bluuebunny/crossref_metadata_2025 huggingface dataset:
On the connectivity of the cosmic web: theory and implications for cosmology and galaxy formation
Authors: Codis Sandrine , Pogosyan Dmitri , Pichon Christophe
Published: June 2018

Cosmic connectivity and multiplicity, i.e. the number of filaments globally or locally connected to a given cluster is a natural probe of the growth of structure and in particular of the nature of dark energy. It is also a critical ingredient driving the assembly history of galaxies as it controls mass and angular momentum accretion. The connectivity of the cosmic web is investigated here via the persistent skeleton. This tool identifies topologically the ridges of the cosmic landscape which allows us to investigate how the nodes of the cosmic web are connected together. When applied to Gaussian random fields corresponding to the high-redshift universe, it is found that on average the nodes are connected to exactly κ = 4 neighbours in two dimensions and ∼6.1 in three dimensions. Investigating spatial dimensions up to d = 6, typical departures from a cubic lattice κ = 2d are shown to scale like the power 7/4 of the dimension. These numbers strongly depend on the height of the peaks: the higher the peak the larger the connectivity. Predictions from first principles based on peak theory are shown to reproduce well the connectivity and multiplicity of Gaussian random fields and cosmological simulations. As an illustration, connectivity is quantified in galaxy lensing convergence maps and large dark haloes catalogues. As a function of redshift and scale the mean connectivity decreases in a cosmology-dependent way. As a function of halo mass, it scales like 10/3 times the log of the mass. Implications on galactic scales are discussed.
A Meta-Analysis of Risk Factors for the Formation of de novo Intracranial Aneurysms
Authors: Hu Si , Yu NianZu , Li YiYun , Hao Zheng , Liu Zheng , Li Mei-hua
Published: June 2018

BACKGROUND

Understanding the risk factors for the formation of de novo intracranial aneurysms (IAs) is important for patients who have ever suffered a cerebral aneurysm.

OBJECTIVE

To estimate the risk factors for the development of a de novo IA to identify which patients need more aggressive surveillance after aneurysm treatment.

METHODS

We followed the preferred reporting items for systematic reviews and meta-analyses guidelines and searched the PubMed, CENTRAL, EMBASE, and LILACS databases using the key words cerebral aneurysms, de novo, IAs, risk factors combined using and/or. The search was performed in July 2017.We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using RevMan 5.3 (Cochrane, London, United Kingdom) to evaluate risk factors. Statistical significance was set at P < .05.

RESULTS

The analysis included 14 studies involving 6389 patients, of whom 197 patients had de novo IAs. The main risk factors for formation included sex (OR = 1.82, 95% CI [1.30,2.56], P = .0005, female vs male), age <40 yr (OR = 2.96, 95% CI [1.76,4.96], P < .0001), family history (OR = 2.05, 95% CI [1.07,3.93], P = .03), smoking history (OR = 2.73, 95% CI [1.81,4.12], P < .0001), and multiple saccular intracranial aneurysms (sIAs) at first diagnosis (OR = 2.10, 95% CI [1.12,3.91], P = .02), internal carotid artery (ICA) as the initial site (OR = 2.58, 95% CI [1.43,4.68], P = .002). Heterogeneous analysis showed that these I2 were less than 50% and the results were reliable.

CONCLUSION

Observational evidence identified multiple clinical and anatomic risk factors for the formation of de novo IAs, including female sex, age <40 yr, family history, smoking history, multiple sIAs at first diagnosis, and IC as the initial site. More aggressive long-term angiographic follow-up with digital subtraction angiography, computed tomography angiography, or magnetic resonance angiography is recommended for these patients.
Screening for Exotic Forest Pathogens to Increase Survey Capacity Using Metagenomics
Authors: Tremblay Émilie D. , Duceppe Marc-Olivier , Bérubé Jean A. , Kimoto Troy , Lemieux Claude , Bilodeau Guillaume J.
Published: June 2018

Anthropogenic activities have a major impact on the global environment. Canada’s natural resources are threatened by the spread of fungal pathogens, which is facilitated by agricultural practices and international trade. Fungi are introduced to new environments and sometimes become established, in which case they can cause disease outbreaks resulting in extensive forest decline. Here, we describe how a nationwide sample collection strategy coupled to next-generation sequencing (NGS) (i.e., metagenomics) can achieve fast and comprehensive screening for exotic invasive species. This methodology can help provide guidance to phytopathology stakeholders such as regulatory agencies. Several regulated invasive species were monitored by processing field samples collected over 3 years (2013 to 2015) near high-risk areas across Canada. Fifteen sequencing runs were required on the Ion Torrent platform to process 398 samples that yielded 45 million reads. High-throughput screening of fungal and oomycete operational taxonomic units using customized fungi-specific ribosomal internal transcribed spacer 1 barcoded primers was performed. Likewise, Phytophthora-specific barcoded primers were used to amplify the adenosine triphosphate synthase subunit 9–nicotinamide adenine dinucleotide dehydrogenase subunit 9 spacer. Several Phytophthora spp. were detected by NGS and confirmed by species-specific quantitative polymerase chain reaction (qPCR) assays. The target species Heterobasidion annosum sensu stricto could be detected only through metagenomics. We demonstrated that screening target species using a variety of sampling techniques and NGS—the results of which were validated by qPCR—has the potential to increase survey capacity and detection sensitivity, reduce hands-on time and costs, and assist regulatory agencies to identify ports of entry. Considering that early detection and prevention are the keys in mitigating invasive species damage, our method represents a substantial asset in plant pathology management.
Detection of Race-Specific Resistance Against Puccinia coronata f. sp. avenae in Brachypodium Species
Authors: Omidvar Vahid , Dugyala Sheshanka , Li Feng , Rottschaefer Susan M. , Miller Marisa E. , Ayliffe Mick , Moscou Matthew J. , Kianian Shahryar F. , Figueroa Melania
Published: June 2018

