bluuebunny/crossref_metadata_2025 huggingface dataset:
Energy scaling of targeted optimal control of complex networks
Authors: Klickstein Isaac , Shirin Afroza , Sorrentino Francesco
Published: April 2017

Recently it has been shown that the control energy required to control a dynamical complex network is prohibitively large when there are only a few control inputs. Most methods to reduce the control energy have focused on where, in the network, to place additional control inputs. Here, in contrast, we show that by controlling the states of a subset of the nodes of a network, rather than the state of every node, while holding the number of control signals constant, the required energy to control a portion of the network can be reduced substantially. The energy requirements exponentially decay with the number of target nodes, suggesting that large networks can be controlled by a relatively small number of inputs as long as the target set is appropriately sized. We validate our conclusions in model and real networks to arrive at an energy scaling law to better design control objectives regardless of system size, energy restrictions, state restrictions, input node choices and target node choices.
Interactions of AMTN, ODAM and SCPPPQ1 proteins of a specialized basal lamina that attaches epithelial cells to tooth mineral
Authors: Fouillen Aurélien , Dos Santos Neves Juliana , Mary Charline , Castonguay Jean-Daniel , Moffatt Pierre , Baron Christian , Nanci Antonio
Published: April 2017

A specialized basal lamina (sBL) mediates adhesion of certain epithelial cells to the tooth. It is distinct because it does not contain collagens type IV and VII, is enriched in laminin-332, and includes three novel constituents called amelotin (AMTN), odontogenic ameloblast-associated (ODAM), and secretory calcium-binding phosphoprotein proline-glutamine rich 1 (SCPPPQ1). The objective of this study was to clarify the structural organization of the sBL. Fluorescence and immunogold labeling showed that the three proteins co-localize. Quantitative analysis of the relative position of gold particles on the sBL demonstrates that the distribution of ODAM is skewed towards the cell while that of AMTN and SCPPPQ1 tends towards the tooth surface. Bacterial two-hybrid analysis and co-immunoprecipitation, gel filtration of purified proteins and transmission electron and atomic force microscopies highlight the propensity of AMTN, ODAM, and SCPPPQ1 to interact with and among themselves and form supramolecular aggregates. These data suggest that AMTN, ODAM and SCPPPQ1 participate in structuring an extracellular matrix with the distinctive capacity of attaching epithelial cells to mineralized surfaces. This unique feature is particularly relevant for the adhesion of gingival epithelial cells to the tooth surface, which forms a protective seal that is the first line of defense against bacterial invasion.
Multiplex lexical networks reveal patterns in early word acquisition in children
Authors: Stella Massimo , Beckage Nicole M. , Brede Markus
Published: April 2017

Network models of language have provided a way of linking cognitive processes to language structure. However, current approaches focus only on one linguistic relationship at a time, missing the complex multi-relational nature of language. In this work, we overcome this limitation by modelling the mental lexicon of English-speaking toddlers as a multiplex lexical network, i.e. a multi-layered network where N = 529 words/nodes are connected according to four relationship: (i) free association, (ii) feature sharing, (iii) co-occurrence, and (iv) phonological similarity. We investigate the topology of the resulting multiplex and then proceed to evaluate single layers and the full multiplex structure on their ability to predict empirically observed age of acquisition data of English speaking toddlers. We find that the multiplex topology is an important proxy of the cognitive processes of acquisition, capable of capturing emergent lexicon structure. In fact, we show that the multiplex structure is fundamentally more powerful than individual layers in predicting the ordering with which words are acquired. Furthermore, multiplex analysis allows for a quantification of distinct phases of lexical acquisition in early learners: while initially all the multiplex layers contribute to word learning, after about month 23 free associations take the lead in driving word acquisition.
Nanotube enhanced carbon grids as top electrodes for fully printable mesoscopic semitransparent perovskite solar cells
Authors: Li F. R. , Xu Y. , Chen W. , Xie S. H. , Li J. Y.
Published: April 2017

Semitransparent solar cells have attracted significant attention for their potential applications, though obtaining high average visible transmittance (AVT) while maintaining good conversion efficiency is a challenge.
A series of water-soluble A–π–A′ typological indolium derivatives with two-photon properties for rapidly detecting HSO3−/SO32−in living cells
Authors: Zhu Yingzhong , Du Wei , Zhang Mingzhu , Xu Ying , Song Leilei , Zhang Qiong , Tian Xiaohe , Zhou Hongping , Wu Jieying , Tian Yupeng
Published: April 2017

It is believed that HSO3−and SO32−play important roles in several physiological processes.
Single-walled carbon nanotubes as optical probes for bio-sensing and imaging
Authors: Pan Jing , Li Feiran , Choi Jong Hyun
Published: April 2017

A review on the applications of single-walled carbon nanotube photoluminescence in biomolecular sensing and biomedical imaging.
Upper semicontinuity of the lamination hull
Authors: Harris Terence L.J.
Published: April 2017

Let  K ⊆ ℝ2×2 be a compact set, let Krc be its rank-one convex hull, and let L (K) be its lamination convex hull. It is shown that the mapping K ↦ L̅(K̅) is not upper semicontinuous on the diagonal matrices in ℝ2×2, which was a problem left by Kolář. This is followed by an example of a 5-point set of 2 × 2 symmetric matrices with non-compact lamination hull. Finally, another 5-point set K is constructed, which has L (K) connected, compact and strictly smaller than Krc.
Transition from diffuse to self-organized discharge in a high frequency dielectric barrier discharge
Authors: Belinger Antoine , Naudé Nicolas , Gherardi Nicolas
Published: April 2017

