bluuebunny/crossref_metadata_2025 huggingface dataset:
The Association Between Symptoms of Anxiety, Depression, and Cardiovascular Risk Factors
Authors: Rioli Giulia , Tassi Silvia , Mattei Giorgio , Ferrari Silvia , Galeazzi Gian Maria , Mancini Stefano , Alboni Silvia , Roncucci Luca
Published: April 2019

Cardiovascular diseases, anxiety, and depression are among the most frequent clinical conditions in the Western world, often in comorbidity. Evidence regarding a shared pathophysiology suggests a mediating role by chronic systemic inflammation. The aims of this study were to measure the association between anxiety and depressive symptoms, cardiovascular risk factors, and inflammatory markers. Outpatients aged 40 years or more undergoing colonoscopy after positive fecal occult blood test were enrolled; the following data were collected: body mass index, blood pressure, blood glucose, lipid profile, C-reactive protein (CRP) level, carotid thickness, Hospital Anxiety and Depression Scale, Temperament and Character Inventory, INTERdisciplinary MEDicine Self-Assessment, and 36-Item Short-Form Health Survey scores. Fifty-four patients were enrolled; 30.2% had anxiety symptoms, 18.9% depressive symptoms, and 9.4% concomitant anxiety-depressive symptoms. Anxiety symptoms were associated with low high-density lipoprotein levels. Depressive symptoms were associated with CRP levels, providing supporting evidence for the role of inflammation in the pathophysiology of depression.
Relationship of Suicidal Ideation With Demoralization, Depression, and Anxiety
Authors: Xu Ke , Hu Deying , Liu Yilan , Han Yanhong , Guo Xin , Teng Fen , Zhou Yi
Published: April 2019

Demoralization is a form of psychological distress that may cause suicidal ideation. Demoralization syndrome is common among cancer patients, but there has been little empirical study on the association of suicidal ideation with demoralization, depression, and anxiety in this population. This study aims to investigate the prevalence of high demoralization among cancer patients in mainland China and the contribution of high demoralization to suicidal ideation beyond the impact of self-report depression and anxiety. In this cross-sectional study, 303 patients with cancer were invited to complete questionnaires. In total, 14.5% participants reported suicidal ideation and 49.50% high demoralization. Logistic regression analysis identified high demoralization as an independent risk factor for suicidal ideation. Only depression (odds ratio [OR], 6.68) had a stronger influence on suicidal ideation than demoralization (OR, 5.85), and patients with both depression and high demoralization were most likely to experience suicidal ideation. These findings suggest that measures of demoralization can help identify cancer patients at high suicide risk and that such patients require further attention and measures targeting demoralization for suicide prevention.
Methadone-Related Delirium
Authors: Westermeyer Joseph , Thuras Paul , Yoon Gihyun , Kolla Bhanu Prakash , Batres-y-Carr Tegan , Dimitropoulos Erica
Published: April 2019

Goals consist of determining 5-year prevalence and recurrence of methadone-related delirium (MRD), along with causes, treatments, and outcomes. Sample comprised 81 patients in methadone maintenance treatment. Criteria for MRD encompassed delirium with high methadone serum levels plus alleviation of delirium upon lowering methadone serum levels. MRD occurred in 14 cases who had 25 episodes. MRD precipitants included physician prescribing (i.e., excessive methadone or medications slowing methadone metabolism), drug misuse, and renal-fluid alterations. Social affiliation (housing with family, intimate partner) reduced MRD; employment increased MRD. Recovery occurred in 23/25 episodes of MRD; two episodes progressed to dementia. Obtaining serum methadone levels fostered prompt recognition.
An Examination of the Association Between Emotion Reactivity and Distress Tolerance Among College Students
Authors: Bruns Kaitlyn M. , O'Bryan Emily M. , McLeish Alison C.
Published: April 2019

