bluuebunny/crossref_metadata_2025 huggingface dataset:
Modulation of estrogen synthesis and metabolism by phytoestrogensin vitroand the implications for women's health
Authors: van Duursen Majorie B. M.
Published: September 2017

Phytoestrogens are increasingly used as dietary supplements due to their suggested health promoting properties, but also by women for breast enhancement and relief of menopausal symptoms. Generally, phytoestrogens are considered to exert estrogenic activity via estrogen receptors (ERs), but they may also affect estrogen synthesis and metabolism locally in breast, endometrial and ovarian tissues. Considering that accurate regulation of local hormone levels is crucial for normal physiology, it is not surprising that interference with hormonal synthesis and metabolism is associated with a wide variety of women's health problems, varying from altered menstrual cycle to hormone-dependent cancers. Yet, studies on phytoestrogens have mainly focused on ER-mediated effects of soy-derived phytoestrogens, with less attention paid to steroid synthesis and metabolism or other phytoestrogens. This review aims to evaluate the potential of phytoestrogens to modulate local estrogen levels and the implications for women's health. For that, an overview is provided of the effects of commonly used phytoestrogens, i.e. 8-prenylnaringenin, biochanin A, daidzein, genistein, naringenin, resveratrol and quercetin, on estrogen synthesizing and metabolizing enzymes in vitro. The potential implications for women's health are assessed by comparing the in vitro effect concentrations with blood concentrations that can be found after intake of these phytoestrogens. Based on this evaluation, it can be concluded that high-dose supplements with phytoestrogens might affect breast and endometrial health or fertility in women via the modulation of steroid hormone levels. However, more data regarding the tissue levels of phytoestrogens and effect data from dedicated, tissue-specific assays are needed for a better understanding of potential risks. At least until more certainty regarding the safety has been established, especially young women would better avoid using supplements containing high doses of phytoestrogens.
Post-translational modification of the interferon-gamma receptor alters its stability and signaling
Authors: Londino James D. , Gulick Dexter L. , Lear Travis B. , Suber Tomeka L. , Weathington Nathaniel M. , Masa Luke S. , Chen Bill B. , Mallampalli Rama K.
Published: September 2017

The IFN gamma receptor 1 (IFNGR1) binds IFN-γ and activates gene transcription pathways crucial for controlling bacterial and viral infections. Although decreases in IFNGR1 surface levels have been demonstrated to inhibit IFN-γ signaling, little is known regarding the molecular mechanisms controlling receptor stability. Here, we show in epithelial and monocytic cell lines that IFNGR1 displays K48 polyubiquitination, is proteasomally degraded, and harbors three ubiquitin acceptor sites at K277, K279, and K285. Inhibition of glycogen synthase kinase 3 beta (GSK3β) destabilized IFNGR1 while overexpression of GSK3β increased receptor stability. We identified critical serine and threonine residues juxtaposed to ubiquitin acceptor sites that impacted IFNGR1 stability. In CRISPR–Cas9 IFNGR1 generated knockout cell lines, cellular expression of IFNGR1 plasmids encoding ubiquitin acceptor site mutations demonstrated significantly impaired STAT1 phosphorylation and decreased STAT1-dependent gene induction. Thus, IFNGR1 undergoes rapid site-specific polyubiquitination, a process modulated by GSK3β. Ubiquitination appears to be necessary for efficient IFNGR1-dependent gamma gene induction and represents a relatively uncharacterized regulatory mechanism for this receptor.
Alarm- und Einsatzplanung im Krankenhaus: Vorbereitung auf Großschadenslagen
Authors: Wurmb Thomas , Scholtes Katja , Kolibay Felix , Rechenbach Peer , Vogel Ulrich , Kowalzik Barbara
Published: September 2017

Krankenhäuser spielen bei der Bewältigung von Großschadenslagen oder Katastrophen eine entscheidende Rolle. Dies wurde durch die terroristischen Anschläge und Amoktaten der letzten Jahre in Europa besonders deutlich. Die Anschlagsnacht in Paris vom November 2015 hat eindrücklich gezeigt, welche außerordentlichen Leistungen Krankenhäuser in solchen Fällen erbringen können. Um außergewöhnliche Situationen und Schadenslagen bewältigen zu können, bedarf es seitens der Krankenhäuser einer detaillierten Vorbereitung – der Erstellung eines Krankenhaus-Alarm- und Einsatzplanes. Der hier vorgelegte Artikel beschreibt ausführlich die theoretischen Hintergründe der Alarm- und Einsatzplanung an Krankenhäusern. Darüber hinaus wird anhand eines Beispiels anschaulich gezeigt, wie die konkrete Erstellung eines Einsatzplanes erfolgt.
Simulations of a beam-driven plasma antenna in the regime of plasma transparency
Authors: Timofeev I. V. , Berendeev E. A. , Dudnikova G. I.
Published: September 2017

