bluuebunny/crossref_metadata_2025 huggingface dataset:
Squeezing out in a “tug of war”: The role of myosin in neural stem cell delamination
Authors: Sidor Clara , Röper Katja
Published: April 2017

Neural stem cells or neuroblasts in the Drosophila melanogaster embryo delaminate as single cells from the embryonic epidermis to give rise to the nervous system. Using this accessible system to examine the molecular mechanisms of cell ingression at a high temporal and spatial resolution, in this issue, Simões et al. (2017. J. Cell Biol. https://doi.org/10.1083/jcb.201608038) reveal that myosin-driven anisotropic junction loss and apical constriction are the main drivers of this process.
On the set of the difference of primes
Authors: Huang Wen , Wu XiaoSheng
Published: April 2017

In this work we prove that the set of the difference of primes is a

Δ
r
∗

\Delta _r^*

-set. The work is based on the recent dramatic new developments in the study of bounded gaps between primes, reached by Zhang, Maynard and Tao.
SVMQA: support–vector-machine-based protein single-model quality assessment
Authors: Manavalan Balachandran , Lee Jooyoung
Published: April 2017

Motivation

The accurate ranking of predicted structural models and selecting the best model from a given candidate pool remain as open problems in the field of structural bioinformatics. The quality assessment (QA) methods used to address these problems can be grouped into two categories: consensus methods and single-model methods. Consensus methods in general perform better and attain higher correlation between predicted and true quality measures. However, these methods frequently fail to generate proper quality scores for native-like structures which are distinct from the rest of the pool. Conversely, single-model methods do not suffer from this drawback and are better suited for real-life applications where many models from various sources may not be readily available.

Results

In this study, we developed a support-vector-machine-based single-model global quality assessment (SVMQA) method. For a given protein model, the SVMQA method predicts TM-score and GDT_TS score based on a feature vector containing statistical potential energy terms and consistency-based terms between the actual structural features (extracted from the three-dimensional coordinates) and predicted values (from primary sequence). We trained SVMQA using CASP8, CASP9 and CASP10 targets and determined the machine parameters by 10-fold cross-validation. We evaluated the performance of our SVMQA method on various benchmarking datasets. Results show that SVMQA outperformed the existing best single-model QA methods both in ranking provided protein models and in selecting the best model from the pool. According to the CASP12 assessment, SVMQA was the best method in selecting good-quality models from decoys in terms of GDTloss.

Availability and implementation

SVMQA method can be freely downloaded from http://lee.kias.re.kr/SVMQA/SVMQA_eval.tar.gz.

Supplementary information

Supplementary data are available at Bioinformatics online.
γ-Ray emission from Arp 220: indications of an active galactic nucleus
Authors: Yoast-Hull Tova M. , Gallagher John S. , Aalto Susanne , Varenius Eskil
Published: April 2017

Extragalactic cosmic ray populations are important diagnostic tools for tracking the distribution of energy in nuclei and for distinguishing between activity powered by star formation versus active galactic nuclei (AGNs). Here, we compare different diagnostics of the cosmic ray populations of the nuclei of Arp 220 based on radio synchrotron observations and the recent γ-ray detection. We find the γ-ray and radio emission to be incompatible; a joint solution requires at minimum a factor of 4–8 times more energy coming from supernovae and a factor of 40–70 more mass in molecular gas than that is observed. We conclude that this excess of the γ-ray flux in comparison to all other diagnostics of star-forming activity indicates that there is an AGN present that is providing the extra cosmic rays, likely in the western nucleus.
Members of the Meloidogyne Avirulence Protein Family Contain Multiple Plant Ligand-Like Motifs
Authors: Rutter William B. , Hewezi Tarek , Maier Tom R. , Mitchum Melissa G. , Davis Eric L. , Hussey Richard S. , Baum Thomas J.
Published: April 2017

Sedentary plant-parasitic nematodes engage in complex interactions with their host plants by secreting effector proteins. Some effectors of both root-knot nematodes (Meloidogyne spp.) and cyst nematodes (Heterodera and Globodera spp.) mimic plant ligand proteins. Most prominently, cyst nematodes secrete effectors that mimic plant CLAVATA3/ESR-related (CLE) ligand proteins. However, only cyst nematodes have been shown to secrete such effectors and to utilize CLE ligand mimicry in their interactions with host plants. Here, we document the presence of ligand-like motifs in bona fide root-knot nematode effectors that are most similar to CLE peptides from plants and cyst nematodes. We have identified multiple tandem CLE-like motifs conserved within the previously identified Meloidogyne avirulence protein (MAP) family that are secreted from root-knot nematodes and have been shown to function in planta. By searching all 12 MAP family members from multiple Meloidogyne spp., we identified 43 repetitive CLE-like motifs composing 14 unique variants. At least one CLE-like motif was conserved in each MAP family member. Furthermore, we documented the presence of other conserved sequences that resemble the variable domains described in Heterodera and Globodera CLE effectors. These findings document that root-knot nematodes appear to use CLE ligand mimicry and point toward a common host node targeted by two evolutionarily diverse groups of nematodes. As a consequence, it is likely that CLE signaling pathways are important in other phytonematode pathosystems as well.
Serologic Screening for Genital Herpes: An Updated Evidence Report and Systematic Review for the US Preventive Services Task Force
Authors: Feltner Cynthia , Grodensky Catherine , Ebel Charles , Middleton Jennifer C. , Harris Russell P. , Ashok Mahima , Jonas Daniel E.
Published: April 2017

