bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk stratification and treatment of ICU-acquired pneumonia caused by multidrug- resistant/extensively drug-resistant/pandrug-resistant bacteria
Authors: Bassetti Matteo , Righi Elda , Vena Antonio , Graziano Elena , Russo Alessandro , Peghin Maddalena
Published: August 2018

Purpose of review

Describe the risk factors and discuss the management of multidrug-resistant (MDR) bacteria responsible for pneumonia among critically ill patients, including methicillin-resistant Staphylococcus aureus, extended spectrum beta-lactamase-producing Enterobactericeae, carbapenem-resistant Enterobactericeae, multidrug resistant Pseudomonas aeruginosa, and Acinetobacter baumannii.

Recent findings

Multiple factors have been associated with infections because of MDR bacteria, including prolonged hospital stay, presence of invasive devices, mechanical ventilation, colonization with resistant pathogens, and use of broad-spectrum antibiotics. Management of these infections includes the prompt use of appropriate antimicrobial therapy, implementation of antimicrobial stewardship protocols, and targeted active microbiology surveillance. Combination therapy and novel molecules have been used for the treatment of severe infections caused by resistant bacteria.

The exponential increase of antimicrobial resistance among virulent pathogens currently represents one of the main challenges for clinicians in the intensive care unit. Knowledge of the local epidemiology, patient risk stratification, and infection-control policies remain key elements for the management of MDR infections. Results from clinical trials on new molecules are largely awaited.
Pathophysiological relevance of deiodinase polymorphism
Authors: Bianco Antonio C. , Kim Brian S.
Published: August 2018

Purpose of review

To assess new findings and clinical implications of deiodinase gene polymorphism. Deiodinases are enzymes that can activate or inactivate thyroid hormone molecules. Whereas the types 1 and 2 deiodinase (D1 and D2) activate thyroxine (T4) to 3,5,3′-triiodothyronine (T3) via deiodination of T4's outer ring, D1 and D3 inactivate both T4 and T3 and terminate thyroid hormone action via deiodination of T4's inner molecular ring. A number of polymorphisms have been identified in the three deiodinase genes; the most investigated and likely to have clinical relevance is the Thr92 substitution for Ala substitution in DIO2 (Thr92Ala-DIO2). There are a number of reports describing the association between the Thr92Ala-DIO2 polymorphism and clinical syndromes that include hypertension, type 2 diabetes, mental disorders, lung injury, bone turnover, and autoimmune thyroid disease; but these associations have not been reproduced in all population studies.

Recent findings

A new report indicates that carriers of the Thr92Ala-DIO2 polymorphism exhibit lower D2 catalytic activity and localized/systemic hypothyroidism. This could explain why certain groups of levothyroxine-treated hypothyroid patients have improved quality of life when also treated with liothyronine (LT3). Furthermore, Ala92-D2 was abnormally found in the Golgi apparatus, what could constitute a disease mechanism independent of T3 signaling. Indeed, brain samples of Thr92Ala-DIO2 carriers exhibit gene profiles suggestive of brain degenerative disease. In addition, African American carriers of Thr92Ala-DIO2 exhibit an about 30% higher risk of developing Alzheimer's disease.

The finding of deiodinase polymorphisms that can diminish thyroid hormone signaling and/or disrupt normal cellular function opens the door to customized treatment of hypothyroidism. Future studies should explore how the racial background modulates the clinical relevance of the Thr92Ala-DIO2 gene polymorphism.
New insights into cardiovascular disease in patients with Kawasaki disease
Authors: Burns Jane C. , Matsubara Tomoyo
Published: August 2018

Purpose of review

Kawasaki disease presents many challenges to the diverse group of physicians who care for these patients including infectious disease specialists, rheumatologists, and cardiologists. Here we review some of the progress being made toward improved understanding of disease pathogenesis, treatment, and long-term outcomes.

Recent findings

Epidemiologic studies in different populations documented increasing numbers of cases in countries with high physician awareness of the disease. These data suggest true increases in patient numbers rather than increases because of increased case ascertainment. Adequately powered clinical trials for adjunctive therapies continue to be an unmet need. Long-term consequences of damage to the arterial wall and myocardium are beginning to emerge and systematic, longitudinal observational studies are needed to better define outcomes.

The unknown cause, lack of a specific diagnostic test, and uncertain future for patients who develop permanent cardiovascular damage all require further study.
Endoscopy in Pediatric Inflammatory Bowel Disease
Authors: Oliva Salvatore , Thomson Mike , de Ridder Lissy , Martín‐de‐Carpi Javier , Van Biervliet Stephanie , Braegger Christian , Dias Jorge Amil , Kolacek Sanja , Miele Erasmo , Buderus Stephan , Bronsky Jiri , Winter Harland , Navas‐López Víctor Manuel , Assa Amit , Chong Sonny K.F. , Afzal Nadeem Ahmad , Smets Francoise , Shaoul Ron , Hussey Séamus , Turner Dan , Cucchiara Salvatore
Published: August 2018

Endoscopy is a central tool for the evaluation and management of inflammatory bowel disease (IBD). In the last few decades, gastrointestinal (GI) endoscopy has undergone significant technological developments including availability of pediatric‐size equipment, enabling comprehensive investigation of the GI tract in children. Simultaneously, professional organization of GI experts have developed guidelines and training programs in pediatric GI endoscopy. This prompted the Porto Group on Pediatric IBD of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition to develop updated guidelines on the role of GI endoscopy in pediatric IBD, specifically taking into considerations of recent advances in the diagnosis, disease stratification, and novel therapeutic targets in these patients.
Nutritional Comparison of Raw, Holder Pasteurized, and Shelf‐stable Human Milk Products
Authors: Lima Hope , Vogel Kenneth , Wagner‐Gillespie Montana , Wimer Courtney , Dean Lisa , Fogleman April
Published: August 2018

Objective:

We aim to assess the nutritional composition of shelf‐stable (SS) human milk and compare the nutritional profile to Holder pasteurized (HP) and raw human milk from the same pool.