In this paper, the theoretically predicted possibility to increase the efficiency of electromagnetic radiation generated by a thin beam-plasma system in the regime of oblique emission, when a plasma column becomes transparent to radiation near the plasma frequency, is investigated using particle-in-cell simulations. If a finite-size plasma column has a longitudinal density modulation, such a system is able to radiate electromagnetic waves as a dipole antenna. This radiation mechanism is based on the conversion of an electron beam-driven potential plasma wave on the periodic perturbation of plasma density. In this case, the frequency of radiated waves appears to be slightly lower than the plasma frequency. That is why their fields enable the penetration into the plasma only to the skin-depth. This case is realized when the period of density modulation coincides with the wavelength of the most unstable beam-driven mode, and the produced radiation escapes from the plasma in the purely transverse direction. In the recent theoretical paper [I. V. Timofeev et al. Phys. Plasmas 23, 083119 (2016)], however, it has been found that the magnetized plasma can be transparent to this radiation at certain emission angles. It means that the beam-to-radiation power conversion can be highly efficient even in a relatively thick plasma since not only boundary layers but also the whole plasma volume can be involved in the generation of electromagnetic waves. Simulations of steady-state beam injection into a pre-modulated plasma channel confirm the existence of this effect and show limits of validity for the simplified theoretical model.
Microwave absorbing performance enhancement of Fe75Si15Al10 composites by selective surface oxidation
Authors: Zhang Nan , Wang Xin , Liu Tao , Xie Jianliang , Deng Longjiang
Published: September 2017

An excessively large dielectric constant is a challenge to improve the performances of the Fe-based absorbing material. Here, we propose a selective surface oxidation method to reduce the permittivity without sacrificing the permeability, by annealing under 5%H2—95%N2 (H2/N2). It is found that a thin layer of aluminum and silicon oxides formed on the surface of Fe75Si15Al10 particles during annealing in the range of 500–780 °C under H2/N2, thereby leading to an obvious decrease of permittivity of the Fe75Si15Al10 composite. According to Gibbs free energy, aluminum and silicon oxides are formed and iron oxides are reduced during annealing under H2/N2 at above 500 °C. Interestingly, the XPS result shows that the atomic ratio of Fe decreases significantly on the particle surface, which infers that the reduced Fe atoms diffuse to the interior of the particles. The surface oxide layer can protect the inner part of the alloy from further oxidation, which contributes to a high permeability. Meanwhile, the XRD result shows the formation of DO3-type ordering, which leads to the promotion of permeability. The two reasons lead to the improvement of permeability of the Fe75Si15Al10 composite after annealing. The composite is confirmed to have high permeability and low permittivity, exhibiting better electromagnetic wave absorption properties.
Distance decay as a descriptor of the diatom compositional variation in tropical reservoirs
Authors: Marquardt Gisele C. , Blanco Saúl , Bicudo Carlos E. de M.
Published: September 2017

In the present study, distance decay was used as a descriptor of the compositional variation in diatom communities’ similarity between different habitats (phytoplankton and surface sediment) and seasons (summer and winter; only for phytoplankton) along a geographical gradient of ~64km over six reservoirs located in south-east Brazil. Whether rates of decay in similarity changed with distance in tropical biological communities was tested, and the degree to which dispersal (geographic distance) and niche (habitat association) processes explain variation in the diatom communities was estimated. In addition, whether the diatom assemblage captured in the surface sediment reflected the water column assemblage events was evaluated. Distance–decay curves were estimated using linear regressions. Partial Mantel tests were performed to examine the significance of relationships among the biological, environmental and spatial datasets. Similarity decreased significantly with distance between habitats and seasons, but the results were not statistically significant for surface sediment assemblages. All diatom communities were controlled more by limited dispersal than by environmental factors, probably as a result of the water quality and scale of the study area.
Improving prediction accuracy of cooling load using EMD, PSR and RBFNN
Authors: Shen Limin , Wen Yuanmei , Li Xiaohong
Published: September 2017

To increase the accuracy for the prediction of cooling load demand, this work presents an EMD (empirical mode decomposition)-PSR (phase space reconstruction) based RBFNN (radial basis function neural networks) method. Firstly, analyzed the chaotic nature of the real cooling load demand, transformed the non-stationary cooling load historical data into several stationary intrinsic mode functions (IMFs) by using EMD. Secondly, compared the RBFNN prediction accuracies of each IMFs and proposed an IMF combining scheme that is combine the lower-frequency components (called IMF4-IMF6 combined) while keep the higher frequency component (IMF1, IMF2, IMF3) and the residual unchanged. Thirdly, reconstruct phase space for each combined components separately, process the highest frequency component (IMF1) by differential method and predict with RBFNN in the reconstructed phase spaces. Real cooling load data of a centralized ice storage cooling systems in Guangzhou are used for simulation. The results show that the proposed hybrid method outperforms the traditional methods.
Amplified summer warming in Europe–West Asia and Northeast Asia after the mid-1990s
Authors: Hong Xiaowei , Lu Riyu , Li Shuanglin
Published: September 2017

Regional temperature changes are a crucial factor in affecting agriculture, ecosystems and societies, which depend greatly on local temperatures. We identify a nonuniform warming pattern in summer around the mid-1990s over the Eurasian continent, with a predominant amplified warming over Europe–West Asia and Northeast Asia but much weaker warming over Central Asia. It is found that the nonuniform warming concurs with both the phase shift of the Atlantic Multi-decadal Oscillation (AMO) and the decadal change in the Silk Road Pattern (SRP), which is an upper-tropospheric teleconnection pattern over the Eurasian continent during summer. We suggest that the AMO may modulate the decadal change in SRP and then induce the zonal asymmetry in temperature changes. Our results have important implications for decadal prediction of regional warming pattern in Eurasia based on the predictable AMO.
Image Fusion Algorithms Using Human Visual System in Transform Domain
Authors: Vadhi Radhika , Kilari Veera Swamy , Samayamantula Srinivas Kumar
Published: September 2017

