was relatively good and exhibited no significant differences among the surveyed hospitals by various regions (Shanghai vs Hubei Province vs Gansu Province) and diverse hospital levels (tertiary vs secondary) using hierarchical linear models. “Fear of blame and punishment” and “fear of shame” had the highest PPRs and were prevalent in various types of hospitals. “Provision of safe care” and “organizational resources for safety” also had notably high PPRs. There were 4 dimensions varied by region and hospital level in this survey.

Conclusions
Fear of shame and fear of blame are the most important barriers to the improvement of patient safety in the hospitals of China. Facility characteristics contributed somewhat to hospital patient safety climate in some dimensions. The initiatives to improve hospital patient safety climate are necessary and its implementation strategies needs to be shared.
Clinical Application of Acellular Dermal Matrix in the Treatment of Aplasia Cutis Congenita on Scalp
Authors: Park Eun Soo , Park Jun Ho , Shin Ho Seong , Nam Seung Min 
Published: September 2017

Abstract
Aplasia cutis congenita (ACC), also called cutis aplasia, is a rare congenital abnormality characterized by focal defect of the skin at birth, frequently involving the scalp, but may affect any region of the body. Approximately 80% of patients have the defect confined to the skin and generally less than 2 cm diameter, which can be managed conservatively with dressing alone. However, some patients present large cutaneous defects and aplasia of the underlying skull may also be present. The main complications of large defects include meningeal infection, bleeding, and thrombosis, which may be deadly. Some controversy remains in the literature regarding ACC treatment, with surgical and conservative treatment modalities having proponents and opponents.
This article presents the first case of a newborn with full-thickness ACC lesion of the vertex healed by conservative treatment with application of acellular dermal matrix.
Hemoglobin-based Oxygen Carriers: Current State-of-the-art and Novel Molecules
Authors: Sen Gupta Anirban 
Published: September 2017

ABSTRACTIn blood, the primary role of red blood cells (RBCs) is to transport oxygen via highly regulated mechanisms involving hemoglobin (Hb). Hb is a tetrameric porphyrin protein comprising of two α- and two β-polypeptide chains, each containing an iron-containing heme group capable of binding one oxygen molecule. In military as well as civilian traumatic exsanguinating hemorrhage, rapid loss of RBCs can lead to suboptimal tissue oxygenation and subsequent morbidity and mortality. In such cases, transfusion of whole blood or RBCs can significantly improve survival. However, blood products including RBCs present issues of limited availability and portability, need for type matching, pathogenic contamination risks, and short shelf-life, causing substantial logistical barriers to their prehospital use in austere battlefield and remote civilian conditions. While robust research is being directed to resolve these issues, parallel research efforts have emerged toward bioengineering of semisynthetic and synthetic surrogates of RBCs, using various cross-linked, polymeric, and encapsulated forms of Hb. These Hb-based oxygen carriers (HBOCs) can potentially provide therapeutic oxygenation when blood or RBCs are not available. Several of these HBOCs have undergone rigorous preclinical and clinical evaluation, but have not yet received clinical approval in the USA for human use. While these designs are being optimized for clinical translations, several new HBOC designs and molecules have been reported in recent years, with unique properties. The current article will provide a comprehensive review of such HBOC designs, including current state-of-the-art and novel molecules in development, along with a critical discussion of successes and challenges in this field.
Behavioral diversity assisting obstacle navigation during group transportation in ant
Authors: Utsunomiya Shohei , Takamatsu Atsuko 
Published: September 2017

AbstractCooperative transportation behavior in ants has attracted attention from a wide range of researchers, from behavioral biologists to roboticists. Ants can accomplish complex tasks as a group whereas individual ants are not intelligent (in the context of thisstudy’s tasks). In this study, group transportation and obstacle navigation inFormica japonica, an ant species exhibiting ‘uncoordinated transportation’ (primitive group transportation), are observed using two differently conditioned colonies. Analysesfocus on the effect of group size on two key quantities: transportation speed and obstacle navigation period. Additionally, this study examines how these relationships differ between colonies. The tendencies in transportation speed differ between colonies whereas the obstacle navigation period is consistently reduced irrespective of the colony. To explain this seemingly inconsistent result in transportation speed, we focus on behavioral diversity in ‘directivity’, defined as the tendency of individual ants totransport a food item toward their own preferential direction. Directivity is not always toward the nest, but rather is distributed around it. The diversity of the first colony is less than that of the second colony. Based on the above results, a mechanical model is constructed. Using the translational and rotational motion equations of a rigid rod, the model mimics a food item being pulled by single or multiple ants. The directions of pulling forces exerted by individual ants are assumed to be distributed around the direction pointing toward the nest. The simulation results suggest that, as diversity in directivity increases, so does the success rate in more complicated obstacle navigation. In contrast, depending on group size, the speed of group transportation increases in the case of lower diversity while it is almost constant in the case of higher diversity. Transportation speed and obstacle navigation success rate are in a trade-off relationship.
ATRX, DAXX or MEN1mutant pancreatic neuroendocrine tumors are a distinct alpha-cell signature subgroup
Authors: Chan Chang S , Laddha Saurabh V , Lewis Peter , Koletsky Matthew , Robzyk Kenneth , Da Silva Edaise , Torres Paula J. , Untch Brian , Bose Promita , Chan Timothy A. , Klimstra David S. , Allis C. David , Tang Laura H. 
Published: September 2017

AbstractThe most commonly mutated genes in pancreatic neuroendocrine tumors (PanNETs) areATRX,DAXX, andMEN1. Little is known about the cells-of-origin for non-functional neuroendocrine tumors. Here, we genotyped 64 PanNETs for mutations inATRX,DAXX, andMEN1and found 37 tumors (58%) carry mutations in these three genes (A-D-M mutant PanNETs) and this correlates with a worse clinical outcome than tumors carrying the wild-type alleles of all three genes (A-D-M WT PanNETs). We performed RNA sequencing and DNA-methylation analysis on 33 randomly selected cases to reveal two distinct subgroups with one group consisting entirely of A-D-M mutant PanNETs. Two biomarkers differentiating A-D-M mutant from A-D-M WT PanNETs were highARXgene expression and lowPDX1gene expression withPDX1promoter hyper-methylation in the A-D-M mutant PanNETs. Moreover, A-D-M mutant PanNETs had a gene expression signature related to that of alpha cells (pval < 0.009) of pancreatic islets including increased expression of HNF1A and its transcriptional target genes. This gene expression profile suggests that A-D-M mutant PanNETs originate from or transdifferentiate into a distinct cell type similar to alpha cells.