Methods:

Milk samples from 60 mothers were pooled. From this pool, 36 samples were taken; 12 samples were kept raw, 12 samples were HP, and 12 samples were retort processed to create an SS product. Samples were analyzed for percent fat, percent solids, total protein, lactose, amino acids, and thiamine.

Results:

Percent fat, percent solids, and lactose were similar between raw, HP, and SS samples. Total protein was statistically increased in SS samples when compared to raw (P = 0.005) and HP (P < 0.001) samples, but protein differences were not clinically relevant (raw = 15.1 mg/mL, HP = 14.8 mg/mL, and SS = 15.8 mg/mL). Lysine was the only amino acid impacted by processing, and its destruction increased as heat increased (raw = 0.85 mg/100 mL, HP = 0.77 mg/100 mL, SS = 0.68 mg/100 mL). Total thiamine was significantly decreased in SS samples (0.14 mg/L; P < 0.01) when compared with raw samples (0.24 mg/L) and HP samples (0.26 mg/L).

Conclusions:

Macronutrient content is relatively unaffected by processing; Holder pasteurization and retort processing maintain similar fat, lactose, and total protein levels. Lysine and thiamine were significantly decreased by retort processing, but not by Holder pasteurization. Thiamine losses are clinically significant, and fortification may be necessary if SS donor milk is a long‐term feeding choice.
Recent Prescription Patterns for Children With Acute Infectious Diarrhea
Authors: Okubo Yusuke , Miyairi Isao , Michihata Nobuaki , Morisaki Naho , Kinoshita Noriko , Urayama Kevin Y. , Yasunaga Hideo
Published: August 2018

Background:

This study investigated recent trends in antibiotic use and factors associated with antibiotic use among children with acute infectious diarrhea. We obtained records of outpatients aged under 18 years diagnosed with acute infectious diarrhea from the Japan Medical Data Center database during 2012–2015.

Objective:

We investigated prescription patterns of antibiotics at their initial visit and evaluated factors associated with antibiotic usage using multivariable log‐binomial regression models.

Results:

Overall, we identified 4493 patients diagnosed with acute infectious diarrhea; 29.6% received antibiotics. The most commonly prescribed antibiotic is fosfomycin (20.3%). In multivariable log‐binomial regression analysis, out‐of‐hour visits, clinical diagnoses of suspected bacterial enterocolitis, private outpatient clinics, and pediatric departments are significantly associated with higher prevalence of antibiotic use.

Conclusions:

Antibiotics are over‐prescribed for children with acute infectious diarrhea. Our investigation provides important information to promote education of physicians and of health policy considerations for appropriate antibiotic prescription practices.
Is the Scout Out? The Utility of Scout Radiographs in the Pediatric Upper Gastrointestinal Examination
Authors: Abdullah Selwan , Shet Narendra , Watkins Runa , Kim Jane S.
Published: August 2018

Objective:

The aim of the study is to demonstrate the scout radiograph does not change patient management, alter planning, or contribute to interpretation of the outpatient pediatric upper gastrointestinal fluoroscopic examination (UGI).

Methods:

We retrospectively reviewed 197 outpatient pediatric UGIs performed over a 2‐year period. We performed a chart review on all patients to evaluate for potentially clinically significant findings on the scout radiograph. Scout findings were categorized into 4 groups: no new clinically significant findings (group 1), potentially clinically significant findings that were not directly addressed in the electronic medical record (group 2), incidental non‐gastrointestinal (GI) findings that necessitated further workup, however, were later deemed insignificant (group 3), and clinically significant findings that changed patient GI management, altered the planning of the procedure, or contributed to the interpretation of the fluoroscopic study (group 4).

Results:

A total of 197 UGIs were analyzed. A significant majority of cases (97.0%) were classified into group 1. Three cases (1.5%) were classified into group 2 with findings not addressed in the medical record. Two cases (1.0%) were classified into group 3, which, after further workup, were deemed not clinically significant. One case (0.5%) was classified into group 4, which resulted in a change in patient GI management.

