bluuebunny/crossref_metadata_2025_split huggingface dataset:
Restless legs syndrome secondary to pontine infarction: Clinical analysis of five cases
Authors: Tuo Hou‐Zhen , Tian Ze‐Long , Cui Yi‐Nong , Ma Xiao‐Yang , Xu Chun‐Ling , Bi Hong‐Yan , Zhang Li‐Yan , Zhang Yong‐Bo , Le Wei‐Dong , Ondo William 
Published: September 2017

AbstractObjectivePontine infarction is a common type of stroke in the cerebral deep structures, resulting from occlusion of small penetrating arteries, may manifest as hemi‐paralysis, hemi‐sensory deficit, ataxia, vertigo, and bulbar dysfunction, but patients presenting with restless legs syndrome (RLS) are extremely rare. Herein, we reported five cases with RLS as a major manifestation of pontine infarction.MethodsFive cases of pontine infarction related RLS were collected from July 2013 to February 2016. The diagnosis of RLS was made according to criteria established by the International RLS Study Group (IRLSSG) in 2003. Neurological functions were assessed according to the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Severity of RLS was based on the International RLS Rating Scale (IRLS‐RS). Sleep quality was assessed by Epworth Rating Scale (ERS), and individual emotional and psychological states were assessed by Hamilton Depression Scale (HDS) and Hamilton Anxiety Scale (HAS).ResultsThe laboratory data at the onset including hemoglobin, serum concentration of homocysteine, blood urea nitrogen (BUN), creatinine, electrolytes, and thyroid hormones were normal. The electroencephalogram (EEG), lower‐extremity somatosensory evoked potential (SEP), and nerve conduction velocity (NCV) in four limbs were normal. The average period of follow‐up was 34.60 ± 12.76 months. The MRI examination showed acute or subacute pontine infarction lesions, 3 cases in the rostral inner side, 1 case in the rostral lateral and inner side, and 1 case in rostral lateral side. The neurological deficits included weakness in 4 cases, contralateral sensory deficit in 1 case, and ataxia in 2 cases. All 5 patients presented with symptom of RLS at or soon after the onset of infarction and 4 patients experienced uncomfortable sensations in the paralyzed limbs contralateral to the ischemic lesion. Their neurological deficits improved significantly 2 weeks later, but the symptoms of RLS did not resolve. Among them, 3/5 patients were treated with dopaminergic drugs. At the end of the follow‐up, RLS symptom eventually resolved in 3 patients but persisted in two. The IRLS‐RS, NIHSS and mRS scores were significantly lower at the onset than those at the last follow‐up (P = 0.035, 0.024 and 0.049, respectively). However, there was no significant difference in the ERS, HDS and HAS scores (P = 0.477, 0.226 and 0.778, respectively).ConclusionRLS can be an onset manifestation of pontine infarction, clinicians should be aware of this potential symptom. RLS usually occurs in the paralyzed limbs contralateral to the infarction lesion. The pathogenesis still needs further investigation.
Syncope and the risk of sudden cardiac death: Evaluation, management, and prevention
Authors: Koene Ryan J. , Adkisson Wayne O. , Benditt David G. 
Published: September 2017

AbstractSyncope is a clinical syndrome defined as a relatively brief self‐limited transient loss of consciousness (TLOC) caused by a period of inadequate cerebral nutrient flow. Most often the trigger is an abrupt drop of systemic blood pressure. True syncope must be distinguished from other common non‐syncope conditions in which real or apparent TLOC may occur such as seizures, concussions, or accidental falls. The causes of syncope are diverse, but in most instances, are relatively benign (e.g., reflex and orthostatic faints) with the main risks being accidents and/or injury. However, in some instances, syncope may be due to more worrisome conditions (particularly those associated with cardiac structural disease or channelopathies); in such circumstances, syncope may be an indicator of increased morbidity and mortality risk, including sudden cardiac death (SCD). Establishing an accurate basis for the etiology of syncope is crucial in order to initiate effective therapy. In this review, we focus primarily on the causes of syncope that are associated with increased SCD risk (i.e., sudden arrhythmic cardiac death), and the management of these patients. In addition, we discuss the limitations of our understanding of SCD in relation to syncope, and propose future studies that may ultimately address how to improve outcomes of syncope patients and reduce SCD risk.
The Relationship Between Incontinence and Erectile Dysfunction After Robotic Prostatectomy: Are They Mutually Exclusive?
Authors: Tsikis Savas T. , Nottingham Charles U. , Faris Sarah F. 
Published: September 2017

Abstract

Background
Urinary incontinence (UI) and erectile dysfunction (ED) remain the most common long-term complications of prostatectomy, with a significant impact on sexual health and quality of life.