(Abstracted from JAMA 2016;316(23):2531–2543)

Herpes simplex virus (HSV) can cause genital herpes infection, and there are 2 subtypes of the virus: HSV-1 and HSV-2. The infection is transmitted sexually, and infected patients may or may not experience symptoms.
Survival Implications of Time to Surgical Treatment of Endometrial Cancers
Authors: Shalowitz David I. , Epstein Andrew J. , Buckingham Lindsey , Ko Emily M. , Giuntoli Robert L.
Published: April 2017

(Abstracted from Am J Obstet Gynecol 2017;216:268.e1–268.e18)

For optimal care, women with endometrial cancers diagnosed by obstetrician-gynecologists or other clinicians are often transferred to treating physicians (eg, gynecologic oncologists). Overall survival for many cancers is worsened by delay between diagnosis and surgical treatment.
Impact of Patient Affect on Physician Estimate of Probability of Serious Illness and Test Ordering
Authors: Kline Jeffrey A. , Neumann Dawn , Raad Samih , Schriger David L. , Hall Cassandra L. , Capito Jake , Kammer David
Published: April 2017

Purpose

The authors hypothesize patient facial affect may influence clinician pretest probability (PTP) estimate of cardiopulmonary emergency (CPE) and desire to order a computerized tomographic pulmonary angiogram (CTPA).

Method

This prospective study was conducted at three Indiana University–affiliated hospitals in two parts: collecting videos of patients undergoing CTPA for suspected acute pulmonary embolism watching a humorous video (August 2014–April 2015) and presenting the medical histories and videos to clinicians to determine the impact of patient facial affect on physicians’ PTP estimate of CPE and desire to order a CTPA (June–November 2015). Patient outcomes were adjudicated as CPE+ or CPE− by three independent reviewers. Physicians completed a standardized test of facial affect recognition, read standardized medical histories, then viewed videos of the patients’ faces. Clinicians marked their PTP estimate of CPE and desire for a CTPA before and after seeing the video on a visual analog scale (VAS).

Results

Fifty physicians completed all 73 videos. Seeing the patient’s face produced a > 10% absolute change in PTP estimate of CPE in 1,204/3,650 (33%) cases and desire for a CTPA in 1,095/3,650 (30%) cases. The mean area under the receiver operating characteristic curve for CPE estimate was 0.55 ± 0.15, and the change in CPE VAS was negatively correlated with physicians’ standardized test scores (r = −0.23).

Conclusions

Clinicians may use patients’ faces to make clinically important inferences about presence of serious illness and need for diagnostic testing. However, these inferences may fail to align with actual patient outcomes.
Survivorship After High-Energy Geriatric Trauma
Authors: Gitajn Ida L. , Castillo Renan , Breazeale Stephen , Schoonover Carrie , Berger Peter , Huang Yanjie , O'Hara Nathan , O'Toole Robert V. , Sciadini Marcus F.
Published: April 2017

Objectives:

To evaluate in-hospital, 1-year, and 5-year survivorship of geriatric patients after high-energy trauma, to compare survivorship of geriatric patients who sustained high-energy trauma with that of those who sustained low-energy trauma, and to identify predictors for mortality.

Design:

Retrospective.

Setting:

Urban Level I trauma center.

Patients:

Study group of 1849 patients with high-energy trauma and comparison group of 761 patients with low-energy trauma.

Intervention:

Each patient was observed from the time of index admission through the end of the study period or until death or readmission.

Main Outcome Measurement:

Long-term survivorship based on the Social Security Death Index.

Results:

Survivorship between patients with high-energy and low-energy injuries was statistically significant. Among patients who sustained high-energy injuries, in-hospital mortality was 8%, 1-year mortality was 15%, and 5-year mortality was 25%. Among patients who sustained low-energy injuries, in-hospital mortality was 3%, 1-year mortality was 23%, and 5-year mortality was 40%. Low-energy mechanism of injury was an independent predictor for 1-year and 5-year mortality, even when controlling for Charlson Comorbidity Index (CCI), Injury Severity Score (ISS), age, sex, body mass index (BMI), and admission Glasgow Coma Scale (GCS) score.

Conclusions:

Geriatric patients with high-energy injuries and those with low-energy injuries seem to represent different patient populations, and low-energy mechanism seems to be a marker for frailty. High-energy mechanism was associated with lower long-term mortality rates, even when controlling for CCI, ISS, age, sex, BMI and admission GCS score.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Validation of Intensive Care and Mechanical Ventilation Codes in Medicare Data*
Authors: Wunsch Hannah , Kramer Andrew , Gershengorn Hayley B.
Published: April 2017

Objectives:

To assess the reliability of codes relevant to critically ill patients in administrative data.

Design:

Retrospective cohort study linking data from Acute Physiology and Chronic Health Evaluation Outcomes, a clinical database of ICU patients with data from Medicare Provider Analysis and Review. We linked data based on matching for sex, date of birth, hospital, and date of admission to hospital.

Setting:

Forty-six hospitals in the United States participating in Acute Physiology and Chronic Health Evaluation Outcomes.

Patients:

All patients in Acute Physiology and Chronic Health Evaluation Outcomes greater than or equal to 65 years old who could be linked with hospitalization records in Medicare Provider Analysis and Review from January 1, 2009, through September 30, 2012.

