bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of outcomes of pulmonary valve replacement in adult versus paediatric hospitals: institutional influence†
Authors: Fuller Stephanie , Ramachandran Abhinay , Awh Katherine , Faerber Jennifer A , Patel Prakash A , Nicolson Susan C , O’Byrne Michael L , Mascio Christopher E , Kim Yuli Y
Published: March 2019

OBJECTIVES

Controversy exists in ascertaining the ideal location for adults with congenital heart disease requiring surgical intervention. In this study, we sought to compare the perioperative management between our paediatric and adult hospitals and to determine how clinical factors and the location affect the length of stay after pulmonary valve replacement.

METHODS

A retrospective analysis of patients, ≥18 years of age, undergoing pulmonary valve replacement was conducted at our paediatric and adult hospitals between 1 January 2000 and 30 October 2014. Patients with previous Ross or concomitant left heart procedures were excluded. Descriptive statistics were used to assess demographics and clinical characteristics. Inverse probability weight-adjusted models were used to determine differences in the number of surgical complications, duration of mechanical ventilation and postoperative length of stay between paediatric and adult hospitals. Additional models were calculated to identify factors associated with prolonged length of stay.

RESULTS

There were altogether 98 patients in the adult (48 patients) and paediatric (50 patients) hospitals. Patients in the adult hospital were older with more comorbidities (arrhythmia, hypertension, depression and a history of cardiac arrest, all P < 0.05). Those at the paediatric hospital had better preoperative right ventricular function and less tricuspid regurgitation. The cardiopulmonary bypass time, the length of intubation and the length of stay were higher at the adult hospital, despite no difference in the number of complications between locations. Factors contributing to the increased length of stay include patient characteristics and postoperative management strategies. There were no deaths.

CONCLUSIONS

Pulmonary valve replacement may be performed safely with no deaths and with a comparable complication rate at both hospitals. Patients undergoing surgery at the adult hospital have longer intubation times and length of stay. Opportunities exist to streamline management strategies.
Open distal anastomosis in the frozen elephant trunk technique: initial experiences and preliminary results of arch zone 2 versus arch zone 3†
Authors: Leone Alessandro , Di Marco Luca , Coppola Giuditta , Amodio Ciro , Berardi Marianna , Mariani Carlo , Votano Daniela , Bacchi Reggiani Maria Letizia , Di Bartolomeo Roberto , Pacini Davide
Published: March 2019

OBJECTIVES

We compared the results of 2 groups of patients who underwent aortic arch replacement with the frozen elephant trunk technique. In the first group, the distal anastomosis was performed in arch zone 2; in the second control group, the distal anastomosis was performed in arch zone 3.

METHODS

Between January 2007 and April 2018, the frozen elephant trunk technique was used in 282 patients. The median age was 62 years (range 18–83 years), and 233 patients were men (82.6%). Two different frozen elephant trunk prostheses were used: the Jotec E-vita open prosthesis in 167 patients (59.2%) and the Vascutek Thoraflex hybrid prosthesis in 115 patients (40.8%). Patients were divided into 2 groups according to the distal anastomosis site: zone 2 group (69 patients) and zone 3 group (213 patients). The main indications were chronic aortic dissection (n = 164, 58.2%), degenerative aneurysm (n = 72, 25.5%) and acute aortic dissections (n = 45, 16%).

RESULTS

The overall in-hospital mortality rate was 17%: 20% for the zone 2 group and 16% for the zone 3 group, without significant differences, also in terms of cardiopulmonary bypass and myocardial ischaemia times. However, the visceral ischaemia time was significantly shorter for the zone 2 group, whereas the antegrade selective cerebral perfusion time was significantly longer for the same group. Recurrent laryngeal nerve injury rate was lower in the zone 2 group. The overall postoperative paraplegia rate was 3.5%, whereas the occurrence of permanent neurological dysfunction and dialysis was 9% and 19%, respectively, with no significant differences between the groups.

CONCLUSIONS

‘Proximalization’ of the distal anastomosis can be used for arch reconstruction, especially in complex cases such as reoperations or acute aortic dissections. Furthermore, with the aid of branched hybrid grafts, a reduction of the visceral ischaemia time is achieved.
Differential clinical features and long-term prognosis of acute aortic syndrome according to disease entity
Authors: Ahn Jung-Min , Kim Hoyun , Kwon Osung , Om Sang Yong , Heo Ran , Lee Sahmin , Kim Dae-Hee , Kim Ho Jin , Kim Joon Bum , Jung Sung Ho , Choo Suk Jung , Song Jong-Min , Kang Duk-Hyun , Chung Cheol Hyun , Lee Jae Won , Song Jae-Kwan
Published: March 2019

Aims

To evaluate the acute and long-term prognosis of acute aortic syndrome (AAS) according to the disease entity [intramural haematoma (IMH) vs. aortic dissection (AD)] and the anatomical location (type A vs. B).