Aims
To determine the relation between UI and moderate to severe ED and the risk factors for UI in patients undergoing robotic-assisted laparoscopic prostatectomy.

Methods
Patients in our institutional database who underwent robotic-assisted laparoscopic prostatectomy for prostate cancer (2006–2013) and who completed the University of California–Los Angeles Prostate Cancer Index and the Sexual Health Inventory for Men (SHIM) surveys at 12 months after prostatectomy were eligible for inclusion. Men who reported use of no urinary pads per day were considered continent, whereas men who used at least one pad per day were considered incontinent. Men with moderate to severe ED based on a SHIM score no higher than 11 were considered to have ED. Patients who had preoperative moderate to severe ED and/or UI based on these definitions were excluded from further analysis.

Outcomes
A better understanding of what increases the risk for UI after a prostatectomy and how it can co-occur with ED.

Results
We analyzed 464 patients who met the inclusion criteria. After prostatectomy, 36% of patients had UI and 47% of patients had moderate to severe ED. Of all patients with ED, 45% (98 of 216) were incontinent compared with 27% (67 of 248) of patients without ED (P &lt; .001). On multivariable analysis, older age at diagnosis (odds ratio [OR] = 1.05, P = .002) and ED (OR = 1.88, P = .005) were independent predictors for incontinence. The use of unilateral nerve sparing (OR = 1.03, P = .94) or no nerve sparing (OR = 0.53, P = .50) during surgery did not have an impact on postoperative incontinence.

Clinical Implications
Understanding that ED is an independent predictor of UI after robotic-assisted laparoscopic prostatectomy has important clinical implications and suggests a common anatomic pathway.

Strengths and Limitations
Our focus on different measurements of incontinence and their relation to ED and our use of validated questionnaires to define incontinence and ED were important strengths of this study. Limitations of our study include its retrospective nature and the fact that our results were drawn from a single-center database of a tertiary referral hospital.

Conclusion
Our results show that the presence of moderate to severe ED after prostatectomy is an independent risk factor for incontinence, suggesting a possible common pathway for these two complications. Further studies to investigate the anatomic and clinical bases of this relation are warranted.
Prevalence and Risk Factors for Erectile Dysfunction in Chinese Adult Males
Authors: Zhang Xinyu , Yang Bin , Li Ni , Li Hongjun 
Published: September 2017

Abstract

Background
There is a lack of nationwide epidemiologic survey data on the prevalence estimate of erectile dysfunction (ED) in Chinese men living on the mainland China.

Aim
To attain the representative prevalence estimate of ED in the Chinese male population and to analyze potential risk factors associated with ED by demographics, socioeconomic status, and medical comorbidities.

Methods
The study was community based. The five-item Internation Index of Erectile Function questionnaire and in-person interview were used to obtain data. The survey subjects were 5,210 non-institutionalized Chinese men at least 40 years old residing in 30 provinces and autonomies of China. Multiple logistic regression analysis was used to disclose risk factors associated with ED.

Outcomes
The prevalence estimate of ED was 40.56% in Chinese men at least 40 years old.

Results
The prevalence of ED increased with increasing age. A significant high prevalence of ED was observed in men who smoked heavily, were estranged from a partner, had diabetes, and lower urinary tract symptoms from benign prostatic hyperplasia. Smoking more than 30 cigarettes daily and obesity (body mass index ≥ 30 kg/m2) significantly increased the risk for ED by multivariable-adjusted odds ratios. Stable or erratic sexual partners, personal incomes, alcohol consumption, and cardiovascular and/or cerebrovascular diseases were not risk factors associated with ED prevalence. Other sexual problems commonly seen in this group of men included difficulty achieving erectile rigidness, ejaculation, and climax during intercourse.