The endeavor of digital image fusion is to combine the important visual parts from various sources to advance the visibility eminence of the image. The fused image has a more visual quality than any source images. In this paper, the Human Visual System (HVS) weights are used in the transform domain to select appropriate information from various source images and then to attain a fused image. In this process, mainly two steps are involved. First, apply the DWT to the registered source images. Later, identify qualitative sub-bands using HVS weights. Hence, qualitative sub-bands are selected from different sources to form high quality HVS based fused image. The quality of the HVS based fused image is evaluated with general fusion metrics. The results show the superiority among the state-of-the art resolution Transforms (MRT) such as Discrete Wavelet Transform (DWT), Stationary Wavelet Transform (SWT), Contourlet Transform (CT), and Non Sub Sampled Contourlet Transform (NSCT) using maximum selection fusion rule.
Towards generic adiabatic elimination for bipartite open quantum systems
Authors: Azouit R , Chittaro F , Sarlette A , Rouchon P
Published: September 2017

We consider a composite open quantum system consisting of a fast subsystem coupled to a slow one. Using the time scale separation, we develop an adiabatic elimination technique to derive at any order the reduced model describing the slow subsystem. The method, based on an asymptotic expansion and geometric singular perturbation theory, ensures the physical interpretation of the reduced second-order model by giving the reduced dynamics in a Lindblad form and the state reduction in Kraus map form. We give explicit second-order formulas for Hamiltonian or cascade coupling between the two subsystems. These formulas can be used to engineer, via a careful choice of the fast subsystem, the Hamiltonian and Lindbald operators governing the dissipative dynamics of the slow subsystem.
Effects of dapagliflozin on human epicardial adipose tissue: modulation of insulin resistance, inflammatory chemokine production, and differentiation ability
Authors: Díaz-Rodríguez Esther , Agra Rosa M , Fernández Ángel L , Adrio Belén , García-Caballero Tomás , González-Juanatey José R , Eiras Sonia
Published: September 2017

Aims

In patients with cardiovascular disease, epicardial adipose tissue (EAT) is characterized by insulin resistance, high pro-inflammatory chemokines, and low differentiation ability. As dapagliflozin reduces body fat and cardiovascular events in diabetic patients, we would like to know its effect on EAT and subcutaneous adipose tissue (SAT).

Methods and results

Adipose samples were obtained from 52 patients undergoing heart surgery. Sodium-glucose cotransporter 2 (SGLT2) expression was determined by real-time polymerase chain reaction (n = 20), western blot, and immunohistochemistry. Fat explants (n = 21) were treated with dapagliflozin and/or insulin and glucose transporters expression measured. Glucose, free fatty acid, and adipokine levels (by array) were measured in the EAT secretomes, which were then tested on human coronary endothelial cells using wound healing assays. Glucose uptake was also measured using the fluorescent glucose analogue (6NBDG) in differentiated stromal vascular cells (SVCs) from the fat pads (n = 11). Finally, dapagliflozin-induced adipocyte differentiation was assessed from the levels of fat droplets (AdipoRed staining) and of perilipin. SGLT2 was expressed in EAT. Dapagliflozin increased glucose uptake (20.95 ± 4.4 mg/dL vs. 12.97 ± 4.1 mg/dL; P < 0.001) and glucose transporter type 4 (2.09 ± 0.3 fold change; P < 0.01) in EAT. Moreover, dapagliflozin reduced the secretion levels of chemokines and benefited wound healing in endothelial cells (0.21 ± 0.05 vs. 0.38 ± 0.08 open wound; P < 0.05). Finally, chronic treatment with dapagliflozin improved the differentiation of SVC, confirmed by AdipoRed staining [539 ± 142 arbitrary units (a.u.) vs. 473 ± 136 a.u.; P < 0.01] and perilipin expression levels (121 ± 10 vs. 84 ± 11 a.u.).

Conclusions

Dapagliflozin increased glucose uptake, reduced the secretion of pro-inflammatory chemokines (with a beneficial effect on the healing of human coronary artery endothelial cells), and improved the differentiation of EAT cells. These results suggest a new protective pathway for this drug on EAT from patients with cardiovascular disease.
Migrants’ transnational political engagement in Spain and Italy
Authors: Guarnizo Luis Eduardo , Chaudhary Ali R , Sørensen Ninna Nyberg
Published: September 2017

International migrants’ cross-border political activities challenge singular notions of national citizenship and political belonging. Yet most sociological studies of migrants’ transnational political engagement are based on single national groups in the USA, and limit themselves to examining how assimilation and contexts of reception determine migrants’ propensity to engage with homeland politics—thereby under theorizing the influence of origin countries. This study moves beyond this approach by recognizing the multi-directionality of migration, and testing the applicability of existing theoretical approaches across two different origins and receiving contexts. We compare a sample of Colombian and Dominican migrants in Spain and Italy, analyzing how contexts in countries of origin, as well as migrants’ social networks across borders, interact with assimilation and contexts of reception to determine migrants’ political transnational engagement. Findings reveal migrants’ transnational political engagement in Spain and Italy appears to be a highly selective process dominated by a small minority of well-educated males from high social status in origin. Findings also suggest immigrant incorporation and transnational political engagement form a dialectical relationship operating at different scales that is simultaneously complementary and contradictory. Contextual conditions in origin countries explain observed much of variation in Colombian and Dominican migrants’ transnational political engagement.
The Cost-effectiveness of a Point-of-Care Paper Transaminase Test for Monitoring Treatment of HIV/TB Co-Infected Persons
Authors: Rajasingham Radha , Pollock Nira R , Linas Benjamin P
Published: September 2017