Conclusions:

In our review, there was only 1 case in which the scout radiograph changed patient GI management, with moderate stool burden leading to a miralax cleanout, although there were no cases, which altered the planning of the procedure or contributed to the interpretation of the study. The scout radiograph can be omitted and/or substituted with the last image hold function to decrease radiation exposure.
The effects of proprioceptive neuromuscular facilitation lower-leg taping and treadmill training on mobility in patients with stroke
Authors: Kim Beom-Ryong , Kang Tae-Woo
Published: August 2018

The elastic-taping method of the proprioceptive neuromuscular facilitation (PNF) concept is nonexistent. Therefore, our study aimed to investigate the effect of treadmill training (TT) using PNF lower-leg taping (PNFLT) on walking and balance ability in patients with stroke. There were a total of 27 patients: a stroke allocated control group (n=13) and an experimental group (n=14). The control group performed the TT and the experimental group performed the TT using PNF taping five times a week for 6 weeks. Walking and balance ability were measured using the 6-min walk test (6MWT), the 10-m walking test (10MWT), and the timed up and go test (TUG). Before and after the intervention, a paired t-test was performed to compare different within-group differences. Independent t-tests were performed to compare different between-group differences. All statistical significance levels were set at α of 0.05. After intervention, 6MWT, 10MWT and TUG improved significantly in PNFLT-TT and TT group (P<0.01). After intervention, the PNFLT-TT group showed more effective changes that the TT group in 6MWT, 10MWT, and TUG (P<0.05 and <0.01) between PNFLT-TT and TT group. The intervention of PNFLT-TT was effective in improving walking and balance ability in patients with stroke. Basic elastic tape for the PNF concept and TT may be useful interventions as a program to improve walking and balance ability in patients with stroke.
Evaluating the Usability of a Second-Generation Virtual Reality Game for Refreshing Sterile Urinary Catheterization Skills
Authors: Kardong-Edgren Suzan , Breitkreuz Karen , Werb Michael , Foreman Stephen , Ellertson Anthony
Published: August 2018

Background

Virtual reality (VR) allows risk- and anxiety-free practice, mediated by consistent objective feedback.

Purpose

This study evaluated the usability of a VR game system for sterile catheterization practice. Participant enjoyment, engagement, likelihood to practice, and comfort using VR are reported.

Methods

Thirty-one students and faculty tested a VR game using Oculus Rift devised to allow practice of placing a urinary catheter in a virtual patient. Data were collected via an electronic survey using the System Usability Survey (SUS) and a User Reaction Survey (URS).

Results

The SUS score was 64.03. Seventy-five percent of participants rated the game as positive overall on the URS. Left-handed players had more difficulty playing the game. Players with prescription glasses could not comfortably place the Oculus Rift over their glasses to play.

Conclusions

The VR game shows promise for refreshing sterile catheterization skills.
Benefits of Peer Mentoring in Prelicensure Nursing Education
Authors: Miller Hailey , Bosselait Lauren , Venturato Linda , Irion Kendall , Schmidt Nicole , DiGeronimo Jaclyn , Pritchard Tracy
Published: August 2018

Background

College retention rates continue to be a national issue in the United States. Solutions to decrease attrition have not been adequately tested in the nursing student population.

Purpose

The purpose of this study was to investigate the benefits of a peer-mentoring program in a baccalaureate nursing program from the perspectives of both the mentor and mentee.

Methods

Electronic surveys were used to evaluate the impact of a peer-mentoring program.

Results

Responses showed the peer-mentoring program to be beneficial academically, personally, and professionally. A large majority (89%-96%) of mentees agreed or strongly agreed with the positive effects of the peer-mentoring program, whereas all of the mentors agreed or strongly agreed with the positive effects.

Conclusions

Peer mentoring was found to be advantageous for both the mentees and mentors.
Effects of Measurement Center Shift on Ganglion Cell–inner Plexiform Layer Thickness Measurements
Authors: Kim Kyoung-Nam , Shin Il-Hwan , Kwak Baek-Soo , Sung Jae-Yun , Lim Hyung-Bin , Jo Young-Joon , Kim Jung-Yeul
Published: August 2018

SIGNIFICANCE

Our authors studied the effects of measurement center shift on ganglion cell–inner plexiform layer (GCIPL) thickness measurements in Cirrus spectral-domain optical coherence tomography (SD-OCT). The measurement center shift affects the GCIPL thickness measurement depending on the distance of shift.

PURPOSE

The purpose of this study was to explore changes in macular GCIPL thicknesses measurements after manual shifting of the measurement center using SD-OCT.

METHODS

A prospective study was conducted. A total of 30 normal eyes of 30 subjects were included in the study. An experienced examiner obtained two consecutive measurements of GCIPL thickness using SD-OCT. Coefficients of repeatability were calculated for the average, minimum, and sectoral (superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal) thicknesses. Next, the measurement center was manually shifted from the foveal center. Three measurement centers were horizontally placed at 59-μm intervals from the foveal center, and two further centers were placed 176 μm apart. Also, three measurement centers were vertically placed at 47-μm intervals from the foveal center, and two further centers were placed 142 μm apart. The thickness of GCIPL was measured again at each shift point, and the changes of thickness before and after movement were analyzed.

RESULTS

When the measurement centers were shifted to positions 59 μm horizontally or 47 μm vertically from the fovea, no significant changes in GCIPL thicknesses were evident. However, upon more pronounced shifting, the average GCIPL thickness of the direction of the shift region was significantly lower than baseline, whereas the GCIPL of the diametrically opposite sector was thicker than baseline.

CONCLUSIONS

The impact of changes associated with shifting of the measurement center should be taken into consideration when measuring GCIPL thickness in patients with retinal diseases, glaucoma, or neuro-ophthalmological conditions.
Case Report: Post-keratoplasty Filamentary Keratitis Managed with Scleral Lens
Authors: Bhattacharya Pradipta , Mahadevan Rajeswari
Published: August 2018

SIGNIFICANCE

This case report details a unique case of filamentary keratitis after penetrating keratoplasty managed with a scleral contact lens. The positive effect on vision and comfort are reported, and the challenges related to hypoxia are discussed.