Measurements and Main Results:

Of 62,451 patients in the Acute Physiology and Chronic Health Evaluation Outcomes dataset, 80.1% were matched with data in Medicare Provider Analysis and Review. All but 2.7% of Acute Physiology and Chronic Health Evaluation Outcomes ICU patients had either an ICU or coronary care unit charge in Medicare Provider Analysis and Review. In Acute Physiology and Chronic Health Evaluation Outcomes, 37.0% received mechanical ventilation during the ICU stay versus 24.1% in Medicare Provider Analysis and Review. The Medicare Provider Analysis and Review procedure codes for mechanical ventilation had high specificity (96.0%; 95% CI, 95.8–96.2), but only moderate sensitivity (58.4%; 95% CI, 57.7–59.1), with a positive predictive value of 89.6% (95% CI, 89.1–90.1) and negative predictive value of 79.7% (95% CI, 79.4–80.1). For patients with mechanical ventilation codes, Medicare Provider Analysis and Review overestimated the percentage with a duration greater than 96 hours (36.6% vs 27.3% in Acute Physiology and Chronic Health Evaluation Outcomes). There was discordance in the hospital discharge status (alive or dead) for only 0.47% of all linked records (κ = 1.00).

Conclusions:

Medicare Provider Analysis and Review data contain robust information on hospital mortality for patients admitted to the ICU but have limited ability to identify all patients who received mechanical ventilation during a critical illness. Estimates of use of mechanical ventilation in the United States should likely be revised upward.
Multistep Approach for Improved Aesthetic and Functional Outcomes for Lower Extremity Wound Closure After Mohs Micrographic Surgery
Authors: Kiwanuka Elizabeth , Cruz Antonio P.
Published: April 2017

BACKGROUND

Lower extremity wounds present a major clinical challenge.

OBJECTIVE

This paper introduces a new multistep approach for improved aesthetic and functional outcome for lower extremity wound closure after Mohs micrographic surgery.

PATIENTS AND METHODS

In this prospective case series, 12 consecutive patients undergoing Mohs micrographic surgery for cutaneous malignancies of the lower extremities underwent closure assisted by elastic bandages, proper positioning with 45° flexion of the knee, buried vertical mattress sutures, and careful eversion, using a premium angled stapler. Assessment of cosmetic outcome was performed by 2 blinded observers, using the Hollander Wound Evaluation Scale.

RESULTS

The mean age was 73 ± 9 years with most patients having at least one comorbidity. Six patients (50%) underwent resection of a basal cell carcinoma and 5 patients (42%) underwent resection of a squamous cell carcinoma and 1 patient (8%) underwent resection of a keratoacanthomatous carcinoma. There were no wound complications, and at the 3- to 6-month follow-up, 11 of the 12 wounds (92%) had an optimal Hollander Wound Evaluation Scale score of 6.

CONCLUSION

This new approach to lower extremity wounds provides excellent cosmetic outcome with no reported complications.
RESIDUAL INTRARETINAL EDEMA AFTER 25-GAUGE VITRECTOMY AND MACULAR PUCKER REMOVAL
Authors: Guidi Gianluca , Casini Giamberto , Ripandelli Guido , Piaggi Paolo , Dalle Lucche Flavio , Sartini Mariasole , Loiudice Pasquale , Nasini Francesco , Stirpe Mario , Lazzeri Stefano
Published: April 2017

Purpose:

To investigate the efficacy and safety of intraoperative slow-release dexamethasone implant and 25-gauge (G) vitrectomy plus epiretinal membrane removal in patients affected by idiopathic macular pucker.

Methods:

In this randomized, clinical, multicenter study, 60 eyes of 60 pseudophakic eyes having idiopathic macular pucker were enrolled. Thirty eyes underwent 25-G pars plana vitrectomy and internal limiting membrane peeling (“Control group”), whereas 30 eyes underwent 25-G pars plana vitrectomy and internal limiting membrane peeling combined with dexamethasone implant (“DEX group”). Best-corrected visual acuity was investigated using Snellen visual acuity ratio. Anatomical outcomes (foveal thickness and total macular volume) were analyzed with spectral domain optical coherence tomography.

Results:

After 6-month follow-up, best-corrected visual acuity significantly increased in each group (P < 0.05), but there were no significant differences between groups (P = 0.60). Foveal thickness showed a significant decrease in both groups (P < 0.05), but no differences were seen between groups (P = 0.80). Finally, also total macular volume decreased significantly in both groups at the last follow-up visit (P < 0.05), but both groups a showed similar trend (P = 0.12).

Conclusions:

Intraoperative sustained-release dexamethasone implant, a powerful antiinflammatory agent with significant efficacy in vitrectomized eyes, did not result in a significant change in macular thickness and volume compared with the vitrectomy alone without dexamethasone implant at 6-month follow-up. These data support the hypothesis that its etiology does not seem to be mainly related to an inflammatory process.
MULTIMODAL IMAGING OF MOSAIC RETINOPATHY IN CARRIERS OF HEREDITARY X-LINKED RECESSIVE DISEASES
Authors: Wu An-Lun , Wang Jung-Pan , Tseng Yun-Ju , Liu Laura , Kang Yu-Chuan , Chen Kuan-Jen , Chao An-Ning , Yeh Lung-Kun , Chen Tun-Lu , Hwang Yih-Shiou , Wu Wei-Chi , Lai Chi-Chun , Wang Nan-Kai
Published: April 2017

Purpose:

To investigate the clinical features in carriers of X-linked retinitis pigmentosa, X-linked ocular albinism, and choroideremia (CHM) using multimodal imaging and to assess their diagnostic value in these three mosaic retinopathies.