Oat crown rust caused by Puccinia coronata f. sp. avenae is the most destructive foliar disease of cultivated oat. Characterization of genetic factors controlling resistance responses to Puccinia coronata f. sp. avenae in nonhost species could provide new resources for developing disease protection strategies in oat. We examined symptom development and fungal colonization levels of a collection of Brachypodium distachyon and B. hybridum accessions infected with three North American P. coronata f. sp. avenae isolates. Our results demonstrated that colonization phenotypes are dependent on both host and pathogen genotypes, indicating a role for race-specific responses in these interactions. These responses were independent of the accumulation of reactive oxygen species. Expression analysis of several defense-related genes suggested that salicylic acid and ethylene-mediated signaling but not jasmonic acid are components of resistance reaction to P. coronata f. sp. avenae. Our findings provide the basis to conduct a genetic inheritance study to examine whether effector-triggered immunity contributes to nonhost resistance to P. coronata f. sp. avenae in Brachypodium spp.
Peptidylarginine deiminase 4: a nuclear button triggering neutrophil extracellular traps in inflammatory diseases and aging
Authors: Wong Siu Ling , Wagner Denisa D.
Published: June 2018

Peptidylarginine deiminase 4 (PAD4) is a nuclear citrullinating enzyme that is critically involved in the release of decondensed chromatin from neutrophils as neutrophil extracellular traps (NETs). NETs, together with fibrin, are implicated in host defense against pathogens; however, the formation of NETs (NETosis) has injurious effects that may outweigh their protective role. For example, PAD4 activity produces citrullinated neoantigens that promote autoimmune diseases, such as rheumatoid arthritis, to which PAD4 is genetically linked and where NETosis is prominent. NETs are also generated in basic sterile inflammatory responses that are induced by many inflammatory stimuli, including cytokines, hypoxia, and activated platelets. Mice that lack PAD4—deficient in NETosis—serve as an excellent tool with which to study the importance of NETs in disease models. In recent years, animal and human studies have demonstrated that NETs contribute to the etiology and propagation of many common noninfectious diseases, the focus of our review. We will discuss the role of NETs in thrombotic and cardiovascular disease, the induction of NETs by cancers and its implications for cancer progression and cancer‐associated thrombosis, and elevated NETosis in diabetes and its negative impact on wound healing, and will propose a link between PAD4/NETs and age‐related organ fibrosis. We identify unresolved issues and new research directions.—Wong, S.L., Wagner, D.D. Peptidylargininedeiminase 4: a nuclear button triggering neutrophil extracellular traps in inflammatory diseases and aging. FASEB J. 32, 6358–6370 (2018). www.fasebj.org
Evaluation of Nursing School Educators’ Knowledge and Attitudes Regarding Infant Sleep Safety
Authors: Cirelli Jane , Clymer Beverly , Burgess Adriane , Aguilar Jennifer , Bell Theodore , Goodstein Michael
Published: June 2018

AIM

The purpose of this study was to evaluate nursing educators’ attitudes and knowledge regarding current American Academy of Pediatrics recommendations for a safe infant sleeping environment.

METHOD

This was a cross-sectional prospective survey of all nursing programs with associate degrees or higher in the United States. Instructors teaching pediatric and obstetric didactic or clinical material at an Accreditation Commission for Education in Nursing-approved nursing school could participate.

RESULTS

Of 396 educators surveyed, 70 percent identified all sudden infant death syndrome risk factors. Correct responses for individual safe sleep recommendations ranged from 99 percent for correct room temperature to 53 percent for pacifier use; 9 percent said it was safest for infants to sleep in a position other than on the back.

CONCLUSION

Nursing educators need ongoing training on infant sleep safety to maintain mastery of the information that students need for competency in the workforce involving infant care.
The Consultation Observed Simulated Clinical Experience: Training, Assessment, and Feedback for Incoming Interns on Requesting Consultations
Authors: Martin Shannon K. , Carter Keme , Hellermann Noah , Glick Laura R. , Ngooi Samantha , Kachman Marika , Farnan Jeanne M. , Arora Vineet M.
Published: June 2018

Problem

Formal education in requesting consultations is inconsistent in medical education. To address this gap, the authors developed the Consultation Observed Simulated Clinical Experience (COSCE), a simulation-based curriculum for interns using Kessler and colleagues’ 5Cs of Consultation model to teach and assess consultation communication skills.

Approach

In June 2016, 127 interns entering 12 University of Chicago Medicine residency programs participated in the COSCE pilot. The COSCE featured an online training module on the 5Cs and an in-person simulated consultation. Using specialty-specific patient cases, interns requested telephone consultations from faculty, who evaluated their performance using validated checklists. Interns were surveyed on their preparedness to request consultations before and after the module and after the simulation. Subspecialty fellows serving as consultants were surveyed regarding consultation quality before and after the COSCE.

Outcomes

After completing the online module, 84% of interns (103/122) were prepared to request consultations compared with 52% (63/122) at baseline (P < .01). After the COSCE, 96% (122/127) were prepared to request consultations (P < .01). Neither preparedness nor simulation performance differed by prior experience or training. Over 90% (115/127) indicated they would recommend the COSCE for future interns. More consultants described residents as prepared to request consultations after the COSCE (54%; 21/39) than before (27%; 11/41, P = .01).

