bluuebunny/crossref_metadata_2025 huggingface dataset:
Benign Temporomandibular Joint Lesions Presenting as Masses in the External Auditory Canal
Authors: Williams Ryan A. , Jackler Robert K. , Corrales C. Eduardo
Published: February 2017

Objective:

Describe benign lesions arising from the temporomandibular joint (TMJ) that presented as masses in the external auditory canal (EAC).

Study Design:

Retrospective case series of two academic medical centers.

Patients:

Six patients with lesions emanating from the TMJ that presented as EAC masses. Lesions included pigmented villonodular synovitis (PVNS), nodular fasciitis, foramen of Huschke herniation with salivary fistula, fibroepithelial polyp, superficial angiomyxoma, and giant cell tumor (GCT).

Intervention:

Surgical resection.

Main Outcome Measures:

Tumor control, TMJ function, and hearing.

Results:

All patients presented with hearing loss, TMJ pain, and otalgia. Three patients with EAC occluding masses developed entrapment cholesteatoma between the mass and tympanic membrane. Following surgical resection, four patients were free of disease. The patient with PVNS has a stable remnant at 3 years follow up and the patient with giant cell tumor is under active surveillance. Hearing improved in three patients, remained stable in one patient, and worsened in two patients. All had resolution of their TMJ and ear pain.

Conclusions:

EAC masses of uncertain origin should be imaged preoperatively to exclude lesions best not biopsied (e.g., encephalocele, facial nerve schwannoma, paraganglioma). In the differential of EAC masses, lesions emanating from the TMJ need to be considered, especially for those based anteriorly. Understanding the extent of TMJ involvement is crucial for surgical planning which optimizes outcome. Goals for therapy are to control the underlying disease process, restore patency of the EAC, improve hearing, and preserve function of TMJ.
United States Trends in Pediatric Ventricular Assist Implantation as Bridge to Transplantation
Authors: Villa Chet R. , Khan Muhammad S. , Zafar Farhan , Morales David L.S. , Lorts Angela
Published: February 2017

Ventricular assist devices (VADs) are increasingly used to support children to heart transplant, however, it is unclear whether this trend is broadly applicable across the age/size spectrum. Children (≤18 years) listed for transplant were identified from the United Network of Organ Sharing (UNOS) database between January 2006 and May 2014. Patients were stratified by era (Early: 2006–2010, Current: 2011–2014), size (<25, 25–50, and >50 kg), and device type. Of 3,986 patients, 520 (13%) were supported by a VAD. The proportion of patients supported with a VAD has increased in the current era (16% vs. 11%, p < 0.001). The increase has occurred in children <25 kg (11% vs. 7%, p < 0.001) and >50 kg (26% vs. 17%, p < 0.002). Although VAD utilization was similar across eras in patients 25–50 kg (14% vs. 13%, p = 0.6), continuous flow VAD (cfVAD) use increased dramatically from 7% to 52% (p < 0.001). Waitlist outcome (p = 0.6) and posttransplant survival (p = 0.53) were similar between eras despite the shift to cfVADs in patients ≥25 kg. The emergence of cfVAD technology in an era of increasing waitlist times raises the prospect of an increasing population of children with cfVADs at home and in our communities.
Supraclavicular Approach to the Subclavian Vein as an Alternative Venous Access Site for ECMO Cannulae? A Retrospective Comparison
Authors: Bojic Andja , Steiner Irene , Gamper Jutta , Schellongowski Peter , Lamm Wolfgang , Hermann Alexander , Riss Katharina , Robak Oliver , Staudinger Thomas
Published: February 2017

Venous reperfusion and double-lumen cannulae for extracorporeal membrane oxygenation (ECMO) are usually inserted via the right internal jugular vein. The supraclavicular approach to the right or left subclavian vein could serve as a possible alternative. The aim of this analysis was to compare feasibility, complications, and performance of supraclavicular and jugular cannulation. We retrospectively analyzed charts and registry data of patients undergoing venovenous ECMO. Twenty-four patients underwent jugular cannulation, and 11 patients underwent supraclavicular cannulation. Ten patients underwent femoro-jugular, and five patients underwent femoro-supraclavicular ECMO. Double-lumen cannulae were inserted via the jugular approach in 14 patients and via the supraclavicular approach in 6 patients. No cannulation-associated complications but for a single minor bleeding from the insertion site of a supraclavicular double-lumen cannula were recorded. Performance of the extracorporeal circuit was comparable between jugular and supraclavicular groups but for a more pronounced oxygenation effect in the supraclavicular double-lumen group caused by higher blood flows via larger (24 F) cannulae. The supraclavicular approach seems safe and equivalent to jugular cannulation and could serve as a valid alternative.
Fiber Bundle Design for an Integrated Wearable Artificial Lung
Authors: Madhani Shalv P. , Frankowski Brian J. , Federspiel William J.
Published: February 2017

Mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO) are the only viable treatment options for lung failure patients at the end-stage, including acute respiratory distress syndrome (ARDS) and chronic obstructive pulmonary disease (COPD). These treatments, however, are associated with high morbidity and mortality because of long wait times for lung transplant. Contemporary clinical literature has shown ambulation improves post-transplant outcomes in lung failure patients. Given this, we are developing the Pittsburgh Ambulatory Assist Lung (PAAL), a truly wearable artificial lung that allows for ambulation. In this study, we targeted 180 ml/min oxygenation and determined the form factor for a hollow fiber membrane (HFM) bundle for the PAAL. Based on a previously published mass transfer correlation, we modeled oxygenation efficiency as a function of fiber bundle diameter. Three benchmark fiber bundles were fabricated to validate the model through in vitro blood gas exchange at blood flow rates from 1 to 4 L/min according to ASTM standards. We used the model to determine a final design, which was characterized in vitro through a gas exchange as well as a hemolysis study at 3.5 L/min. The percent difference between model predictions and experiment for the benchmark bundles ranged from 3% to 17.5% at the flow rates tested. Using the model, we predicted a 1.75 in diameter bundle with 0.65 m2 surface area would produce 180 ml/min at 3.5 L/min blood flow rate. The oxygenation efficiency was 278 ml/min/m2 and the Normalized Index of Hemolysis (NIH) was less than 0.05 g/100 L. Future work involves integrating this bundle into the PAAL for which an experimental prototype is under development in our laboratory.
Effect of Hydroxyethyl Starch Priming on the Systemic Inflammatory Response and Lung Edema after Cardiopulmonary Bypass in a Rat Model
Authors: Fujii Yutaka , Tanabe Takayuki , Yamashiro Tsubasa , Shirai Mikiyasu , Takewa Yoshiaki , Tatsumi Eisuke
Published: February 2017

Cardiopulmonary bypass (CPB) preserves patients’ lives during open heart surgery by providing sufficient oxygen delivery and blood supply to vital organs. However, previous studies have suggested that the interaction of hemodilution and vascular hyperpermeability induces tissue edema and an inflammatory response during CPB. In this study, we hypothesized the suppression of the systemic inflammatory response and tissue edema during CPB by a plasma substitute (hydroxyethyl starch [HES]). Rats (450–500 g) were divided into a SHAM group (n = 5), a Ringer’s acetate CPB group (n = 7), and an HES CPB group (n = 7). In the Ringer’s acetate group, the CPB circuit was primed with Ringer’s acetate solution, and in the HES CPB group, it was primed with HES formulation (6% HES 130/0.4). Blood samples were collected before (baseline) and 30, 60, 90 and 120 min after initiation of CPB. Plasma cytokine levels of tumor necrosis factor-α, interleukin (IL)-6, and IL-10, and biochemical markers (lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, creatinine, liver-type fatty acid–binding protein, and colloid osmotic pressure [COP]) were measured before and 30, 60, 90, and 120 min after the initiation of CPB. In the Ringer’s acetate CPB group, the inflammatory cytokines and biochemical markers increased significantly during CPB compared with the SHAM group, but such increases were significantly suppressed in the HES CPB group. In addition, during CPB, it was possible to preserve normal plasma COP in the HES CPB group. The data suggest that 6% HES 130/0.4 is effective for suppressing the inflammatory response during CPB.
Is Extracorporeal CO2 Removal Really “Safe” and “Less” Invasive? Observation of Blood Injury and Coagulation Impairment during ECCO2R
Authors: Kalbhenn Johannes , Neuffer Nadine , Zieger Barbara , Schmutz Axel
Published: February 2017

Extracorporeal CO2 removal (ECCO2R) is promoted with attributes like “safe” and “less invasive” compared with (high-flow) venovenous extracorporeal membrane oxygenation (ECMO) systems. With our experience in coagulation disorders during ECMO therapy with this observational study, we for the first time prospectively evaluate hemolysis and coagulation disorders during ECCO2R. Eight consecutive patients with predominant hypercapnic respiratory failure were treated with the Hemolung respiratory assist system (Alung-Technologies, Pittsburg, PA). Bleeding as well as changes of coagulation parameters was prospectively assessed. Overall therapy was observed in seven patients with 52 treatment days. In four of seven patients (57%), relevant clinical bleeding symptoms occurred. Thrombocytopenia, hemolysis, factor XIII deficiency and acquired von Willebrand syndrome (loss of high-molecular-weight von Willebrand factor multimers) were typical findings, and the patients spontaneously recovered after discontinuation of the extracorporeal system. In one patient, extracorporeal system stopped because of thrombotic occlusion. Six of seven patients required transfusion of red blood cells. Our observation shows that even low-flow extracorporeal lung support is associated with relevant clinical bleeding symptoms, blood cell injury, development of acquired von Willebrand syndrome and need for transfusion. In our opinion, it therefore is too early to quote ECCO2R “safe” and “less invasive.”
Factors Associated With Mortality in Continuous Renal Replacement Therapy for Pediatric Patients With Acute Kidney Injury*
Authors: Choi Seung Jun , Ha Eun-Ju , Jhang Won Kyoung , Park Seong Jong
Published: February 2017

Objectives:

To analyze the epidemiology of pediatric acute kidney injury requiring continuous renal replacement therapy and identify prognostic factors affecting mortality rates.

Design:

Retrospective analysis.

Setting:

PICU of a tertiary medical center.

Patients:

One hundred-twenty three children diagnosed with acute kidney injury requiring continuous renal replacement therapy.

Interventions:

None.