Methods and results

A total of 1012 patients [672 with AD and 340 with IMH (33.6%)] were enrolled between 1993 and 2015. Compared with AD patients, IMH patients were older and had higher frequency of female sex and distal aorta involvement. The overall crude in-hospital mortality of AAS was 8.6%; type A AD [15.0%; adjusted hazard ratio (aHR) 30.4; 95% confidence interval (CI) 8.62–107.3; P < 0.001], type A IMH (8.0%; aHR 4.85; 95% CI 1.29–18.2; P = 0.019), type B AD (5.0%; aHR 3.51; 95% CI 1.00–12.4; P = 0.051), and type B IMH [1.5%; aHR 1.00 (reference)]. During a median follow-up duration of 8.5 years (interquartile range: 4.0–13.5 years), AD (aHR 2.78; 95% CI 1.87–4.14; P < 0.001) and type A (aHR 2.28; 95% CI 1.45–3.58; P < 0.001) was associated with a higher risk of aortic death. After 90 days, a risk of aortic death was no longer associated with anatomical location (aHR 0.74; 95% CI 0.40–1.36; P = 0.33), but remained associated with disease entity (aHR 1.83; 95% CI 1.10–3.04; P = 0.02).

Conclusion

The clinical features, response to treatment strategy, and outcomes of IMH patients were distinct from those of AD patients. Both early and late survival was better for IMH than for AD. In addition to the anatomical location of AAS, the disease entity is an independent factor associated with both acute and long-term mortality in patients with AAS. Further investigation is necessary to confirm the prognostic implication of disease entity in different patient populations.
The association between vegetation size and surgical treatment on 6-month mortality in left-sided infective endocarditis
Authors: Fosbøl Emil L , Park Lawrence P , Chu Vivian H , Athan Eugene , Delahaye Francois , Freiberger Tomas , Lamas Cristiane , Miro Jose M , Strahilevitz Jacob , Tribouilloy Christophe , Durante-Mangoni Emanuele , Pericas Juan M , Fernández-Hidalgo Nuria , Nacinovich Francisco , Rizk Hussein , Barsic Bruno , Giannitsioti Efthymia , Hurley John P , Hannan Margaret M , Wang Andrew ,   ICE-PLUS Investigators
Published: March 2019

Aims

In left-sided infective endocarditis (IE), a large vegetation >10 mm is associated with higher mortality, yet it is unknown whether surgery during the acute phase opposed to medical therapy is associated with improved survival. We assessed the association between surgery and 6-month mortality as related to vegetation size.

Methods and results

Patients with definite, left-sided IE (2008–2012) from The International Collaboration on Endocarditis prospective, multinational registry were included. We compared clinical characteristics and 6-month mortality (by Cox regression with inverse propensity of treatment weighting) between patients with vegetation size ≤10 mm vs. >10 mm in maximum length by surgical treatment strategy. A total of 1006 patients with left sided IE were included; 422 with a vegetation size ≤10 mm (median age 66.0 years, 33% women) and 584 (median age 58.4 years, 34% women) patients with a large vegetation >10 mm. Operative risk by STS-IE score was similar between groups. Embolic events occurred in 28.4% vs. 44.3% (P < 0.001), respectively. Patients with a vegetation >10 mm was associated with higher 6-month mortality (25.1% vs. 19.4% for small vegetation, P = 0.035). However, after propensity adjustment, the association with higher mortality persisted only in patients with a large vegetation >10 mm vs. ≤10 mm: hazard ratio (HR) 1.55 (1.27–1.90); but only in patients with large vegetation managed medically [HR 1.86 (1.48–2.34)] rather than surgically [HR 1.01 (0.69–1.49)].

Conclusion

Left-sided IE with vegetation size >10 mm was associated with an increased mortality at 6 months in this observational study but was dependent on treatment strategy. For patients with large vegetation undergoing surgical treatment, survival was similar to patients with smaller vegetation size.
Parents survive longer after stroke than childless individuals: a prospective cohort study of Swedes over the age of 65
Authors: Meyer Anna C , Torssander Jenny , Talbäck Mats , Modig Karin
Published: March 2019

Background

Parents have lower mortality than childless individuals, and one possible explanation is support provided by adult children. Since stroke often results in functional limitations, support from children may be of particular importance. Here, we examine whether the presence of children matters for survival after stroke among older Swedish men and women.

Methods

This prospective cohort study linked data from several Swedish population registers. Individuals aged 65 years and older hospitalized for their first ischemic stroke between 1998 and 2002 (33 960 men and 36 189 women) were followed 12 years for survival. Hazard ratios for all-cause mortality were calculated by number of children using Cox proportional hazard regression stratified by sex and marital status and adjusted for education, income and comorbidities.

Results

Childlessness and having only one child was associated with higher mortality after stroke compared with having two children among men and women. The relative survival disadvantage of childless individuals was largest among married women [HR 1.28 (1.18–1.39)] and smallest among married men [1.09 (1.03–1.15)]. The differences in predicted median survival between childless individuals and those with two children were 4 and 7 months among married and unmarried men, and 15 and 9 months among married and unmarried women, respectively.