Depending on the operating conditions, different regimes can be obtained in a dielectric barrier discharge (DBD): filamentary, diffuse (also called homogeneous) or self-organized. For a plane-to-plane DBD operated at high frequency (160 kHz) and at atmospheric pressure in helium gas, we show that the addition of a small amount of nitrogen induces a transition from the diffuse regime to a self-organized regime characterized by the appearance of filaments at the exit of the discharge. In this paper, we detail mechanisms that could be responsible of the transition from diffuse mode to this self-organized mode. We point out the critical role of the power supply and the importance of the gas memory effect from one discharge to the following one on the transition to the self-organised mode. The self-organized mode is usually attributed to a surface memory effect. In this work, we show an additional involvement of the gas memory effect on the self-organized mode.
Draft genome of the lined seahorse, Hippocampus erectus
Authors: Lin Qiang , Qiu Ying , Gu Ruobo , Xu Meng , Li Jia , Bian Chao , Zhang Huixian , Qin Geng , Zhang Yanhong , Luo Wei , Chen Jieming , You Xinxin , Fan Mingjun , Sun Min , Xu Pao , Venkatesh Byrappa , Xu Junming , Fu Hongtuo , Shi Qiong
Published: April 2017

Background: The lined seahorse, Hippocampus erectus, is an Atlantic species and mainly inhabits shallow sea beds or coral reefs. It has become very popular in China for its wide use in traditional Chinese medicine. In order to improve the aquaculture yield of this valuable fish species, we are trying to develop genomic resources for assistant selection in genetic breeding. Here, we provide whole genome sequencing, assembly, and gene annotation of the lined seahorse, which can enrich genome resource and further application for its molecular breeding. Findings: A total of 174.6 Gb (Gigabase) raw DNA sequences were generated by the Illumina Hiseq2500 platform. The final assembly of the lined seahorse genome is around 458 Mb, representing 94% of the estimated genome size (489 Mb by k-mer analysis). The contig N50 and scaffold N50 reached 14.57 kb and 1.97 Mb, respectively. Quality of the assembled genome was assessed by BUSCO with prediction of 85% of the known vertebrate genes and evaluated using the de novo assembled RNA-seq transcripts to prove a high mapping ratio (more than 99% transcripts could be mapped to the assembly). Using homology-based, de novo and transcriptome-based prediction methods, we predicted 20 788 protein-coding genes in the generated assembly, which is less than our previously reported gene number (23 458) of the tiger tail seahorse (H. comes). Conclusion: We report a draft genome of the lined seahorse. These generated genomic data are going to enrich genome resource of this economically important fish, and also provide insights into the genetic mechanisms of its iconic morphology and male pregnancy behavior.
Economic Barriers in the Treatment of Clostridium difficile Infection With Oral Vancomycin
Authors: Bunnell Kristen L. , Danziger Larry H. , Johnson Stuart
Published: April 2017

Vancomycin is an increasingly important option for the treatment of Clostridium difficile infection, but economic barriers to its use remain significant in the outpatient setting. Generic vancomycin capsules are still inexplicably expensive and not universally covered by insurers. This report highlights the potential adverse consequences of cost-related nonadherence to vancomycin therapy and the challenges that clinicians face when prescribing oral vancomycin.
MicroRNA-21 Is Required for Local and Remote Ischemic Preconditioning in Multiple Organ Protection Against Sepsis*
Authors: Jia Ping , Wu Xiaoli , Dai Yan , Teng Jie , Fang Yi , Hu Jiachang , Zou Jianzhou , Liang Mingyu , Ding Xiaoqiang
Published: April 2017

Objective:

Sepsis, triggered by microbial infection, is a common and life-threatening systemic illness, often leads to impaired function of vital organs. Ischemic preconditioning induced by transient brief episodes of ischemia is a powerful innate mechanism of organ protection. We have reported that a 15-minute renal ischemic preconditioning substantially attenuated subsequent renal ischemia-reperfusion injury. Here, we investigate whether a brief ischemia and reperfusion in kidney can provide protection at local and remote sites against sepsis-induced organ injury, and whether this protection is microRNA-21 dependent.

Design:

Laboratory study.

Setting:

University laboratory.

Subjects:

Mouse renal tubular epithelial cells, C57BL/6 J wildtype (Animal Center of Fudan University, Shanghai, China) and microRNA-21–/– mice (B6.129-Mir21atm1Smoc, Shanghai Biomodel Organism Science & Technology Development Co. Shanghai, China).

Interventions:

Mouse renal tubular epithelial cells were treated with hypoxia (2% oxygen). Renal ischemic preconditioning was induced by bilateral renal pedicle clamping for 15 minutes, and sepsis was induced by a single intraperitoneal injection of lipopolysaccharide at a dose of 20 mg/kg or cecal ligation and puncture in mice.