Measurements and Main Results:

Vasoactive-Inotropic Score, arterial blood gas analysis, blood chemistry at continuous renal replacement therapy initiation, the extent of fluid overload 24 hours prior to continuous renal replacement therapy initiation, Pediatric Risk of Mortality III score at admission, and need for mechanical ventilation during continuous renal replacement therapy were compared in survivors and nonsurvivors. Out of 1,832 patient admissions, 185 patients (10.1%) developed acute kidney injury during the study period. Of these, 158 patients were treated with continuous renal replacement therapy, and finally, 123 patients were enrolled. Of the enrolled patients, 50 patients died, corresponding to a mortality rate of 40.6%. The survivor group and the nonsurvivor group were compared, and the following factors were associated with an increased risk of mortality: higher Pediatric Risk of Mortality III score at admission and Vasoactive-Inotropic Score when initiating continuous renal replacement therapy, increased fluid overload 24 hours before continuous renal replacement therapy initiation, and need for mechanical ventilation during continuous renal replacement therapy. The percentage of fluid overload difference between the survivors and the nonsurvivors was 1.2% ± 2.2% versus 4.1% ± 4.6%, respectively. Acidosis, elevated lactic acid and blood urea nitrogen, and lower serum creatinine level were laboratory parameters associated with increased mortality. On multivariate analysis, Vasoactive-Inotropic Score, need for mechanical ventilation, blood urea nitrogen, and creatinine level were statistically significant. (Odds ratio: 1.040, 6.096, 1.032, and 0.643, respectively.)

Conclusions:

A higher Vasoactive-Inotropic Score, need for mechanical ventilation, elevated blood urea nitrogen, and lower creatinine level were associated with increased mortality in pediatric acute kidney injury patients who underwent continuous renal replacement therapy. Lower creatinine levels may be associated with increased mortality in the context of fluid overload, which is correlated with a reduced chance of survival.
Ultrasound-Guided Subclavian Vein Cannulation in Low Birth Weight Neonates
Authors: Lausten-Thomsen Ulrik , Merchaoui Zied , Dubois Cécile , Eleni Dit Trolli Sergio , Le Saché Nolwenn , Mokhtari Mostafa , Tissières Pierre
Published: February 2017

Objectives:

Central venous access in critically ill, small infants remains technically challenging even in experienced hands. Several vascular accesses exist, but the subclavian vein is often preferred for central venous catheter insertion in infants where abdominal malformation and/or closure of the vein preclude the use of umbilical venous catheters, as catheterization of the subclavian vein is easier in very short necks than the internal jugular vein for age-related anatomical reasons. The subclavian vein approach is yet relatively undescribed in low birth weight infants (i.e., < 2,500 g), and this study aims to explore the feasibility of this technique in very small infants.

Design:

Retrospective data collection of prospectively registered data on central venous catheter insertion in infants.

Setting:

Neonatal ICU and PICU at a university hospital.

Patients:

One hundred and five newborn children hospitalized in at the ICU.

Interventions:

An ultrasound-guided supraclavicular approach was applied on all infants who had an subclavian vein catheterization during a 30-month period from January 2013 to July 2015.

Measurements and Main Results:

One hundred seven supraclavicular subclavian vein catheters were placed in 105 children weighing less than 5,000 g. Among those, 40 patients weighed less than 2,500 g and 10 patients weighed less than 1,500 g. Successful central venous catheter insertion, defined as the correct placement of a functional double-lumen catheter (3F or 4F), was obtained in 97.3%. All three registered failed attempts were due to hematomas from venous bleeding and occurred in infants weighing greater than 2,500 g. No case of accidental arterial puncture or pleural puncture was registered.

Conclusions:

This large series of subclavian vein catheterizations in small infants demonstrates the feasibility of subclavian vein catheterizations even in very small neonates weighing less than 1,500 g.
Withdrawal Assessment Tool-1 Monitoring in PICU: A Multicenter Study on Iatrogenic Withdrawal Syndrome
Authors: Amigoni Angela , Mondardini Maria Cristina , Vittadello Ilaria , Zaglia Federico , Rossetti Emanuele , Vitale Francesca , Ferrario Stefania , Savron Fabio , Coffaro Giancarlo , Brugnaro Luca , Amato Roberta , Wolfler Andrea , Franck Linda S.
Published: February 2017

Objectives:

Withdrawal syndrome is an adverse reaction of analgesic and sedative therapy, with a reported occurrence rate between 17% and 57% in critically ill children. Although some factors related to the development of withdrawal syndrome have been identified, there is weak evidence for the effectiveness of preventive and therapeutic strategies. The main aim of this study was to evaluate the frequency of withdrawal syndrome in Italian PICUs, using a validated instrument. We also analyzed differences in patient characteristics, analgesic and sedative treatment, and patients’ outcome between patients with and without withdrawal syndrome.

Design:

Observational multicenter prospective study.

Setting:

Eight Italian PICUs belonging to the national PICU network Italian PICU network.

Patients:

One hundred thirteen patients, less than 18 years old, mechanically ventilated and treated with analgesic and sedative therapy for five or more days. They were admitted in PICU from November 2012 to May 2014.

Interventions:

Symptoms of withdrawal syndrome were monitored with Withdrawal Assessment Tool-1 scale.

Measurements and Main Results:

The occurrence rate of withdrawal syndrome was 64.6%. The following variables were significantly different between the patients who developed withdrawal syndrome and those who did not: type, duration, and cumulative dose of analgesic therapy; duration and cumulative dose of sedative therapy; clinical team judgment about analgesia and sedation’s difficulty; and duration of analgesic weaning, mechanical ventilation, and PICU stay. Multivariate logistic regression analysis revealed that patients receiving morphine as their primary analgesic were 83% less likely to develop withdrawal syndrome than those receiving fentanyl or remifentanil.