Conclusions

Having children is associated with a longer survival after stroke among men and women regardless of marital status. Our findings further suggest that the presence of children is especially connected to married women’s survival. These results may have implications for the improvement of informal care for childless older individuals.
Drug development against human adenoviruses and its advancement by Syrian hamster models
Authors: Wold William S M , Tollefson Ann E , Ying Baoling , Spencer Jacqueline F , Toth Karoly
Published: March 2019

The symptoms of human adenovirus infections are generally mild and self-limiting. However, these infections have been gaining importance in recent years because of a growing number of immunocompromised patients. Solid organ and hematopoietic stem cell transplant patients are subjected to severe immunosuppressive regimes and cannot efficaciously eliminate virus infections. In these patients, adenovirus infections can develop into deadly multi-organ disseminated disease. Presently, in the absence of approved therapies, physicians rely on drugs developed for other purposes to treat adenovirus infections. As there is a need for anti-adenoviral therapies, researchers have been developing new agents and repurposing existing ones to treat adenovirus infections. There are several small molecule drugs that are being tested for their efficacy against human adenoviruses; some of these have reached clinical trials, while others are still in the preclinical phase. Besides these compounds, research on immunotherapy against adenoviral infection has made significant progress, promising another modality for treatment. The availability of an animal model confirmed the activity of some drugs already in clinical use while proving that others are inactive. This led to the identification of several lead compounds that await further development. In the present article, we review the current status of anti-adenoviral therapies and their advancement by in vivo studies in the Syrian hamster model.
A Phase I Randomized Clinical Trial of Evidence-Based, Pragmatic Interventions to Improve Functional Recovery After Hospitalization in Geriatric Patients
Authors: Deer Rachel R , Dickinson Jared M , Baillargeon Jacques , Fisher Steven R , Raji Mukaila , Volpi Elena
Published: March 2019

Background

Physical function declines during hospitalization in geriatric patients, increasing the risk of loss of independence. There is a need for evidence-based, pragmatic interventions to improve functional recovery of older adults following acute hospitalization. Here, we report the results of a Phase I randomized clinical trial designed to determine safety and effect size of protein supplementation, exercise, and testosterone interventions on 30-day post-discharge functional recovery and readmissions in geriatric patients.

Methods

A total of 100 patients admitted to the University of Texas Medical Branch hospital for an acute medical illness were randomized to one of five intervention groups: isocaloric placebo, whey protein supplement, in-home rehabilitation + placebo, in-home rehabilitation + whey protein, or testosterone. Primary outcome measure was the change from baseline in short physical performance battery score at 1 and 4 weeks post-discharge. Secondary outcomes were changes in body composition, activities of daily living, and 30-day readmissions. Comparisons were made across study groups and between placebo and all active intervention groups.

Results

Four weeks post-discharge, the short physical performance battery total score and balance score increased more in active intervention groups than placebo group (p < .05). There were no significant differences in change in body composition or activities of daily living across groups or between active intervention groups and placebo group. Readmission rates were highest in placebo (28%), followed by rehabilitation + placebo (15%), whey protein (12%), rehabilitation + whey protein (11%), and testosterone (5%). There was a trend for lower readmission rates in all active intervention groups (11%) versus placebo group (28%).

Conclusions

Findings from this Phase I clinical trial suggest that pragmatic, evidence-based interventions may accelerate recovery from acute hospitalization in geriatric patients. These data provide essential information to design larger randomized controlled trials to test the effectiveness of these interventions.
The use of aminoglycosides in animals within the EU: development of resistance in animals and possible impact on human and animal health: a review
Authors: van Duijkeren Engeline , Schwarz Christine , Bouchard Damien , Catry Boudewijn , Pomba Constança , Baptiste Keith Edward , Moreno Miguel A , Rantala Merja , Ružauskas Modestas , Sanders Pascal , Teale Christopher , Wester Astrid L , Ignate Kristine , Kunsagi Zoltan , Jukes Helen
Published: March 2019

Aminoglycosides (AGs) are important antibacterial agents for the treatment of various infections in humans and animals. Following extensive use of AGs in humans, food-producing animals and companion animals, acquired resistance among human and animal pathogens and commensal bacteria has emerged. Acquired resistance occurs through several mechanisms, but enzymatic inactivation of AGs is the most common one. Resistance genes are often located on mobile genetic elements, facilitating their spread between different bacterial species and between animals and humans. AG resistance has been found in many different bacterial species, including those with zoonotic potential such as Salmonella spp., Campylobacter spp. and livestock-associated MRSA. The highest risk is anticipated from transfer of resistant enterococci or coliforms (Escherichia coli) since infections with these pathogens in humans would potentially be treated with AGs. There is evidence that the use of AGs in human and veterinary medicine is associated with the increased prevalence of resistance. The same resistance genes have been found in isolates from humans and animals. Evaluation of risk factors indicates that the probability of transmission of AG resistance from animals to humans through transfer of zoonotic or commensal foodborne bacteria and/or their mobile genetic elements can be regarded as high, although there are no quantitative data on the actual contribution of animals to AG resistance in human pathogens. Responsible use of AGs is of great importance in order to safeguard their clinical efficacy for human and veterinary medicine.
E3 ligase Herc4 regulates Hedgehog signalling through promoting Smoothened degradation
Authors: Jiang Weirong , Yao Xia , Shan Zhaoliang , Li Wenting , Gao Yuxue , Zhang Qing
Published: March 2019