Background

Persons with HIV and tuberculosis (TB) co-infection require transaminase monitoring while on hepatotoxic medications. A novel paper-based, point-of-care transaminase test is in development at an anticipated cost of $1 per test.

Methods

To project long-term clinical outcomes and estimate the cost-effectiveness of using a paper-based fingerstick test to monitor for drug-induced liver injury (DILI), as compared with automated testing and with no laboratory monitoring. The design was a decision analytic model, including deterministic and probabilistic sensitivity analyses. Data sources were observational cohorts and a validation study of the paper-based test. The target population was HIV/TB co-infected persons in South Africa on antiretroviral therapy who were initiating TB therapy. Interventions: (1) clinical (no laboratory) monitoring; (2) monitoring using the paper-based test with a ≥120 IU/mL threshold for positivity; (3) monitoring using the paper-based test with a ≥200 IU/mL threshold for positivity; (4) monitoring using the paper-based test using 1 of 3 categories: <120 IU/mL, 120 to 200 IU/mL, and >200 IU/mL (“bin placement”); (5) monitoring using automated ALT testing using the same 3 categories (“automated testing”). The outcome measures were discounted quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs).

Results

The ICER of automated testing was $5180/QALY. Use of the paper-based test with the bin placement strategy was cost-effective compared with clinical monitoring alone.

Conclusion

At its current performance, monthly DILI monitoring by bin placement using the paper-based test was cost-effective, compared with clinical monitoring, in HIV/TB co-infected persons in South Africa.
Pathogenicity of Fumonisin-producing and Nonproducing Strains of Aspergillus Species in Section Nigri to Maize Ears and Seedlings
Authors: Munkvold G. P. , Weieneth L. , Proctor R. H. , Busman M. , Blandino M. , Susca A. , Logrieco A. , Moretti A.
Published: September 2017

Species of Aspergillus section Nigri are commonly associated with maize kernels, and some strains can produce fumonisin mycotoxins. However, there is little information about the extent to which these fungi contribute to fumonisin contamination in grain, the damage they cause to maize ears, or their effects on maize seed germination and seedling health. We compared fumonisin-producing and nonproducing strains of A. niger, A. welwitschiae, A. phoenicis, A. tubingensis, and A. carbonarius from the United States and Italy in laboratory and field studies to assess their ability to contribute to fumonisin contamination, to cause maize ear rot, and to affect seed germination and seedling growth. In laboratory experiments, some strains of each Aspergillus species reduced germination or seedling growth, but there was high variability among strains within species. There were no consistent differences between fumonisin-producing and nonproducing strains. In field studies in Iowa and Illinois, strains were variable in their ability to cause ear rot symptoms, but this was independent of the ability of the Aspergillus strains to produce fumonisins. Contamination of grain with fumonisins was not consistently increased by inoculation with Aspergillus strains compared with the control, and was much greater in F. verticillioides-inoculated treatments than in Aspergillus-inoculated treatments. However, the ratio of the FB analogs FB2 and FB1 was altered by inoculation with some Aspergillus strains, indicating that FB2 production by Aspergillus strains occurred in the field. These results demonstrate the pathogenic capabilities of strains of Aspergillus in section Nigri, but suggest that their effects on maize ears and seedlings are not related to their ability to produce fumonisins, and that fumonisin contamination of grain caused by Aspergillus spp. is not as significant as that caused by Fusarium spp.
Identification of Weather Conditions Associated with the Occurrence, Severity, and Incidence of Black Seed Disease of Strawberry Caused by Mycosphaerella fragariae
Authors: Carisse Odile , McNealis Vanessa
Published: September 2017

Black seed disease (BSD) of strawberry is a sporadic disease caused by Mycosphaerella fragariae. Because little is known about potential crop losses or the weather conditions conducive to disease development, fungicides are generally not applied or are applied based on a preset schedule. Data collected from 2000 to 2011 representing 50 farm-years (total of 186 strawberry fields) were used to determine potential crop losses and to study the influence of weather on disease occurrence and development. First, logistic regression was used to model the relationship between occurrence of BSD and weather variables. Second, linear and nonlinear regressions were used to model the number of black seed per berry (severity) and the percentage of diseased berries (incidence). Of the 186 fields monitored, 78 showed black seed symptoms, and the number of black seed per berry ranged from 1 to 10, whereas the percentage of diseased berries ranged from 3 to 32%. The most influential weather variable was total rainfall (in millimeters) in May, with a threshold of 103 mm of rain (absence of BSD < 103 mm < presence of BSD). Similarly, nonlinear models with the total rainfall in May accurately predicted both disease severity and incidence (r = 0.94 and 0.97, respectively). Considering that management actions such as fungicide application are not needed every year in every field, these models could be used to identify fields that are at risk of BSD.
Transitional Objects to Faciliate Grieving Following Perinatal Loss
Authors: LeDuff Lawrence D. , Bradshaw Wanda T. , Blake Stephanie M.
Published: September 2017

Background:

Parents who experience a perinatal loss often leave the hospital with empty arms and no tangible mementos to validate the parenting experience. Opportunities to create parenting experiences with transitional objects exist following the infant's death.