PURPOSE

The purpose of this study was to report the outcome of scleral lens use in the treatment of filamentary keratitis post–penetrating keratoplasty.

CASE REPORT

A patient who underwent penetrating keratoplasty twice in both eyes for keratoconus presented with filamentary keratitis in the left eye. The prosthetic replacement of the ocular surface ecosystem scleral lens trial was performed for improving vision and comfort. After 6 hours of wearing prosthetic replacement of the ocular surface ecosystem device, the left eye showed complete resolution of filaments with an improved visual acuity and better comfort in both eyes. Corneal swelling indicating hypoxia was noticed in both eyes with scleral lenses and was managed accordingly.

CONCLUSIONS

Scleral lenses are a viable treatment option for patients with corneal filamentary keratitis after penetrating keratoplasty for achieving better vision and improved comfort. However, the risk of hypoxia cannot be undermined, which necessitates careful evaluation, follow-up, and management for safe lens wear.
Case Series: Management of Neurotrophic Keratitis from Familial Dysautonomia
Authors: Scanzera Angelica C. , Shorter Ellen
Published: August 2018

SIGNIFICANCE

Familial dysautonomia is a rare genetic disorder that affects the sensory and autonomic nervous systems. Affected individuals have decreased corneal sensation and can develop serious complications from neurotrophic keratitis. Scleral devices are an excellent option for the long-term management of patients with familial dysautonomia and neurotrophic keratitis.

PURPOSE

In this series, we describe three patients with familial dysautonomia and classic ocular complications fit with scleral devices. No identifiable health information is included in this case report.

CASE REPORTS

Case 1: A 35-year-old white male presented with blurred vision without complaint of pain or dryness. He had moderate punctate corneal staining and central stromal corneal scarring in both eyes despite use of artificial tears, punctal plugs, and therapeutic soft lenses. He was fit with 18.2-mm commercial scleral devices, which improved vision and protected the ocular surface. Case 2: A 20-year-old cognitively impaired white female presented with history of frequent eye rubbing and self-mutilation. She had recurrent corneal abrasions with corneal scarring in both eyes and was fit with 16-mm gas-permeable prosthetic replacement of the ocular surface ecosystem devices. Case 3: An 18-year-old white male with history of frequent corneal abrasions and blurred vision was referred by his medical doctor. He and his mother were trained in the safe handling of 16- and 16.5-mm gas-permeable prosthetic replacement of the ocular surface ecosystem devices in the right and left eyes. Corneal epithelial defects healed and vision improved with daily use.

CONCLUSIONS

Individuals with familial dysautonomia present unique clinical challenges owing to severe ocular surface disease and inability to perceive pain. Initial therapy for neurotrophic keratitis includes lubrication, punctal occlusion, and therapeutic lenses. Additional therapies include autologous serum tears, amniotic membrane treatment, scleral devices, and tarsorrhaphy. In this series, scleral devices are an excellent option to protect the ocular surface and prevent common ocular complications.
2017 Glenn A. Fry Award Lecture: Establishing an Evidence-based Literature for Vision Therapy — A 25-year Journey
Authors: Scheiman Mitchell M.
Published: August 2018

In this article, I summarize the 2017 Glenn A. Fry Award Lecture and my journey from student, to clinician, to optometric educator, and finally researcher/vision scientist. Although content for many years of teaching and practicing vision therapy, the era of evidence-based health care created a level of discomfort, as it became evident that my area of interest, vision therapy, had minimal quality evidence to support its use. Joining forces with a group of exceptional colleagues, we established the Convergence Insufficiency Treatment Trial Investigator group, and we were able to achieve funding from the National Eye Institute for multiple randomized clinical trials. The results of our studies demonstrate that vision therapy is an effective treatment option for convergence insufficiency in children, and office-based therapy is more effective than home-based therapy. These studies also demonstrated that home-based pencil push-ups commonly used by both optometrists and ophthalmologists are no more effective than placebo therapy. More recently, working in a new arena of objective recording of vergence, accommodative, and versional eye movements, my research has demonstrated that objective outcome measures of vergence are feasible for future randomized clinical trials. In pilot studies with both naturally occurring convergence insufficiency and concussion-related convergence insufficiency, statistically significant and clinically meaningful changes have been found in both disparity vergence peak velocity and response amplitude after office-based vision therapy. With new evidence about the high prevalence of concussion-related convergence insufficiency, there is much work to be accomplished to study the effectiveness of vision therapy for convergence insufficiency as well as the underlying mechanisms for how and why vision therapy is effective.
Comparisons of Two Microperimeters: The Clinical Value of an Extended Stimulus Range
Authors: Arango Tiffany , Morse Alan R. , Seiple William
Published: August 2018

SIGNIFICANCE

Fundus-guided perimetry is a common clinical tool used to measure visual field sensitivities. Comparisons between perimeters are often made despite relative differences in hardware parameters. We directly compared two perimeters using Weber contrast, which allowed us to assess the clinical gain associated with the extended stimulus range of the macular integrity assessment (MAIA).