Conclusions:

Withdrawal syndrome was frequent in PICU patients, and patients with withdrawal syndrome had prolonged hospital treatment. We suggest adopting the lowest effective dose of analgesic and sedative drugs and frequent reevaluation of the need for continued use. Further studies are necessary to define common preventive and therapeutic strategies.
HIV Drug Resistance Mutations in Non-B Subtypes After Prolonged Virological Failure on NNRTI-Based First-Line Regimens in Sub-Saharan Africa
Authors: Kityo Cissy , Thompson Jennifer , Nankya Immaculate , Hoppe Anne , Ndashimye Emmanuel , Warambwa Colin , Mambule Ivan , van Oosterhout Joep J. , Wools-Kaloustian Kara , Bertagnolio Silvia , Easterbrook Philippa J. , Mugyenyi Peter , Walker A. Sarah , Paton Nicholas I. ,   for the Europe Africa Research Network for Evaluation of Second-line Therapy (EARNEST) Trial Team
Published: February 2017

Objective:

To determine drug resistance mutation (DRM) patterns in a large cohort of patients failing nonnucleoside reverse transcriptase inhibitor (NNRTI)-based first-line antiretroviral therapy regimens in programs without routine viral load (VL) monitoring and to examine intersubtype differences in DRMs.

Design:

Sequences from 787 adults/adolescents who failed an NNRTI-based first-line regimen in 13 clinics in Uganda, Kenya, Zimbabwe, and Malawi were analyzed. Multivariable logistic regression was used to determine the association between specific DRMs and Stanford intermediate-/high-level resistance and factors including REGA subtype, first-line antiretroviral therapy drugs, CD4, and VL at failure.

Results:

The median first-line treatment duration was 4 years (interquartile range 30–43 months); 42% of participants had VL ≥100,000 copies/mL and 63% participants had CD4 <100 cells/mm3. Viral subtype distribution was A1 (40%; Uganda and Kenya), C (31%; Zimbabwe and Malawi), and D (25%; Uganda and Kenya), and recombinant/unclassified (5%). In general, DRMs were more common in subtype-C than in subtype-A and/or subtype-D (nucleoside reverse transcriptase inhibitor mutations K65R and Q151M; NNRTI mutations E138A, V106M, Y181C, K101E, and H221Y). The presence of tenofovir resistance was similar between subtypes [P (adjusted) = 0.32], but resistance to zidovudine, abacavir, etravirine, or rilpivirine was more common in subtype-C than in subtype-D/subtype-A [P (adjusted) < 0.02].

Conclusions:

Non-B subtypes differ in DRMs at first-line failure, which impacts on residual nucleoside reverse transcriptase inhibitor and NNRTI susceptibility. In particular, higher rates of etravirine and rilpivirine resistance in subtype-C may limit their potential utility in salvage regimens.
Direct Targeting of Macrophages With Methylglyoxal-Bis-Guanylhydrazone Decreases SIV-Associated Cardiovascular Inflammation and Pathology
Authors: Walker Joshua A. , Miller Andrew D. , Burdo Tricia H. , McGrath Michael S. , Williams Kenneth C.
Published: February 2017

Background:

Despite effective combination antiretroviral therapy, HIV-infected individuals develop comorbidities, including cardiovascular disease, where activated macrophages play a key role. To date, few therapies target activated monocytes and macrophages.

Methods:

We evaluated a novel oral form of the polyamine biosynthesis inhibitor methylglyoxal-bis-guanylhydrazone (MGBG) on cardiovascular inflammation, carotid artery intima–media thickness (cIMT), and fibrosis in a simian immunodeficiency virus infection model of AIDS. Eleven simian immunodeficiency virus–infected animals received MGBG (30 mg/kg) once daily and 8 received a placebo control both beginning at 21 days postinfection (dpi). Animals were time sacrificed at 49 days post infection (dpi), when their matched placebo controls developed AIDS (63, 70, 77, 80), or at the study end-point (84 dpi). Aorta, carotid artery, and cardiac tissues were analyzed. Quantitative analyses of macrophage populations and T lymphocytes were done and correlated with cIMT and fibrosis.

Results:

MGBG treatment resulted in 2.19-fold (CD163+), 1.86-fold (CD68+), 2.31-fold (CD206+), and 2.12-fold (MAC387+) decreases in macrophages in carotid arteries and significant 2.07-fold (CD163+), 1.61-fold (CD68+), 1.95-fold (MAC387+), and 1.62-fold (CD206+) decreases in macrophages in cardiac tissues. cIMT (1.49-fold) and fibrosis (2.05-fold) also were significantly decreased with MGBG treatment. Numbers of macrophage and the degree of fibrosis in treated animals were similar to uninfected animals. A positive correlation between decreased macrophage in the carotid artery and cIMT, and cardiac macrophages and fibrosis was found.

Conclusions:

These data demonstrate that directly targeting macrophages with MGBG can reduce cardiovascular inflammation, cIMT, and fibrosis. They suggest that therapies targeting macrophages with HIV could be used in conjunction with combination antiretroviral therapy.
Impact of HIV and Atiretroviral Therapy on Neurocognitive Outcomes Among School-Aged Children
Authors: Brahmbhatt Heena , Boivin Michael , Ssempijja Victor , Kagaayi Joseph , Kigozi Godfrey , Serwadda David , Violari Avy , Gray Ronald H.
Published: February 2017

Introduction:

The impact of HIV infection and antiretroviral therapy (ART) on neurocognitive outcomes among children aged 7–14 years was assessed. We hypothesized that ART would ameliorate neurocognitive sequelae of HIV infection.