Next Steps

The COSCE was well received and effective for preparing entering interns with varying experience and training to request consultations. Future work will emphasize consultation communication specific to training environments and evaluate skills via direct observation of clinical performance.
An Update on the Basic and Clinical Science of Ketamine Analgesia
Authors: Doan Lisa V. , Wang Jing
Published: June 2018

Objective:

In the context of the current opioid epidemic, there has been a renewed interest in the use of ketamine as an analgesic agent.

Methods:

We reviewed ketamine analgesia.

Results:

Ketamine is well-known as an antagonist for N-methyl-D-aspartate receptors. In addition, it can regulate the function of opioid receptors and sodium channels. Ketamine also increases signaling through α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors. These myriad of molecular and cellular mechanisms are responsible for a number of pharmacological functions including pain relief and mood regulation. Clinically, a number of studies have investigated the role of ketamine in the setting of acute and chronic pain, and there is evidence that ketamine can provide analgesia in a variety of pain syndromes.

Discussion:

In this review, we examined basic mechanisms of ketamine and its current clinical use and potential novel use in pain management.
Adenosine Plasma Level and A2A Receptor Expression in Patients With Cardiogenic Shock
Authors: Gaubert Mélanie , Marlinge Marion , Kerbaul François , Resseguier Noemie , Laine Marc , Cautella Jennifer , Cordier Charlotte , Colomb Benjamin , Kipson Nathalie , Thuny Franck , Mottola Giovanna , Fenouillet Emmanuel , Ruf Jean , Paganelli Franck , Guieu Régis , Bonello Laurent
Published: June 2018

Objectives:

To investigate whether adenosine A2A receptors lead to vasodilation and positive inotropic function under stimulation and whether they play a role in the control of blood pressure in patients with cardiogenic shock.

Design:

Prospective observational study.

Setting:

Monocentric, Hopital Nord, Marseille, France.

Subjects:

Patients with cardiogenic shock (n = 16), acute heart failure (n = 16), and acute myocardial infarction (n = 16).

Interventions:

None.

Measurements and Main Results:

Arterial adenosine plasma level and A2A receptor expression on peripheral blood mononuclear cells were evaluated by mass spectrometry and Western blot, respectively, at admission and after 24 hours. Hemodynamic parameters, including systemic vascular resistance, were also assessed. Mean adenosine plasma level at admission was significantly higher in patients with cardiogenic shock (2.74 ± 1.03 µM) versus acute heart failure (1.33 ± 0.27) or acute myocardial infarction (1.19 ± 0.27) (normal range, 0.4–0.8 µM) (p < 0.0001). No significant correlation was found between adenosine plasma level and systemic vascular resistance. Mean adenosine plasma level decreased significantly by 24 hours after admission in patients with cardiogenic shock (2.74 ± 1.03 to 1.53 ± 0.68; p < 0.001). Mean A2A receptor expression was significantly lower in patients with cardiogenic shock (1.18 ± 0.11) versus acute heart failure (1.18 ± 0.11 vs 1.39 ± 0.08) (p = 0.005).

Conclusions:

We observed high adenosine plasma level and low A2A receptor expression at admission in patients with cardiogenic shock versus acute heart failure or acute myocardial infarction. This may contribute to the physiopathology of cardiogenic shock.
The Role of Orthokeratology in Myopia Control: A Review
Authors: Lipson Michael J. , Brooks Moya M. , Koffler Bruce H.
Published: June 2018

The prevalence of myopia and high myopia has significantly increased worldwide and in the United States. The serious implications of these trends are being recognized. Myopia is not just a minor inconvenience requiring vision correction with glasses or contact lenses, but a disease process creating significant risk of serious vision-threatening eye disease. Various methods of treatment for myopia and myopic progression have been prescribed and studied in effort to find one that is effective, safe, and that patients will be compliant with. Numerous peer-reviewed studies have shown orthokeratology (OrthoK) is effective in slowing myopic progression. This review article covers the development of OrthoK, its mechanism of action, its evolution, and refinement from a refractive option to its use as a mean of slowing myopic progression. After detailing patterns of myopia progression, a description of theories and studies as to how OrthoK slows myopia progression in children is also explained. The review will focus on progression of myopia and the use of OrthoK to slow myopia progression after myopia has been diagnosed.
Anterior Segment Optical Coherence Tomography of Post-Descemet Stripping Automated Endothelial Keratoplasty Eyes to Evaluate Graft Morphology and Its Association With Visual Outcome
Authors: Graffi Shmuel , Leon Pia , Mimouni Michael , Nahum Yoav , Spena Rossella , Mattioli Leila , Busin Massimo
Published: June 2018

Purpose:

To evaluate the relationship between graft thickness/regularity and visual outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK).

Methods:

Records of post-DSAEK patients who were examined by anterior segment optical coherence tomography at “Villa Igea” Private Hospital (Forlì, Italy) since April 2015 were reviewed. Pachymetric and elevation maps of both host cornea and graft were analyzed. Graft regularity was determined based on the root mean square error (RMSE) of the graft pachymetric measurements taken 3 and 6 mm from the center and the RMSE of the corneal elevation measurements at its posterior and interface surfaces. These parameters were correlated with best-spectacle-corrected visual acuity (BSCVA) (expressed in logarithm of the minimum angle of resolution) and compared between eyes with central graft thickness (CGT) ≥100 μm (group 1) and eyes with CGT <100 μm (group 2).

