bluuebunny/crossref_metadata_2025_split huggingface dataset:
SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY EVALUATION OF CHORIORETINAL CHANGES IN HYPERTENSIVE CHOROIDOPATHY RELATED TO HELLP SYNDROME
Authors: Velazquez-Villoria Daniel , Marti Rodrigo Pablo , DeNicola Maria L. , Zapata Vitori Miguel A. , Segura García Antonio , García-Arumí Jose 
Published: January 2017

Purpose:
To report a case of hypertensive choroidopathy with detailed chorioretinal images obtained using swept source optical coherence tomography.

Methods:
We report the case of a 36-year-old pregnant woman who presented with extensive bilateral exudative retinal detachments (visual acuity of hands movement bilaterally), high blood pressure, and severe alteration of the laboratory test results resulting in the diagnosis of HELLP syndrome. The baby was delivered by emergency cesarean section and the patient was hospitalized in the intensive care unit.

Results:
Two weeks later, exudative retinal detachments improved substantially and bilateral Elschnig spots were present in the posterior fundus. Swept source optical coherence tomography revealed serous retinal detachment, multiple pigmentary epithelial detachments (PEDs), a thickened subfoveal choroid (437 and 466 μm), and fibrinous material between the neurosensory retina and retinal pigment epithelium in the B-scans of both eyes. En face swept source optical coherence tomography allowed a more precise evaluation of the multiple and confluent PEDs. Six weeks later, despite some focal areas of thickened retinal pigment epithelium, the serous retinal detachment, PEDs, and fibrinous material resolved bilaterally and visual acuity and choroidal thickness returned to normal range (361 and 366 μm). En face swept source optical coherence tomography revealed a dramatic improvement of PEDs in terms of extension and distribution.

Conclusion:
Swept source optical coherence tomography detected serous retinal detachment, PEDs, increased subfoveal choroidal thickness, and fibrinous material under the neurosensory retina in the acute phase of hypertensive choroidopathy. En face OCT is useful for monitoring the evolution of confluent PEDs in hypertensive choroidopathy.
Biased interpretations of ambiguous bodily threat information in adolescents with chronic pain
Authors: Heathcote L.C. , Jacobs K. , Eccleston C. , Fox E. , Lau J.Y.F. 
Published: January 2017

Abstract
Adult patients with chronic pain are consistently shown to interpret ambiguous health and bodily information in a pain-related and threatening way. This interpretation bias may play a role in the development and maintenance of pain and disability. However, no studies have yet investigated the role of interpretation bias in adolescent patients with pain, despite that pain often first becomes chronic in youth. We administered the Adolescent Interpretations of Bodily Threat (AIBT) task to adolescents with chronic pain (N = 66) and adolescents without chronic pain (N = 74). Adolescents were 10 to 18 years old and completed the study procedures either at the clinic (patient group) or at school (control group). We found that adolescents with chronic pain were less likely to endorse benign interpretations of ambiguous pain and bodily threat information than adolescents without chronic pain, particularly when reporting on the strength of belief in those interpretations being true. These differences between patients and controls were not evident for ambiguous social situations, and they could not be explained by differences in anxious or depressive symptoms. Furthermore, this interpretation pattern was associated with increased levels of disability among adolescent patients, even after controlling for severity of chronic pain and pain catastrophizing. The current findings extend our understanding of the role and nature of cognition in adolescent pain, and provide justification for using the AIBT task in longitudinal and training studies to further investigate causal associations between interpretation bias and chronic pain.
What are the most promising new agents in acute myeloid leukemia?
Authors: Sallman David A. , Lancet Jeffrey E. 
Published: January 2017

Purpose of review
Although the treatment paradigm for acute myeloid leukemia (AML) had been largely unchanged for many years, in-depth molecular characterization has revolutionized our understanding of mutations that drive the disease, subsequently serving to guide current clinical investigation. Furthermore, recent advances in the field have highlighted the importance of optimizing known efficacious agents by improving drug delivery or bypassing resistance mechanisms. The current status of novel agents which are shaping the clinical management of AML patients are summarized in this review.

