bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiological “Teddy Bear” Sign on CT Imaging to Aid Internal Carotid Artery Localization in Transsphenoidal Pituitary and Anterior Skull Base Surgery
Authors: Yeung W. , Twigg V. , Carr S. , Sinha S. , Mirza S. 
Published: December 2017

Objectives Internal carotid artery (ICA) injury remains a rare but potentially fatal complication of transsphenoidal pituitary or anterior skull base surgery. Preoperative imaging must be scrutinized to minimize risk. On axial computed tomography (CT), the protrusions of the ICAs into the sphenoid resemble a “teddy bear.” This article aims to describe the sign, its grading system (0–2) and quantify its presence.
Design Retrospective review of preoperative CT imaging.
Setting Tertiary referral center in the United Kingdom.
Participants One hundred patients who underwent endoscopic transsphenoidal surgery for pituitary disease were enrolled.
Main Outcome Measure The presence and grading of the “teddy bear” sign were assessed on preoperative CT imaging.
Results A grade 2 (strongly positive) “teddy bear” sign was identified in 40% at the level of the superior pituitary fossa, 78% at the inferior pituitary fossa, and 59% at the clivus. A grade 1 (intermediate) sign was seen in 23.5, 7.5, and 10% of cases, respectively. In 5% of cases, the sign was grade 0 at all levels—indicating poor intraoperative localization of the ICA.
Conclusion The “teddy bear” sign is a useful preoperative tool for identification of anatomy predisposing patients to a higher risk of ICA injury. Those patients who have an absent or grade 0 “teddy bear” sign require extra care to ensure intraoperative localization of the ICAs which may include the use of neuronavigation or a Doppler probe. A grade 2 sign predicts good intraoperative localization of the ICA intraoperatively to inform the safe lateral limit of sellar bone resection.
Stroke Volume Recruitability during the Third Trimester of Pregnancy
Authors: Herrera Sandra , Kuhlmann-Capek Maggie , Rogan Sarah , Saad Antonio , Saade George , Hankins Gary , Pacheco Luis 
Published: December 2017

Objective It is unknown whether the heart operates in the ascending or flat portion of the Starling curve during normal pregnancy. Pregnant women do not respond to the passive leg-raising maneuver secondary to mechanical obstruction of the inferior vena cava by the gravid uterus. Our objective was to evaluate if administration of a fluid bolus increases baseline stroke volume (SV) among healthy pregnant patients during the third trimester.
Study Design Healthy pregnant women who underwent elective term cesarean sections were included. A noninvasive cardiac output monitor was used to measure hemodynamic variables at baseline and after administration of a 500-mL crystalloid bolus.
Results Forty-five women were included in the study. Fluid administration was associated with a statistically significant increase in SV from a baseline value of 71 ± 11 to 90 ± 19 mL (95% confidence interval [CI]: 13.67–21.49; p < 0.01) and a significant decrease in maternal heart rate from a baseline of 87 ± 9 beats per minute to 83 ± 8 after the fluid bolus (95% CI: −6.81 to −2.78; p = 0.03). No changes in peripheral vascular resistances or any other measured hemodynamic parameters were noted with volume expansion.
Conclusion In healthy term pregnancy, the heart operates in the ascending portion of the Starling's curve, rendering it fluid responsive.
RSK2 drives cell motility by serine phosphorylation of LARG and activation of Rho GTPases
Authors: Shi Geng-Xian , Yang Won Seok , Jin Ling , Matter Michelle L. , Ramos Joe W. 
Published: December 2017

Significance
Cell motility is a dynamic process that requires the directed application of force and continuous coordinated changes in cell adhesion and cytoskeletal architecture often in response to extracellular stimuli. Here we have defined a mechanism by which RSK2 can promote cell migration and invasion in response to promotility stimuli. We show that in response to these signals RSK2 directly binds the RhoGEF LARG and phosphorylates it, thereby promoting LARG activation of RhoA GTPases. Moreover, we find that RSK2 is important for epidermal growth factor activation of Rho GTPases. These results advance our understanding of cell motility, RSK kinase function, and LARG/RhoA activation by revealing that these pathways are integrated and the precise mechanism by which that is accomplished.
Designing a retrievable and scalable cell encapsulation device for potential treatment of type 1 diabetes
Authors: An Duo , Chiu Alan , Flanders James A. , Song Wei , Shou Dahua , Lu Yen-Chun , Grunnet Lars G. , Winkel Louise , Ingvorsen Camilla , Christophersen Nicolaj Strøyer , Fels Johannes Josef , Sand Fredrik Wolfhagen , Ji Yewei , Qi Ling , Pardo Yehudah , Luo Dan , Silberstein Meredith , Fan Jintu , Ma Minglin 
Published: December 2017