Measurements and Main Results:

Mice treated with renal ischemic preconditioning were protected from endotoxemia or polymicrobial sepsis-induced multiple organ injury, including kidneys, heart, liver, and lungs. Renal ischemic preconditioning induced activation of hypoxia-inducible factor-1α in kidneys, which up-regulated microRNA-21 at transcriptional level, subsequently, leading to increased expression of microRNA-21 in serum exosomes and remote organs, resulting in decreased apoptosis and reduced proinflammatory cytokines production in these organs. In vivo knockdown of microRNA-21 or genetic deletion of microRNA-21 abrogated the organoprotective effects conferred by renal ischemic preconditioning. Mechanistically, we discovered that knockdown of microRNA-21 increased programmed cell death protein 4 expression and nuclear factor-kappa B activity, decreased expression of anti-apoptotic B-cell lymphoma-2.

Conclusion:

MicroRNA-21 is required for local and remote ischemic preconditioning in multiple organ protection against sepsis, and up-regulation of miR-21 may be a potential therapy for sepsis.
ICU Patients Requiring Renal Replacement Therapy Initiation: Fewer Survivors and More Dialysis Dependents From 80 Years Old
Authors: Commereuc Morgane , Guérot Emmanuel , Charles-Nelson Anais , Constan Adrien , Katsahian Sandrine , Schortgen Frédérique
Published: April 2017

Objectives:

To assess the role of advanced age on survival and dialysis dependency after initiation of renal replacement therapy for acute kidney injury.

Design:

Retrospective pooled analysis of prospectively collected data.

Setting:

ICUs of two teaching hospitals in Paris area, France.

Subjects:

One thousand five hundred thirty adult patients who required renal replacement therapy initiation in the ICU.

Interventions:

None.

Measurements and Main Results:

Survival and post acute kidney injury chronic dialysis dependency were assessed at hospital discharge according to the quintile (Q) of age. The oldest quintile included 289 patients 80 years old and over. Seventy-three percent of included patients had respiratory and hemodynamic supports at renal replacement therapy initiation, similarly distributed across quintiles. Mortality increased with age strata from 63% in Q1 (≤ 52 yr) to 76% in Q5 (≥ 80 yr) (p < 0.001). After adjustment, age did not increase the risk of death up to 80 years. The oldest patients (≥ 80 yr) had a significant higher risk of dying (adjusted odds ratio, 2.59; 95% CI, 1.66–4.03). Dialysis dependency was more frequent among survivors 80 years old or older (30% vs 14%; p = 0.001). Age 80 years old or older was an independent risk for dialysis dependency only for patients with prior advanced chronic kidney disease (p = 0.04). Baseline estimated glomerular filtration rate was the only one predictor of dialysis dependency identified.

Conclusions:

Patients with advanced age represent a substantial subgroup of patients requiring renal replacement therapy in the ICU. From 80 years, age should be considered as an additional risk of dying over the severity of organ failures. Patients 80 years old or older are likely to recover sufficient renal function allowing renal replacement therapy discontinuation when baseline estimated glomerular filtration rate is above 44 mL/min/1.73 m2. At 3 months, only 6% were living at home, dialysis independent.
Heart Rate Modification of Cardiac Output Following Cardiac Surgery: The Importance of Cardiac Time Intervals*
Authors: Tavazzi Guido , Kontogeorgis Andy , Guarracino Fabio , Bergsland Niels , Martinez-Naharro Ana , Pepper John , Price Susanna
Published: April 2017

Objectives:

Inadequate cardiac output is associated with a poor outcome following cardiac surgery and is generally modified by the use of positive inotropic agents, volume resuscitation, and pacing. Echocardiography-guided pacemaker optimization is used in the outpatient setting, using different variables including total isovolumic time and the Tei index. We sought to determine the acute impact of heart rate on cardiac electromechanics, cardiac output, and stroke volume in the perioperative setting.

Design:

Observational study.

Setting:

Cardiothoracic adult intensive care department.

Patients:

Twenty-four sequential patients admitted after cardiac surgery.

Interventions:

Patients with pacemaker set by the treating anesthesiologist using hemodynamic parameters in theatre, within 4 hours of returning to intensive care, they were reassessed using transthoracic echocardiography. A comprehensive baseline echocardiographic study was performed at the clinician set RR interval and at heart rates from 70 to 110 beats/min, in increments of 10 beats/min. Pearson correlation coefficients were used to assess relationships between the measurements.

Measurements and Main Results:

Cardiac output and cardiac index were increased significantly in 79% patients using echocardiography-guided pacemaker optimization (2.21 L/min [± 0.97] and 1.2 L/min/m2 [± 0.52]). The echocardiography-driven cardiac output optimization protocol led to a significant reduction of total isovolumic time with concurrent increase of cardiac output and cardiac index in the overall population (p < 0.001). There was no consistent correlation between changes in RR interval and stroke volume, cardiac output, or cardiac index in the overall population. A strong negative correlation was found between the left ventricular total isovolumic time and stroke volume, cardiac output, and cardiac index in all groups.

Conclusion:

Echocardiography-guided heart rate optimization results in a significant increase in cardiac output when compared with clinically derived pacing settings in the postoperative period. The optimal heart rate should be individualized for each patient, and total isovolumic time is the echocardiographic index with the highest sensitivity to determine the optimal hemodynamic profile.
Organizational Issues, Structure, and Processes of Care in 257 ICUs in Latin America: A Study From the Latin America Intensive Care Network
Authors: Estenssoro Elisa , Alegría Leyla , Murias Gastón , Friedman Gilberto , Castro Ricardo , Nin Vaeza Nicolas , Loudet Cecilia , Bruhn Alejandro , Jibaja Manuel , Ospina-Tascon Gustavo , Ríos Fernando , Machado Flavia R. , Biasi Cavalcanti Alexandre , Dubin Arnaldo , Hurtado F. Javier , Briva Arturo , Romero Carlos , Bugedo Guillermo , Bakker Jan , Cecconi Maurizio , Azevedo Luciano , Hernandez Glenn
Published: April 2017

Objective:

Latin America bears an important burden of critical care disease, yet the information about it is scarce. Our objective was to describe structure, organization, processes of care, and research activities in Latin-American ICUs.