The goal of the present investigation was to examine associations between emotion reactivity in global and specific distress tolerance domains. Participants were 113 undergraduates (65.5% female, 82.3% Caucasian; M
age = 20.0, SD = 4.02, range = 18–45 years) who completed a battery of self-report measures. As hypothesized, the results indicate that, after controlling for sex and negative affectivity, greater levels of emotion reactivity were significantly associated with lower levels of global distress tolerance (12.5% unique variance) and the four specific distress tolerance domains: tolerance (8.6% unique variance), absorption (11.4% unique variance), appraisal (8% unique variance), and regulation (8.1% unique variance). These findings suggest that individuals who tend to react more strongly to their emotions have greater difficulty tolerating emotional distress, and interventions that target emotion reactivity may be an effective way to improve distress tolerance and reduce the risk of developing psychopathology among undergraduates.
“Formal Thought Disorder” in a General-Community Sample With Elevated Schizotypal Traits
Authors: Deyo Cliff , Langdon Robyn
Published: April 2019

Different dimensions of formal thought disorder (FTD) are distinguished by different patterns of cognitive dysfunction and cortical variability in patients with schizophrenia; however, inconsistent findings may relate to patient-related confounds. Investigating FTD in nonpatient samples with elevated levels of schizotypal traits avoids these confounds, but its utility to FTD research is unknown. Thus, we performed principal components analysis (PCA) of FTD ratings using the Scale for the Assessment of Thought, Language, and Communication (TLC) and the Thought and Language Index (TLI) in a general-community sample with elevated schizotypal traits. Both scales showed “clinically elevated” FTD, particularly, the TLC. PCA described a three-component TLC solution (“disorganization,” “verbosity,” “emptiness”) and a two-component TLI solution (“negative,” “idiosyncratic”), generally consistent with schizophrenia research. TLC “disorganization” and “emptiness” were correlated with psychosis-like experiences. TLI “negative” was associated with lower general cognitive function, consistent with schizophrenia research. FTD may have shared etiology along the schizophrenia spectrum.
A multicenter observational study on the distribution of orthopaedic fracture types across 17 low- and middle-income countries
Authors: Pouramin Panthea , Li Chuan Silvia , Sprague Sheila , Busse Jason W. , Bhandari Mohit
Published: April 2019

Objectives:

To describe the regional distribution of fractures sustained by women and health care system characteristics across 17 low- and middle-income countries (LMICs).

Methods:

The INternational ORthopaedic MUlticentre Study in fracture care (INORMUS) is an observational study collecting data on patients in LMICs who sustained a fracture or musculoskeletal injury. As a planned analysis for the INORMUS study, we explored differences in fracture locations and demographics reported among 9878 female patients who sustained a fracture within 17 LMICs in 5 regions (China, Africa, India, Other Asia, and Latin America).

Results:

Half of our study population (49.6%) was ≥60 years of age. Across all regions, 58.3% of patients possessed health insurance. Latin America possessed the highest proportion (88.8%) of health insurance, while in Africa, patients possessed the lowest (18.0%). Falls from standing were the most prevalent mechanism of injury (51.7%) followed by falls from height (12.8%) and motorcycle-related road traffic injuries (9.7%). The majority of the fractures (65.6%) occurred in patients aged 50 and older. Hip fractures were the most common fracture (26.8%), followed by tibia/fibula (12.6%) and spine fractures (9.7%). Open fractures accounted for 7.6% of fractures and were most commonly tibia/fibula fractures (35.1%). Despite these severe injuries, less than one-third (28.8%) of patients were transported for care after sustaining a fracture by ambulance. Regionally, a majority of female patients in Africa were working age and suffered tibia/fibula (21.6%) and femur fractures (14.0%). Patients in the regional category Other Asia, suffered the highest frequencies of open fractures (9.6% low grade, 7.1% high grade), and disproportionately from motorcycle road traffic injuries (29.9%).