Hedgehog (Hh) signalling plays conserved roles in controlling embryonic development; its dysregulation causes many diseases including cancers. The G protein-coupled receptor Smoothened (Smo) is the key signal transducer of the Hh pathway, whose posttranslational regulation has been shown to be critical for its accumulation and activation. Ubiquitination has been reported an essential posttranslational regulation of Smo. Here, we identify a novel E3 ligase of Smo, Herc4, which binds to Smo, and regulates Hh signalling by controlling Smo ubiquitination and degradation. Interestingly, our data suggest that Herc4-mediated Smo degradation is regulated by Hh in PKA-primed phosphorylation-dependent and independent manners.
Identification of Candidates for Longer Lung Cancer Screening Intervals Following a Negative Low-Dose Computed Tomography Result
Authors: Robbins Hilary A , Berg Christine D , Cheung Li C , Chaturvedi Anil K , Katki Hormuzd A
Published: March 2019

Lengthening the annual low-dose computed tomography (CT) screening interval for individuals at lowest risk of lung cancer could reduce harms and improve efficiency. We analyzed 23 328 participants in the National Lung Screening Trial who had a negative CT screen (no ≥4-mm nodules) to develop an individualized model for lung cancer risk after a negative CT. The Lung Cancer Risk Assessment Tool + CT (LCRAT+CT) updates “prescreening risk” (calculated using traditional risk factors) with selected CT features. At the next annual screen following a negative CT, risk of cancer detection was reduced among the 70% of participants with neither CT-detected emphysema nor consolidation (median risk = 0.2%, interquartile range [IQR] = 0.1%–0.3%). However, risk increased for the 30% with CT emphysema (median risk = 0.5%, IQR = 0.3%–0.8%) and the 0.6% with consolidation (median = 1.6%, IQR = 1.0%–2.5%). As one example, a threshold of next-screen risk lower than 0.3% would lengthen the interval for 57.8% of screen-negatives, thus averting 49.8% of next-screen false-positives among screen-negatives but delaying diagnosis for 23.9% of cancers. Our results support that many, but not all, screen-negatives might reasonably lengthen their CT screening interval.
Conditional Bias Robust Estimation of the Total of Curve Data by Sampling in a Finite Population: An Illustration on Electricity Load Curves
Authors: Cardot Hervé , De Moliner Anne , Goga Camelia
Published: March 2019

For marketing or power grid management purposes, many studies based on the analysis of total electricity consumption curves of groups of customers are now carried out by electricity companies. Aggregated totals or mean load curves are estimated using individual curves measured at fine time grid and collected according to some sampling design. Due to the skewness of the distribution of electricity consumptions, these samples often contain outlying curves which may have an important impact on the usual estimation procedures. We introduce several robust estimators of the total consumption curve which are not sensitive to such outlying curves. These estimators are based on the conditional bias approach and robust functional methods. We also derive mean square error estimators of these robust estimators, and finally, we evaluate and compare the performance of the suggested estimators on Irish electricity data.
Plasmodium malariae in a Spanish traveller returning from Colombia
Authors: Aznar Maria Luisa , Zarzuela Francesc , Sulleiro Elena , Treviño Begoña , Serre Nuria , Pou Diana , Salvador Fernando , Sanchez-Montalvá Adrian , Bosch-Nicolau Pau , Molina Israel , Oliveira Ines
Published: March 2019

Plasmodium malariae is a rare cause of malaria in the WHO region of America, accounting for <0.1% of cases. We described a malaria case caused by Plasmodium malariae in a Spanish traveller returning from Colombia.
12 The Supreme Court and the European Convention on Human Rights
Authors: Brice Dickson
Published: March 2019

This chapter examines the engagement of the Irish Supreme Court with the European Convention on Human Rights. It reviews all of the occasions on which decisions of the Supreme Court have been reviewed by the European Commission or Court of Human Rights, cases such as Lawless, Norris, Open Door, Keegan, Heaney, Murphy, Independent News, Bosphorus Airways, McFarlane and O’Keeffe. The argument is made that, like the UK Supreme Court, Ireland’s top court has not been as committed to adopting the ECHR’s standards as it might have been and that the Court is still not adapting its own judgment-writing to take proper account of the jurisprudence of the European Court of Human Rights. That Court has frequently highlighted the inordinate delays which plagued the Irish Supreme Court in the 1990s. More could be done to integrate the European Court’s thinking into the way the Supreme Court goes about developing Ireland’s human rights law.
13 Conclusion
Authors: Brice Dickson
Published: March 2019

This chapter attempts to sum up the conclusions that can be drawn about the Irish Supreme Court from the surveys and analyses in foregoing chapters. It highlights the constraints placed on the Court’s decision-making, especially its lack of power to turn away many appeals. Some of the Court’s principal achievements are reviewed but some of the opportunities it has failed to exploit are also referred to. The future of the Court is considered, especially in light of the creation of the Court of Appeal in 2014. Attention is given to the importance of strong leadership at the Chief Justice level and to the need for more public pronouncements from the judges in lectures and conference papers. Final remarks are made on how the Court compares to supreme courts in other common law countries.
Soft Law, Authoritative Advice and Non-binding Agreements
Authors: Marmor Andrei
Published: March 2019