Methods:

HIV-positive and HIV-negative mother–child pairs from the Rakai Community Cohort Study and ART clinics in Rakai, Uganda, were followed prospectively for 4 years. Exposures were stratified as: perinatally HIV infected, perinatally HIV exposed but uninfected, and HIV unexposed and uninfected. The Kaufman Assessment Battery for Children assessed sequential and simultaneous processing, learning, planning, knowledge, and fluid crystalized index for overall functioning. Multivariable generalized linear models estimated adjusted prevalence rate ratios by age.

Results:

Of the 370 mother–child pairs, 55% were HIV unexposed and uninfected, 7% were perinatally HIV exposed but uninfected, and 37.9% were perinatally HIV infected. Among HIV-infected children, longer duration of ART was associated with a significant improvement of sequential processing skills (adjusted prevalence rate ratios 25–36 months: 0.55, 95% confidence interval [CI]: 0.34 to 0.9; 37–48 months: 0.39, 95% CI: 0.2 to 0.76; 49+ months: 0.23, 95% CI: 0.1 to 0.54). Each additional year of schooling was associated with a 30%–40% decrease of impairment for all neurocognitive measures assessed. Healthier children (higher age-standardized height and weight) had improved sequential and simultaneous processing and overall fluid crystalized index.

Conclusions:

Sequential processing skills of working memory improved with prolonged ART, and increased duration of schooling was associated with a reduction of neurocognitive impairment. Early initiation and sustained use of ARTs and longer schooling are needed to reduce neurocognitive impairment among HIV-infected school-aged children.
Project Engage: Snowball Sampling and Direct Recruitment to Identify and Link Hard-to-Reach HIV-Infected Persons Who Are Out of Care
Authors: Wohl Amy Rock , Ludwig-Barron Natasha , Dierst-Davies Rhodri , Kulkarni Sonali , Bendetson Jesse , Jordan Wilbert , Bolan Robert , Smith Terry , Cunningham William , Pérez Mario J.
Published: February 2017

Introduction:

Innovative strategies are needed to identify and link hard-to-find persons living with HIV (PLWH) who are out of care (OOC). Project Engage, a health department–based project in Los Angeles County, used a mixed-methods approach to locate and provide linkage for PLWH who have limited contact with HIV medical and nonmedical services.

Methods:

Incentivized social network recruitment (SNR) and direct recruitment (DR) was used to identify eligible OOC alters for a linkage intervention that included HIV clinic selection, appointment and transportation support, reminder calls/texts, and clinic navigation.

Results:

Between 2012 and 2015, 112 alters were identified using SNR (n = 74) and DR (n = 38). Most alters were male (80%), African American (38%), and gay (60%). Sizable percentages were homeless (78%), had engaged in sex work (32%) in the previous 6 months, had injected drugs (47%), were incarcerated in the previous 12 months (50%), and had only received HIV care during the previous 5 years while incarcerated (24%). SNR alters were more likely than DR alters to be African American, uninsured, unemployed, homeless, sex workers, injection drug users, recently incarcerated, and have unmet service needs. Alters linked to care within 3 (69%), 4–6 (5%), and 7–12 months (8%), and 72% were retained at 6–12 months. The percent virally suppressed increased (27% vs. 41%) and the median viral load decreased (P = 0.003) between linkage and follow-up at 6–12 months.

Discussion:

The alternative approaches presented were effective at locating marginalized HIV-positive persons who are OOC for linkage and retention. The SNR approach was most successful at identifying alters with serious social challenges and gaps in needed medical/ancillary services.
Preoperative Axillary Lymph Node Evaluation in Breast Cancer
Authors: Choi Hee Young , Park Minho , Seo Mirinae , Song Eunjee , Shin So Youn , Sohn Yu-Mee
Published: February 2017

Axillary lymph node (ALN) status is an important prognostic factor for overall breast cancer survival. In current clinical practice, ALN status is evaluated before surgery via multimodal imaging and physical examination. Mammography is typically suboptimal for complete ALN evaluation. Currently, ultrasonography is widely used to evaluate ALN status; nonetheless, results may vary according to operator. Ultrasonography is the primary imaging modality for evaluating ALN status. Other imaging modalities including contrast-enhanced magnetic resonance imaging, computed tomography, and positron emission tomography/computed tomography can play additional roles in axillary nodal staging.

The purpose of this article is (1) to review the strengths and weaknesses of current imaging modalities for nodal staging in breast cancer patients and (2) to discuss updated guidelines for ALN management with regard to preoperative ALN imaging.
Oral Polyphosphate Suppresses Bacterial Collagenase Production and Prevents Anastomotic Leak Due to Serratia marcescens and Pseudomonas aeruginosa
Authors: Hyoju Sanjiv K. , Klabbers Robin E. , Aaron Melissa , Krezalek Monika A. , Zaborin Alexander , Wiegerinck Mara , Hyman Neil H. , Zaborina Olga , Van Goor Harry , Alverdy John C.
Published: February 2017

Objective:

The objective of this study was to determine the effect of polyphosphate on intestinal bacterial collagenase production and anastomotic leak in mice undergoing colon surgery.

Background:

We have previously shown that anastomotic leak can be caused by intestinal pathogens that produce collagenase. Because bacteria harbor sensory systems to detect the extracellular concentration of phosphate which controls their virulence, we tested whether local phosphate administration in the form of polyphosphate could attenuate pathogen virulence and prevent leak without affecting bacterial growth.