Design:

Web-based survey submitted to ICU directors.

Settings:

ICUs located in nine Latin-American countries.

Subjects:

Individual ICUs.

Interventions:

None.

Measurements and Main Results:

Two hundred fifty-seven of 498 (52%) of submitted surveys responded: 51% from Brazil, 17% Chile, 13% Argentina, 6% Ecuador, 5% Uruguay, 3% Colombia, and 5% between Mexico, Peru, and Paraguay. Seventy-nine percent of participating hospitals had less than 500 beds; most were public (59%) and academic (66%). ICUs were mainly medical-surgical (75%); number of beds was evenly distributed in the entire cohort; 77% had 24/7 intensivists; 46% had a physician-to-patient ratio between 1:4 and 7; and 69% had a nurse-to-patient ratio of 1 ≥ 2.1. The 24/7 presence of other specialists was deficient. Protocols in use averaged 9 ± 3. Brazil (vs the rest) had larger hospitals and ICUs and more quality, surveillance, and prevention committees, but fewer 24/7 intensivists and poorer nurse-to-patient ratio. Although standard monitoring, laboratory, and imaging practices were almost universal, more complex measurements and treatments and portable equipment were scarce after standard working hours, and in public hospitals. Mortality was 17.8%, without differences between countries.

Conclusions:

This multinational study shows major concerns in the delivery of critical care across Latin America, particularly in human resources. Technology was suboptimal, especially in public hospitals. A 24/7 availability of supporting specialists and of key procedures was inadequate. Mortality was high in comparison to high-income countries.
Risk Factors for Pediatric Extubation Failure: The Importance of Respiratory Muscle Strength*
Authors: Khemani Robinder G. , Sekayan Tro , Hotz Justin , Flink Rutger C. , Rafferty Gerrard F. , Iyer Narayan , Newth Christopher J. L.
Published: April 2017

Objective:

Respiratory muscle weakness frequently develops during mechanical ventilation, although in children there are limited data about its prevalence and whether it is associated with extubation outcomes. We sought to identify risk factors for pediatric extubation failure, with specific attention to respiratory muscle strength.

Design:

Secondary analysis of prospectively collected data.

Setting:

Tertiary care PICU.

Patients:

Four hundred nine mechanically ventilated children.

Interventions:

Respiratory measurements using esophageal manometry and respiratory inductance plethysmography were made preextubation during airway occlusion and on continuous positive airway pressure of 5 and pressure support of 10 above positive end-expiratory pressure 5 cm H2O, as well as 5 and 60 minutes postextubation.

Measurements and Main Results:

Thirty-four patients (8.3%) were reintubated within 48 hours of extubation. Reintubation risk factors included lower maximum airway pressure during airway occlusion (aPiMax) preextubation, longer length of ventilation, postextubation upper airway obstruction, high respiratory effort postextubation (pressure rate product, pressure time product, tension time index), and high postextubation phase angle. Nearly 35% of children had diminished respiratory muscle strength (aPiMax ≤ 30 cm H2O) at the time of extubation, and were nearly three times more likely to be reintubated than those with preserved strength (aPiMax > 30 cm H2O; 14% vs 5.5%; p = 0.006). Reintubation rates exceeded 20% when children with low aPiMax had moderately elevated effort after extubation (pressure rate product > 500), whereas children with preserved aPiMax had reintubation rates greater than 20% only when postextubation effort was very high (pressure rate product > 1,000). When children developed postextubation upper airway obstruction, reintubation rates were 47.4% for those with low aPiMax compared to 15.4% for those with preserved aPiMax (p = 0.02). Multivariable risk factors for reintubation included acute neurologic disease, lower aPiMax, postextubation upper airway obstruction, higher preextubation positive end-expiratory pressure, higher postextubation pressure rate product, and lower height.

Conclusions:

Neuromuscular weakness at the time of extubation was common in children and was independently associated with reintubation, particularly when postextubation effort was high.
Connective Tissue Nevi: A Review of the Literature
Authors: Arora Harleen , Falto-Aizpurua Leyre , Cortés-Fernandez Andrea , Choudhary Sonal , Romanelli Paolo
Published: April 2017

Connective tissue nevi (CTN) are hamartomas of the dermis, with the 3 main components being collagen, elastin, and proteoglycans. Each subtype can present as a solitary lesion or multiple lesions. They could present as part of systemic diseases or inherited disorders. This article provides a comprehensive literature review of the different types of CTN, their clinical presentations, associations, and treatment options. Treatment options for 56 lesions were reviewed. Fifty-two percent of lesions were present in males, and the age range at the time of presentation was wide (1.6–80 years). Management varied according to CTN subtypes. Most lesions (14) received topical or intralesional treatment with corticosteroids, followed by surgical removal of lesions (12), whereas the remaining lesions were clinically monitored.
Cardioprotection by Low-dose of Estrogen and Testosterone at the Physiological Ratio on Ovariectomized Rats During Ischemia/Reperfusion Injury
Authors: Fu Lu , Liu Yuyu , Wang Jiaxing , Sun Yu , Zhang Lei , Wu Ting , Li Yiqian , Wang Bin , Huang Shuting , Bu Huimin , Sun Hong
Published: April 2017