Purpose:

This article offers suggestions for staff in units where infant loss is possible to best assist parents in optimal grieving through the offering of transitional bereavement objects.

Methods/Search Strategy:

CINAHL Complete, MEDLINE, and the Cochrane Database of Systematic Reviews were searched using the following key words—perinatal bereavement, grief, perinatal loss, transitional objects, bereavement photography—and the search was limited to 5 years and the English language.

Findings/Results:

Recommendations exist and are well supported by leading neonatal and perinatal nursing and medicine organizations for the use of transitional objects to facilitate healthy grieving when parents experience perinatal loss. Transitional objects are mementos that validate the meaning of parenthood—even if the physical act of parenting was brief. Nursing and medical staff have significant roles in guiding parents to a healthy state of bereavement and ultimately managing long-term grief.

Implications for Practice:

Transitional objects can be provided by staff that are low-cost or free, such as taking photographs for parents, or they can involve purchased products from perinatal bereavement programs. In the latter case, funding needs are a consideration for budgeting decisions.

Implications for Research:

Immediately following a loss, parents experience a brief sense of healing after receiving mementos of their infant. However, further research is needed to assess long-term effects of receiving transitional objects following perinatal loss.
Overcoming Education Failures and Retakes
Authors: Wynn Stephanie T.
Published: September 2017

The retention of students is a major challenge for nursing education programs. Although students who fail can often retake courses, negative internalities may occur. After a failure, students regularly present with emotional distress. A mental health practitioner, who is a nursing faculty member, is ideal to assist these students and offer support. The integration of spirituality as a coping mechanism for these students can serve as a protective factor.
Welcome Day
Authors: Wyss Lora , Hess Rosanna F.
Published: September 2017

Welcome Day, one specific day in the life of Hartville Migrant Ministry (HMM), a faith-based ministry in Ohio, illustrates the organization's vision, mission, and community collaboration. Migrant and seasonal farm workers, the Migrant Head Start program, HMM and Welcome Day, interprofessional collaboration, and Malone University School of Nursing faculty and students support are discussed. Programs and activities presented here could be reproduced in other communities.
African American Hemodialysis Patients' Perceptions of Faith and Nursing
Authors: Nix Elizabeth Seaton
Published: September 2017

Numerous quantitative studies have been conducted with African Americans (AAs) receiving hemodialysis. This article shares a portion of a larger qualitative study that explored the role spirituality plays in the lives of AAs undergoing hemodialysis for management of end-stage renal disease (ESRD). Interview questions centered on the roles of spirituality, health beliefs, and different social support systems used in coping. By understanding the perceptions of AAs with ESRD, nurses and other providers can offer better support.
Racial and Socioeconomic Differences Manifest in Process Measure Adherence for Enhanced Recovery After Surgery Pathway
Authors: Leeds Ira L. , Alimi Yewande , Hobson Deborah R. , Efron Jonathan E. , Wick Elizabeth C. , Haut Elliott R. , Johnston Fabian M.
Published: September 2017

BACKGROUND:

Adherence to care processes and surgical outcomes varies by population subgroups for the same procedure. Enhanced recovery after surgery pathways are intended to standardize care, but their effect on process adherence and outcomes for population subgroups is unknown.

OBJECTIVE:

This study aims to demonstrate the association between recovery pathway implementation, process measures, and short-term surgical outcomes by population subgroup.

DESIGN:

This study is a pre- and post-quality improvement implementation cohort study.

SETTING:

This study was conducted at a tertiary academic medical center.

INTERVENTION:

A modified colorectal enhanced recovery after surgery pathway was implemented.

PATIENTS:

Patients were included who had elective colon and rectal resections before (2013) and following (2014–2016) recovery pathway implementation.

MAIN OUTCOME MEASURE:

Thirty-day outcomes by race and socioeconomic status were analyzed using a difference-in-difference approach with correlation to process adherence.

RESULTS:

We identified 639 cases (199 preimplementation, 440 postimplementation). In these cases, 75.2% of the patients were white, and 91.7% had a high socioeconomic status. Groups were similar in terms of other preoperative characteristics. Following pathway implementation, median lengths of stay improved in all subgroups (–1.0 days overall, p ≤ 0.001), but with no statistical difference by race or socioeconomic status (p = 0.89 and p = 0.29). Complication rates in both racial and socioeconomic groups were no different (26.4% vs 28.8%, p = 0.73; 27.3% vs 25.0%, p = 0.86) and remained unchanged with implementation (p = 0.93, p = 0.84). By race, overall adherence was 31.7% in white patients and 26.5% in nonwhite patients (p = 0.32). Although stratification by socioeconomic status demonstrated decreased overall adherence in the low-status group (31.8% vs 17.1%, p = 0.05), white patients were more likely to have regional pain therapy (57.1% vs 44.1%, p = 0.02) with a similar trend seen with socioeconomic status.