Methods:

Groups of mice underwent a colorectal anastomosis which was then exposed to collagenolytic strains of either Serratia marcescens or Pseudomonas aeruginosa via enema. Mice were then randomly assigned to drink water or water supplemented with a 6-mer of polyphosphate (PPi-6). All mice were sacrificed on postoperative day 10 and anastomoses assessed for leakage, the presence of collagenolytic bacteria, and anastomotic PPi-6 concentration.

Results:

PPi-6 markedly attenuated collagenase and biofilm production, and also swimming and swarming motility in both S. marcescens and P. aeruginosa while supporting their normal growth. Mice drinking PPi-6 demonstrated increased levels of PPi-6 and decreased colonization of S. marcescens and P. aeruginosa, and collagenase activity at anastomotic tissues. PPi-6 prevented anastomotic abscess formation and leak in mice after anastomotic exposure to S. marcescens and P. aeruginosa.

Conclusions:

Polyphosphate administration may be an alternative approach to prevent anastomotic leak induced by collagenolytic bacteria with the advantage of preserving the intestinal microbiome and its colonization resistance.
Detection of Donor-Derived Microparticles in the Peripheral Blood of a Hand Transplant Recipient During Rejection
Authors: Kim Joseph Y. , Kelesidis Theodoros , Yang Otto O.
Published: February 2017

Background

Microparticles (MPs) are released from the plasma membrane of activated or dying cells and bear surface molecules from those cells. We examined whether donor-derived MPs in the peripheral blood of the recipient could serve as a marker of tissue damage due to rejection of a transplanted hand.

Methods

Platelet-free plasma from the recipient of the transplanted hand was analyzed for MPs bearing the donor-specific HLA molecule A*02 using flow cytometry. Rejection status of the transplanted hand was monitored by histopathology of skin punch biopsies.

Results

Donor-specific MPs expressing HLA A*02 were quantifiable in the peripheral blood of the recipient. Levels of these MPs increased with worsening rejection of the transplanted hand.

Conclusions

These findings demonstrate the ability to detect donor specific MPs through staining of graft cell-specific HLA and promote further investigation into the potential utility of flow cytometry for donor-derived MPs as a noninvasive tool to assess rejection in solid organ transplantation patients.
Development and Validation of the Kidney Transplant Understanding Tool (K-TUT)
Authors: Rosaasen Nicola , Taylor Jeff , Blackburn David , Mainra Rahul , Shoker Ahmed , Mansell Holly
Published: February 2017

Background

Several educational interventions have been designed to improve patient knowledge before and after kidney transplantation. However, evaluation of such interventions has been difficult because validated instruments to measure knowledge-based outcomes in this population have not been developed.

Objective

To create a tool to measure patient knowledge of kidney transplantation and to evaluate its validity.

Methods

The Kidney Transplant Understanding Tool (K-TUT) was created using a stepwise iterative process. Experts in the field and transplant recipients were consulted to establish content validity. The K-TUT consists of 9 true/false and 13 multiple-choice questions, and scores are based on the number correct answers [YES/NO format] of 69 items. The questionnaire was piloted in a study that also measured health literacy (via the Short Test of Functional Health Literacy) in transplant candidates, whereas the main survey was mailed to transplant recipients. Test-retest was performed, and completed surveys were analyzed for internal consistency, construct validity, floor and ceiling effects, and reproducibility.

Results

Surveys were offered to 106 pretransplant patients and 235 in the posttransplant period, and response rates were 38.7% (41/106) and 63.4% (149/235), respectively. The mean corrected scores were 53.1 ± 8.5 (77%) and 56.2 ± 6.3 (81%), respectively. Test-retest was performed over 20% of both cohorts and percent agreement ranged between 70% and 100% in the pretransplant group and 66% and 100% in the posttransplant group. Cronbach α ranged from 0.794 to 0.875 in all cohorts indicating favorable internal consistency. Increased health literacy in the pretransplant group was significantly associated with increased knowledge (r = 0.52; P < 0.001), suggestive of construct validity, and the absence of floor and ceiling effects was positive. The majority of transplant recipients (98/148, 67%) believed the questionnaire adequately assessed transplant knowledge, about a quarter (36/148, 24.3%) were “unsure,” and 85% (126/148) agreed that no questions should be removed.

Conclusions

Although more study is warranted to further assess psychometric properties, the K-TUT appears to be a promising tool to measure transplant knowledge.
Evaluation of Carotid Ultrasonography Screening Among Kidney Transplant Candidates: A Single-Center, Retrospective Study
Authors: Rossitter Chad W. , Vigo Ronald B. , Gaber Ahmed Osama , Swan Joshua T. , Suki Wadi N.
Published: February 2017

Background

Kidney transplant candidates undergo rigorous testing prior to clearance for transplantation. Because kidney transplant candidates may be at increased risk for carotid artery stenosis because of arteriosclerosis and atherosclerosis secondary to hypertension, vascular calcification, and diabetes, carotid ultrasound is often performed with the intent of preventing a cerebrovascular accident in the perioperative or posttransplant period. To our knowledge, there has not been a study investigating the utility of screening carotid ultrasonography in pretransplant candidates. The purpose of the present study was to investigate the yield of carotid ultrasonography in end-stage renal disease patients, at high risk for having clinically significant vascular disease evaluated at our center for kidney transplantation during the years 2009 to 2014.

Methods

Data for carotid ultrasound findings and risk factors for carotid artery disease were extracted from the medical records.