Conclusion:

Across all regions, the most significant source of fracture burden was in the elderly, and included common fragility fractures, such as hip fractures. Notable regional deviations in fracture distributions were observed within Africa, and Other Asia. Across all studied LMICs, ambulance usage was low, and health insurance coverage was particularly low in Africa and India.
Nasal Septum Defects Detected on Postmortem Computed Tomography
Authors: Chatzaraki Vasiliki , Schweitzer Wolf , Thali Michael J. , Ampanozi Garyfalia
Published: April 2019

Nasal septum defects may have forensic relevance because they are associated with various mechanisms, including trauma and cocaine abuse. Like all human body tissues, the nasal septum may be affected by maggots' infestation during postmortem decomposition. Postmortem computed tomography (PMCT) can reveal small findings and related details. Three cases of early postmortem period and 2 cases of advanced decomposition, where external examination of the nasal cavities and PMCT revealed nasal septum defect, are presented. In the early postmortem period cases, the lesions' edges appeared smoother on PMCT, whereas in the advanced decomposed cases, the edges were irregular and maggots were infested. Postmortem computed tomography can detect nasal septum defects and may help differentiate the preexisting from the postmortem ones based on their edges' radiological appearance. Such findings may indicate possible chronic cocaine abuse (cocaine nose), trauma, or other nasal pathology. It is important to note that such defects may be altered or caused by advanced decomposition.
Leaving Without Being Seen From a Pediatric Emergency Department
Authors: Moskalewicz Risha L. , Pham Phung K. , Liberman Danica B. , Hall Jeanine E.
Published: April 2019

Objective

National rates of left (or leaving) without being seen (LWBS) in pediatric emergency departments (PED) are higher than general emergency departments. We investigated coexisting perspectives on LWBS.

Methods

Q-methodology was implemented through a mixed-methods design. Semistructured interviews elicited a concourse of caregivers' thoughts on waiting in the PED and their consideration of LWBS. Themes from the concourse were identified and framed as statements. Caregivers sorted these statements, which ranged from choosing to stay versus leave the PED before their child is seen by a physician. Sorted data were analyzed through centroid factor analysis.

Results

Seventy-seven caregivers contributed interview data, from which 31 themes were identified and framed as statements. Thirty-one different caregivers contributed Q-sort data, from which 2 factors were revealed, each representing a unique perspective on LWBS. Most caregivers (26 of 31) shared the following perspective: “I would leave the PED before my child is seen by a doctor if there are no reassessments for my child while we are in the queue, no updates on our queue position, or no explanations for wait time.” The remaining caregivers (5 of 31) perceived feelings of uncertainty and helplessness, lack of updates, and competing obligations as primary influences on LWBS.

Conclusions

Elements that factor into caregivers' decision to LWBS from a PED include lack of reassessments, lack of updates on queue position, and lack of information about the triage process. Quality improvement interventions for decreasing LWBS rates should account for diverse coexisting perspectives such as these.
Development of a Clinical Prediction Model for Central Line–Associated Bloodstream Infection in Children Presenting to the Emergency Department
Authors: Figueroa-Phillips Laura M. , Bonafide Christopher P. , Coffin Susan E. , Ross Michelle E. , Guevara James P.
Published: April 2019

Objective

The majority of the children with a central line who present to the emergency department with fever or other signs of bacteremia do not have a central line–associated bloodstream infection (CLABSI). Our objective was to develop a clinical prediction model for CLABSI among this group of children in order to ultimately limit unnecessary hospital admissions and antibiotic use.

Methods

We performed a nested case-control study of children with a central line who presented to the emergency department of an urban, tertiary care children's hospital between January 2010 and March 2015 and were evaluated for CLABSI with a blood culture.

Results

The final multivariable model developed to predict CLABSI consisted of 12 factors: age younger than 5 years, black race, use of total parenteral nutrition, tunneled central venous catheter, double-lumen catheter, absence of other bacterial infection, absence of viral upper respiratory tract infection symptoms, diarrhea, emergency department temperature greater than 39.5°C, fever prior to presentation, neutropenia, and spring/summer season. The clinical prediction score had good discrimination for CLABSI with a c-statistic of 0.81 (confidence interval, 0.77–0.85). A cut point less than 6 was associated with a sensitivity of 98.5% and a negative predictive value of 99.2% for CLABSI.