LIMITATIONS:

Data were collected primarily for quality improvement purposes.

CONCLUSIONS:

Differences in outcomes by race and socioeconomic status did not arise following implementation of an enhanced recovery pathway. Differences in process measures by population subgroups highlight differences in care that require further investigation. See Video Abstract at http://links.lww.com/DCR/A386.
Ligation of Intersphincteric Fistula Tract for Fistula in Ano: Lessons Learned From a Decade of Experience
Authors: Malakorn Songphol , Sammour Tarik , Khomvilai Supakij , Chowchankit Irin , Gunarasa Shankar , Kanjanasilp Prapon , Thiptanakij Charnjiroj , Rojanasakul Arun
Published: September 2017

BACKGROUND:

Ligation of intersphincteric fistula tract is a well-described sphincter-preserving technique for the management of fistula in ano. In 2007, we reported our early experience demonstrating a primary success rate of 94.4%. These findings have since been supported by several short-term studies, but long-term results and secondary cure rates after ligation of intersphincteric fistula tract failure remain unknown.

OBJECTIVE:

This study aims to report a 10-year experience of ligation of intersphincteric fistula tract with extended long-term follow-up.

DESIGN:

Retrospective analysis of single-center data from May 2006 to October 2010 was performed.

SETTINGS:

This study was conducted at a large tertiary hospital in Bangkok, Thailand.

PATIENTS:

All patients with primary or recurrent fistula in ano who underwent a ligation of intersphincteric fistula tract procedure were included. Patients with malignancy, incontinent patients, and patients with rectovaginal fistula were excluded.

MAIN OUTCOME MEASURES:

Healing as defined by the absence of symptoms with no visible external opening on clinical examination. Follow-up was continued until May 2016.

RESULTS:

In total, 251 patients were identified, with a primary healing rate of 87.65% at a median follow-up of 71 months. The healing rates for low transsphincteric, intersphincteric, high transsphincteric, semihorseshoe, and horseshoe fistulas were 92.1%, 85.2%, 60.0%, 89.0%, and 40.0%. Of the 42 patients who had an unhealed fistula after previous non-ligation of intersphincteric fistula tract surgery, 38 (90.48%) healed after the first attempt at ligation of intersphincteric fistula tract. There were 31 patients with unhealed fistulas after the first ligation of intersphincteric fistula tract. Of these, 3 healed spontaneously, and the rest underwent either repeat ligation of intersphincteric fistula tract, fistulotomy (if the recurrence was intersphincteric), or simple curettage (if no internal opening was found). Ultimately, only 2 of the original 251 patients remained unhealed, and there was no change in subjective continence status after surgery.

LIMITATIONS:

This study was limited by its retrospective design.

CONCLUSION:

Ligation of intersphincteric fistula tract is an effective technique for the treatment of fistula in ano, including recurrent or unhealed fistula after other procedures. See Video Abstract at http://links.lww.com/DCR/A387.
Adjuvant Chemotherapy After Preoperative Chemoradiation Improves Survival in Patients With Locally Advanced Rectal Cancer
Authors: Sun Zhifei , Gilmore Brian , Adam Mohamed A. , Kim Jina , Hsu Shiao-wen D. , Migaly John , Mantyh Christopher R.
Published: September 2017

BACKGROUND:

Practice guidelines differ in their support of adjuvant chemotherapy use in patients who received preoperative chemoradiation for rectal cancer.

OBJECTIVE:

The purpose of this study was to evaluate the impact of adjuvant chemotherapy among patients with locally advanced rectal cancer who received neoadjuvant chemoradiation and surgery.

DESIGN:

This was a retrospective study. Multivariable Cox proportional hazard modeling was used to evaluate the adjusted survival differences.

SETTINGS:

Data were collected from the National Cancer Database.

PATIENTS:

Adults with pathologic stage II and III rectal adenocarcinoma who received neoadjuvant chemoradiation and surgery were included.

MAIN OUTCOME MEASURES:

Overall survival was measured.

RESULTS:

Among 12,696 patients included, 4023 (32%) received adjuvant chemotherapy. The use of adjuvant chemotherapy increased over the study period from 23% to 36%. Although older age and black race were associated with a lower likelihood of receiving adjuvant chemotherapy, patients with higher education level and stage III disease were more likely to receive adjuvant chemotherapy (all p < 0.05). At 7 years, overall survival was improved among patients who received adjuvant chemotherapy (60% vs. 55%; p < 0.001). After risk adjustment, the use of adjuvant chemotherapy was associated with improved survival (HR = 0.81 (95% CI, 0.72–0.91); p < 0.001). In the subgroup of patients with stage II disease, survival was also improved among patients who received adjuvant chemotherapy (68% vs 58% at 7 y; p < 0.001; HR = 0.70 (95% CI, 0.57–0.87); p = 0.002). Among patients with stage III disease, the use of adjuvant chemotherapy was associated with a smaller but persistent survival benefit (56% vs 51% at 7 y; p = 0.017; HR = 0.85 (95% CI, 0.74–0.98); p = 0.026).

LIMITATIONS:

The study was limited by its potential for selection bias and inability to compare specific chemotherapy regimens.