One of the most fascinating developments in the domain of international law in the last few decades is the astonishing proliferation of non-binding legal instruments or soft law, namely, norms or directives explicitly avoiding the imposition of legal obligations on the relevant parties. From a philosophical perspective, this is rather puzzling: how can we explain the idea of a non-binding directive or a non-binding contract? In this article I aim to provide an account of the rationale of soft law from the perspective of the practical reasons in play. First, I analyse the idea of authoritative advice, suggesting that when authorities advise their putative subjects, they purport to give the subject presumptive reasons for action. I explain what presumptive reasons are. Secondly, I suggest the possibility that something very similar is at work in cases of non-binding agreements, coupled with special accountability relations that such agreements invariably constitute.
Gender aspects in food allergy
Authors: Pali-Schöll Isabella , Jensen-Jarolim Erika
Published: March 2019

Purpose of review

The difference of food allergy prevalence between male and female individuals is well documented and should have more impact for personalized diagnosis and management. Although in younger age male sex dominates, in adults more women are affected by food allergies. This sex disparity diminishes again around menopause, underlining the influence of sex hormones, but in addition, also metabolic gender-specific factors and differences in microbiome composition might contribute to the different expression of food allergy in the two genders. The sex-dependent and gender-dependent influence on development of food allergy, disease severity, as well as on social, dietary and neuropsychological factors in studies mainly published within past 18 months are discussed in this review.

Recent findings

Sex and gender differences likely play a role in food allergy development, for instance via influence on immune cells and mediators, or on the composition of the microbiome, but only few controlled studies on this specific topic are available.

Future prospective studies need to clearly take into account the sex and gender difference in order to provide personalized diagnosis, management and treatment of food allergy.
Shifting Academic Health Centers From a Culture of Community Service to Community Engagement and Integration
Authors: Wilkins Consuelo H. , Alberti Philip M.
Published: March 2019

There is an increasing need for academic health centers (AHCs) to engage communities across their clinical, research, and educational missions. Although AHCs have a long-standing history of community service, a more comprehensive approach to working with communities is required to respond to shifts toward a population health paradigm, funder requirements for community engagement in research, and demands that medical education focus more on social and environmental determinants of health. Community engagement has been employed at many AHCs, though often in limited ways or relying heavily on students and faculty interested in serving communities. This limited involvement has been due, in part, to lack of infrastructure to support engagement, resource constraints, and the lack of a clear value proposition for long-term investments in community partnerships. However, there are compelling reasons for AHCs to take an enterprise-wide approach to working with communities. An enterprise-wide approach to community engagement will require reconsideration of communities, moving from viewing them as people or groups in need of service to seeing them as assets who can help AHCs better understand and address social determinants of health, enhance students’ and trainees’ ability to provide care, and increase the relevance and potential impact of research discoveries. To accomplish this, AHCs will need to establish the necessary infrastructure to support long-term community partnerships, adapt policies to support and reward engaged scholarship and teaching, and consider new ways of integrating community members in roles as advisors and collaborators across the AHC.
The Effect of Otoacoustic Emission Stimulus Level on the Strength and Detectability of the Medial Olivocochlear Reflex
Authors: Lewis James D.
Published: March 2019

Objectives:

Previous work demonstrates the importance of a high signal to noise ratio (SNR) when using transient evoked otoacoustic emissions (TEOAEs) to assay the medial olivocochlear reflex (MOCR). Increasing stimulus level provides one means to increase TEOAE SNR. However, this may come at the expense of a smaller MOCR effect. It is not clear whether the gain in SNR associated with the use of higher stimulus levels outweighs the disadvantage of a potentially smaller MOCR effect. The present study investigated the strength and detectability of the MOCR when assayed using TEOAEs at different stimulus levels. The hypothesis was that although the strength of the MOCR decreases with increasing stimulus level, the occurrence of statistically significant MOCR effects increases due to an increase in TEOAE SNR.

Design:

Twenty-five young adult females with normal hearing participated in the study. TEOAEs were measured in the right ear with and without broadband noise presented in the left ear. The strength of the MOCR was quantified as the percent difference in the TEOAE between the contralateral noise and quiet conditions. Statistical bootstrapping was used to detect significant MOCR effects in individual subjects across different frequency bands and stimulus levels. The relationship between a detectable MOCR (response variable) and frequency, stimulus level, TEOAE SNR, MOCR strength, and subject (predictor variables) was evaluated using generalized linear mixed-effect models.

Results:

The number of statistically significant MOCR effects increased with stimulus level at all frequencies. Occurrence was highest for the 2-kHz TEOAE frequency band and lowest for the 4-kHz frequency band. The strength of the MOCR decreased with increasing click level. TEOAE SNR, MOCR strength, and stimulus level were significant predictors of a detectable MOCR: The likelihood of a detectable MOCR increased with TEOAE SNR, MOCR strength, and stimulus level.