Although estrogen and testosterone deficiency have often been associated with the development of cardiac diseases in postmenopausal women, the benefits of estrogen or testosterone therapy are controversial. Supplementation with high dose of estrogen or testosterone alone has been associated with many side effects, especially estrogen. This study was aimed to investigate whether supplementation of testosterone in combination with low-dose estrogen conferred stronger cardioprotective effects on ovariectomized rats subjected to ischemia/reperfusion injury. Female Sprague Dawley rats were subjected to sham operation (Sham) or bilateral ovariectomy (OVX). Two weeks after ovariectomy, OVX rats were treated with one of the following: (1) vehicle (OVX), (2) testosterone (100 μg·kg−1·d−1) (OVX+T), (3) estrogen (20 μg·kg−1·d−1) (OVX+E), (4) testosterone (100 μg·kg−1·d−1) + estrogen (20 μg·kg−1·d−1) (OVX+T+E) for 4 weeks. The hearts were mounted on the Langendorff apparatus and subjected to ischemia/reperfusion injury subsequent to the determination of hemodynamic parameters. We examined the release of lactate dehydrogenase, serum estrogen, and testosterone levels and the expression of pAkt/Akt and bax/bcl-2. Testosterone supplementation alone improved the heart function, increased p-Akt/Akt and bcl-2 expression, and decreased the release of lactate dehydrogenase. Accordingly, these effects of testosterone were more pronounced when low-dose estrogen was administered simultaneously, whereas estrogen alone at the dose of the experiment had no significant effects. These effects might be partially orchestrated by the Akt signaling pathway.
A 10-year Follow-up of a Free Vascularized Fibula Flap Clavicle Reconstruction in an Adult
Authors: Ye Louie , Taylor G. Ian
Published: April 2017

The free vascularized fibula flap has been widely used for clavicle reconstruction. Limited evidence exists for the long-term outcome of clavicle reconstruction using the free vascularized fibula flap in adults. We report the functional and aesthetic outcome in a 52-year old man a decade after clavicle reconstruction using a free vascularized fibula flap in combination with a modified Richardson Hook Plate. At the 10-year follow-up, panoramic shoulder X-ray showed the modified Richardson Hook Plate had remained firmly in place with the fibula and the hook positioned beneath the acromion. Functionally, the patient presented with a constant shoulder score of 77, with a pain-free symmetrical full range of motion. In conclusion, reconstruction of lateral clavicle defect using free vascularized fibula flap in conjunction with modified Richardson Hook plate may provide patients with excellent long-term functional and aesthetic outcomes.
Axial Length and Anterior Segment Alterations in Former Preterm Infants and Full-Term Neonates Analyzed With Scheimpflug Imaging
Authors: Fieß Achim , Kölb-Keerl Ruth , Knuf Markus , Kirchhof Bernd , Blecha Christiane , Oberacher-Velten Isabel , Muether Philipp S. , Bauer Jacqueline
Published: April 2017

Purpose:

To compare the axial length and anterior segment alterations in preterm infants with and without retinopathy of prematurity with those of full-term infants.

Methods:

The Wiesbaden Prematurity Study investigated 503 participants of former gestational age ≤32 weeks and gestational age ≥37 weeks now being aged 4 to 10 years. This study included 485 participants in the prospective controlled cross-sectional, hospital-based study with successful Pentacam Scheimpflug imaging. Anterior segment parameters, axial length measurements, and associated factors were analyzed.

Results:

Corneal thickness did not differ between former preterm and full-term infants. Significant differences were found between preterm and full-term infants now aged ≤7 years for spherical equivalent, astigmatism, corneal diameter, and axial length. In preterm infants aged ≥8 years compared with full terms of the same age, we found a significant difference only in the corneal diameter. In multivariable analysis of the corneal diameter, we detected an association with birth weight and perinatal adverse events. Astigmatism correlated with birth weight and laser treatment, anterior chamber depth with birth weight, laser treatment and age at examination, and axial length with birth weight and age at examination.

Conclusions:

This study demonstrated altered axial length and anterior segment morphology in former preterm infants, especially in the first years of life. In addition, we observed that preterm infants seemed to catch up, so that the differences in ocular growth in terms of spherical equivalent, astigmatism, and axial length decreased within the first 8 years of life.
Descemet Membrane Endothelial Keratoplasty After Failed Descemet Stripping Without Endothelial Keratoplasty
Authors: Rao Rohini , Borkar Durga S. , Colby Kathryn A. , Veldman Peter B.
Published: April 2017

Purpose:

To describe the clinical course, surgical experience, and postoperative outcomes of 3 patients with Fuchs endothelial dystrophy who underwent Descemet membrane endothelial keratoplasty (DMEK) after failed Descemet stripping without endothelial keratoplasty.

Methods:

Three patients who underwent DMEK for management of persistent corneal edema after deliberate Descemet stripping in the setting of Fuchs endothelial dystrophy were identified. Patients were examined at day 1, week 1, and months 1, 3, and 6 after DMEK. Visual acuity, central corneal thickness (CCT), and evaluation of central corneal endothelial cell counts were recorded.