CONCLUSIONS:

The use of adjuvant chemotherapy among patients with rectal cancer who received preoperative chemoradiation conferred a survival benefit. This study emphasizes the importance of adjuvant chemotherapy in the management of rectal cancer and advocates for its increased use in the setting of neoadjuvant therapy. See Video Abstract at http://link.lww.com/DCR/A428.
The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Colon Cancer
Authors: Vogel Jon D. , Eskicioglu Cagla , Weiser Martin R. , Feingold Daniel L. , Steele Scott R.
Published: September 2017

The American Society of Colon and Rectal Surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Clinical Practice Guidelines Committee is composed of society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This committee was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus. This is accompanied by developing Clinical Practice Guidelines based on the best available evidence. These guidelines are inclusive and not prescriptive. Their purpose is to provide information on which decisions can be made, rather than to dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. It should be recognized that these guidelines should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient.
Safety and Efficacy of a Noninvasive 1,060-nm Diode Laser for Fat Reduction of the Flanks
Authors: Katz Bruce , Doherty Sean
Published: September 2017

BACKGROUND

Preliminary reports indicate a hyperthermic diode laser treatment could be a safe and effective method for noninvasive fat reduction using the 1,060-nm wavelength. This wavelength penetrates the skin to heat subcutaneous adipocytes causing cellular disruption, leaving extracellular lipids, and cellular debris to be evacuated naturally by the body.

OBJECTIVE

To evaluate the safety and effectiveness of this modality for noninvasive fat reduction of the flanks.

MATERIALS AND METHODS

Forty-nine subjects received single laser treatment to 1 flank. Ultrasound images were taken at baseline, follow-up at 6 and 12 weeks after treatment. High-resolution photographs were taken at baseline and 12 weeks after treatment and then evaluated by independent reviewers. Adverse events recorded at all visits. Subjects completed a satisfaction questionnaire at the conclusion of the trial.

RESULTS

Ultrasound images showed statistically significant (p < .001) average fat reduction of 2.6 ± 1.1 mm. Reviewers correctly ordered photographs 90.3% of the time. Ninety-six percentage of subjects rated that they were satisfied. Noted side effects were transient mild to moderate tenderness which subsided within 1 to 3 weeks; no serious adverse events were reported.

CONCLUSION

The hyperthermic 1,060-nm diode laser treatment used in this study was safe and effective for noninvasive fat reduction of the flank.
Multimodal Approach for Treating Horizontal Neck Wrinkles Using Intensity Focused Ultrasound, Cohesive Polydensified Matrix Hyaluronic Acid, and IncobotulinumtoxinA
Authors: Jeon Heedae , Kim Taeyoon , Kim Heesu , Cho Sung Bin
Published: September 2017

BACKGROUND

For the restoration of horizontal neck wrinkles, multimodal approaches using neuromodulators, intensity focused ultrasound (IFU), and fine line fillers are recommended.

OBJECTIVE

To evaluate the efficacy and safety of a 1-day, multimodal approach for horizontal neck wrinkles.

METHODS

Twelve female patients with horizontal neck wrinkles were treated with a combined treatment of IFU, cohesive polydensified matrix hyaluronic acid (CPMHA), and incobotulinumtoxinA. Therapeutic outcomes were assessed on Day 0 and 1, 2, 3, and 6 months thereafter.

RESULTS

Horizontal neck wrinkles decreased significantly in length from a median at baseline of 269.75 mm (interquatile range [IQR], 235.35–302.94 mm) to 91.5 mm (IQR, 51.4–108.61 mm) at 1 month, 92.3 mm (IQR, 69.66–132.07 mm) at 2 months, 101.88 mm (IQR, 86–146.77 mm) at 3 months, and 109.48 mm (IQR, 85.06–148.17 mm) at 6 months after the combined treatment. The median global aesthetic improvement scale scores were 3.5 (IQR, 2–4) at 1 month, 3 (IQR, 3–3.5) at 2 months, 3 (IQR, 2–4) at 3 months, and 3 (IQR, 3–3) at 6 months. Post-treatment petechiae resolved completely within 7 days, and CPMHA-induced lumps disappeared within 1 month.

CONCLUSION

The present data demonstrated that the multimodal, combined treatment used in the present study provides satisfactory and long-lasting therapeutic outcomes by targeting different pathogenetic factors of horizontal neck wrinkles.
Mechanism of Proliferation of Cultured Human Corneal Endothelial Cells
Authors: Joko Takeshi , Shiraishi Atsushi , Kobayashi Takeshi , Ohashi Yuichi , Higashiyama Shigeki
Published: September 2017

Because human corneal endothelial cells (HCECs) do not proliferate once the endothelial monolayer has formed, corneal wound healing is believed to be mediated by cell enlargement or migration, rather than by proliferation. However, the cellular mechanisms involved in wound healing by HCECs have not been fully determined. In this review, we focus on the effects of promyelocytic leukemia zinc finger (PLZF), a DNA-binding transcription factor, and transforming growth factor (TGF)-β2 on the proliferation and migration of cultured HCECs. Involvement of the mitogen-activated protein kinase (MAPK) signaling pathway in the migration of HCECs was also investigated. Expression of PLZF mRNA decreased as cell–cell contact was disrupted and returned to the original level as cell–cell contact was re-formed. Assessment with a real-time cell electronic sensing system revealed that proliferation of cultured HCECs was inhibited after infection with Ad-PLZF and exposure to TGF-β2. Migration of cultured HCECs was increased by TGF-β2 through p38 MAPK activation. We conclude that PLZF expression in cultured HCECs is closely related to the formation of cell–cell contact and that TGF-β2 suppresses proliferation of cultured HCECs, while promoting their migration through p38 MAPK activation.
Propionibacterium Acnes
Authors: Carneiro Inês Marques , Pereira Ana Sousa , Pinto Sara , Prata Filipa , Faria Cláudia C. , Marques José Gonçalo
Published: September 2017