Methods:

We prospectively examined 14 carriers of 3 X-linked recessive disorders (X-linked retinitis pigmentosa, X-linked ocular albinism, and CHM). Details of abnormalities of retinal morphology were evaluated using fundus photography, fundus autofluorescence (FAF) imaging, and spectral domain optical coherence tomography.

Results:

In six X-linked retinitis pigmentosa carriers, fundus appearance varied from unremarkable to the presence of tapetal-like reflex and pigmentary changes. On FAF imaging, all carriers exhibited a bright radial reflex against a dark background. By spectral domain optical coherence tomography, loss of the ellipsoid zone in the macula was observed in 3 carriers (50%). Regarding the retinal laminar architecture, 4 carriers (66.7%) showed thinning of the outer nuclear layer and a dentate appearance of the outer plexiform layer. All five X-linked ocular albinism carriers showed a characteristic mud-splatter patterned fundus, dark radial streaks against a bright background on FAF imaging, and a normal-appearing retinal structure by spectral domain optical coherence tomography imaging. Two of the 3 CHM carriers (66.7%) showed a diffuse moth-eaten appearance of the fundus, and all 3 showed irregular hyper-FAF and hypo-FAF spots throughout the affected area. In the CHM carriers, the structural changes observed by spectral domain optical coherence tomography imaging were variable.

Conclusion:

Our findings in an Asian cohort suggest that FAF imaging is a practical diagnostic test for differentiating X-linked retinitis pigmentosa, X-linked ocular albinism, and CHM carriers. Wide-field FAF is an easy and helpful adjunct to testing for the correct diagnosis and identification of lyonization in carriers of these three mosaic retinopathies.
COMPARISON OF GANGLION CELL INNER PLEXIFORM LAYER THICKNESS BY CIRRUS AND SPECTRALIS OPTICAL COHERENCE TOMOGRAPHY IN DIABETIC MACULAR EDEMA
Authors: Hafner Julia , Prager Sonja , Lammer Jan , Kriechbaum Katharina , Scholda Christoph , Pablik Eleonore , Schmidt-Erfurth Ursula
Published: April 2017

Purpose:

Reduced thickness of the ganglion cell inner plexiform layer indicates diabetic neurodegeneration and can be assessed by spectral domain optical coherence tomography. The authors investigated the comparability of ganglion cell inner plexiform layer measurements from two spectral domain optical coherence tomography devices in patients with diabetic macular edema (DME).

Methods:

Analysis of optical coherence tomography data sets of eyes with and fellow eyes without DME. Macular cube scans of sufficient signal strength on Cirrus (Carl Zeiss Meditec) were compared with correlating scans on Spectralis (Heidelberg Engineering, Germany) being acquired within 1 hour.

Results:

Eighty-one equivalent data sets for 20 eyes with DME (20 patients; 6 female) and 33 for 9 fellow eyes without DME (9 patients; 2 female) were included from each device. In DME eyes, mean ganglion cell inner plexiform layer thicknesses were 62.5 ± 20.4 μm on Cirrus and 91.2 ± 9.3 μm on Spectralis. Ganglion cell inner plexiform layer was significantly thicker on Spectralis analyzing eyes with and without signs of DME (P < 0.001). The ganglion cell inner plexiform layer variance (54.2%) related to device differences decreased to 34.8% in eyes without DME.

Conclusion:

Ganglion cell inner plexiform layer data from different devices vary considerably and cannot be used interchangeably. As spectral domain optical coherence tomography is indispensable for identifying ganglion cell loss associated with diabetic neurodegeneration, clinicians should be aware of the difference when monitoring patients.
EFFECT OF BODY POSITION ON INTRAOCULAR PRESSURE IN SILICONE OIL TAMPONADE EYES
Authors: Pan Jiandong , Cheng Dan , Feng Xiaofen , Zheng Liya , Dong Yugui , Hou Qiang , Chen Feng
Published: April 2017

Purpose:

To investigate the effect of body position on intraocular pressure (IOP) in silicone oil tamponade eyes.

Methods:

This prospective study included 18 eyes from 18 silicone oil tamponade patients and 24 eyes from 24 healthy subjects. Intraocular pressures were measured by Accupen Applanation Tonometer sitting with face forward, sitting with face down, supine, nondependent lateral decubitus, dependent lateral decubitus, and prone positions. The IOPs in each position and the magnitudes of IOP change were compared between the silicone oil and normal groups.

Results:

In both groups, the IOPs in sitting positions were significantly lower than that of each recumbent position. The IOPs were highest in prone among all positions. No significant difference was found between IOPs of each group in each position. Between both groups, the IOP elevations in each position had no statistical difference compared with sitting with face forward.

Conclusion:

The IOP is lowest in the sitting position and highest in the prone position in both silicone oil and normal groups. Between both groups, the amount of IOP elevations is equivalent in each position compared with sitting with face forward. Ophthalmologists should be aware that IOP is higher in the prone position and that it should be monitored accordingly.
Clinician Perceptions of the Importance of Hospital Discharge Components for Children
Authors: Blaine Kevin , Rogers Jayne , O'Neill Margaret R. , McBride Sarah , Faerber Jennifer , Feudtner Chris , Berry Jay G.
Published: April 2017

Background:

Discharging hospitalized children involves several different components, but their relative value is unknown. We assessed which discharge components are perceived as most and least important by clinicians.