Recent findings
Practice changing findings over the past year include improved overall survival (OS) in a molecularly defined AML subgroup as well as in elderly patients with secondary AML (sAML). Specifically, synergistic combination of daunorubicin and cytarabine (i.e., CPX-351) was found to improve OS in sAML patients. Furthermore, although multiple mutation specific inhibitors have been developed, optimal combination with additional agents appears critical, as monotherapies have not resulted in durable remissions or improved outcomes. Improved OS via the addition of midostaurin to intensive chemotherapy in FLT3 mutant AML supports this concept.

Summary
For the first time in AML, personalized therapy has become possible through improved understanding of the molecular architecture and survival pathways of an individual's disease. The landscape of AML treatment is encouraging, with multiple novel agents likely to gain approval over the next 5 years.
‘JAK–ing’ up the treatment of primary myelofibrosis: building better combination strategies
Authors: Assi Rita , Verstovsek Srdan , Daver Naval 
Published: January 2017

Purpose of reviewThe article discusses the promising agents that are approved or currently under investigation for the treatment of myelofibrosis and reviews the ongoing Janus kinase (JAK) inhibitors–based combinatorial strategies in this setting.Recent findingsMyelofibrosis is a Philadelphia-negative myeloproliferative neoplasm with constitutive JAK/STAT activation. The JAK-inhibitor ruxolitinib is the only approved drug for this disease in the United States and Europe based on two randomized phase III studies that demonstrated clinically meaningful reduction in spleen size, improvement in symptoms, quality of life, and an overall survival advantage with prolonged follow-up. Emerging data have revealed the complex molecular architecture of myelofibrosis with clonal evolution playing a central role in disease progression or transformation. These molecular pathways may explain the heterogeneous benefits obtained by JAK-inhibitors in patients with myelofibrosis. In addition, the genetic and epigenetic mutations appear to work in concert with overactive JAK/STAT signaling and contribute to myelofibrosis pathogenesis and prognosis, suggesting a potential to exploit them as potential therapeutic targets.SummaryCombining JAK-inhibitors with agents that target parallel prosurvival pathways or agents that enhance hematopoiesis may enhance efficacy and/or mitigate on-target myelosuppression, thereby extending the therapeutic benefits observed with JAK-inhibitors alone.
A Fatal Case of Coin Battery Ingestion in an 18-Month-Old Child
Authors: Ventura Francesco , Candosin Sara , Barranco Rosario , Bonsignore Alessandro , Andrello Luisa , Tajana Luca , Osculati Antonio 
Published: January 2017

Abstract
The ingestion of extraneous substances is quite common in clinical practice; it usually befalls in the pediatric age, mostly between 6 months and 6 years. In most cases, complications do not emerge, and the prognosis is considered favorable. However, when a case of battery ingestion occurs, serious adverse events may develop. The ingestion of these components is a potential life-threatening event for children.
In this article, we report the case of an 18-month-old child who died from hemorrhagic shock due to an aortoesophageal fistula caused by a 20 mm lithium button battery lodged in the esophagus.
The child presented vomiting blood, and laboratory results revealed a severe anemization, which later led to death.
The autopsy showed a coin battery located in the middle third of the esophagus as well as a transmural erosion of the esophageal wall with fistulization into the aortic wall. The histological examination revealed a severe necrosis of the esophageal and aortic walls in line with the junction between the aortic arch and the descending part.
Perioperative Near-Infrared Spectroscopy Monitoring in Neonates With Congenital Heart Disease: Relationship of Cerebral Tissue Oxygenation Index Variability With Neurodevelopmental Outcome
Authors: Spaeder Michael C. , Klugman Darren , Skurow-Todd Kami , Glass Penny , Jonas Richard A. , Donofrio Mary T. 
Published: January 2017