Results:

Two women and one man, aged 56, 72, and 68 years, were included. The time interval between primary Descemet stripping and DMEK ranged from 3.5 to 8 months. Preoperative visual acuities were 20/200, 20/300, and 20/80. Immediately before DMEK, no patients had countable central endothelial cells, and CCTs were 825, 1034, and 878 μm. After DMEK, all patients had improvement in visual acuity to 20/70, 20/20, and 20/20 with CCTs of 529, 504, and 528. The postoperative period in the first case was notable for the immediate development of a pigmented pupillary membrane with posterior synechiae, as well as cystoid macular edema, of uncertain chronicity, noted 1 month postoperatively. The second case also developed posterior synechiae. Two cases completed 6-month endothelial cell counts totaling 2200 and 3114 cells per square millimeter (endothelial cell loss of 13% and 5.3%).

Conclusions:

DMEK is a reliable procedure to facilitate corneal rehabilitation and visual recovery in the event of poor corneal clearance after Descemet stripping without endothelial keratoplasty.
Clinical Outcome of Rebubbling for Graft Detachment After Descemet Membrane Endothelial Keratoplasty
Authors: Gerber-Hollbach Nadine , Baydoun Lamis , López Ester Fernández , Frank Laurence E. , Dapena Isabel , Liarakos Vasilios S. , Schaal Sontje-Chiao , Ham Lisanne , Oellerich Silke , Melles Gerrit R. J.
Published: April 2017

Purpose:

To assess the clinical outcome after successful rebubbling procedures for visually significant graft detachment after Descemet membrane endothelial keratoplasty (DMEK).

Methods:

From a total of 760 consecutive DMEK surgeries, 41 eyes required rebubbling. Of those, 33 eyes of 31 patients were successful and were included in our retrospective outcome analysis study. Main outcome measures were compared with those of matched controls with uneventful primary DMEK (attached DMEK grafts without rebubbling). Rebubbling was performed on average 25 (±20) days (range 7–91 days) after DMEK. All eyes were evaluated for best-corrected visual acuity, endothelial cell density (ECD), pachymetry, and complications up to 6 months after rebubbling.

Results:

At 6 months after DMEK, best-corrected visual acuity in rebubbled eyes did not differ from that in control eyes (P = 0.514). The mean ECD decrease was higher in rebubbled than in control eyes (54% vs. 35%, respectively, P = 0.001). Pachymetry did not differ between both groups (P = 0.153). After rebubbling, one buphthalmic eye showed temporary intraocular pressure elevation and 5 eyes had minor graft edge detachment that did not require further treatment.

Conclusions:

Rebubbling for DMEK graft detachment may result in similar visual outcomes as in uncomplicated DMEK, when performed within the first 6 to 8 postoperative weeks. However, rebubbled eyes may have lower ECD, which may be attributed to additional air bubble trauma and/or selection bias through more extensive manipulation during initial DMEK or higher risk of graft detachment in more complicated eyes.
Pain Management in the Opioid-Dependent Pregnant Woman
Authors: Safley Rebecca R. , Swietlikowski Jamie
Published: April 2017

Opioid dependence is an epidemic in the United States, and the percentage of pregnant women who are opioid dependent has increased dramatically in the last decade. Pain management, already a concern for intrapartum and postpartum care, is complicated in the context of opioid dependence. This clinical review surveys the literature on pain management in opioid-dependent pregnant women to summarize current consensus and evidence to guide clinical practice. Points of consensus for pain management in opioid-dependent pregnant women include continual opioid maintenance therapy throughout the pregnancy and the postpartum period; adequate management of acute pain; the contraindication of opioid agonist-antagonists for pain management; and the need for interdisciplinary teams using a multimodal approach to provide optimal care to opioid-dependent pregnant women.
Neurobiological Consequences of Early Painful Experience
Authors: Young Erin E. , D'Agata Amy , Vittner Dorothy , Baumbauer Kyle M.
Published: April 2017

As healthcare teams have worked to improve infant survival rates, the management of painful events experienced by these hospitalized neonates has increased and yet pain management remains highly variable between healthcare institutions. At the same time, emerging evidence suggests that these early painful experiences may alter the trajectory of development for pain-processing pathways both peripherally and centrally. This concise review highlights findings from both the basic and clinical science literature supporting the hypothesis that early painful experiences can have long-lasting negative effects on biological, psychological, and socioemotional functions. Implications for pain management in neonates and considerations for evidence-based practice change are discussed.
Intratympanic Dexamethasone in the Treatment of Ménière's Disease: A Comparison of Two Techniques
Authors: Beyea Jason A. , Instrum Ryan S. , Agrawal Sumit K. , Parnes Lorne S.
Published: April 2017

Objective:

To assess the efficacy and safety of two different intratympanic dexamethasone (IT Dex) injection protocols for intractable unilateral Ménière's disease.

Study Design:

Prospective case series.

Setting:

Tertiary neurotology clinic.

Patients:

One hundred six consecutive adult patients with definite unilateral Ménière's disease who had failed medical management were studied for an average of 1,061 days. None had previous oral steroid, IT steroid, or ablative treatment.

Interventions:

Two different IT Dex regimes, either a single injection or a series of four injections, that were subsequently repeated as indicated.

Main Outcome Measure:

Requirement for subsequent ablative therapy in the form of intratympanic gentamicin, vestibular nerve section, or labyrinthectomy. Hearing outcomes were measured using pure-tone average of 0.5, 1, 2, and 3 kHz on standard audiometry.