Results:

Eighty-nine post-DSAEK eyes of 89 patients with Fuchs endothelial dystrophy or bullous keratopathy and no significant comorbidities were included. There were 40 eyes (CGT = 138.2 ± 31.7 μm) in group 1 and 49 eyes (CGT = 73.3 ± 15.5 μm) in group 2. The RMSEs of graft pachymetry and the RMSEs of the interface and posterior surface elevation maps at 3 and 6 mm differed significantly between both groups (P < 0.05). When only eyes with Fuchs endothelial dystrophy (n = 54) were considered in both groups, there was a statistically significant correlation (r = 0.44; P = 0.001) between BSCVA and CGT.

Conclusions:

DSAEK grafts thinner than 100 μm are more regular than thicker ones. In eyes with Fuchs endothelial dystrophy that are otherwise healthy, thinner grafts yield significantly better BSCVA.
Central Corneal Thickness Increase Due to Stromal Thickening With Diabetic Peripheral Neuropathy Severity
Authors: Kumar Navasuja , Pop-Busui Rodica , Musch David C. , Reed David M. , Momont Anna C. , Hussain Munira , Raval Nilesh , Moroi Sayoko E. , Shtein Roni
Published: June 2018

Purpose:

To investigate the relationship between central corneal thickness (CCT) and diabetes disease severity among patients with diabetic peripheral neuropathy (DPN) compared with controls.

Methods:

In this cross-sectional study, 34 participants were examined. DPN status was assessed by clinical examination, nerve conduction studies, and quantitative sensory testing. All participants underwent comprehensive eye examination that included intraocular pressure measured by Goldmann applanation tonometry. CCT was measured by ultrasound pachymetry, and the thickness of corneal layers was assessed by corneal confocal microscopy. Association of CCT and DPN was examined using ANOVA.

Results:

Among the 34 participants, there were 9 controls, 16 patients with mild DPN, and 9 patients with severe DPN. CCT was significantly increased in the DPN groups compared with controls (P = 0.0003). Mean CCT among controls was 552.7 ± 29.2 μm compared with 583.4 ± 25.0 μm in the mild DPN group and 613.3 ± 28.8 μm in the severe DPN group. In addition, stromal thickness differed significantly between the 3 study groups (P = 0.045). Mean stromal thickness among controls was 439.5 ± 23.5 μm compared with 478.9 ± 37.5 μm in the mild DPN group and 494.5 ± 39.1 μm in the severe DPN group.

Conclusions:

This study demonstrates that CCT increases with DPN severity because of an increase in stromal thickness. CCT increase associated with DPN has important clinical implications including glaucoma progression, keratoconus susceptibility, and intraocular pressure assessment and should be accounted for when evaluating patients with diabetes.
Optimized Protocol for Regeneration of the Conjunctival Epithelium Using the Cell Suspension Technique
Authors: Bertolin Marina , Breda Claudia , Ferrari Stefano , Van Acker Sara Ilse , Zakaria Nadia , Di Iorio Enzo , Migliorati Angelo , Ponzin Diego , Ferrari Barbara , Lužnik Zala , Barbaro Vanessa
Published: June 2018

Purpose:

To develop autologous tissue-engineered conjunctival epithelial sheets to be used as advanced therapy medicinal products for severe ocular surface disorders involving the conjunctiva.

Methods:

Methods used aimed at 1) mapping the conjunctiva for identification of the stem cell location, 2) establishing proper cell culturing conditions, 3) identifying the proper scaffold, and 4) characterizing the conjunctival grafts better. For these purposes, immunostaining and PAS staining, serial cultivation of cells, and quantitative polymerase chain reaction (∆Np63α and MUC5AC) were performed.

Results:

The inferior fornix represents the ideal area where to take the conjunctival biopsies from, with at least +3.58% of clonogenic colonies and higher percentages of stem cells compared with other areas, as confirmed by ∆Np63α expression levels (6.79% ± 1.18%). The standard culture conditions are necessary when cells are cultured on bare plastic, while animal-free media can be used for conjunctival cell culture on the scaffold. Fibrin glue represents the ideal scaffold for production of epithelial conjunctival grafts because it allows physiological expression of the main conjunctival cell markers, with K19 as the ideal one (98.5% ± 0.5% positive cells). The presence of goblet cells (6.3% ± 1.3%) and expression of the stem cell marker ∆Np63α (1.65% ± 0.35% positive cells) were also assessed.

Conclusions:

Our findings pave the way for ex vivo cultivation of conjunctival epithelial cells onto a scaffold using the cell suspension technique by means of animal-free media. This would allow us to obtain conjunctival grafts for clinical purposes, thus giving a therapeutic option to patients with conjunctival diseases refractory to current therapies.
Risk Factors for Sporadic Diffuse Lamellar Keratitis After Microkeratome Laser-Assisted In Situ Keratomileusis: A Retrospective Large Database Analysis
Authors: Segev Fani , Mimouni Michael , Sela Tzahi , Munzer Gur , Kaiserman Igor
Published: June 2018

Purpose:

To determine the factors associated with sporadic diffuse lamellar keratitis (DLK) after microkeratome laser-assisted in situ keratomileusis (LASIK).

Methods:

This large database retrospective study included consecutive cases of LASIK performed between 2007 and 2016 at Care-Vision Laser Centers, Tel-Aviv, Israel. Patients were divided into 2 groups according to whether or not they subsequently developed DLK.