Methods:

March and June of 2014, we conducted an online discrete choice experiment (DCE) among national societies representing 704 nursing, physician, case management, and social work professionals from 46 states. The DCE consisted of 14 discharge care components randomly presented two at a time for a total of 28 choice tasks. Best-worst scaling of participants' choices generated mean relative importance (RI) scores for each component, which allowed for ranking from least to most important.

Results:

Participants, regardless of field or practice setting, perceived “Discharge Education/Teach-Back” (RI 11.1 [95% confidence interval, CI: 11.0–11.3]) and “Involve the Child's Care Team” (RI 10.6 [95% CI: 10.4–10.8]) as the most important discharge components, and “Information Reconciliation” (RI 4.1 [95% CI: 3.9–4.4]) and “Assigning Roles/Responsibilities of Discharge Care” (RI 2.8 [95% CI: 2.6–3.0]) as least important.

Conclusions:

A diverse group of pediatric clinicians value certain components of the pediatric discharge care process much more than others. Efforts to optimize the quality of hospital discharge for children should consider these findings.
Two Tumors in 1: What Should be the Therapeutic Target? Pediatric Germ Cell Tumor With Somatic Malignant Transformation
Authors: Faure Conter Cecile , Fresneau Brice , Thebaud Estelle , Bertrand Amandine , Dijoud Frederique , Rome Angelique , Dumesnil Cecile , Castex Marie Pierre , Ghanem Anguella , Orbach Daniel
Published: April 2017

Background:

Germ cell tumors with somatic malignant transformation (GCT with SMT) are rare in children and poorly described. Data are missing to determine if therapies should target the GCT, the SMT compound, or both simultaneously.

Patients and Methods:

A retrospective national study was conducted in the Société Française des cancers de l’Enfant (SFCE) Centers. Medical records from patients aged 0 to 18 years diagnosed with GCT with SMT between 2000 and 2015 were analyzed. Any stages and primary sites were considered as well as synchronous and metachronous cases.

Results:

Fifteen patients were identified. Thirteen patients had synchronous GCT with SMT. In the latter cases, primaries were ovary (5), mediastinum (3), pineal gland (3), sacrococcyx (1), and parametrium (1). SMT histologies were central primitive neuroectodermal tumor (5), embryonal rhabdomyosarcomas (3) or thyroid papillary adenocarcinoma, leukemia, poorly differentiated carcinoma, mixed sarcomas, and miscellaneous histology (1 case each). Chemotherapy was targeted against the GCT (3), the SMT (6), or both components (3). The last patient received surgery exclusively. Partial or complete response to chemotherapy was observed in 5/10 assessable cases: 2/3 patients treated with GCT-dedicated chemotherapy, 3/6 patients treated with SMT-dedicated therapy, and 0/1 treated with combined therapy. In addition, 2 patients with mediastinal GCT primary had metachronous SMT, with acute myeloid leukemia and thyroid papillary adenocarcinoma, 8 months and 8 years, respectively, after the diagnoses of GCT. Two patients (1 synchronous and 1 metachronous) were cured with surgery exclusively. At the end of follow-up, 6 patients died of their disease including all 4 with postsurgical macroscopic residue.

Conclusions:

GCT with SMT constitutes a very rare entity in children and adolescents. Surgical removal of the tumor is the cornerstone of the treatment and might be sufficient in selected cases. In the remaining cases, the best management is still unknown and should take into account both components and their respective chemosensitivity. Long-term surveillance is advised for patient with unresected teratoma as late transformation can occur.
HFE Gene Mutations and Iron Status in 100 Healthy Polish Children
Authors: Kaczorowska-Hac Barbara , Luszczyk Marcin , Antosiewicz Jedrzej , Ziolkowski Wieslaw , Adamkiewicz-Drozynska Elzbieta , Mysliwiec Malgorzata , Milosz Ewa , Kaczor Jan J.
Published: April 2017

Iron participates in oxygen transport, energetic, metabolic, and immunologic processes. There are 2 main causes of iron overload: hereditary hemochromatosis which is a primary cause, is a metabolic disorder caused by mutations of genes that control iron metabolism and secondary hemochromatosis caused by multitransfusions, chronic hemolysis, and intake of iron rich food. The most common type of hereditary hemochromatosis is caused by HFE gene mutation. In this study, we analyzed iron metabolism in 100 healthy Polish children in relation to their HFE gene status. The wild-type HFE gene was predominant being observed in 60 children (60%). Twenty-five children (25%), presented with heterozygotic H63D mutation, and 15 children (15%), presented with other mutations (heterozygotic C282Y and S65C mutation, compound heterozygotes C282Y/S65C, C282Y/H63D, H63D homozygote). The mean concentration of iron, the level of ferritin, and transferrin saturation were statistically higher in the group of HFE variants compared with the wild-type group. H63D carriers presented with higher mean concentration of iron, ferritin levels, and transferrin saturation compared with the wild-type group. Male HFE carriers presented with higher iron concentration, transferrin saturation, and ferritin levels than females. This preliminary investigation demonstrates allelic impact on potential disease progression from childhood.
Postpartum Hypertension: Etiology, Diagnosis, and Management
Authors: Sharma Kathryn J. , Kilpatrick Sarah J.
Published: April 2017

Importance

Postpartum hypertension complicates approximately 2% of pregnancies and, similar to antepartum severe hypertension, can have devastating consequences including maternal death.