Results

A total of 882 patients were included in our study of which only 13 patients (1.47% of the cohort) had significant carotid artery stenosis (>70%) on ultrasound testing. Using multiple logistic regression on the outcome of carotid stenosis, congestive heart failure (adjusted odds ratio, 5.2), and peripheral vascular disease (adjusted odds ratio, 4.4) were positively associated with carotid stenosis.

Conclusions

The prevalence of significant carotid artery stenosis was only 1.47% in our cohort of kidney transplant candidates, and the routine use of carotid ultrasound testing in this population may not be an efficient use of clinical resources. Use of risk factors, such as congestive heart failure or peripheral vascular disease, may identify patients who are more likely to benefit from carotid ultrasonography screening.
Polarity sensitive probes for super resolution STED microscopy
Authors: Sezgin E , Schneider F , Zilles V , Garcia E , Waithe D , Klymchenko A S , Eggeling C
Published: February 2017

The lateral organization of molecules in the cellular plasma membrane plays an important role in cellular signaling. A critical parameter for membrane molecular organization is how the membrane lipids are packed (or ordered). Polarity sensitive dyes are powerful tools to characterize such lipid membrane order, employing for example confocal and two-photon microscopy. The investigation of potential lipid nanodomains, however, requires the use of super resolution microscopy. Here, we test the performance of the polarity sensitive membrane dyes Di-4-ANEPPDHQ, Di-4-AN(F)EPPTEA and NR12S in super resolution STED microscopy. Measurements on cell-derived membrane vesicles, in the plasma membrane of live cells, and on single virus particles show the high potential of these dyes for probing nanoscale membrane heterogeneity.
Investigating circadian rhythmicity in pain sensitivity using a neural circuit model for spinal cord processing of pain
Authors: Crodelle Jennifer A. , Piltz Sofia H. , Booth Victoria , Hagenauer Megan Hastings
Published: February 2017

Primary processing of painful stimulation occurs in the dorsal horn of the spinal cord. In this article, we introduce mathematical models of the neural circuitry in the dorsal horn responsible for processing nerve fiber inputs from noxious stimulation of peripheral tissues and generating the resultant pain signal. The differential equation models describe the average firing rates of excitatory and inhibitory interneuron populations, as well as the wide dynamic range (WDR) neurons whose output correlates with the pain signal. The temporal profile of inputs on the different afferent nerve fibers that signal noxious and innocuous stimulation and the excitability properties of the included neuronal populations are constrained by experimental results. We consider models for the spinal cord circuit in isolation and when top-down inputs from higher brain areas that modulate pain processing are included. We validate the models by replicating experimentally observed phenomena of A fiber inhibition of pain and wind-up. We then use the models to investigate mechanisms for the observed phase shift in circadian rhythmicity of pain that occurs with neuropathic pain conditions. Our results suggest that changes in neuropathic pain rhythmicity can occur through dysregulation of inhibition within the dorsal horn circuit.
Sorting of molecular shuttles by designing electrical and mechanical properties of microtubules
Authors: Isozaki Naoto , Shintaku Hirofumi , Kotera Hidetoshi , Hawkins Taviare L. , Ross Jennifer L. , Yokokawa Ryuji
Published: February 2017

Kinesin-driven microtubules have been a focus to serve as molecular shuttles to replace multiple on-chip functions in micro total analysis systems μTAS). Although transport, concentration, and detection of target molecules have been demonstrated, controllability of transport directions is still a major challenge. To define multiple moving directions for selective molecular transport, we integrated the bottom-up molecular design of microtubules and the top-down design of a microfluidic device. The surface charge density and stiffness of microtubules were controlled, allowing us to create three different types of microtubules with different gliding directions corresponding to their electrical and mechanical properties. The measured curvature of gliding microtubules enabled us to optimize the size and design of the device for molecular sorting in a top-down approach. The integrated bottom-up and top-down design achieved separation of stiff microtubules from negatively-charged soft microtubules with approximately 80% efficiency under an electric field. Our method is the first to sort multiple microtubules by integrating molecular control and microfluidic device design, and is applicable to multiplexed molecular sorters.
Orientation relationships between α-zirconium and δ-hydride within a hydride blister
Authors: Kerr David , Long Fei , Domizzi Gladys , Daymond Mark R.
Published: February 2017

Both the expected and an additional orientation relationship between α-Zr and δ-hydride in blistered zirconium alloys are explored through the reconstruction of the parent α-Zr phase from electron backscatter diffraction maps of δ-hydride. Parent and child variant relationships for the transformation are presented with the aim of reconstruction of the parent α-Zr grain structure and texture from orientation maps of the δ-hydride at varying distances from the blister centre in a recrystallized Zircaloy-4 sample. Up to 13% of the δ-hydride is found to be variants of the additional orientation relationship, the fraction of which decreases with increasing distance from the blister centre. Texture reconstructions by other experimental methods are accordingly suggested to incorporate the additional orientation relationship.
Energy-resolved small-angle neutron scattering from steel
Authors: Oba Yojiro , Morooka Satoshi , Ohishi Kazuki , Suzuki Jun-ichi , Takata Shin-ichi , Sato Nobuhiro , Inoue Rintaro , Tsuchiyama Toshihiro , Gilbert Elliot Paul , Sugiyama Masaaki
Published: February 2017

Recent progress of pulsed neutron sources has enabled energy-resolved analysis of neutron attenuation spectra, which include information on neutron scattering. In this study, a new analysis technique for small-angle neutron scattering (SANS) is demonstrated. A clear difference is observed in the neutron attenuation spectra between steels with different nanostructures; this difference can be understood as arising from attenuation due to SANS. The neutron attenuation spectra calculated from the corresponding SANS profiles agree well with the experimentally observed attenuation spectra. This result indicates that measurement of neutron attenuation spectra may enable the development of a novel experimental technique,i.e.energy-resolved SANS.
Optimization of the blowing ratio for film cooling on a flat plate
Authors: Kazemi Kelishami Mojtaba , Lakzian Esmail
Published: February 2017

Purpose

The purpose of this paper is to report the result of a numerical investigation of film cooling performance on a flat plate for finding optimum blowing ratios.