Significance
Cell encapsulation holds great potential as a better treatment for type 1 diabetes. An encapsulation system that is scalable to a clinically relevant capacity and can be retrieved or replaced whenever needed is highly desirable for clinical applications. Here we report a cell encapsulation device that is readily scalable and conveniently retrievable through a minimally invasive laparoscopic procedure. We demonstrated its mechanical robustness and facile mass transfer as well as its durable function in diabetic mice. We further showed, as a proof of concept, its scalability and retrievability in dogs. We believe this encapsulation device may contribute to a cellular therapy for type 1 diabetes and potentially other endocrine disorders and hormone-deficient diseases.
Impact of an historic underground gas well blowout on the current methane chemistry in a shallow groundwater system
Authors: Schout Gilian , Hartog Niels , Hassanizadeh S. Majid , Griffioen Jasper 
Published: December 2017

Significance
The rapid increase in shale gas production in recent years has led to increased attention to its potential negative environmental effects, including the risks of contaminating groundwater with methane and other substances. In this context, the uncontrolled gas migration that is triggered during well blowouts is an understudied environmental hazard. We show that the methane chemistry in shallow groundwater overlying the site of a catastrophic underground blowout continues to be impacted 50 y later. The occurrence of anaerobic methane oxidation limits the spatial extent to which the dissolved thermogenic methane plume could be observed and discerned from local biogenic methane sources. However, it also highlights the requirement to carry out monitoring in close proximity to potential gas leakage sources.
Dynamic force spectroscopy of synthetic oligorotaxane foldamers
Authors: Sluysmans Damien , Devaux Floriane , Bruns Carson J. , Stoddart J. Fraser , Duwez Anne-Sophie 
Published: December 2017

Significance
Donor–acceptor oligorotaxane foldamers are a class of molecular switches elegantly incorporating mechanical bonds in a folded molecular architecture. Such examples of foldamers are very rare, leaving the question wide open regarding what might emerge from a synergistic combination of mechanically interlocked molecules and foldamers. Here, using atomic-force-microscopy-based dynamic single-molecule force spectroscopy, we mechanically drive oligorotaxanes out of equilibrium at a wide range of loading rates and observe their exceptional refolding capabilities and the very fast dynamics of the process. The near-equilibrium pulling–relaxing cycles were exploited to determine the energy required to break one single donor–acceptor interaction from the distribution of work trajectories using fluctuation theorems. Our findings highlight the importance of molecular design on the performance of artificial molecular machines.
Genetic variation interacts with experience to determine interindividual differences in learned song
Authors: Mets David G. , Brainard Michael S. 
Published: December 2017

Significance
Learning reflects the influence of experience on genetically determined circuitry, but little is known about how experience and genetics interact to determine learned phenotypes. Here, we use vocal learning in songbirds to study genetic influences on learned behavior. We first show that the tempo of learned song is strongly influenced by genetics. However, increasing richness of the learning experience from weak (tutoring by computer) to strong (tutoring by a live bird) reduces this genetic influence in favor of experiential influence. Our results demonstrate a strong, heritable contribution to individual variation in song learning but that the degree of heritability depends profoundly on the quality of instructive experience. Therefore, increasing the richness of instruction can overcome even strong genetic bias.
Enhancement of hepatic autophagy increases ureagenesis and protects against hyperammonemia
Authors: Soria Leandro R. , Allegri Gabriella , Melck Dominique , Pastore Nunzia , Annunziata Patrizia , Paris Debora , Polishchuk Elena , Nusco Edoardo , Thöny Beat , Motta Andrea , Häberle Johannes , Ballabio Andrea , Brunetti-Pierri Nicola 
Published: December 2017

Significance
Waste nitrogen is converted into urea by the healthy liver. Systemic ammonia is elevated in patients with inherited urea-cycle disorders or acute and chronic liver diseases. Hyperammonemia is a challenging medical condition that holds high risks of mortality and irreversible brain damage. Current treatments are often inadequate. Autophagy is a lysosomal recycling pathway that plays a major role in metabolism. Here, we found that liver autophagy is involved in ammonia homeostasis in vivo and that enhancement of hepatic autophagy increases ureagenesis by providing key urea-cycle intermediates and ATP. Importantly, pharmacological enhancement of autophagy protects against hyperammonemia resulting from both inherited and acquired causes. These findings may lead to development of new drugs promoting ammonia clearance in patients with hyperammonemia.
A mixed-scale dense convolutional neural network for image analysis
Authors: Pelt Daniël M. , Sethian James A. 
Published: December 2017