Objective

This review aims to increase the knowledge and skills of women’s health care providers in understanding, diagnosing, and managing hypertension in the postpartum period.

Results

Hypertension complicating pregnancy, including postpartum, is defined as systolic blood pressure 140 mm Hg or greater and/or diastolic blood pressure 90 mm Hg or greater on 2 or more occasions at least 4 hours apart. Severe hypertension is defined as systolic blood pressure 160 mm Hg or greater and/or diastolic blood pressure 110 mm Hg or greater on 2 or more occasions repeated at a short interval (minutes). Workup for secondary causes of hypertension should be pursued, especially in patients with severe or resistant hypertension, hypokalemia, abnormal creatinine, or a strong family history of renal disease. Because severe hypertension is known to cause maternal stroke, women with severe hypertension sustained over 15 minutes during pregnancy or in the postpartum period should be treated with fast-acting antihypertension medication. Labetalol, hydralazine, and nifedipine are all effective for acute management, although nifedipine may work the fastest. For persistent postpartum hypertension, a long-acting antihypertensive agent should be started. Labetalol and nifedipine are also both effective, but labetalol may achieve control at a lower dose with fewer adverse effects.

Conclusions and Relevance

Providers must be aware of the risks associated with postpartum hypertension and educate women about the symptoms of postpartum preeclampsia. Severe acute hypertension should be treated in a timely fashion to avoid morbidity and mortality. Women with persistent postpartum hypertension should be administered a long-acting antihypertensive agent.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to assist patients and providers in identifying postpartum hypertension; provide a framework for the evaluation of new-onset postpartum hypertension; and provide instructions for the management of acute severe and persistent postpartum hypertension.
Mycoplasma genitalium Antibiotic Resistance–Mediating Mutations in Canadian Women With or Without Chlamydia Trachomatis Infection
Authors: Chernesky Max A. , Jang Dan , Martin Irene , Hoang Linda M.N. , Naidu Prenilla , Levett Paul N. , Wylie John , Rebbapragada Anu , Ratnam Sam , Smieja Marek , Weinbaum Barbara , Getman Damon
Published: April 2017

Testing remnant Aptima specimens from women infected withChlamydia trachomatisdetected 13.4% (53/396) withMycoplasma genitaliumcompared with 5.4% (22/406) in matchedC. trachomatis–negative women. Overall, 9.4% (provincial ranges of 3–20%) were infected withM. genitaliumand resistance mediating mutations were found in 47.3% (26/55) to macrolides and 1.9% (1/53) to fluoroquinolones by sequencing.
Is Patient-Reported Exposure a Reliable Indicator for Anogenital Gonorrhea and Chlamydia Screening in Young Black Men Who Have Sex With Men?
Authors: Chamberlain Nicholas , Crosby Richard A. , Mena Leandro , Chan Philip A. , Mayer Kenneth H.
Published: April 2017

Among 485 young black men who have sex with men recruited in Jackson, MS, 90-day anal sexual exposure significantly predicted rectal infection, but 19.4% of rectal infections would have been missed among men denying receptive anal sex. Reports of consistent condom use were associated with lower infection rates only in men reporting insertive anal sex.
Sexually Transmitted Infection Prevention With Long-Acting Reversible Contraception: Factors Associated With Dual Use
Authors: Thompson Erika L. , Vamos Cheryl A. , Griner Stacey B. , Logan Rachel , Vázquez-Otero Coralia , Daley Ellen M.
Published: April 2017

Background

Long-acting reversible contraception (LARC) is extremely effective in preventing pregnancy; however, it does not provide sexually transmitted infection (STI) prevention. Therefore, dual use is recommended for the prevention of STIs, in addition to pregnancy, by using LARC methods with condoms. This study assessed factors associated with LARC only use and dual-LARC and condom use among college women.

Methods

The National College Health Assessment-II Fall 2012 to 2013 was used for this analysis. The analytic sample was restricted to women who used a LARC method (ie, intrauterine device or implant) (N = 1658). The main outcome was dual method use, LARC and condom, at last sex. An adjusted logistic regression model assessed sociodemographic factors (age, relationship, race), health care utilization (routine gynecological examination), and sexual behavior (number of partners) as factors associated with dual condom-LARC use at the last time of vaginal-sex. Prevalence ratios (PR) and 95% confidence intervals (CI) were estimated.

Results

Among women reporting LARC use, 24% used a condom. Dual users were less likely to have only 1 sexual partner (adjusted PR [aPR], 0.66; 95% CI, 0.54–0.81) and be in a relationship. Dual users were more likely than LARC-only users to be Hispanic (aPR, 1.34; 95% CI, 1.01–1.78), black (aPR, 1.40; 95% CI, 1.07–1.83), and biracial/multiracial (aPR, 1.38; 95% CI, 1.10–1.73).

Conclusions

These findings illustrate differences between dual-condom LARC and LARC-only college users. It is likely that relationship status and number of partners influences perceived risk for STIs and decision making for dual use among this population.
Effect of gastroretentive gabapentin (Gralise) on postmastectomy pain syndrome: a proof-of-principle open-label study
Authors: Belfer Inna , Pollock Netanya I. , Martin Jodi L. , Lim Katherine G. , De La Cruz Carolyn , Van Londen Gijsberta , Nunziato-Virga Stephanie R. , Stranieri Katherine , Brufsky Adam M. , Wang Haibin
Published: April 2017

Introduction:

Chronic pain is a common and debilitating complication following breast surgery. One of the most challenging for treatment is the neuropathic pain condition, postmastectomy pain syndrome (PMPS). Gabapentin is a pharmacotherapy for neuropathic pain disorders; however, its once-daily, gastroretentive formulation, Gralise, has not been evaluated in PMPS.