Objectives:To evaluate the value of perioperative cerebral near-infrared spectroscopy monitoring using variability analysis in the prediction of neurodevelopmental outcomes in neonates undergoing surgery for congenital heart disease.Design:Retrospective cohort study.Setting:Urban, academic, tertiary-care children’s hospital.Patients:Neonates undergoing surgery with cardiopulmonary bypass for congenital heart disease.Interventions:Perioperative monitoring of continuous cerebral tissue oxygenation index by near-infrared spectroscopy and subsequent neurodevelopmental testing at 6, 15, and 21 months of age.Measurements and Main Results:We developed a new measure, cerebral tissue oxygenation index variability, using the root mean of successive squared differences of averaged 1-minute cerebral tissue oxygenation index values for both the intraoperative and first 24-hours postoperative phases of monitoring. There were 62 neonates who underwent cerebral tissue oxygenation index monitoring during surgery for congenital heart disease and 44 underwent subsequent neurodevelopmental testing (12 did not survive until testing and six were lost to follow-up). Among the 44 monitored patients who underwent neurodevelopmental testing, 20 (45%) had abnormal neurodevelopmental indices. Patients with abnormal neurodevelopmental indices had lower postoperative cerebral tissue oxygenation index variability when compared with patients with normal indices (p= 0.01). Adjusting for class of congenital heart disease and duration of deep hypothermic circulatory arrest, lower postoperative cerebral tissue oxygenation index variability was associated with poor neurodevelopmental outcome (p= 0.02).Conclusions:We found reduced postoperative cerebral tissue oxygenation index variability in neonatal survivors of congenital heart disease surgery with poor neurodevelopmental outcomes. We hypothesize that reduced cerebral tissue oxygenation index variability may be a surrogate for impaired cerebral metabolic autoregulation in the immediate postoperative period. Further research is needed to investigate clinical implications of this finding and opportunities for using this measure to drive therapeutic interventions.
Pain Assessment in Children Younger Than 8 Years in Out-of-Hospital Emergency Medicine
Authors: Beltramini Alexandra , Galinski Michel , Chabernaud Jean Louis , Ruiz Almenar Ramon , Tsapis Michael , Goddet Nathalie Sybille , Kessous Katia , Falissard Bruno , Fournier-Charrière Elisabeth 
Published: January 2017

Objective
Pain in children is underestimated and undertreated in out-of-hospital emergency medicine. In this setting, caregivers need a reliable pain scale, but none has been validated. A single observational pain scale for all children younger than 8 years, EVENDOL, has been validated in emergency pediatric units. We study the feasibility of EVENDOL score in an out-of-hospital emergency setting.

Methods
This prospective multicenter study included all conscious children younger than 8 years transported by a mobile intensive care unit between October 2008 and May 2010. The emergency physician and nurse independently assessed the child’s pain using first a numeric rating scale (score 0-10), then the 5-item EVENDOL scale (verbal/vocal expression, facial expression, movements, postures, and relationship with entourage) (score 0-3/item) at 3 time points (at rest, during examination, and after analgesia). We studied the scale’s internal validity, interrater reliability, discriminant ability (influence of fever and anxiety), and face validity.

Results
Of the 422 included children, 82 and 62 (29%–39%) were in pain according to the emergency physician and nurses (numeric rating scale >3/10). All EVENDOL scale attributes were satisfied at all 3 time points, for all population subsets. Values for the first assessment (entire study population) were as follows: internal validity (0.78–0.89), interrater reliability (r = 0.63–0.76, weighted κ = 0.49–0.65), construct validity, and discriminant ability (r = 0.6–0.7). Fever did not impact on EVENDOL score. Anxiety level and pain were correlated. Completion time was fast (mean, 2.3–3.4 minutes). Face validity was good.

Conclusion
EVENDOL is a quick, easy-to-use, discriminant instrument to assess pain in young children in out-of-hospital emergency settings.
Parent Perceptions on Transfers to Pediatric Emergency Departments and the Role of Telemedicine
Authors: Mollen Cynthia J. , Henien Mira , Jacobs Lisa M. , Myers Sage 
Published: January 2017

Objective
Real-time audiovisual consultation (telemedicine) has been proven feasible and is a promising alternative to interfacility transfer. We sought to describe caregiver perceptions of the decision to transfer his or her child to a pediatric emergency department and the potential use of telemedicine as an alternative to transfer.

Methods
Semistructured interviews of caregivers of patients transferred to a pediatric emergency department. Purposive sampling was used to recruit caregivers of patients who were transferred from varying distances and different times of the day. Interviews were conducted in person or on the phone by a trained interviewer. Interviews were recorded, transcribed, and analyzed using modified grounded theory.