PURPOSE

The purpose of this study was to directly compare sensitivity thresholds for two microperimeters, the MAIA and Optos optical coherence tomography/scanning laser ophthalmoscope, using Weber contrast values. We also examined the clinical utility of the extended stimulus range of the MAIA.

METHODS

Six normally sighted adults with no visual field loss and 16 adults with low vision were recruited. Thresholds were measured on the MAIA and Optos using the same threshold algorithm and test points. To compare equivalent units, decibel thresholds were converted to light increments in apostilbs and then to delta increment intensities relative to each instrument's background luminance. Repeatability was assessed for normally sighted adults by testing both instruments on 3 separate days.

RESULTS

For normally sighted observers, mean thresholds were similar on both instruments, and repeatability within microperimeters was high. The MAIA has a 0.3-log lower contrast range and 1.37 higher contrast range. The lower contrast values did not result in lower thresholds for the normally sighted observers on the MAIA. There was a 25% increase in the number of measurable thresholds owing to the higher contrast values in low-vision observers.

CONCLUSIONS

The higher contrast range in the MAIA yielded only a small increase in detectable thresholds for participants with visual field loss.
Postextubation Dysphagia in Children: The Role of Speech-Language Pathologists*
Authors: da Silva Paulo Sergio Lucas , Lobrigate Nádia Lais , Fonseca Marcelo Cunio Machado
Published: August 2018

Objectives:

Postextubation dysphagia is common and associated with worse outcomes in the PICU. Although there has been an increased participation of speech-language pathologists in its treatment, there is limited evidence to support speech-language pathologists as core PICU team member. We aimed to assess the impact of speech-language pathologists interventions on the treatment of postextubation dysphagia.

Design:

A quasi-experimental prospective study. In the historical group (controls), patients received a standard care management for dysphagia whereas the intervention group was routinely treated by speech-language pathologists.

Setting:

PICU of a tertiary hospital.

Patients:

Children who were endotracheally intubated for a period greater than 24 hours with greater oral intake limitation as defined by a Functional Oral Intake Scale less than or equal to 3.

Intervention:

Routine speech-language pathologist assessment.

Measurements and Main Results:

A total of 74 patients were enrolled to receive intervention (January 2015 to December 2016) and 41 patients to the historical group (January 2014 to December 2014). There were no differences in the demographic and clinical characteristics. The historical group had both longer time to initiate oral intake (7 vs 4 d; p = 0.0002; hazard ratio, 2.33) and to reach full oral intake compared with intervention group (9 vs 13 d; p < 0.001; hazard ratio, 2.51). A total of 32 controls (78%) and 74 intervention patients (100%) were on total oral intake at discharge (p ≤ 0.001). Three of nine control patients were feeding tube dependent at hospital discharge. Also, controls had a longer length of hospital stay (25 vs 20 d) and a higher rate of reintubation when compared with those patients of intervention group (10% vs 2%).

Conclusions:

Incorporating speech-language pathologists in the routine management of postextubation dysphagia can result in faster functional improvement and favorable patient outcomes. Yet, further and larger studies in pediatric dysphagia are required to support the related interventions and strategies to guide clinical practice.
Brief Report: Pulmonary Tuberculosis Is Associated With Persistent Systemic Inflammation and Decreased HIV-1 Reservoir Markers in Coinfected Ugandans
Authors: Olson Alex , Ragan Elizabeth J. , Nakiyingi Lydia , Lin Nina , Jacobson Karen R. , Ellner Jerrold J. , Manabe Yukari C. , Sagar Manish
Published: August 2018

Background:

Mycobacterium tuberculosis (TB) infection induces systemic inflammation that could impact HIV-1 persistence.

Setting:

HIV-1–seropositive individuals either with or without pulmonary TB disease were recruited in Kampala, Uganda.

Methods:

Plasma cytokines, HIV-1 DNA, and cell-associated (ca)-RNA were compared among those coinfected with TB (cases) to those without TB (controls). TB-coinfected cases and controls were compared at presentation (n = 15 and n = 16, respectively) and at around 6 months after HIV-1 treatment initiation among those who had achieved virologic suppression (n = 6 and n = 8, respectively). At follow-up, the TB-coinfected cases had also finished TB treatment.

Results:

Before treatment, the TB-coinfected cases as compared to the controls had higher levels of soluble(s)-CD163 (P = 0.0002) and interleukin-6 (P = 0.006) but lower levels of macrophage chemoattractant protein-1 (P = 0.04). After treatment, the TB-coinfected cases as compared to controls still had higher plasma s-CD163 levels (P = 0007). Controls as compared to the coinfected cases had higher ca-RNA per DNA template both at baseline (P = 0.03) and at follow-up (P = 0.07). Levels of ca-RNA per DNA copy at follow-up showed a negative correlation with baseline plasma s-CD163 (P = 0.008) and interleukin-6 (P = 0.05) levels.

Conclusions:

TB disease is associated with inflammation and decreased HIV-1 RNA expression relative to the number of infected cells, both before and after viral suppression. Infections present before antiretroviral initiation impact HIV-1 latency.
Importance of Stem Cell Transplantation in Cleft Lip and Palate Surgical Treatment Protocol
Authors: Mazzetti Marcelo Paulo Vaccari , Alonso Nivaldo , Brock Ryane Schmidt , Ayoub Alexandre , Massumoto Sally Mizukami , Eça Lilian Piñero
Published: August 2018

Cleft lip and palate is a congenital malformation that requires a multidisciplinary treatment that evolves pediatrician, obstetrics, fetal medicine, genetics, plastic surgery, orthodontics, speech therapist, nursery, and psychology. Actually, the authors believe that it could be possible to ad protocols to use stem cells.