Conclusions

We were able to identify risk factors and develop a clinical prediction model for CLABSI in children presenting to the emergency department. Once validated in future study, this clinical prediction model could be used to assess the need for hospitalization and/or antibiotics among this group of patients.
Image Fusion: A Novel Approach in Gamma Knife Surgery Treating Trigeminal Neuralgia
Authors: Tang Ke , Zhao Yaqun , Yu Jianchen , Gao Hao , Gao Dongxiao , Di Cuili , Wang Yuping
Published: April 2019

Objective:

Finding accurate locations for radiosurgical targets in trigeminal neuralgia (TN) remains challenging. This study provides a novel approach of image fusion used in locating radiosurgical targets for gamma knife surgery (GKS) in the treatment of TN.

Methods:

Magnetic resonance imaging (MRI) scans were performed before frame fixation, and computed tomography (CT) scans were performed following frame fixation. Fusion of the CT and MRI images was performed to locate the treatment target. The therapeutic effects were evaluated following GKS.

Results:

The CT image ensures precise imaging for defining the fiducial localizers. Multi-modality medical imaging allows the trigeminal nerve (CN V) to be distinguished from the adjacent corresponding vessels. Thus, image fusion makes isocenter positioning more accurate. Significant changes in the frequency, intensity, and length of pain attacks following GKS were achieved.

Conclusion:

Diagnostic MRI co-registered with stereotactic CT can be used for accurate target location. The therapeutic effects of image fusion for GKS treatment of TN are satisfactory.
Midface Growth in Patients With Unilateral Cleft Lip and Palate Treated With a Nasoalveolar Molding Protocol
Authors: Rubin Marcie S. , Clouston Sean A.P. , Esenlik Elçin , Shetye Pradip R. , Flores Roberto L. , Grayson Barry H.
Published: April 2019

This retrospective cohort study aimed to determine the impact of a nasoalveolar molding (NAM) protocol on midface growth in school-aged children with non-syndromic unilateral cleft lip and palate (UCLP). Data from 56 consecutively treated, NAM-prepared, Caucasian patients with non-syndromic UCLP from a single US cleft palate center were compared to pooled center data based on 56 patients with non-syndromic UCLP treated at 2 Eurocleft centers that did not use presurgical infant orthopedics (non-PSIO). Lateral cephalograms were obtained and 28 landmarks were identified. Published cephalometric measurements from Eurocleft centers were used for comparison. Seven cephalometric measurements (SNA, SNB, ANB, A’N’B’, G’-Sn’-Pg’, Sn-CT-LS, ANS-Me/N-Me%), available or derivable for both centers, were analyzed. Means and standard deviations for the 7 measurements were calculated for the NAM center. Student's t-tests were used to compare group means for 6 of the measures and a test of proportion was used for ANS-Me/N-Me%. No significant differences were found between the NAM protocol-prepared group and the Eurocleft non-PSIO centers on any of the 7 analyzed cephalometric relationships after accounting for false discovery rate. The NAM treatment protocol does not appear to impact skeletal or soft tissue facial growth in school-aged children with non-syndromic UCLP.
Approach to Feminization Surgery and Facial Masculinization Surgery: Aesthetic Goals and Principles of Management
Authors: Deschamps-Braly Jordan C.
Published: April 2019