Clinical Translation
Knowledge on the prevalence of ED and its associated risk factors will help physicians in the clinical management and prevention of ED with the use of counseling for lifestyle adjustment and drug therapy.

Strengths and Limitations
Data on the influence of psychological conditions on ED were not collected. ED was not categorized as minor, moderate, or severe for analysis during processing of data.

Conclusion
The national representative prevalence of ED was determined for the first time in the Chinese male population.
Endoluminal stenting for the management of leak following sleeve gastrectomy and loop duodenojejunal bypass with sleeve gastrectomy
Authors: Tsai Ying‐Nan , Wang Hsiu‐Po , Huang Chih‐Kun , Chang Po‐Chin , Lin I‐Chang , Tai Chi‐Ming 
Published: September 2017

AbstractPostoperative leak is a serious complication of bariatric surgery and often results in significant morbidity and mortality. Stent placement is a less invasive alternative to surgery for the treatment of bariatric surgical leak. We evaluated the efficacy and complications of covered self‐expandable metal stents (SEMS) in the treatment of post‐bariatric surgical leak. We retrospectively reviewed patients who underwent stent placement for leak after bariatric surgery. Leak was diagnosed by upper gastrointestinal series or was visualized during the endoscopy. We examined the timing of stent placement, size of the leak, stent migration and its complications, total stent treatment duration, and treatment outcome. Between January 2011 and April 2015, seven patients underwent covered SEMS placement for leak after bariatric surgery, including laparoscopic sleeve gastrectomy (LSG) (n = 5) and laparoscopic loop duodenojejunal bypass with sleeve gastrectomy (LDJB‐SG) (n = 2). A stent was placed in one patient for infection control and bridging to revisional surgery. Among the other six patients, one patient who received stent placement one year after leak diagnosis failed to achieve leak closure, and five patients with early stent placement achieved leak closure. Three patients with small leak achieved leak closure more quickly. Stent migration was found in six patients, and associated ulcers occurred in five patients. We conclude that stenting is effective in the management of staple‐line leaks following LSG and LDJB‐SG. Stent migration and associated ulcers are common after stent placement. Early stent removal can be achieved in patients with small leaks.
Long‐Term Effects of Orthoses Use on the Changes of Foot and Ankle Joint Motions of Children With Spastic Cerebral Palsy
Authors: Liu Xue‐Cheng , Embrey David , Tassone Channing , Zvara Kim , Brandsma Brenna , Lyon Roger , Goodfriend Karin , Tarima Sergey , Thometz John 
Published: September 2017

AbstractBackgroundOrthoses commonly are prescribed to children with cerebral palsy (CP) to provide foot correction and to improve ambulatory function. Immediate effects of ankle foot orthosis (AFOs) have been investigated, but long‐term kinematic effects are lacking clinical evidence.ObjectiveTo determine changes in 3‐dimensional ankle and foot segment motion in pediatric patients with CP between initial and follow‐up visits (18‐month average time differences) in both barefoot gait and gait with their AFO. We also investigated intravisit changes between barefoot and AFO gait.DesignA prospective cohort study.SettingChildren's Hospital of Wisconsin, Department of Orthopaedic Surgery, Medical College of Wisconsin.PatientsA total of 23 children with CP, mean age 10.5 years (6.2‐18.1 years) were clinically prescribed either a solid ankle foot orthotic (SAFO), hinged ankle foot orthotic (HAFO), or supramalleolar orthotic.MethodsHoles were cut in the study orthoses so that electromagnetic markers could be directly placed on the skin. A 6‐foot segment model was used.Outcome MeasurementsKinematic and kinetic data were recorded for each patient's initial and follow‐up visit (18‐month follow‐up average, 15‐20 months range).ResultsFor the SAFO group (gait with AFO), a significant decrease in dorsiflexion was found between the initial and third visit (P = .008). Furthermore, the SAFO group (barefoot gait) had an increased eversion at the midfoot for most of the gait cycle (P < .008). Sagittal forefoot range of motion was reduced for all 3 groups between the barefoot and AFO groups.ConclusionThe use of AFOs long term either maintained or improved foot deformities or dysfunction.Level of EvidenceLevel II.
Unilateral Lower Extremity Pain Due to Malignancy Managed With Cordotomy: A Case Report
Authors: Chai Thomas , Suleiman Zakari A. , Roldan Carlos J. 
Published: September 2017