The intrauterine diagnosis leads to preborn parental orientation and better parental collaboration to accept a precocious multidisciplinary treatment. After birth the authors’ protocol is: orthodontic devices, phonoaudiology, and surgical procedures.

The authors’ cleft lip and palate reconstructive surgery protocol demands several steps and begins at 4 to 6-month old with rhinocheiloplasty and soft palate closure at the same moment. The treatment sequence involves the hard palate surgery (8–18 months after the first surgical step), alveoloplasty (after 10 years old), and secondary rhinoplasty (after 14 years old).

New ideas to use stem cells and blood from the umbilical cord and also blood from placenta are discussed to improve final surgical results. Maternal stem cells are easy to collect, there are no damage to the patient and mother, it is autologous and it could be very useful in the authors’ protocol.

Nine patients with clef lip and palate were operated and had stem cells from umbilical cord blood and placenta blood injected into the bone and soft tissue during the primary procedure (rhinocheiloplasty).

The stem cells activity into soft tissue and bone were evaluated. Preliminary results have shown no adverse results and improvement at the inflammatory response. A treatment protocol with stem cells was developed. It had a long time follow-up of 10 years.
Resuscitative Endovascular Balloon Occlusion of the Aorta in Experimental Cardiopulmonary Resuscitation: Aortic Occlusion Level Matters
Authors: Dogan Emanuel M. , Beskow Linus , Calais Fredrik , Hörer Tal M. , Axelsson Birger , Nilsson Kristofer F.
Published: August 2018

Introduction:

Aortic occlusion during cardiopulmonary resuscitation (CPR) increases systemic arterial pressures. Correct thoracic placement during the resuscitative endovascular balloon occlusion of the aorta (REBOA) may be important for achieving effective CPR.

Hypothesis:

The positioning of the REBOA in the thoracic aorta during CPR will affect systemic arterial pressures.

Methods:

Cardiac arrest was induced in 27 anesthetized pigs. After 7 min of CPR with a mechanical compression device, REBOA in the thoracic descending aorta at heart level (zone Ib, REBOA-Ib, n = 9), at diaphragmatic level (zone Ic, REBOA-Ic, n = 9) or no occlusion (control, n = 9) was initiated. The primary outcome was systemic arterial pressures during CPR.

Results:

During CPR, REBOA-Ic increased systolic blood pressure from 86 mmHg (confidence interval [CI] 71–101) to 128 mmHg (CI 107–150, P < 0.001). Simultaneously, mean and diastolic blood pressures increased significantly in REBOA-Ic (P < 0.001 and P = 0.006, respectively), and were higher than in REBOA-Ib (P = 0.04 and P = 0.02, respectively) and control (P = 0.005 and P = 0.003, respectively). REBOA-Ib did not significantly affect systemic blood pressures. Arterial pH decreased more in control than in REBOA-Ib and REBOA-Ic after occlusion (P = 0.004 and P = 0.005, respectively). Arterial lactate concentrations were lower in REBOA-Ic compared with control and REBOA-Ib (P = 0.04 and P < 0.001, respectively).

Conclusions:

Thoracic aortic occlusion in zone Ic during CPR may be more effective in increasing systemic arterial pressures than occlusion in zone Ib. REBOA during CPR was found to be associated with a more favorable acid–base status of circulating blood. If REBOA is used as an adjunct in CPR, it may be of importance to carefully determine the aortic occlusion level.

The study was performed following approval of the Regional Animal Ethics Committee in Linköping, Sweden (application ID 418).
The Value of the Inferior Vena Cava Area Distensibility Index and its Diameter Ratio for Predicting Fluid Responsiveness in Mechanically Ventilated Patients
Authors: Yao Bo , Liu Jian-yu , Sun Yun-bo , Zhao Yu-xiao , Li Lian-di
Published: August 2018

Introduction:

It is necessary to evaluate fluid responsiveness before fluid resuscitation. We evaluated the value of inferior vena cava (IVC) area respiratory variation and the IVC diameter ratio (IVC DR) for predicting fluid responsiveness in mechanically ventilated patients.

Methods:

A prospective observational study was performed in the intensive care unit between December 2017 and March 2018. Mechanically ventilated patients were enrolled and received ultrasound monitoring. IVC diameter distensibility index from the subxiphoid area (IVC-sx DDI), IVC diameter distensibility index from the right midaxillary line (IVC-rm DDI), IVC area distensibility index (IVC ADI), and IVC DR in cross-section were calculated by ultrasound monitoring IVC parameters. The enrolled patients were classified as nonresponders group and responders group according to whether the cardiac output increased by >10% after passive leg raising.

Results:

Data from 67 mechanically ventilated patients were analyzed. 55.2% of patients had positive fluid responsiveness. The area of receiver operating characteristic curves evaluating the ability of the IVC-sx DDI, IVC-rm DDI, IVC ADI, and IVC DR to predict the fluid responsiveness were 0.702, 0.686, 0.749, and 0.829, respectively. IVC DR level of 1.43 was predictive of positive fluid responsiveness with 90.0% specificity and 67.6% sensitivity. IVC ADI level of 10.2% was predictive of positive fluid responsiveness with 40.0% specificity and 97.3% sensitivity.