Conclusions:

Despite a reduction in the strength of the MOCR with increasing stimulus level, the detectability of the MOCR increased. This is due, in part, to an increase in TEOAE SNR with stimulus level. For clinical implementation of TEOAE-based MOCR assays, achieving a high SNR is necessary to permit the detection of the MOCR in individual patients.
Acute Kidney Injury in Critically Ill Patients After Noncardiac Major Surgery: Early Versus Late Onset
Authors: Li Shengnan , Wang Shu , Priyanka Priyanka , Kellum John A.
Published: March 2019

Objectives:

Acute kidney injury is a common complication of major surgery. However, acute kidney injury occurring within the first 48 hours after surgery (early acute kidney injury) and therefore likely related to the surgery itself is possibly different from acute kidney injury occurring after 48 hours (late acute kidney injury). The aim of this study was to describe the epidemiology and identify differences in risk factors and outcomes between early and late acute kidney injury following major surgery.

Design:

Retrospective cohort study.

Setting:

Academic Medical Center.

Patients:

Patients admitted to ICU following noncardiac major surgery.

Interventions:

None.

Measurements and Main Results:

We analyzed data from 3,499 patients and defined acute kidney injury according to full Kidney Disease: Improving Global Outcomes criteria and classified as early (48 hr or less) or late (> 48 hr to 7 d) based on time from surgery. Separate multivariable logistic regression models were fit to identify risk factors of early acute kidney injury compared with no acute kidney injury and risk factors of late acute kidney injury compared with no acute kidney injury. Overall 41.7% (1,459/3,499) developed early acute kidney injury versus 14.4% (504/3,499) late acute kidney injury. Most acute kidney injury occurred within 48 hours following surgery and 12 hours was the peak interval. Risk factors for early acute kidney injury included increased age, body mass index, decreased estimated glomerular filtration rate, and anemia, whereas late acute kidney injury cases were closely associated with postoperative factors, like sepsis, mechanical ventilation, positive fluid balance, blood transfusions and exposure to diuretics, vasopressors, and nonsteroidal anti-inflammatory drugs. After adjusting for age, body mass index, estimated glomerular filtration rate, comorbidities, surgery type, both early acute kidney injury (odds ratio [95% CI], 1.84 [1.50–2.27]) and late acute kidney injury (odds ratio [95% CI], 1.42 [1.09–1.85]) were associated with higher 1-year mortality compared with patients without acute kidney injury. We found similar results in a validation cohort of 10,723 patients admitted between 2008 and 2014.

Conclusions:

Most surgery-related acute kidney injury occurred within 48 hours of surgery. Acute kidney injury occurring within the first 48 hours was associated with underlying health, whereas acute kidney injury occurring after 48 hours was related to postoperative complications or drugs. Design of clinical and experimental interventions for acute kidney injury in this population should consider these differences.
Adjuvant systemic therapy in high-risk melanoma
Authors: Blankenstein Stephanie A. , van Akkooi Alexander C.J.
Published: March 2019

In resected high-risk melanoma (stage IIB/C-III) the risk of locoregional and/or distant recurrence is substantial and so far adjuvant therapies have been fairly unsuccessful. Interferon showed slight improvements in recurrence-free survival (RFS) but failed to convincingly improve overall survival (OS). In these patients, adjuvant therapy with treatments that show promising results in stage IV disease is arising. Studies using immune checkpoint blockade with anti-CTLA-4 and anti-PD-1 agents reveal convincing RFS benefits. OS rates, however, are not mature yet in most studies. Only ipilimumab has shown an OS benefit but at a high cost of toxicity. Also in studies with adjuvant targeted therapy using BRAF and MEK inhibitors, ensuring results are reported regarding RFS. As possible toxicity cannot be ignored, it is crucial to identify patients who would benefit most from these adjuvant therapies. In patients with clinically detectable lymph node metastases, studies using neoadjuvant schedules of immunotherapy and targeted therapy have been performed. In phase I and II studies the most optimal schedule of combination immunotherapy was identified and further research on this front will follow in the coming years. Concluding, after decades of scarce options for patients with high-risk melanoma, recent developments in adjuvant therapy have changed the standard of care for these patients.
Evaluating the Effects of Injected Calcium Hydroxylapatite on Changes in Human Skin Elastin and Proteoglycan Formation
Authors: González Noelani , Goldberg David J.
Published: March 2019

BACKGROUND

Previous studies have shown that calcium hydroxylapatite (CaHa) injected intradermally resulted in new collagen production at 6 months after injection, and a possible increase in elastin formation. In addition, a recent study showed the formation of new collagen, elastin, and angiogenesis after injection at 4 and 9 months.

OBJECTIVE

To evaluate any changes in the presence of elastic fibers, proteoglycans, and elastin in photodamaged skin after injections with CaHa.

METHODS AND MATERIALS:

Fifteen subjects underwent a punch biopsy of the right infra-auricular areas before and after injection of CaHa on day 180. Specimens were stained for elastic fibers, elastin, and proteoglycan presence.

RESULTS

Quantitative analysis demonstrated a percent change in elastic fibers varying between 29% and 179% at 6 months in comparison with baseline. Subjects showed an increase in elastin between 12% and 66%. Subjects had positive mean percentage change in proteoglycans of 76.27% (t-test of 0.198).