AbstractCancer pain management is comprehensive, and it generally begins with pharmacotherapy in a step‐wise approach per analgesic guidelines established decades ago by the World Health Organization. This analgesic ladder involves the prescribing of co‐analgesics, adjuvants, and opioids, with each step depending on pain severity. Although the majority of cancer pain responds to this strategy, there exist patients who do not respond adequately or experience significant side effects or intolerance to pain medications. It is in these patients whom clinicians consider interventional approaches. One approach to manage unremitting unilateral malignant pain includes evaluation for cordotomy, which is an approach that has been effective in such cases. We present a patient with breast cancer metastatic to the pelvis, with associated severe pelvic and right lower limb pain. Due to progressive disease, her pain worsened despite aggressive opioid dose escalations. She ultimately underwent percutaneous left anterolateral cervical cordotomy for malignant right leg pain, resulting in complete resolution of leg pain. We propose that, in select patients with neoplasm‐related pain, cordotomy may prove very effective.Level of EvidenceV
Incomplete atrioventricular dissociation and isorhythmic atrioventricular dissociation during general anesthesia with desflurane and remifentanil: A case report
Authors: Hirase Masayasu , Seto Mika , Koga Sayo , Takaoka Masao , Kita Ryosuke , Kikuta Toshihiro 
Published: September 2017

AbstractWe encountered a patient who experienced incomplete atrioventricular (A‐V) dissociation and isorhythmic A‐V dissociation during general anesthesia with desflurane and remifentanil. A 38‐year‐old man was scheduled to undergo extraction of both the upper and the right lower impacted wisdom teeth under general anesthesia. After anesthesia induction, we maintained anesthesia with desflurane and remifentanil. After 15min, incomplete A‐V dissociation was observed on electrocardiography (ECG). After atropine sulfate 0.3mg was administered intravenously, isorhythmic A‐V dissociation was observed. Atropine sulfate 0.2mg was administered intravenously, and we observed normal ECG findings. Subsequently, no abnormal ECG findings were observed.
Model predictive stator current control of doubly fed induction generator during network unbalance
Authors: Cheng Chenwen , Cheng Peng , Nian Heng , Sun Dan 
Published: September 2017

This study proposes a model predictive stator current control (MPSCC) strategy of doubly fed induction generator (DFIG) under unbalanced grid voltage conditions. Sinusoidal and balanced stator currents injected into the power grid can be ensured due to the direct control of stator currents rather than rotor currents. Model predictive control instead of traditional vector control is adopted, which can increase the current loop bandwidth and obtain faster dynamic responses. Conventional resonant regulators such as second‐order generalised integrators or second‐order vector integrators that are usually used to eliminate unbalanced components in stator currents can also be avoided. Moreover, both extractions of negative sequence components in rotor or stator currents and calculation of commanded rotor current are avoided, which simplifies the control scheme. The proposed MPSCC strategy can also implement the grid connection by introducing the virtual stator currents without any changes in the control scheme. Finally, experimental results based on a 1 kW lab DFIG system are provided to validate the effectiveness of the proposed control strategy.
Thyroid hormone receptor beta and NCOA4 regulate terminal erythrocyte differentiation
Authors: Gao Xiaofei , Lee Hsiang-Ying , Li Wenbo , Platt Randall Jeffrey , Barrasa M. Inmaculada , Ma Qi , Elmes Russell R. , Rosenfeld Michael G. , Lodish Harvey F. 
Published: September 2017

Significance
We have long known that thyroid hormone (TH) stimulates formation of red blood cells and patients with thyroid diseases are often anemic, but the underlying molecular mechanisms are unclear. This study uses pharmacologic and genetic approaches in primary cells and animal models to demonstrate essential roles of nuclear receptor coactivator 4 (NCOA4) and TH in late erythropoiesis. We show that TH is essential for the last steps in formation of red cells in culture, and that treatment of cells with drugs that activate a particular nuclear TH receptor, TRβ, stimulates erythroid differentiation and alleviates anemic symptoms in a chronic anemia mouse model, indicating potential clinical applications. Further, we show that TRβ functions together with NCOA4 to regulate red cell formation.
Clinical decision support alert malfunctions: analysis and empirically derived taxonomy
Authors: Wright Adam , Ai Angela , Ash Joan , Wiesen Jane F , Hickman Thu-Trang T , Aaron Skye , McEvoy Dustin , Borkowsky Shane , Dissanayake Pavithra I , Embi Peter , Galanter William , Harper Jeremy , Kassakian Steve Z , Ramoni Rachel , Schreiber Richard , Sirajuddin Anwar , Bates David W , Sittig Dean F 
Published: September 2017