Results:

A total of 24,026 eyes of 12,013 patients with a mean age of 32.9 ± 10.3 years were included. Post-LASIK DLK developed in 464 eyes (1.9%), and the annual rate decreased from 7.1% (2007) to 1.7% (2016) (P < 0.001). The DLK group had a higher proportion of males (58.5% vs. 52.1%, P = 0.006), greater preoperative central corneal thickness (549.5 ± 32.6 vs. 545.3 ± 30.5 μm, P = 0.005), and a lower proportion of high astigmatism (>3 D) (0.4% vs. 1.6%, P = 0.05). The DLK group had a higher proportion of previous LASIK treatment (2.8% vs. 1.3%, P = 0.006), Moria M2 (rather than the SBK) microkeratome (71.1% vs. 34.0%, P < 0.001), smaller suction ring number (P < 0.001), greater stop size (P < 0.001), and greater flap thickness (119.2 ± 50.4 vs. 110.8 ± 22.2, P = 0.007). In multivariable analysis, a smaller suction ring number [odds ratio (OR) 0.89, P = 0.04], Moria M2 microkeratome (OR 5.26, P < 0.001), larger optical zone (OR = 2.04, P = 0.01), and higher spherical equivalent (OR = 1.08, P = 0.02) were associated with DLK.

Conclusions:

In the modern LASIK era, the incidence of DLK continues to decrease. Higher preoperative ametropia, smaller suction ring number, an older type of microkeratome, and larger optical zones are associated with higher DLK rates after LASIK.
Efficacy and Safety of Immunosuppressive Agents for Thyroid Eye Disease
Authors: Strianese Diego
Published: June 2018

Purpose:

To present an update on the efficacy and safety of immunosuppressive therapy for thyroid eye disease (TED) and to offer a general recommendation for management of TED, in light of these reports.

Methods:

Data were retrieved from a literature search on PubMed, using the following words: thyroid eye disease, immunosuppressant, corticosteroid, methotrexate, azathioprine, cyclosporine, cyclophosphamide, rituximab, etanercept, adalimumab, tocilizumab, teprotumumab, adverse effects, side effects, and complications.

Results:

Corticosteroids continue to be the primary medical therapy for TED. Recent research has offered insight into potential differences between oral corticosteroid and intravenous corticosteroid treatment regimens in terms of efficacy and side-effect profiles, which proved more favorable for the latter. The use of some traditional immunosuppressive agents, such as methotrexate and mycophenolate, seems suitable as steroid-sparing medications. In recent years, many scientific reports demonstrated the effectiveness of biologic immunosuppressive agents in the management of TED. Etanercept, adalimumab, and tocilizumab have been shown to be effective in reduction of the inflammatory signs with the possible added advantage of preventing relapse of the disease. Teprotumumab may control the disease activity, and it seems to be very effective in preventing disease progression. Infliximab might be useful in severe TED resistant to steroids and orbital decompression.

Conclusions:

Steroid therapy remains the first-line therapy for moderate/severe and severe vision-threatening TED. The biological agents may provide a deep and long-standing block of inflammatory activity in TED, with the hope to lower the risk of recurrences and to reduce the need of surgical intervention in moderate-to-severe disease. Indeed, the actual incidence of adverse effects is not yet well assessed because of the paucity of studies. Therefore, their use should be limited to those cases that really need an alternative therapy to steroids, handled by expert physician in this field.
Orbital Mass With Features of Both Kimura Disease and Immunoglobulin G4-Related Disease
Authors: Lee Jung Hyun , Kim Jeong Hee , Lee Sang Un , Kim Sung Chul
Published: June 2018

Kimura disease has been known as a chronic inflammatory disease of unknown etiology, since the first report in 1937 and characterized by an increased eosinophil fraction in peripheral blood, increased serum immunoglobulin E (IgE) levels, and lymphoid granuloma with eosinophilic infiltration on histopathological examination. The authors present a 30-year-old man who visited their clinic with a 3-month history of protrusion and conjunctival injection of the right eye. Surgical mass resection was performed, and initial histopathology revealed Kimura disease. Additional immunohistochemical examination revealed IgG4-related disease in another hospital, which showed more than 80 IgG4-positive plasma cells per high-power field and an IgG4+/IgG+ ratio more than 40%. There are histopathological similarities, and several reports have suggested a relationship between Kimura disease and IgG4-related disease. Thus, it is difficult to classify them as completely different diseases. Kimura disease and IgG4 can be considered a part of a clinical spectrum of abnormal immune reactions.
Improvement in Both Primary and Eccentric Ocular Alignment After Thyroid Eye Disease-Strabismus Surgery With Tenon’s Recession
Authors: Scofield-Kaplan Stacy M. , Dunbar Kristen , Stein Gregory , Kazim Michael
Published: June 2018

Purpose:

To evaluate the improvement in primary and eccentric gaze ocular alignment in thyroid eye disease (TED) patients undergoing horizontal strabismus surgery with Tenon’s recession.

Methods:

This is an Institutional Review Board-approved retrospective analysis of TED patients undergoing horizontal strabismus surgery for esotropia. The study included all patients from 2007 to 2016 operated on by a single surgeon at Columbia University Medical Center. Surgical success was defined as the ability to fuse at both near and distance either without prismatic correction or with less than 10 prism diopters (PD) of correction. Measurements of ocular alignment were also made in eccentric fields of gaze. This study was Health Insurance Portability and Accountability Act compliant with protection of individually identifiable information.

Results:

Thirty-eight patients with TED and restrictive horizontal strabismus underwent unilateral or bilateral medial rectus recession to relieve diplopia. All patients underwent Tenon’s recession with dissection of Tenon’s from the overlying conjunctiva permitting it to retract into the orbit. Overall the success rate was 87% with a reoperation rate of 7.9%. The improvement in horizontal deviation in both primary and eccentric gaze was statistically significant (p < 0.001). The change in vertical deviation in the 5 cardinal positions of gaze was not statistically significant. The postoperative change in vertical deviation was not proportional to the preoperative horizontal deviation or the amount of horizontal recession.