CONCLUSION

This is the first study to show that CaHa can increase proteoglycans and echoed previous studies showing it can also have an effect on elastin, which indicates it can induce remodeling of all aspects of the extracellular matrix. Much larger and longer studies are required to confirm its unique impact on collagen, elastin, and proteoglycans.
Effectiveness of Early Laser Treatment in Surgical Scar Minimization: A Systematic Review and Meta-analysis
Authors: Kent Rhett A. , Shupp Jeffrey , Fernandez Stephen , Prindeze Nick , DeKlotz Cynthia M.C.
Published: March 2019

BACKGROUND

Studies investigating the efficacy of lasers to minimize early surgical scars are low powered and report variable results. To further examine the evidence, the authors performed a systemic review and meta-analysis.

OBJECTIVE

To present the evidence of randomized controlled trials investigating the efficacy of laser modalities in minimizing surgical scars when applied <1 month after operation.

MATERIALS AND METHODS

A literature search of PubMed, EMBASE, Northern Light Life Sciences Conference Abstracts, and Cochrane Library was performed between November 6, 2015, and November 20, 2015. After assessing for inclusion, data extraction used the PRISMA checklist. Assessment for quality, validity, and risk of bias applied a scale devised by Jadad and colleagues, the Oxford Pain Validity Scale, and the RevMan risk of bias assessment tool, respectively. The GRADEpro application graded overall quality, and statistical analysis was performed with RevMan.

RESULTS

Approximately 4,373/4,397 abstracts and 16/24 full articles were excluded using predefined criteria, leaving 8 articles in the systematic review and 4 in the meta-analysis. The primary outcome reached statistical significance favoring the intervention group with standardized mean difference 0.39 (95% confidence interval, 0.05–0.74) and p = .03.

CONCLUSION

The outcome supports the efficacy of lasers in minimizing primarily closed surgical scars when treated <1 month after surgery.
Thread-Lifts: A Double-Edged Suture? A Comprehensive Review of the Literature
Authors: Tong Lana X. , Rieder Evan A.
Published: March 2019

BACKGROUND

Thread-lifting has experienced a recent surge in popularity as interest in minimally invasive techniques for facial rejuvenation continues to grow. By placing barbed sutures along specific trajectories to lift the superficial musculoaponeurotic system to address facial ptosis, thread-lifting carries several advantages over the traditional facelift. Over the past few decades, there have been ongoing advances in the implementation of thread-lifting using barbed sutures.

OBJECTIVE

To review the current evidence regarding the safety and efficacy of thread-lifting for facial rejuvenation.

MATERIALS AND METHODS

An analysis was conducted of PubMed indexed English language literature regarding thread-lifting using barbed sutures.

RESULTS

Early studies using nonabsorbable barbed sutures described high revision and complication rates. Newer techniques implementing absorbable sutures have fewer adverse events, although the long-term efficacy of these procedures remains unclear.

CONCLUSION

Thread-lifts play a substantial role in minimally invasive techniques for facial rejuvenation. Additional studies are needed to better evaluate the safety and long-term efficacy of this quick, in-office procedure.
Skin Quality Improvement With VYC-12, a New Injectable Hyaluronic Acid: Objective Results Using Digital Analysis
Authors: Cavallini Maurizio , Papagni Marco , Ryder Timothy J. , Patalano Mariagrazia
Published: March 2019

BACKGROUND

VYC-12 is a novel hyaluronic acid–based dermal filler designed to treat fine lines and improve skin quality. A specialist digital camera and proprietary Digital Analysis of the Cutaneous Surface (DACS) software have previously been used to objectively measure changes in skin features.

OBJECTIVE

To assess the effect of facial treatment with VYC-12 on skin texture using the specialist camera.

MATERIALS AND METHODS

This was a prospective, open-label, 2-center study of 40 women aged 35 to 60 years treated with multiple, microdepot intradermal injections of VYC-12 (2 mL in the face; 1 mL in the neck if required). Eight patients (20.0%) required a touch-up at Day 45. Images were acquired using the specialist camera at baseline and 45 days and 6 months after treatment, and were analyzed by DACS. Clinical improvements were also assessed subjectively using the Global Aesthetic Improvement Scale (GAIS).

RESULTS

VYC-12 improved skin texture from baseline after 45 days (mean improvement: 25.9% ± 9.2%) and 6 months (mean improvement: 30.7% ± 18.2%). Improvements were also evident using the GAIS. There were no major adverse events.

CONCLUSIONS

VYC-12 improves skin quality, as measured using an objective, fast, and reproducible measuring tool. VYC-12 represents a valuable addition to the treatment armamentarium.
Selection Bias When Estimating Average Treatment Effects Using One-sample Instrumental Variable Analysis
Authors: Hughes Rachael A. , Davies Neil M. , Davey Smith George , Tilling Kate
Published: March 2019