Results
Twenty-three caregivers were interviewed. Sixteen (70%) were mothers; 57% of patients were transported from hospitals outside of the city limits. Most caregivers reported transfer for a specific resource need, such as a pediatric subspecialist. Generally, caregivers felt that the decision to transfer was made unilaterally by the treating physician, although most reported feeling comfortable with the decision. Almost no one had heard about telemedicine; after hearing a brief description, most were receptive to the idea. Caregivers surmised that telemedicine could reduce the risks and cost associated with transfer. However, many felt telemedicine would not be applicable to their particular situation.

Conclusions
In this sample, caregivers were comfortable with the decision to transfer their child and identified potential benefits of telemedicine as either an adjunct to or replacement of transfer. As hospitals use advanced technology, providers should consider families' opinions about risks and out-of-pocket costs and tailoring explanations to address individual situations.
The microbiome in mechanically ventilated patients
Authors: Yin Yudong , Hountras Peter , Wunderink Richard G. 
Published: January 2017

Purpose of review
Discovery of a normal lung microbiome requires reassessment of our concepts of HAP/VAP pathogenesis and has important implications for clinical diagnosis and management.

Recent findings
Changes in the microbiome of dental plaque are associated with increased risk of HAP/VAP. A transition to a lung microbiome enriched with gut flora is found in ARDS with an increased inflammatory response in patients with this change in microbial flora. A characteristic microbiome pattern of higher amounts of bacterial DNA, lower community diversity, and greater relative abundance of a single species characterize pneumonia and occasionally identify bacteria not found in culture. The influence of the microbiome makes probiotics a logical strategy to prevent or ameliorate HAP/VAP but so far clinical support is unclear.

Summary
The presence of a normal lung microbiome and the interaction of that microbiome with other microbiota have an important but previously overlooked impact on the pathogenesis of HAP/VAP. Deep sequencing suggests that the repertoire of microorganisms and the pattern of bacterial communities associated with HAP/VAP remains incompletely understood but recent studies are adding greater clarity.
Resident Education in Female Pelvic Medicine and Reconstructive Surgery
Authors: Propst Katie , Steinberg Adam C. , O’Sullivan David M. , Schimpf Megan O. , LaSala Christine 
Published: January 2017

Objective
The aim of this study was to evaluate whether obstetrics and gynecology trainees feel satisfied with the female pelvic medicine and reconstructive surgery (FPMRS) education received in residency.

Methods
This is a survey study of obstetrics and gynecology residents in the United States and Puerto Rico during the 2015–2016 academic year. The anonymous 29-question survey was approved by the Hartford HealthCare institutional review board. Responses were included only if the trainee had ever rotated on the FPMRS service. Descriptive analyses were performed using mean and SD for continuous data; categorical data were described using frequencies, expressed as percentages. The results were analyzed for statistical significance using χ2 for categorical variables and Student t test for continuous variables. All results yielding P < 0.05 were deemed statistically significant.

Results
Of the 333 responses received, 172 met criteria for inclusion. Regarding amount of training in FPMRS, 126 trainees (73.3%) reported satisfaction, 40 (23.3%) reported too little training, and 6 trainees (3.5%) reported too much. Residents in programs with a board-certified FPMRS surgeon more commonly reported satisfaction with training (75.0 vs 28.6%, P = 0.02). When fourth-year residents were asked if they would feel comfortable performing specific surgical procedures independently after graduation, the percentage answering affirmatively ranged from 23.6% to 98.8%.

Conclusions
Satisfaction with training in FPMRS has improved, but poor confidence performing surgical procedures compared with previous reports demonstrates that improvements in resident training are still needed.
Increasing Age Is a Risk Factor for Decreased Postpartum Pelvic Floor Strength
Authors: Quiroz Lieschen H. , Pickett Stephanie D. , Peck Jennifer D. , Rostaminia Ghazaleh , Stone Daniel E. , Shobeiri S. Abbas 
Published: January 2017

Objectives
This study aimed to determine factors associated with decreased pelvic floor strength (PFS) after the first vaginal delivery (VD) in a cohort of low-risk women.

Methods
This is a secondary analysis of a prospective study examining the risk of pelvic floor injury in a cohort of primiparous women. All recruited participants underwent an examination, three-dimensional ultrasound and measurement of PFS in the third trimester and repeated at 4 weeks to 6 months postpartum using a perineometer.