Significance
Popular neural networks for image-processing problems often contain many different operations, multiple layers of connections, and a large number of trainable parameters, often exceeding several million. They are typically tailored to specific applications, making it difficult to apply a network that is successful in one application to different applications. Here, we introduce a neural network architecture that is less complex than existing networks, is easy to train, and achieves accurate results with relatively few trainable parameters. The network automatically adapts to a specific problem, allowing the same network to be applied to a wide variety of different problems.
Coordinating carbon and nitrogen metabolic signaling through the cyanobacterial global repressor NdhR
Authors: Jiang Yong-Liang , Wang Xue-Ping , Sun Hui , Han Shu-Jing , Li Wei-Fang , Cui Ning , Lin Gui-Ming , Zhang Ju-Yuan , Cheng Wang , Cao Dong-Dong , Zhang Zhi-Yong , Zhang Cheng-Cai , Chen Yuxing , Zhou Cong-Zhao 
Published: December 2017

Significance
The homeostasis of carbon and nitrogen metabolism needs to be tightly regulated for cell acclimation to fluctuating environments. The related metabolic pathways are ultimately coordinated by the master transcription factors that sense the intracellular metabolites. We report here biochemical, structural, and functional studies of the fine regulation of the transcriptional repressor NAD(P)H dehydrogenase regulator (NdhR). Two key metabolites, 2-OG from the Krebs cycle and 2-PG from photorespiration, have opposite effects on the regulatory activity of NdhR. We propose that 2-OG and 2-PG function together as indicators of intracellular carbon/nitrogen status and that NdhR senses these two effectors in a mutually exclusive manner. Our findings together with previous studies provide a model for the fine coordination of carbon and nitrogen metabolic signaling.
From in silico hit to long-acting late-stage preclinical candidate to combat HIV-1 infection
Authors: Kudalkar Shalley N. , Beloor Jagadish , Quijano Elias , Spasov Krasimir A. , Lee Won-Gil , Cisneros José A. , Saltzman W. Mark , Kumar Priti , Jorgensen William L. , Anderson Karen S. 
Published: December 2017

SignificanceNonnucleoside reverse transcriptase inhibitors (NNRTIs) are essential components of highly active antiretroviral therapy; however, concerns about poor pharmacological properties, dose restriction because of toxicity, and drug resistance have limited treatment options. Our computational and structure-guided design studies for lead optimization have transformed a 5 µM virtual screening hit into a class of NNRTIs with remarkable potency, safety, drug resistance profile, and pharmacological properties. We report a representative, compound I, with marked synergy with existing HIV-1 drugs and antiviral efficacy in HIV-1–infected humanized mice. A single dose of long-acting nanoformulation of compound I retains sustained levels and efficacy for ∼3 weeks, confirming potential as a late-stage preclinical candidate. Additionally, these properties of compound I suggest that it may be a promising candidate to evaluate for preexposure prophylaxis.
Neuronal delivery of Hedgehog directs spatial patterning of taste organ regeneration
Authors: Lu Wan-Jin , Mann Randall K. , Nguyen Allison , Bi Tingting , Silverstein Max , Tang Jean Y. , Chen Xiaoke , Beachy Philip A. 
Published: December 2017

SignificanceThe maintenance of taste sensory organs (taste buds) in the tongue has been known for 140 years to depend on sensory innervation from distant neurons by an unknown mechanism. We find that maintenance and regeneration of taste receptor cells (TRCs) within taste buds requires neuronal delivery of the Sonic hedgehog (Shh) protein signal, thus explaining loss of taste sensation associated with Hedgehog pathway antagonism in patients and illustrating the principle that spatial patterning of TRC regeneration is specified by the projection pattern of Shh-expressing sensory neurons. We also find that pharmacologic Hedgehog pathway activation accelerates TRC recovery, suggesting a means to ameliorate the loss of taste sensation and appetite and the associated delay in recovery in cancer patients undergoing chemotherapy.
Moral priorities under risk
Authors: Lee-Stronach Chad 
Published: December 2017