Results:

The number of intratympanic dexamethasone injections per patient ranged from 1 to 29 (median = 4). Using the Kaplan–Meier method, predicted survival (patients not requiring ablative therapy) at 2 and 4 years after initial treatment was 83.9 and 79.3%, respectively. The injection series protocol ultimately yielded 5% better survival than the single injection protocol, but this was not statistically significant. Injections did not protect against hearing loss, and the most recent pure-tone averages declined compared with pretreatment values by an average of 8.27 dB (p < 0.05). The treatments did not result in any acute hearing losses, permanent tympanic membrane perforations, or other significant adverse events.

Conclusion:

Intratympanic dexamethasone injections were successful in controlling vertigo insofar as they were able to obviate ablative therapy in the majority of Ménière's disease patients in this study. The injection series protocol may have been more beneficial compared with the single injection, although the difference between the two protocols was nonsignificant. Hearing mildly declined over the treatment course, which likely represents natural disease progression. The lack of adverse events suggests that IT Dex may be a nonablative option for patients with bilateral disease or only hearing/vestibular ears.
Medical Expenditures Associated With Diabetes Among Youth With Medicaid Coverage
Authors: Shrestha Sundar S. , Zhang Ping , Thompson Theodore J. , Gregg Edward W. , Albright Ann , Imperatore Giuseppina
Published: April 2017

Background:

Information on diabetes-related excess medical expenditures for youth is important to understand the magnitude of financial burden and to plan the health care resources needed for managing diabetes. However, diabetes-related excess medical expenditures for youth covered by Medicaid program have not been investigated recently.

Objective:

To estimate excess diabetes-related medical expenditures among youth aged below 20 years enrolled in Medicaid programs in the United States.

Methods:

We analyzed data from 2008 to 2012 MarketScan multistate Medicaid database for 6502 youths with diagnosed diabetes and 6502 propensity score matched youths without diabetes, enrolled in fee-for-service payment plans. We stratified analysis by Medicaid eligibility criteria (poverty or disability). We used 2-part regression models to estimate diabetes-related excess medical expenditures, adjusted for age, sex, race/ethnicity, year of claims, depression status, asthma status, and interaction terms.

Results:

For poverty-based Medicaid enrollees, estimated annual diabetes-related total medical expenditure was $9046 per person [$3681 (no diabetes) vs. $12,727 (diabetes); P<0001], of which 41.7%, 34.0%, and 24.3% were accounted for by prescription drugs, outpatient, and inpatient care, respectively. For disability-based Medicaid enrollees, the estimated annual diabetes-related total medical expenditure was $9944 per person ($14,149 vs. $24,093; P<0001), of which 41.5% was accounted for by prescription drugs, 31.3% by inpatient, and 27.3% by outpatient care.

Conclusions:

The per capita annual diabetes-related medical expenditures in youth covered by publicly financed Medicaid programs are substantial, which is larger among those with disabilities than without disabilities. Identifying cost-effective ways of managing diabetes in this vulnerable segment of the youth population is needed.
A Method to Account for Variation in Congenital Heart Surgery Length of Stay*
Authors: Brennan Andrew , Gauvreau Kimberlee , Connor Jean , Almodovar Melvin , DiNardo James , Banka Puja , Nathan Meena , Mathieu Derek , Kaza Aditya , Mayer John E. , Bergersen Lisa
Published: April 2017

Objectives:

We sought to develop a risk-adjustment methodology for length of stay in congenital heart surgery, as none exist.

Design:

Prospective cohort analysis combined with previously obtained retrospective cohort analysis of a Department of Cardiovascular Surgery clinical database.

Patients:

Patients discharged from Boston Children’s Hospital between October 1, 2006, and May 31, 2014, that underwent a congenital heart surgery procedure(s) linked to one of 103 surgical procedure types.

Measurements and Main Results:

Six thousand two hundred nine discharges during the reporting period at Boston Children’s Hospital comprised the cohort. Seven Surgical Length Categories were developed to group surgical procedure types. A multivariable model for outcome length of stay was built using a derivation cohort consisting of a 75% random sample, starting with Surgical Length Categories and considering additional a priori factors. Postoperative factors were then added to improve predictive performance. The remaining 25% of the cohort was used to validate the multivariable models. The coefficient of determination (R
2) was used to estimate the variability in length of stay explained by each factor. The Surgical Length Categories yielded an R
2 of 42%. Model performance increased when the a priori factors preoperative status, noncardiac abnormality, genetic anomaly, preoperative catheterization during episode of care, weight less than 3 kg, and preoperative vasoactive support medication were introduced to the model (R
2 = 60.8%). Model performance further improved when postoperative ventilation greater than 7 days, operating room time, postoperative catheterization during episode of care, postoperative reintubation, number of postoperative vasoactive support medications, postoperative ICU infection, and greater than or equal to one secondary surgical procedure were added (R
2 = 76.7%). The validation cohort yielded an R
2 of 76.5%.

Conclusions:

We developed a statistically valid procedure-based categorical variable and multivariable model for length of stay of congenital heart surgeries. The Surgical Length Categories and important a priori and postoperative factors may be used to pursue a predictive tool for length of stay to inform scheduling and bed management practices.
Lifestyle and Neurocognition in Older Adults With Cardiovascular Risk Factors and Cognitive Impairment
Authors: Blumenthal James A. , Smith Patrick J. , Mabe Stephanie , Hinderliter Alan , Welsh-Bohmer Kathleen , Browndyke Jeffrey N. , Lin Pao-Hwa , Kraus William , Doraiswamy P. Murali , Burke James , Sherwood Andrew
Published: April 2017

Objective

The aim of the study was to determine the relationship of lifestyle factors and neurocognitive functioning in older adults with vascular risk factors and cognitive impairment, no dementia (CIND).