Conclusions:

Due to the preoperative incomitance of ocular deviations in TED patients, persistent postoperative eccentric misalignment is expected. The addition of Tenon’s recession to TED-horizontal strabismus surgery led to statistically significant improvement in ocular alignment in both primary and eccentric gaze. This is the first study of TED-strabismus surgery to analyze the postoperative results in positions outside of primary and reading gaze. The authors postulate that the release of scar tissue by the addition of Tenon’s recession contributes to these improvements.
Epibulbar Mass With Upper Eyelid Cleft and Focal Scalp Alopecia in a Neonate: A New Case of Oculoectodermal Syndrome
Authors: Shoji Marissa K. , Saeed Hajirah N. , Habib Larissa A. , Freitag Suzanne K.
Published: June 2018

A female neonate presented with a pedunculated left lateral epibulbar mass protruding through the eyelids that originated from the temporal cornea and superolateral bulbar and palpebral conjunctiva. She had a cleft in the ipsilateral central upper eyelid with horizontal kink of the tarsus lateral to the cleft and focal patches of alopecia on the scalp. Histopathology of the epibulbar mass revealed conjunctival epithelium with underlying connective tissue, cartilage, bone, adipose, and lacrimal gland consistent with epibulbar dermoid. Genetic testing of the surgical specimen was positive for a KRAS mutation at position 146. MRI showed subarachnoid asymmetry around the left temporal lobe and a C1-C2 enhancing lesion. These clinical and molecular findings suggest that this patient has a new clinical variant of oculoectodermal syndrome, a rare disorder associated with somatic KRAS gene mutations and characterized clinically by epibulbar dermoids, alopecia, aplasia cutis, brain anomalies, umbilical hernias, and congenital heart defects.
Assessment of pruritus in atopic dermatitis: validation of the Severity of Pruritus Scale (SPS)
Authors: Yosipovitch Gil , Simpson Eric L. , Bushmakin Andrew G. , Cappelleri Joseph C. , Luger Thomas , Ständer Sonja , Tom Wynnis L. , Benjamin Katy , Ports William C. , Tallman Anna M. , Tan Huaming , Gerber Robert A.
Published: June 2018

Introduction:

Pruritus, or itch, is a central feature of atopic dermatitis (AD) and is often cited as the most bothersome symptom. The Severity of Pruritus Scale (SPS) is a 4-point rating scale adapted from the Atopic Dermatitis Severity Index to provide a measure of pruritus severity within a 24-hour recall period. The objective of this analysis was to assess the qualitative and quantitative validity of the SPS in AD.

Methods:

Content validity of the SPS was evaluated qualitatively in US patients with AD. Psychometric properties of the SPS were evaluated using data from 2 phase 3 trials conducted to investigate crisaborole in mild to moderate AD (study AD-301: NCT02118766; study AD-302: NCT02118792).

Results:

Fourteen patients were included in the qualitative analysis, considered adequate because of the single-item, single-concept nature of the SPS. Itch was the most prevalent symptom, and the SPS was easily understood and completed in US English (n=9) and US Spanish (n=5). The psychometric analysis used data from 1344 patients. Test-retest reliability analysis identified an intraclass correlation coefficient of 0.54 for a single SPS observation, and at least 0.70 when at least 2 SPS observations were averaged. SPS scores correlated with Investigator’s Static Global Assessment (ISGA) scores, measures of quality of life, and 4 of 5 signs of AD (Pearson correlations, ≥0.40 at day 29). The difference in score between the no disease group/clear (ISGA 0) and the severe disease group (ISGA 4) was 0.80. The clinically important difference was estimated to be 0.20 and the clinically important response was estimated to be at least a 0.19-point reduction from baseline.

Discussion:

The SPS is an appropriate tool to assess itch in patients with AD and is a valid and reliable measure of pruritus severity.
PICU Provider Supply and Demand: A National Survey
Authors: Gigli Kristin H. , Dietrich Mary S. , Buerhaus Peter I. , Minnick Ann F.
Published: June 2018

Objectives:

To describe physicians’ and nurse practitioners’ perceptions of the national and local PICU physician and other provider supply in institutions that employ PICU nurse practitioners, assess for differences in perceptions of supply, and evaluate the intent of institutions to hire additional nurse practitioners to work in PICUs.

Design:

National, quantitative, cross-sectional descriptive study via a postal mail survey from October 2016 to January 2017.

Setting:

Institutions (n = 140) identified in the 2015 American Hospital Association Annual Survey with a PICU who employ PICU nurse practitioners.

Subjects:

PICU physician medical directors and nurse practitioners.

Interventions:

None.

Measurements and Main Results:

There were 119 respondents, representing 93 institutions. Responses were received from 60 PICU medical directors (43%) and 59 lead nurse practitioners (42%). More than half (58%) of all respondents reported the national supply of PICU physicians is less than demand and 61% reported the local supply of PICU providers (physicians in all stages of training, nurse practitioners, and physician assistants) is less than demand. Of the respondents from institutions that self-reported a local provider shortage (n = 54), three fourths (78%) reported plans to increase the number of PICU nurse practitioners in the next 3 years and 40% were likely to expand the nurse practitioner’s role in patient care.

Conclusions:

Most PICU medical directors and lead nurse practitioners in institutions that employ PICU nurse practitioners perceived that national and local supply of providers to be less than the demand. Nurse practitioners are employed in PICUs as part of interdisciplinary models of care being used to address provider demand. The demand for more PICU nurse practitioners with expanded roles in care delivery was reported. Further evaluation of models of care and provider roles in care delivery can contribute to aligning provider supply with demand for care delivery.
Pain Neuroscience Education and Exercise for Neck Pain: A Focus Group Study on Adolescents' Views
Authors: Neto Maritza , Andias Rosa , Silva Anabela G.
Published: June 2018

Purpose:

To explore the views of adolescents with chronic idiopathic neck pain toward an intervention consisting of pain neuroscience education and exercise administered in the school setting.