AbstractMany moral theories are committed to the idea that some kinds of moral considerations should be respected, whatever the cost to ‘lesser’ types of considerations. A person's life, for instance, should not be sacrificed for the trivial pleasures of others, no matter how many would benefit. However, according to the decision-theoretic critique of lexical priority theories, accepting lexical priorities inevitably leads us to make unacceptable decisions in risky situations. It seems that to operate in a risky world, we must reject lexical priorities altogether. This paper argues that lexical priority theories can, in fact, offer satisfactory guidance in risky situations. It does so by equipping lexical priority theories with overlooked resources from decision theory.
Recognizing thyrotoxic hypokalemic periodic paralysis
Authors: Patel Kamini , McCoy Jonathan V. , Davis Patrick M. 
Published: December 2017

ABSTRACT
Thyrotoxic hypokalemic periodic paralysis (THPP) is a rare but potentially serious complication of thyrotoxicosis. The resulting muscle weakness is profound, associated with more severe hypokalemia, yet reversible. However, clinicians must be cautious because patients can develop life-threatening hyperkalemia during treatment. Underlying causes should be investigated as repeated episodes of THPP may occur.
OUTCOMES OF VITRECTOMY WITH SILICONE OIL TAMPONADE FOR MANAGEMENT OF RETINAL DETACHMENT IN EYES WITH CHORIORETINAL COLOBOMA
Authors: Hocaoglu Mumin , Karacorlu Murat , Ersoz Mehmet G. , Sayman Muslubas Isil , Arf Serra 
Published: December 2017

Purpose:
To estimate the outcomes of retinal detachment in eyes with chorioretinal coloboma managed by pars plana vitrectomy and silicone oil tamponade.

Methods:
A retrospective chart review of 10 eyes (10 patients) who underwent pars plana vitrectomy for retinal detachment with chorioretinal coloboma.

Results:
The average age at the time of the surgery was 29.8 ± 19.7 years. The mean follow-up period was 28.8 ± 28.4 months. The mean silicone oil tamponade duration was 9.8 ± 3.5 weeks. Of 10 eyes, 4 (40%) had retinal breaks outside the coloboma, 4 (40%) had breaks inside the coloboma, 1 (10%) had breaks inside and outside the coloboma, and in 1 eye (10%); the causative retinal break was not localized. Preoperatively, the mean visual acuity was 20/2,500 (n = 9), and 1 (10%) was recorded as “Not CSM.” At the final examination, the mean visual acuity for the patients with measurable visual acuity was 20/200 (P = 0.06), and in the remaining eye was recorded as light perception. The retina was finally reattached in nine eyes (90%). Postoperative complications included cataract in three (30%), persistent elevated intraocular pressure in one (10%), band keratopathy in one (10%), and proliferative vitreoretinopathy in one (10%).

Conclusion:
Complete pars plana vitrectomy with or without lensectomy, laser photocoagulation around the peripheral retina, around all the peripheral breaks and around the colobomatous area, and silicone oil tamponade is effective for retinal detachment in eyes with chorioretinal coloboma. Silicone oil removal as early as possible did not increase the risk of redetachment and seems to reduce the incidence of oil-related complications in such cases.
Early complications in cases series in implant-based immediate breast reconstruction with a biological acellular matrix during the learning curve of this technique and using 3 different matrices: a case series of 84 breasts
Authors: Aguilera-Sáez Jorge , Bosacoma Roura Pau , Garrido Ferrer Anselmo , Guinot Madridejos Alberto , Barret Juan P. 
Published: December 2017

Introduction:
We present our experience in implant-based immediate breast reconstruction (IBIBR) with biological acellular matrix during our learning curve and compare the complications with the use of three different matrices.

Materials and methods:
We did a retrospective study on patients who underwent an IBIBR with acellular matrix after skin sparing mastectomy with or without nipple-areolar complex preservation at the Breast Pathology Unit at University Hospital Vall d’Hebron, Barcelona (Spain) between July 2011 and December 2014.

Results:
A total of 84 breasts were reconstructed in 71 women. A therapeutic mastectomy was performed in 55 of them (65.5%) and a prophylactic mastectomy in 29 (34.5%). The total rate of complications was 41.67% (35 patients): we found 11 cases of erythema (13.1%), 19 cases of seroma (22.62%), 9 cases of hematoma (10.71%), 17 cases of wound dehiscence (20.24%), 11 cases of skin flap necrosis (13.1%), and 10 cases of reconstruction failure (11.9%). The probability of reconstruction failure was higher in smokers and former smokers (P=0.0011%). There were more complications with the Protexa matrix than with the other 2, Strattice and Tutomesh (P<0.001) and a higher risk of reconstruction failure as well (P=0.03).