Methods

One hundred sixty adults (M [SD] = 65.4 [6.8] years) with CIND completed neurocognitive assessments of executive function, processing speed, and memory. Objective measures of physical activity using accelerometry, aerobic capacity determined by exercise testing, and dietary habits quantified by the Food Frequency Questionnaire and 4-Day Food Diary to assess adherence to the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets were obtained to assess direct effects with neurocognition. Potential indirect associations of high-sensitivity C-reactive protein and the Framingham Stroke Risk Profile also were examined.

Results

Greater aerobic capacity (β = 0.24) and daily physical activity (β = 0.15) were associated with better executive functioning/processing speed and verbal memory (βs = 0.24; 0.16). Adherence to the DASH diet was associated with better verbal memory (β = 0.17). Greater high-sensitivity C-reactive protein (βs = −0.14; −0.21) and Framingham Stroke Risk Profile (β = −0.18; −0.18) were associated with poorer executive functioning/processing speed and verbal memory. Greater stroke risk partially mediated the association of aerobic capacity with executive functioning/processing speed, and verbal memory and greater inflammation partially mediated the association of physical activity and aerobic fitness, with verbal memory.

Conclusions

Higher levels of physical activity, aerobic fitness, and adherence to the DASH diet are associated with better neurocognitive performance in adults with CIND. These findings suggest that the adoption of healthy lifestyle habits could reduce the risk of neurocognitive decline in vulnerable older adults.

Clinical Trial Registration

NCT01573546.
Associations of Lifetime Trauma and Chronic Stress With C-reactive Protein in Adults Ages 50 Years and Older: Examining the Moderating Role of Perceived Control
Authors: Elliot Ari J. , Mooney Christopher J. , Infurna Frank J. , Chapman Benjamin P.
Published: April 2017

Objective

The aim of the study was to investigate whether high perceived control mitigates systemic inflammatory risk associated with traumatic and chronic stress exposures in older adults.

Methods

A sample of community-dwelling adults ages 50 years and older (N = 4779) was drawn from the Health and Retirement Study. Structural equation models tested interactions of lifetime trauma and chronic stress with mastery and perceived constraints predicting baseline levels and 4-year change in C-reactive protein (CRP).

Results

There were significant interactions of lifetime trauma (β = −.058, p = .012) and chronic stress (β = −.069, p = .010) with mastery as related to baseline CRP levels. Both measures were associated with higher CRP at low (β = .102, p = .003; β = .088, p = .015) but not high levels of mastery. In addition, chronic stress interacted with baseline mastery (β = .056, p = .011) and change in mastery (β = −.056, p = .016) to predict 4-year change in CRP. Chronic stress was associated with an increase in CRP at high baseline mastery (β = .071, p = .022) and when mastery decreased during follow-up (β = .088, p = .011). There were no main effects of stress or control variables other than an association of constraints with a larger increase in CRP (β = .062, p = .017). Interactions were minimally attenuated (<15%) upon further adjustment for negative affect, body mass index, smoking, and physical activity.

Conclusions

High mastery may protect against elevated systemic inflammation associated with substantial lifetime trauma exposure. Individuals who experience declines in mastery may be most susceptible to increases in inflammation associated with chronic stress.
Gelfoam Interposition Minimizes Risk of Fistula and Postoperative Bleeding in Modified-Furlow Palatoplasty
Authors: Li Jing , Gerety Patrick A. , Johnston James , Taylor Jesse A.
Published: April 2017

Failure to accomplish a tension-free, watertight closure predisposes the palatoplasty patient to fistula formation. Perioperative bleeding also places the patient at risk for adverse airway events (AAE). This study introduces the incorporation of a hemostatic gelatin sponge (Gelfoam) into layered palatoplasty to minimize adverse postoperative bleeding and fistula formation. A retrospective chart review was performed to identify subjects who underwent Furlow palatoplasty with insertion of Gelfoam from 2010 to 2015. Exclusion criteria include age >3 years, prior palate surgery, <30-day follow-up, immunosuppressive state, and diagnosis of Treacher–Collins or Apert Syndrome. Demographic data include age, sex, cleft laterality, prior surgeries, Veau classification, Pierre Robin status, and tracheostomy dependence. Primary outcome was fistula formation. Secondary outcomes included perioperative metrics and AAE.

One hundred subjects met criteria, 45% female. Average age was 14.6 months. Subjects with syndromes comprised 28%, with 16% diagnosed with Pierre Robin. Two subjects were tracheostomy-dependent. Prior cleft and mandibular procedures were performed in 55%. Isolated palatal defects were seen in 46%, unilateral lip and palate in 41%, and bilateral lip and palate in 13%. The majority of defects were Veau II and III (35% and 34%, respectively). Adverse airway events occurred in 2%, one of which resulted in reintubation. One subject (1%) was found to have a postoperative fistula.

The incorporation of Gelfoam in the modified-Furlow palatoplasty results in a low rate of oronasal fistula (1%) and low perioperative risk of AAE. Further prospective comparison of this method to others will be the focus of future work.