Infection after implantation of ventriculo-peritoneal shunts is associated with significant morbidity and mortality. We describe a 9-year-old girl with Propionibacterium acnes shunt infection with negative cerebrospinal fluid cultures, diagnosed by broad-range 16S-rRNA gene polymerase chain reaction. This case supports the use of this molecular diagnostic technique in shunt infections, where the offending pathogens are difficult to culture using traditional methods.
Streptococcus pneumoniae Serotyping by a Single Polymerase Chain Reaction–Based Multiplex Assay
Authors: Shokri Moghadam Mohammad , Talebi Malihe , Masjedian Faramarz , Irajian Gholamreza , Pourshafie Mohammad Reza
Published: September 2017

Background

Streptococcus pneumoniae is a prominent pathogen in children younger than 5 years as well as elderly people. Capsular serotyping of S. pneumoniae is necessary to develop the new vaccines and prevent invasive and noninvasive infections by S. pneumoniae. In this study, we used 2-step multiplex polymerase chain reaction (mPCR) that contained primers to detect PCV13 (13-valent pneumococcal conjugated vaccine) and non-PCV13 serotypes in different clinical and normal flora samples.

Methods

A total of 100 S. pneumoniae isolates were obtained between 2013 and 2015 in Tehran, Iran. The sources of isolates were clinical and normal flora. Clinical isolates were eye infection (26%), blood (19%), sputum (18%), sinusitis and cerebrospinal fluid (9% each), trachea (7%), pleural aspirate (3%), otitis (3%), and urine, bronchoalveolar lavage, and abscess (2% each). Moreover, 43 normal flora isolates were collected from healthy individuals. The strain isolates were tested for antimicrobial susceptibility and serotyped by mPCR.

Results

The highest rate of resistance was seen for trimethoprim-sulfamethoxazole (96%) followed by tetracycline (77%), erythromycin (64%), clindamycin (56%), chloramphenicol (44%), and penicillin (26%). All isolates were susceptible to imipenem, ceftriaxone, vancomycin, linezolid, gemifloxacin, levofloxacin, moxifloxacin, and ofloxacin. By using mPCR, 91 and 7 isolates were typed in the first and second reactions, respectively. Two isolates were identified as nontypeable. The most frequent serotypes in 98 typeable serotypes were 23F (n = 21 [22%]), 14 (n = 19 [20%]), 3 (n = 13 [13%]), and 19F (n = 13 [13%]).

Conclusions

Our multiplex assay is a precise and reliable method that can be used instead of the Quellung reaction for S. pneumoniae serotyping studies.
Prion Disease
Authors: Lodhi Sameed Khalid , Mirza Maira , Khawaja Ayaz Mahmood
Published: September 2017

Since the discovery of Prion Proteins (PrPs) in 1982, a new model for an “infectious agent” has been proposed that is substantially different from our understanding of disease transmission by other microorganisms. Prion proteins have been implicated in many different diseases. Various transmission modes have been discovered, including consumption of infected meat, blood transfusion, medical devices used in neurosurgery and corneal transplantation, environmental routes (such as soil), and airborne routes. Familial and sporadic instances of the disease have also been recognized, such as fatal familial insomnia. Prion disease harbors long incubation periods, and subclinical infectious states have been discovered in asymptomatic individuals owing to lymphoreticular accumulation of PrPs. The uniformly fatal outcome after symptom onset secondary to prion disease has prompted rigorous research and attempts at development of prophylactic immunomodulatory techniques, gene therapy, and clinical trials investigating various medications such as doxycycline, quinacrine, pentosan polysulfate, and flupirtine to improve the survival and outcome in patients. In this article, we extensively review the background of PrPs and Creutzfeldt-Jakob disease, the various transmission methods, and recent developments into discovering a treatment for Creutzfeldt-Jakob disease.
Disseminated Mycobacterium Haemophilum Infection Masquerading as Erythema Nodosum and Avascular Necrosis in an Immunocompromised Host
Authors: Sainato Rebecca J. , Smith Benjamin R. , Parekh Dina S. , Flores Michelle S. , Logemann Nicholas F. , Chung Ellen M. , Eberly Matthew D. , Stagliano David R. , Malloy Allison M.W.
Published: September 2017

Mycobacterium haemophilum is likely an underrecognized cause of infection among patients with deficits in their cell-mediated immunity. Despite its name, which translates to “blood loving,” it remains unclear whether hyperferritinemic patients are also at higher risk of this infection. We present a 24-year-old woman with disseminated M. haemophilum infection who has hyperferritinemia and T-cell acute lymphoblastic leukemia in remission and was initially misdiagnosed as having erythema nodosum and avascular necrosis. This report highlights the clinical and histological similarities of M. haemophilum and erythema nodosum, discusses some diagnostic peculiarities, and also reviews similar cases within the literature.