Results
There were 84 women recruited for the study, and 70 completed the postpartum assessment. Average age was 28.4 years (standard deviation, 4.8). There were 46 (66%) subjects with a VD and 24 (34%) with a cesarean delivery who labored. Decreased PFS was observed more frequently in the VD group compared with the cesarean delivery group (68% vs 42%, P = 0.03).
In modified Poisson regression models controlling for mode of delivery and time of postpartum assessment, women who were aged 25 to 29 years (risk ratio = 2.80, 95% confidence interval, 1.03–7.57) and 30 years and older (risk ratio = 2.53, 95% confidence interval, 0.93–6.86) were over 2.5 times more likely to have decreased postpartum PFS compared with women younger than 25 years.

Conclusions
In this population, women aged 25 years and older were more than twice as likely to have a decrease in postpartum PFS.
Association Between Obesity and Perioperative Morbidity in Open Versus Laparoscopic Sacrocolpopexy
Authors: Halder Gabriela E. , Salemi Jason L. , Hart Stuart , Mikhail Emad 
Published: January 2017

Objectives
The aim of this study was to compare differences in 30-day perioperative morbidity and mortality for women undergoing open sacrocolpopexy (OSCP) versus laparoscopic sacrocolpopexy (LSCP) across all body mass index (BMI) groups and between patients of ideal versus elevated BMI (includes overweight, obese, and morbidly obese).

Materials and Methods
Data for this retrospective review were obtained from the American College of Surgeons-National Surgical Quality Improvement Project database using current procedural terminology. All women older than 18 years who underwent an OSCP or LSCP from 2005 to 2013 were included. Patients were divided into 4 BMI (weight [kg]/[height (m)]2) subgroups: (1) less than 25, (2) 25 to 29.9, (3) 30 to 39.9, and (4) 40 or greater. The data were analyzed using Student t or χ2 test and Fisher exact test.

Results
A total of 4894 women underwent an OSCP or LSCP. Shorter operative times were observed with OSCP (P < 0.05) in all BMI groups except morbidly obese patients. Compared with patients of ideal body weight, overweight and obese patients had significantly longer operation times during LSCP (P < 0.05), a difference that was not observed during OSCP. For all BMI subgroups, the length of hospital stay was significantly shorter for LSCP (1 [1–1]) versus OSCP (2 [2–3]) (P < 0.05). Statistically significant increases in the rate of superficial surgical site infections were observed in OSCP in patients of both ideal and overweight BMIs (P < 0.05).

Conclusions
Obesity increases the operative time during LSCP. For patients in all BMI groups, LSCP offers the benefit of shorter hospital stays when compared with OSCP.
Construction and optimization of a heterologous pathway for protocatechuate catabolism inEscherichia colienables rapid bioconversion of model lignin monomers
Authors: Clarkson Sonya M. , Kridelbaugh Donna M. , Elkins James G. , Guss Adam M. , Michener Joshua K. 
Published: January 2017

AbstractCellulosic biofuel production yields a substantial lignin byproduct stream that currently has few applications. Biological conversion of lignin compounds into chemicals and fuels has the potential to improve the economics of cellulosic biofuels, but few microbes are able both to catabolize lignin and generate valuable products. WhileEscherichia colihas been engineered to produce a variety of fuels and chemicals, it is incapable of catabolizing most aromatic compounds. Therefore, we have engineeredE. colito catabolize a model lignin monomer, protocatechuate, as the sole source of carbon and energy, via heterologous expression of a nine-gene pathway fromPseudomonas putidaKT2440. We next used experimental evolution to select for mutations that increased growth with PCA more than two-fold. Increasing the strength of a single ribosome binding site in the heterologous pathway was sufficient to recapitulate the increased growth. After optimization of the core pathway, we extended the pathway to enable catabolism of a second model compound, 4-hydroxybenzoate. These engineered strains will be useful platforms to discover, characterize, and optimize pathways for lignin bioconversions.HighlightsA heterologous pathway for PCA catabolism was transferred to Escherichia coli.Evolution identified a mutation that increased growth with PCA by 2.5-fold.Optimization plus further engineering allowed efficient catabolism of 4-HB