Methods:

Four focus group interviews were conducted with 21 adolescents with chronic idiopathic neck pain who participated in a 4-week intervention consisting of pain neuroscience education and exercise. The interviews were transcribed verbatim and analyzed using content analysis.

Results:

Two main themes emerged: the perceived relevance of acquired knowledge and the perceived adequacy of the intervention.

Conclusion:

An intervention consisting of pain neuroscience education and exercise administered in the school setting is well accepted and considered relevant and appropriate by adolescents with chronic idiopathic neck pain.
Gait Analysis Parameters and Walking Activity Pre- and Postoperatively in Children With Cerebral Palsy
Authors: Nicholson Kristen , Lennon Nancy , Church Chris , Miller Freeman
Published: June 2018

Purpose:

This study examined the relationship between the Gait Deviation Index (GDI) and walking activity preoperatively and postoperatively.

Methods:

The GDI and walking activity from 74 youth with cerebral palsy (CP) were included in the analysis. The preoperative GDI was calculated using gait parameters collected during a clinical gait analysis 1 to 16 months prior to surgery. The postoperative GDI was calculated using gait parameters collected during a clinical gait analysis 10 to 26 months following surgery.

Results:

A weak correlation was present between the change in the average GDI and the change in strides. A moderate correlation was found between the change in the Surgery GDI and the change in strides.

Conclusion:

Single-event multilevel surgery improves gait deviations in children with CP. However, the improvement in gait pattern has limited correlation with postoperative change in walking activity. Our results demonstrate a need to pair surgical with additional intervention to affect long-term improvements in walking activity.
sEMG Analysis During Landing in Children With Autism Spectrum Disorder: A Pilot Study
Authors: Rosales Marcelo R. , Romack Jennifer , Angulo-Barroso Rosa
Published: June 2018

Purpose:

The aim was to explore the timing and duration of muscle activation during a landing task in children with autism spectrum disorder (ASD), and compare their responses to those of children who are developing typically (TD).

Methods:

Six children (ages 3-4.5 years), half with ASD, hung from a vertical bar, landed, and reacted to a light cue that signaled the child to run to the right or left or to stay in place. Electromyography and kinematics were recorded and compared between groups.

Results:

Children with ASD had more and longer bursts of muscle activation during preimpact. In contrast, children TD displayed more and longer burst of muscle activation during impact.

Conclusion:

The results suggest that children with ASD have a less developed landing strategy compared with their peers TD. Further investigation into the neuromuscular components in children with ASD will guide future interventions for this population.
Health Care Access and Receipt of Clinical Diabetes Preventive Care for Working-Age Adults With Diabetes in States With and Without Medicaid Expansion: Results from the 2013 and 2015 BRFSS
Authors: Luo Huabin , Chen Zhuo (Adam) , Xu Lei , Bell Ronny A.
Published: June 2018

Objective:

This study aimed to assess whether the recent Medicaid expansion, as a natural experiment, was associated with better access to care and, as a consequence, better receipt of clinical diabetes care services.

Methods:

Data were from the Behavioral Risk Factor Surveillance System (BRFSS). The analytical sample included 20 708 working-age adults with diabetes aged 18 to 64 years from 22 states. The outcome variables included 4 measures of access to care and 4 measures of receipt of clinical diabetes care services. A difference-in-difference logistic regression model was used to compare changes in outcomes between respondents in Medicaid expansion and nonexpansion states. Data from the 2013 survey provided pre-Medicaid expansion information, and data from the 2015 survey provided postexpansion information. Analyses were conducted using Stata 13 using survey commands to account for the complex survey design of BRFSS.

Results:

A significant increase was observed in health insurance coverage for people with diabetes from 2013 to 2015 (P < .05) in both Medicaid expansion and nonexpansion states, with a larger increase in the Medicaid expansion states. The Time by Medicaid expansion interaction term was significant for 2 measures of access to care: health insurance coverage (adjusted odds ratio [AOR] = 1.43, 95% confidence interval: 1.04-1.96) and having an annual checkup (AOR = 1.30, 95% confidence interval: 1.00-1.71). Respondents in expansion states were more likely to have a personal doctor and more likely to be able to afford a physician visit than those in nonexpansion states. The Time by Medicaid expansion was close to significance for one of the measures of clinical diabetes care: getting flu shots (AOR = 1.20, P = .08).

Conclusions:

Medicaid expansion did improve health care access but no significant improvement was found for receipt of clinical diabetes care for people with diabetes. Resources provided through Medicaid are vital for diabetes control and management.
Anxiety and Depression Symptoms in a General Population and Future Risk of Bloodstream Infection: The HUNT Study
Authors: Askim Åsa , Gustad Lise Tuset , Paulsen Julie , Reitan Solveig Klæbo , Mehl Arne , Mohus Randi Marie , Dewan Andrew , Damås Jan Kristian , Solligård Erik , Åsvold Bjørn Olav
Published: June 2018

Objective

We examined whether anxiety and depression symptoms constitute increased risk of bloodstream infection (BSI), as a proxy for sepsis.

Methods

A general population with self-reported anxiety and depression symptoms was followed prospectively for hospital-verified BSI. Using multivariable Cox regression analysis, we estimated hazard ratios (HR) with 95% confidence intervals (CI) of BSI and BSI mortality, with and without statistical adjustment for comorbidities, BMI, and life-style factors that may confound or mediate the associations.