Conclusions:

IVC ADI and its diameter ratio in cross-section had more value than IVC diameter distensibility index for predicting fluid responsiveness in mechanically ventilated patients.
Analysis of Gender-based Differences in Surgery Faculty Compensation, Promotion, and Retention
Authors: Hoops Heather E. , Brasel Karen J. , Dewey Elizabeth , Rodgers Sally , Merrill Jenny , Hunter John G. , Azarow Kenneth S.
Published: August 2018

Objectives:

The objectives of this study were to evaluate gender-based differences in faculty salaries before and after implementation of a university-wide objective compensation plan, Faculty First (FF), in alignment with Association of American Medical Colleges regional median salary (AAMC-WRMS). Gender-based differences in promotion and retention were also assessed.

Summary Background Data:

Previous studies demonstrate that female faculty within surgery are compensated less than male counterparts are and have decreased representation in higher academic ranks and leadership positions.

Methods:

At a single institution, surgery faculty salaries and work relative value units (wRVUs) were reviewed from 2009 to 2017, and time to promotion and retention were reviewed from 1998 to 2007. In 2015, FF supplanted specialty-specific compensation plans. Salaries and wRVUs relative to AAMC-WRMS, time to promotion, and retention were compared between genders.

Results:

Female faculty (N = 24) were compensated significantly less than males were (N = 62) before FF (P = 0.004). Female faculty compensation significantly increased after FF (P < 0.001). After FF, female and male faculty compensation was similar (P = 0.32). Average time to promotion for female (N = 29) and male faculty (N = 82) was similar for promotion to associate professor (P = 0.49) and to full professor (P = 0.37). Promotion was associated with significantly higher retention for both genders (P < 0.001). The median time of departure was similar between female and male faculty (P = 0.73).

Conclusions:

A university-wide objective compensation plan increased faculty salaries to the AAMC western region median, allowing correction of gender-based salary inequity. Time to promotion and retention was similar between female and male faculty.
Favorable Outcomes After Liver Transplantation With Normothermic Regional Perfusion From Donors After Circulatory Death: A Single-center Experience
Authors: Ruiz Patricia , Gastaca Mikel , Bustamante Francisco Javier , Ventoso Alberto , Palomares Ibone , Prieto Mikel , Fernández Jose Ramón , Salvador Patricia , Pijoan Jose Ignacio , Valdivieso Andres
Published: August 2018

Background.

Controlled donation after circulatory death (cDCD) has been associated with a high incidence of ischemic cholangiopathy and other perioperative complications. In an attempt to avoid these complications, we implemented an active protocol of cDCD liver transplant (LT) with normothermic regional perfusion (NRP) preservation.

Methods.

This is a descriptive analysis of data collected from a prospective date base of cDCD LT preserved with NRP from January 2015 to June 2017 with a minimum follow up of 9 months.

Results.

Fifty-seven potential cDCD donors were connected to the NRP system. Of these, 46 livers were transplanted over a 30-month period (80% liver recovery rate). The median posttransplant peak in alanine transaminase was 1136 U/L (220-6683 U/L). Seven (15%) patients presented postreperfusion syndrome and 11 (23%) showed early allograft dysfunction. No cases of ischemic cholangiopathy were diagnosed, and no graft loss was observed over a medium follow-up period of 19 months. Of note, 13 donors were older than 65 years, achieving comparable perioperative and midterm results to younger donors.

Conclusions.

As far as we know, this represents the largest published series of cDCD LT with NRP preservation. Our results demonstrate that cDCD liver grafts preserved with NRP appear far superior to those obtained by the conventional rapid recovery technique.
Optical coherence tomography as a means to characterize visual pathway involvement in multiple sclerosis
Authors: Wicki Carla A. , Hanson James V.M. , Schippling Sven
Published: August 2018

Purpose of review

Optical coherence tomography (OCT) is a noninvasive in-vivo imaging tool that enables the quantification of the various retinal layer thicknesses. Given the frequent involvement of the visual pathway in multiple sclerosis, OCT has become an important tool in clinical practice, research and clinical trials. In this review, the role of OCT as a means to investigate visual pathway damage in multiple sclerosis is discussed.

Recent findings

Evidence from recent OCT studies suggests that the peripapillary retinal nerve fibre layer (pRNFL) appears to be an ideal marker of axonal integrity, whereas the macular ganglion cell and inner plexiform layer (GCIP) thickness enables early detection of neuronal degeneration in multiple sclerosis. The thickness of the macular inner nuclear layer (INL) has been suggested as a biomarker for inflammatory disease activity and treatment response in multiple sclerosis. OCT parameters may also be used as an outcome measure in clinical trials evaluating the neuroprotective or regenerative potential of new treatments.