Objective:

To evaluate the safety and effectiveness of Gralise in patients with moderate-to-severe PMPS.

Methods:

The primary effectiveness endpoint was a change in the worst pain intensity score from baseline to completion of 8 weeks of Gralise therapy. The secondary endpoints included the change in mood, coping behavior, sleep, and function. Sensitivity to experimental stimuli was tested before and after treatment via quantitative sensory testing. The incidence and type of adverse event were used to evaluate the safety and tolerability of Gralise.

Results:

Twenty-one patients with confirmed moderate-to-severe PMPS were enrolled. Nineteen of 21 (90.5%) patients completed the 8-week treatment with Gralise. A significant positive change was found in pain intensity, pain impact, and sleep. There was no change in sensory testing scores. Of total, 63.16% of patients reported reduction in present pain, 78.95% in average pain, 89.47% in worst pain, and 84.21% in overall pain severity at posttreatment visit. No significant adverse effects were noted in the study.

Limitations:

Variation in type of breast surgery, small sample size, lack of placebo control.

Conclusion:

There was a significant improvement in pain and sleep, and Gralise was well tolerated in patients with PMPS. Further investigation is warranted.
A National Study of the Impact of Delayed Flap Timing for Treatment of Patients with Deep Sternal Wound Infection
Authors: Sears Erika D. , Momoh Adeyiza O. , Chung Kevin C. , Lu Yu-Ting , Zhong Lin , Waljee Jennifer F.
Published: April 2017

Background:

This study aimed to evaluate the impact of delayed flap closure on mortality and resource use for treatment of deep sternal wound infection.

Methods:

The authors analyzed the Truven MarketScan Databases from 2009 to 2013 to identify adult patients who developed deep sternal wound infection after open cardiac surgery and who underwent flap closure for treatment. A multivariable logistic regression model was created to evaluate the relationship between mortality and flap timing. Multivariable Poisson regressions were used to investigate the relationship between flap timing and number of procedures, number of hospitalizations, and length of stay outcomes. A multivariable log-linear regression model was created for cost analysis. All analyses were adjusted for patient risk factors and treatment characteristics.

Results:

The authors identified 612 patients with deep sternal wound infection who underwent flap closure. The timing of flap closure was delayed more than 7 days after diagnosis in 39 percent of patients. Delayed time to flap closure greater than 3 days after diagnosis of infection was associated with higher mortality odds for delay 4 to 7 days (OR, 2.94) and delay greater than 7 days (OR, 2.75; p < 0.03), greater additional procedures for delay 4 to 7 days (incidence rate ratio, 1.72) and delay greater than 7 days (incidence rate ratio, 1.93; p < 0.001), and up to 43 percent longer hospital length of stay and 37 percent greater costs compared with patients undergoing flap closure 0 to 3 days after diagnosis.

Conclusions:

Delay in flap closure was associated with greater mortality and resource use. Prompt involvement of reconstructive surgeons may improve quality and efficiency of deep sternal wound infection care.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Heterogeneity in 14-year Dementia Incidence Between Asian American Subgroups
Authors: Mayeda Elizabeth R. , Glymour M. Maria , Quesenberry Charles P. , Whitmer Rachel A.
Published: April 2017

Background:

Asian Americans are a rapidly growing and diverse population. Prior research on dementia among Asian Americans focused on Japanese Americans or Asian Americans overall, although marked differences in cardiometabolic conditions between subgroups have been documented.

Materials and Methods:

We compared dementia incidence among 4 Asian American subgroups (n=8384 Chinese; n=4478 Japanese; n=6210 Filipino; n=197 South Asian) and whites (n=206,490) who were Kaiser Permanente Northern California members aged 64 years and above with no dementia diagnoses as of January 1, 2000. Dementia diagnoses were collected from medical records January 1, 2000 to December 31, 2013. Baseline medical utilization and comorbidities (diabetes, depression, hypertension, stroke, cardiovascular disease) were abstracted from medical records January 1, 1996 to December 31, 1999. We calculated age-standardized dementia incidence rates and Cox models adjusted for age, sex, medical utilization, and comorbidities.

Results:

Mean baseline age was 71.7 years; mean follow-up was 9.6 years. Age-standardized dementia incidence rates were higher among whites than “All Asian-Americans” or any subgroup. Compared with Chinese (13.7/1000 person-years), dementia incidence was slightly higher among Japanese [14.8/1000 person-years; covariate-adjusted hazard ratio (adjusted-HR)=1.08; 95% confidence interval (CI), 0.99-1.18] and Filipinos (17.3/1000 person-years; adjusted-HR=1.20; 95% CI, 1.11-1.31), and lower among South Asians (12.1/1000 person-years; adjusted-HR=0.81; 95% CI, 0.53-1.25).