AbstractObjectiveTo develop an empirically derived taxonomy of clinical decision support (CDS) alert malfunctions.Materials and MethodsWe identified CDS alert malfunctions using a mix of qualitative and quantitative methods: (1) site visits with interviews of chief medical informatics officers, CDS developers, clinical leaders, and CDS end users; (2) surveys of chief medical informatics officers; (3) analysis of CDS firing rates; and (4) analysis of CDS overrides. We used a multi-round, manual, iterative card sort to develop a multi-axial, empirically derived taxonomy of CDS malfunctions.ResultsWe analyzed 68 CDS alert malfunction cases from 14 sites across the United States with diverse electronic health record systems. Four primary axes emerged: the cause of the malfunction, its mode of discovery, when it began, and how it affected rule firing. Build errors, conceptualization errors, and the introduction of new concepts or terms were the most frequent causes. User reports were the predominant mode of discovery. Many malfunctions within our database caused rules to fire for patients for whom they should not have (false positives), but the reverse (false negatives) was also common.DiscussionAcross organizations and electronic health record systems, similar malfunction patterns recurred. Challenges included updates to code sets and values, software issues at the time of system upgrades, difficulties with migration of CDS content between computing environments, and the challenge of correctly conceptualizing and building CDS.ConclusionCDS alert malfunctions are frequent. The empirically derived taxonomy formalizes the common recurring issues that cause these malfunctions, helping CDS developers anticipate and prevent CDS malfunctions before they occur or detect and resolve them expediently.
Defining the Role of the MADS-Box Gene, Zea Agamous-like1, a Target of Selection During Maize Domestication
Authors: Wills David M , Fang Zhou , York Alessandra M , Holland James B , Doebley John F 
Published: September 2017

AbstractGenomic scans for genes that show the signature of past selection have been widely applied to a number of species and have identified a large number of selection candidate genes. In cultivated maize (Zea mays ssp. mays) selection scans have identified several hundred candidate domestication genes by comparing nucleotide diversity and differentiation between maize and its progenitor, teosinte (Z. mays ssp. parviglumis). One of these is a gene called zea agamous-like1 (zagl1), a MADS-box transcription factor, that is known for its function in the control of flowering time. To determine the trait(s) controlled by zagl1 that was (were) the target(s) of selection during maize domestication, we created a set of recombinant chromosome isogenic lines that differ for the maize versus teosinte alleles of zagl1 and which carry cross-overs between zagl1 and its neighbor genes. These lines were grown in a randomized trial and scored for flowering time and domestication related traits. The results indicated that the maize versus teosinte alleles of zagl1 affect flowering time as expected, as well as multiple traits related to ear size with the maize allele conferring larger ears with more kernels. Our results suggest that zagl1 may have been under selection during domestication to increase the size of the maize ear.
An ensemble algorithm for Kohonen self-organizing map with different sizes
Authors: Pasa Leandro Antonio , Costa José Alfredo F. , Medeiros Marcial Guerra de 
Published: September 2017

Abstract
Data Clustering aims to discover groups within the data based on similarities, with a minimal, if any, knowledge of their structure. Variations in the results may occur due to many factors, including algorithm parameters, initialization and stopping criteria. The usage of different attributes or even different subsets of data usually lead to different results. Self-organizing maps (SOM) has been widely used for a variety of tasks regarding data analysis, including data visualization and clustering. A machine committee, or ensemble, is a set of neural networks working independently with some system that enable the combination of individual results into a single output, with the aim to achieve a better generalization compared to a unique neural network. This article presents a new ensemble method that uses SOM networks. Cluster validity indexes are used to combine neuron weights from different maps with different sizes. Results are shown from simulations with real and synthetic data, from the UCI Repository and Fundamental Clustering Problems Suite. The proposed method presented promising results, with increased performance compared with conventional single Kohonen map.