OCT provides insights into multiple sclerosis beyond the visual pathway. It is capable of quantifying the major pathological hallmarks of the disease, specifically inflammation and neuroaxonal degeneration. OCT, therefore, has the potential to become another mainstay in the monitoring of multiple sclerosis patients.
Combined measurements of prey availability explain habitat selection in foraging seabirds
Authors: Waggitt James J. , Cazenave Pierre W. , Howarth Leigh M. , Evans Peter G. H. , van der Kooij Jeroen , Hiddink Jan G.
Published: August 2018

Understanding links between habitat characteristics and foraging efficiency helps predict how environmental changes influence populations of top predators. This study examines whether measurements of prey (clupeids) availability varied over stratification gradients, and determined if any of those measurements coincided with aggregations of foraging seabirds (common guillemot
Uria aalge
and Manx shearwater
Puffinus puffinus
) in the Celtic Sea, UK. The probability of encountering foraging seabirds was highest around fronts between mixed and stratified water. Prey were denser and shallower in mixed water, whilst encounters with prey were most frequent in stratified water. Therefore, no single measurement of increased prey availability coincided with the location of fronts. However, when considered in combination, overall prey availability was highest in these areas. These results show that top predators may select foraging habitats by trading-off several measurements of prey availability. By showing that top predators select areas where prey switch between behaviours, these results also identify a mechanism that could explain the wider importance of edge habitats for these taxa. As offshore developments (e.g. marine renewable energy installations) change patterns of stratification, their construction may have consequences on the foraging efficiency of seabirds.
Michael Selwyn Longuet-Higgins. 8 December 1925—26 February 2016
Authors: Sajjadi Shahrdad G. , Hunt Julian C. R.
Published: August 2018

Michael Longuet-Higgins was a geometer and applied mathematician who made notable contributions to geophysics and physical oceanography, particularly to the theory of oceanic microseism and to the dynamics of finite amplitude, sharp-crested wind-generated surface waves. The latter led to his pioneering studies on breaking waves. On a much larger scale, he showed how ocean waves produce currents around islands in the ocean. He considered wider aspects of the physics of waves, including wave-driven transport of sand along beaches, and the electrical effects of tidal streams. He also contributed to subjects of a geometrical character such as the growth of quasi-crystals, the assembly of protein sheaths in viruses, to chains of circle themes and to a wide variety of other topics. He was an extraordinary applied mathematician, using the simplest forms of mathematics to demonstrate and discover highly complex nonlinear phenomena. In particular, he often thought of problems involving water waves using his unique knowledge of geometry and then tested his theories by experiment. Along with Brooke Benjamin FRS, Sir James Lighthill FRS, Walter Munk FRS, John Miles and Andrei Monin, Michael Longuet-Higgins stands out as one of the towering figures of theoretical fluid dynamics in the twentieth century. His contributions will have a continuing influence on our attempts to understand better the processes that influence the oceans.
Chronic TNFα-driven injury delays cell migration to villi in the intestinal epithelium
Authors: Muraro Daniele , Parker Aimee , Vaux Laura , Filippi Sarah , Almet Axel A. , Fletcher Alexander G. , Watson Alastair J. M. , Pin Carmen , Maini Philip K. , Byrne Helen M.
Published: August 2018

The intestinal epithelium is a single layer of cells which provides the first line of defence of the intestinal mucosa to bacterial infection. Cohesion of this physical barrier is supported by renewal of epithelial stem cells, residing in invaginations called crypts, and by crypt cell migration onto protrusions called villi; dysregulation of such mechanisms may render the gut susceptible to chronic inflammation. The impact that excessive or misplaced epithelial cell death may have on villus cell migration is currently unknown. We integrated cell-tracking methods with computational models to determine how epithelial homeostasis is affected by acute and chronic TNFα-driven epithelial cell death. Parameter inference reveals that acute inflammatory cell death has a transient effect on epithelial cell dynamics, whereas cell death caused by chronic elevated TNFα causes a delay in the accumulation of labelled cells onto the villus compared to the control. Such a delay may be reproduced by using a cell-based model to simulate the dynamics of each cell in a crypt–villus geometry, showing that a prolonged increase in cell death slows the migration of cells from the crypt to the villus. This investigation highlights which injuries (acute or chronic) may be regenerated and which cause disruption of healthy epithelial homeostasis.
SciPipe - A workflow library for agile development of complex and dynamic bioinformatics pipelines
Authors: Lampa Samuel , Dahlö Martin , Alvarsson Jonathan , Spjuth Ola
Published: August 2018

Background

The complex nature of biological data has driven the development of specialized software tools. Scientific workflow management systems simplify the assembly of such tools into pipelines, assist with job automation and aid reproducibility of analyses. Many contemporary workflow tools are specialized and not designed for highly complex workflows, such as with nested loops, dynamic scheduling and parametriza-tion, which is common in e.g. machine learning.

Findings

SciPipe is a workflow programming library implemented in the programming language Go, for managing complex and dynamic pipelines in bioinformatics, cheminformatics and other fields. SciPipe helps in particular with workflow constructs common in machine learning, such as extensive branching, parameter sweeps and dynamic scheduling and parametrization of downstream tasks. SciPipe builds on Flow-based programming principles to support agile development of workflows based on a library of self-contained, reusable components. It supports running subsets of workflows for improved iterative development, and provides a data-centric audit logging feature that saves a full audit trace for every output file of a workflow, which can be converted to other formats such as HTML, TeX and PDF on-demand. The utility of SciPipe is demonstrated with a machine learning pipeline, a genomics, and a transcriptomics pipeline.

Conclusions

SciPipe provides a solution for agile development of complex and dynamic pipelines, espe-cially in machine leaning, through a flexible programming API suitable for scientists used to programming or scripting.