Results

During 14.8 years median follow-up of 59,301 individuals, 1578 (2.7%) experienced BSI and 328 (0.55%) participants died within 30 days after a BSI. Severe depression symptoms were associated with a 38% increased risk of BSI, adjusted for age, sex, and education (HR = 1.38, 95% CI = 1.10–1.73). The HR was attenuated to 1.23 (0.96–1.59) after adjustment for comorbidities and to 1.15 (0.86–1.53) after additional adjustment for BMI and life-style factors. For severe anxiety symptoms, the corresponding HRs were 1.48 (1.20–1.83), 1.35 (1.07–1.70), and 1.28 (0.99–1.64). Moderate symptoms of depression and anxiety were not associated with increased BSI risk. The analysis of BSI mortality yielded imprecise results but suggested an increased risk of BSI mortality in participants with moderate depression symptoms.

Conclusions

Severe depression and anxiety symptoms were associated with a moderately increased risk of BSI. The association may, at least in part, be confounded or mediated by comorbidities, BMI, and life-style. Future research should investigate whether interventions targeting improved BMI and life-style may reduce the risk of BSI and sepsis in people with depression and anxiety symptoms.
Technological Advancements in Echocardiographic Assessment of Thoracic Aortic Dilatation
Authors: Ghulam Ali Sarah , Fusini Laura , Dalla Cia Alessia , Tamborini Gloria , Gripari Paola , Muratori Manuela , Mancini Maria E. , Annoni Andrea , Formenti Alberto , Pepi Mauro
Published: June 2018

Purpose:

The aim of this study was to evaluate the feasibility and accuracy of 2-dimensional (2D) and 3-dimensional (3D) transthoracic echocardiography (2DTTE, 3DTTE) versus multidetector computed tomography (MDCT) in patients with ascending aortic (AA) dilation.

Materials and Methods:

Fifty consecutive patients with AA dilation were evaluated by 2DTTE, X-plane (XP) 3DTTE, and MDCT. Aorta diameters were measured at aortic annulus, aortic root (SIN), sinotubular junction, AA, aortic arch before the prebrachiocephalic artery (PRE), and before left subclavian artery (INTRA). Leading edge-to-leading edge (L-L) and inner-to-inner (I-I) measurements were compared with MDCT data.

Results:

Feasibility, quality of imaging, and accuracy was high with all echocardiographic methods. Specifically for MDCT maximum SIN diameter, the best correlation and agreement was obtained using XP maximum diameter at 3DTTE (MDCT: 44.8±7.4 mm vs. XP: 44.4±7.4 mm; r=0.975; bias=−0.4 mm). The same was true for AA maximum diameter at MDCT (MDCT: 46.6±8.1 mm vs. XP: 47.5±8.1 mm; r=0.991; bias=0.1 mm). For aortic arch the best correlation and agreement with MDCT were as follows: 2DTTE L-L diameter for arch PRE (MDCT: 37.9±5.3 mm vs. TTE: 36.6±4.5 mm; r=0.927; bias=−0.9 mm) and MDCT minimum diameter with XP minimum diameter for arch INTRA (MDCT: 28.2±5.0 mm vs. TTE 28.8±4.7 mm; r=0.939; bias=−0.3 mm).

Conclusion:

In patients with aortic dilatation or aneurysm, new techniques (mainly 2D-3D probes allowing XP views) facilitate accuracy of aortic measurements at different sites of the vessel and allow standardization of analysis to better compare with MDCT.
Acetyl-11-Keto-β-Boswellic Acid Promotes Osteoblast Differentiation by Inhibiting Tumor Necrosis Factor-α and Nuclear Factor-κB Activity
Authors: Bai Fan , Chen Xuewu , Yang Hui , Xu Hong-Guang
Published: June 2018

Tumor necrosis factor (TNF) -α plays a crucial role in rheumatoid arthritis (RA)-related bone loss disease. The main mechanism of action of RA induced bone loss is the significant inhibitory effect of TNF-α on osteoblast differentiation. TNF-α inhibits osteoblast differentiation mainly by activating nuclear factor (NF) -κB signaling pathway. Owing to the crucial role of TNF-α and NF-κB in the inhibition of osteoblast differentiation, they are considered as targets for the development of therapeutic drugs. In the present study, we evaluated the NF-κB inhibitor Boswellic acid (BA) and its derivatives in the regulation of osteoblast differentiation and the molecular mechanism. Based on the cell model of TNF-α induced inhibition of osteoblast differentiation of MC3T3-E1, the regulatory role of BAs was studied. The result of MTT assay indicated that bone morphogenetic protein (BMP) -2, TNF-α, or acetyl-11-keto-β-BA (AKBA) impact no significant effect for cell viability of MC3T3-E1. The results of alkaline phosphatase (ALP activity assay and real-time polymerase chain reaction indicated that AKBA blocked TNF-α-induced inhibition of the expression of osteoblast markers, suggesting that AKBA rescued osteoblast differentiation from TNF-α-induced inhibition. Additionally, AKBA stimulated the BMP-2-induced expression of osteoblast markers, suggesting that AKBA promotes osteoblast differentiation directly. The results of western blotting and luciferase assay indicated that N-κB signaling was activated by TNF-α. The overexpression of NF-κB component p65 in MC3T3-E1 was found to attenuate the positive effect of AKBA in osteoblast differentiation, suggesting that AKBA potentiates osteoblast differentiation by inhibiting NF-κB signaling. Collectively, AKBA promotes osteoblast differentiation by inhibiting TNF-α and NF-κB. Our study revealed a new discovery of AKBA in regulating osteoblast differentiation, and demonstrated that AKBA may be a potential anabolic agent in the treatment of RA-derived bone loss disease.