Conclusions:
In our experience the use of acellular matrix in IBIBR can have a high rate of complications, especially during the learning curve. Therefore, the selection of suitable patients and the better matrix is an issue of great importance to achieve favorable results.
Brief Report: Disclosure, Consent, Opportunity Costs, and Inaccurate Risk Assessment Deter Pediatric HIV Testing: A Mixed-Methods Study
Authors: Wagner Anjuli D. , O'Malley Gabrielle , Firdawsi Olivia , Mugo Cyrus , Njuguna Irene N. , Maleche-Obimbo Elizabeth , Inwani Irene W. , Wamalwa Dalton C. , John-Stewart Grace C. , Slyker Jennifer A. 
Published: December 2017

Background:
Prompt child HIV testing and treatment is critical; however, children are often not diagnosed until symptomatic. Understanding factors that influence pediatric HIV testing can inform strategies to increase testing.

Methods:
A mixed-methods study was conducted at a tertiary hospital in Nairobi, Kenya. Three focus group discussions with health care workers (HCWs) and 18 in-depth interviews with HIV-infected adults with children of unknown status were analyzed using thematic analysis. A structured questionnaire was administered to 116 HIV-infected caregivers of children of unknown status to triangulate qualitative findings.

Results:
Analysis revealed 3 key periods of the pediatric HIV testing process: decision to test, test visit, and posttest. Key issues included: decision to test: inaccurate HIV risk perception for children, challenges with paternal consent, lack of caregiver HIV status disclosure to partners or older children; test experience: poor understanding of child consent/assent and disclosure guidelines, perceived costs of testing and care, school schedules, HCW discomfort with pediatric HIV testing; and posttest: pessimism regarding HIV-infected children's prognosis, caregiver concerns about their own emotional health if their child is positive, and challenges communicating about HIV with children. Concerns about all 3 periods influenced child testing decisions. In addition, 3 challenges were unique to pediatric HIV: inaccurate HIV risk perception for children; disclosure, consent, and permission; and costs and scheduling.

Conclusions:
Pediatric HIV testing barriers are distinct from adult barriers. Uptake of pediatric HIV testing may be enhanced by interventions to address misconceptions, disclosure services, psychosocial support addressing concerns unique to pediatric testing, child-focused HCW training, and alternative clinic hours.
Evaluating and Improving the Efficiency of Patient Flow in the Bronchoscopy Suite in a Tertiary Care Center: A QI Project!
Authors: Krvavac Armin , Kamel Ghassan , Patel Pujan P. , Rakey Erin , Mwangi John , Jamkhana Zafar , Patolia Setu 
Published: December 2017

Purpose:
The bronchoscopy suite is where pulmonologists perform the majority of their procedures like bronchoscopy, endobronchial ultrasound, and navigational bronchoscopy among others. Faculty and fellows in our division have reported multiple delays in the procedure start time in our bronchoscopy.

Objectives:
Objectives of the study were (1) to identify the areas of delays in procedure start time, (2) to identify potential high-yield areas of interventions to reduce delays, (3) to assess the impact of interventions on efficacy of bronchoscopy suit.

Methods:
We have conducted a quality improvement project aiming at identifying areas of delays and implemented an intervention aiming at minimizing those delays. We retrospectively collected the data about the patient flow from arrival to hospital to discharge between June and August 2016. We used fishbone technique to identify the potential reasons for delay in procedures and to identify low-effort high-yield areas. Our intervention was raising awareness and education among the personnel and designing the process to reduce time delays and improve efficacy. We collected the data about the patient flow prospectively after the invention was implemented.

Results:
The study showed that 76.4% of our preintervention procedures had a late start time. The postintervention results revealed a statistically significant reduction in the procedure late start times by 24.4% (P = .02). Signing the procedure H and P was also identified as a major area of delay, which has improved postintervention (65.5 % vs 33.3%, P = 0.017).

Conclusion:
The faculty and fellows' perceptions were translated into objective data, which serves as a first step in our division to improve the patient flow process in the bronchoscopy suite. Areas of delays were identified and our intervention resulted in significant improvement, but more work needs to be done to achieve a more efficient patient flow in the bronchoscopy suite while maintaining a safe patient care.