Participants in epidemiologic and genetic studies are rarely true random samples of the populations they are intended to represent, and both known and unknown factors can influence participation in a study (known as selection into a study). The circumstances in which selection causes bias in an instrumental variable (IV) analysis are not widely understood by practitioners of IV analyses. We use directed acyclic graphs (DAGs) to depict assumptions about the selection mechanism (factors affecting selection) and show how DAGs can be used to determine when a two-stage least squares IV analysis is biased by different selection mechanisms. Through simulations, we show that selection can result in a biased IV estimate with substantial confidence interval (CI) undercoverage, and the level of bias can differ between instrument strengths, a linear and nonlinear exposure–instrument association, and a causal and noncausal exposure effect. We present an application from the UK Biobank study, which is known to be a selected sample of the general population. Of interest was the causal effect of staying in school at least 1 extra year on the decision to smoke. Based on 22,138 participants, the two-stage least squares exposure estimates were very different between the IV analysis ignoring selection and the IV analysis which adjusted for selection (e.g., risk differences, 1.8% [95% CI, −1.5%, 5.0%] and −4.5% [95% CI, −6.6%, −2.4%], respectively). We conclude that selection bias can have a major effect on an IV analysis, and further research is needed on how to conduct sensitivity analyses when selection depends on unmeasured data.
A Latent Spatial Factor Approach for Synthesizing Opioid-Associated Deaths and Treatment Admissions in Ohio Counties
Authors: Hepler Staci , McKnight Erin , Bonny Andrea , Kline David
Published: March 2019

Background:

Opioid misuse is a major public health issue in the United States and in particular the state of Ohio. However, the burden of the epidemic is challenging to quantify as public health surveillance measures capture different aspects of the problem. Here, we synthesize county-level death and treatment counts to compare the relative burden across counties and assess associations with social environmental covariates.

Methods:

We construct a generalized spatial factor model to jointly model death and treatment rates for each county. For each outcome, we specify a spatial rates parameterization for a Poisson regression model with spatially varying factor loadings. We use a conditional autoregressive model to account for spatial dependence within a Bayesian framework.

Results:

The estimated spatial factor was highest in the southern and southwestern counties of the state, representing a higher burden of the opioid epidemic. We found that relatively high rates of treatment contributed to the factor in the southern part of the state, whereas relatively higher rates of death contributed in the southwest. The estimated factor was also positively associated with the proportion of residents 18–64 years of age on disability and negatively associated with the proportion of residents reporting white race.

Conclusions:

We synthesized the information in the opioid-associated death and treatment counts through a spatial factor model to estimate a latent factor representing the consensus between the two surveillance measures. We believe this framework provides a coherent approach to describe the epidemic while leveraging information from multiple surveillance measures.
The association between assisted reproductive technologies and low birth weight
Authors: Reig Andres , Seli Emre
Published: March 2019

Purpose of review

To examine the existing literature in regards to the relationship between assisted reproductive technologies (ART) and low birth weight (LBW).

Recent findings

In 2017, Martin et al. reported on the incidence of low birth weight in relation to the number of embryos transferred, and showed that incidence of low birth weight in singletons correlates with number of embryos transferred. Meanwhile, several studies have shown increased weight of singletons born after frozen embryo transfers compared with fresh embryo transfers. A recent study published by Sekhon et al., among others, disputes these findings, and claims that frozen and fresh embryo transfers result in comparable birth weights. It is also noteworthy that Mass et al., in 2016, analyzed how birth weight as a result of assisted reproductive technologies has evolved over the years, and concluded that birth weight has not changed significantly over a long period of time.

Newborns conceived via assisted reproductive technologies are three times more likely to have low birth weight. Although multiple gestation and its associated prematurity are the main risk factors for low birth weight in ART-conceived pregnancies, some of the other processes specific to assisted reproduction also impact perinatal outcomes. Options, such as fresh or frozen embryo transfers, the number of embryos transferred, or endometrial preparation may all importantly affect birth weight and prematurity of ART-conceived newborns.
Clinical Application of the Internal Mammary Artery Perforator Adipofascial Flap
Authors: Nishimon Mari , Ohara Hirotoshi , Ohara Kanetoshi , Ogata Hisao , Kishi Kazuo
Published: March 2019

Background:

Skin ulcers on the anterior chest wall are caused mainly by radiation therapy for breast cancer and anterior mediastinitis after thoracotomy, and they are often refractory. Some muscle flaps are commonly used for anterior chest wall reconstruction, but muscle flaps accompany high invasion. We used the internal mammary artery perforator (IMAP) adipofascial flap and IMAP skin flap for the anterior chest wall reconstruction.

Methods:

We examined the IMAPs using a handheld Doppler device and contrast-enhanced computerized tomography preoperatively. Each flap was designed based on the location of the IMAP and the size of the flap was dependent on the coverage required by the size and location of the skin ulcer. The location of the IMAPs functioned as the pivot point of the flap and the flap was flipped or swung on the defect.

Results:

We used IMAP adipofascial flap for 2 cases and IMAP skin flap for 1 case. In those 3 cases, we could elevate the flap with no complications even after the internal mammary artery had been harvested. There was no recurrence of the skin ulcer or wound infection after the operation.

Conclusions:

In this study, we reported 3 cases of skin ulcer on the anterior chest wall reconstructed with the IMAP adipofascial and skin flap. To our knowledge, this is the first report of the use of the IMAP flap as an adipofascial flap. The IMAP adipofascial flap accompanies less invasion than muscle flaps and the surgical procedure is relatively easy. The IMAP adopofascial flap is considered as one of the effective means for anterior chest wall reconstruction.