Design/methodology/approach

Steady-state simulations have been performed, and the flow has been considered incompressible. Calculations have been performed with 3D finite-volume method and the k-e turbulence model.

Findings

The adiabatic film cooling effectiveness and the effects of density ratio (DR), blowing ratio (M) and main stream turbulence intensity (Tu), coolant penetration, hole incline and diameter are studied. The temperature and film cooling effectiveness contours, centerline and laterally film cooling effectiveness are presented for these cases. Results show that the cases with smaller Tu have better effectiveness. In the console, using the air coolant and in cylindrical hole cases, using CO2 coolant fluid has higher effectiveness. The results indicated that there is an optimum blowing ratio in the cylindrical hole cases to optimize the performance of new gas turbines.

Research limitations/implications

Investigation of optimum blowing ratio for the convex surfaces and turbine blades is a prospective topic for future studies.

Practical implications

The motivation of this study comes from several industrial applications such as film cooling of gas turbine components. This research gives the best blowing ratio for receiving maximum cooling effectiveness with minimum coolant velocity.

Originality/value

This study optimizes the blowing ratio for film cooling on a flat plate.
Heat generating/absorbing and chemically reacting Casson fluid flow over a vertical cone and flat plate saturated with non-Darcy porous medium
Authors: Durairaj Mythili , Ramachandran Sivaraj , Mehdi Rashidi Mohammad
Published: February 2017

Purpose

The present investigation aims to deal with the study of unsteady, heat-generating/-absorbing and chemically reacting Casson fluid flow over a vertical cone and flat plate saturated with non-Darcy porous medium in the presence of cross-diffusion effects.

Design/methodology/approach

A numerical computation for the governing equations has been performed using implicit finite difference method of Crank–Nicolson type.

Findings

The influence of various physical parameters on velocity, temperature and concentration distributions is illustrated graphically, and the physical aspects are discussed in detail. Numerical results for average skin-friction, Nusselt number and Sherwood number are tabulated for the pertaining physical parameters. Results indicate that Soret and Dufour effects have notable influence on heat and mass transfer characteristics of the fluid when the temperature and concentration gradients are high. It is also observed that the consideration of heat generation/absorption plays a vital role in predicting the heat transfer characteristics of moving fluids.

Research limitations/implications

Consider a two-dimensional, unsteady, free convective flow of an incompressible Casson fluid over a vertical cone and a flat plate saturated with non-Darcy porous medium. The fluid properties are assumed to be constant except for density variations in the buoyancy force term. The fluid flow is moderate and the permeability of the medium is assumed to be low, so that the Forchheimer flow model is applicable.

Practical implications

The flow of Casson fluids (such as drilling muds, clay coatings and other suspensions, certain oils and greases, polymer melts and many emulsions), in the presence of heat transfer, is an important research area because of its relevance in the optimized processing of chocolate, toffee and other foodstuffs.

Social implications

In the heat and mass transfer investigations, the Casson fluid model is found to be accurately applicable in many practical situations in the wings of polymer processing industries and biomechanics, etc.; some prominent examples are silicon suspensions, suspensions of bentonite in water and lithographic varnishes used for printing inks.

Originality/value

The motivation of the present study is to bring out the effects of heat source/sink, Soret and Dufour effects on chemically reacting Casson fluid flow over a vertical cone and flat plate saturated with non-Darcy porous medium. The flow of Casson fluids (such as certain oils and greases, polymer melts and many emulsions) in the presence of heat transfer is an important research area because of its relevance in the optimized processing of chocolate, toffee and other foodstuffs. A numerical computation for the governing equations has been performed using implicit finite difference method of the Crank–Nicolson type.
A stochastically weighted operator splitting Monte Carlo (SWOSMC) method for the numerical simulation of complex aerosol dynamic processes
Authors: Liu Shuyuan , Chan Tat L.
Published: February 2017

Purpose

The purpose of this paper is to study the complex aerosol dynamic processes by using this newly developed stochastically weighted operator splitting Monte Carlo (SWOSMC) method.

Design/methodology/approach

Stochastically weighted particle method and operator splitting method are coupled to formulate the SWOSMC method for the numerical simulation of particle-fluid systems undergoing the complex simultaneous processes.

Findings

This SWOSMC method is first validated by comparing its numerical simulation results of constant rate coagulation and linear rate condensation with the corresponding analytical solutions. Coagulation and nucleation cases are further studied whose results are compared with the sectional method in excellent agreement. This SWOSMC method has also demonstrated its high numerical simulation capability when used to deal with simultaneous aerosol dynamic processes including coagulation, nucleation and condensation.

Originality/value

There always exists conflict and tradeoffs between computational cost and accuracy for Monte Carlo-based methods for the numerical simulation of aerosol dynamics. The operator splitting method has been widely used in solving complex partial differential equations, while the stochastic-weighted particle method has been commonly used in numerical simulation of aerosol dynamics. However, the integration of these two methods has not been well investigated.