Conclusions:

Future studies are needed to understand how immigration history, social, environmental, and genetic factors contribute to dementia risk in the growing and diverse Asian American population.
Histology-based homogenization analysis of soft tissue: application to prostate cancer
Authors: Palacio-Torralba Javier , Good Daniel W. , McNeill S. Alan , Reuben Robert L. , Chen Yuhang
Published: April 2017

It is well known that the changes in tissue microstructure associated with certain pathophysiological conditions can influence its mechanical properties. Quantitatively relating the tissue microstructure to the macroscopic mechanical properties could lead to significant improvements in clinical diagnosis, especially when the mechanical properties of the tissue are used as diagnostic indices such as in digital rectal examination and elastography. In this study, a novel method of imposing periodic boundary conditions in non-periodic finite-element meshes is presented. This method is used to develop quantitative relationships between tissue microstructure and its apparent mechanical properties for benign and malignant tissue at various length scales. Finally, the inter-patient variation in the tissue properties is also investigated. Results show significant changes in the statistical distribution of the mechanical properties at different length scales. More importantly the loss of the normal differentiation of glandular structure of cancerous tissue has been demonstrated to lead to changes in mechanical properties and anisotropy. The proposed methodology is not limited to a particular tissue or material and the example used could help better understand how changes in the tissue microstructure caused by pathological conditions influence the mechanical properties, ultimately leading to more sensitive and accurate diagnostic technologies.
Response threshold variance as a basis of collective rationality
Authors: Yamamoto Tatsuhiro , Hasegawa Eisuke
Published: April 2017

Determining the optimal choice among multiple options is necessary in various situations, and the collective rationality of groups has recently become a major topic of interest. Social insects are thought to make such optimal choices by collecting individuals' responses relating to an option's value (=a quality-graded response). However, this behaviour cannot explain the collective rationality of brains because neurons can make only ‘yes/no’ responses on the basis of the response threshold. Here, we elucidate the basic mechanism underlying the collective rationality of such simple units and show that an ant species uses this mechanism. A larger number of units respond ‘yes’ to the best option available to a collective decision-maker using only the yes/no mechanism; thus, the best option is always selected by majority decision. Colonies of the ant
Myrmica kotokui
preferred the better option in a binary choice experiment. The preference of a colony was demonstrated by the workers, which exhibited variable thresholds between two options' qualities. Our results demonstrate how a collective decision-maker comprising simple yes/no judgement units achieves collective rationality without using quality-graded responses. This mechanism has broad applicability to collective decision-making in brain neurons, swarm robotics and human societies.
Group theoretical derivation of the minimal coupling principle
Authors: Nisticò Giuseppe
Published: April 2017

The group theoretical methods worked out by Bargmann, Mackey and Wigner, which
deductively
establish the Quantum Theory of a free particle for which Galileian transformations form a symmetry group, are extended to the case of an interacting particle. In doing so, the obstacles caused by loss of symmetry are overcome. In this approach, specific forms of the wave equation of an interacting particle, including the equation derived from the minimal coupling principle, are implied by particular first-order invariance properties that characterize the interaction with respect to specific subgroups of Galileian transformations; moreover, the possibility of yet unknown forms of the wave equation is left open.
Social foraging and individual consistency in following behaviour: testing the information centre hypothesis in free-ranging vultures
Authors: Harel Roi , Spiegel Orr , Getz Wayne M. , Nathan Ran
Published: April 2017

Uncertainties regarding food location and quality are among the greatest challenges faced by foragers and communal roosting may facilitate success through social foraging. The information centre hypothesis (ICH) suggests that uninformed individuals at shared roosts benefit from following informed individuals to previously visited resources. We tested several key prerequisites of the ICH in a social obligate scavenger, the Eurasian griffon vulture (Gyps fulvus), by tracking movements and behaviour of sympatric individuals over extended periods and across relatively large spatial scales, thereby precluding alternative explanations such as local enhancement. In agreement with the ICH, we found that ‘informed’ individuals returning to previously visited carcasses were followed by ‘uninformed’ vultures that consequently got access to these resources. When a dyad (two individuals that depart from the same roost within 2 min of each other) included an informed individual, they spent a higher proportion of the flight time close to each other at a shorter distance between them than otherwise. Although all individuals occasionally profited from following others, they differed in their tendencies to be informed or uninformed. This study provides evidence for ‘following behaviour’ in natural conditions and demonstrates differential roles and information states among foragers within a population. Moreover, demonstrating the possible reliance of vultures on following behaviour emphasizes that individuals in declining populations may suffer from reduced foraging efficiency.
Signatures of optimal control in pairs of schooling zebrafish
Authors: Laan Andress , Gil de Sagredo Raul , de Polavieja Gonzalo G.
Published: April 2017

Animals moving in groups coordinate their motion to remain cohesive. A large amount of data and analysis of movement coordination has been obtained in several species, but we are lacking theoretical frameworks that can derive the form of coordination rules. Here, we examine whether optimal control theory can predict the rules underlying social interactions from first principles. We find that a control rule which is designed to minimize the time it would take a pair of schooling fish to form a cohesively moving unit correctly predicts the characteristics of social interactions in fish. Our methodology explains why social attraction is negatively modulated by self-motion velocity and positively modulated by partner motion velocity, and how the biomechanics of fish swimming can shape the form of social forces. Crucially, the values of all parameters in our model can be estimated from independent experiments that need not relate to measurement of social interactions. We test our theory by showing a good match with experimentally observed social interaction rules in zebrafish. In addition to providing a theoretical rationale for observed decision rules, we suggest that this framework opens new questions about tuning problems and learnability of collective behaviours.