The 1960s and 1970s were an important time for craniofacial surgery because of the work of Paul Tessier and Hugo Obwegeser, both mentored by Sir Harold Gillies, along with many other important monumental minds. During this era, the birth of craniofacial surgery occurred and represented a new discrete specialty within plastic surgery. In the 1980s distraction of the facial skeleton became an indispensable tool in the arsenal of the craniofacial surgeon, based on initial cases in Italy, and rigorous research by McCarthy, Grayson, and others. In more recent times, from 2000 onward, craniofacial surgery has benefitted from the advent and refinement of techniques using computer-aided planning for procedures, spring distraction, as well as the widespread use of fat grafting as part of facial reconstruction. In the last decade, innovations based on the fusion of microsurgical procedures with craniofacial procedures for face allotransplantation and improvements in safety regarding separation of craniopagus infants have been observed. The author thinks it is worth mentioning and conferring praise upon the anesthesia colleagues for improvements in anesthesia which have led to vastly decreased mortality in the infant population undergoing complex procedures.

The common theme among these achievements is that they were quickly adopted by the subspecialty community. However, in the hindsight of history, the author thinks it is now understood that during this time another great achievement, long overlooked, occurred in craniofacial surgery. In the 1980s the author's associate and mentor, Douglas Ousterhout, adapted techniques of craniofacial surgery to change the lives of transgender patients. This new and powerful surgery had the potential to change the course of someone's life just as profoundly as the correction of congenital craniofacial anomalies. This quality of life improvement for trans patients undergoing facial feminization has been evaluated and found to be quite significant. However, it was essentially ignored by the specialty community, and the author and his colleagues were slow to adopt this surgery. In this study, the author will give an overview of the procedures required to feminize or masculinize a face. The history of surgery is fascinating, and the author hopes that the origins of facial gender confirmation surgery (facial feminization and masculinization), which may be found in the forward to this journal, are fascinating to the readers as well.
What Is the Skull Structure Influence of Squamosal Suture Synostosis in Nonsyndromic and Syndromic Crouzon Craniosynostosis?
Authors: Lu Xiaona , Chen Guocheng , Forte Antonio Jorge , Cabrejo Raysa , Singh Anusha , Kyle Gabrick , Steinbacher Derek M. , Alperovich Michael , Alonso Nivaldo , Persing John A.
Published: April 2019

Background:

The morphologic effect of squamosal synostosis has not been clarified, due to its low occurrence rate, and its inclination to be combined with premature closure of other major sutures, especially in syndromic synostosis. This study's goal is to explore the morphological influence of squamosal synostosis in both syndromic and nonsyndromic craniosynostosis patients.

Methods:

Twenty-five computed tomography (CT) scans from nonsyndromic squamosal synostosis (NSS), Crouzon syndrome with squamosal synostosis (CSS), Crouzon syndrome without squamosal synostosis, and normal controls were included. Three-dimensional (3D) cephalometry, entire cranial volume and cranial fossa volume were measured using Materialise software.

Results:

The entire cranial volume of all groups was similar. The NSS developed a gradual reduction in the severity of reduced segmental volume from the anterior cranial fossa, to the middle cranial fossa, and to the unaffected volume of posterior cranial fossa. The CSS developed the most severe volume reduction of middle cranial fossa (12608.30 ± 2408.61 mm3 vs 26077.96 ± 4465.74 mm3, 52%), with proportionate volume reduction of the anterior (7312.21 ± 2435.97 mm3 vs 10520.63 ± 2400.43 mm3, 30%) and posterior cranial fossa (33487.29 ± 5598.93 mm3 vs 48325.04 ± 14700.44 mm3, 31%). The NSS developed a narrower anterior cranial fossa, a clockwise rotated Frankfort horizontal plane, and a retracted chin (pogonion).

Conclusion:

Squamosal synostosis may alter the development of cranial fossa volume, especially the volume of middle cranial fossa. However, the development of cranial base, and related facial features are determined largely by major vault sutures and associated syndromic conditions, rather than the squamosal suture alone.

Level of Evidence: II
Risk Factors for Anterior Hypopituitarism in Patients With Traumatic Brain Injury
Authors: You Wendong , Zhu Yuanrun , Wen Liang , Sun Yun , Pan Desheng , Yang Xiaofeng
Published: April 2019

Background:

Hypopituitarism is a common but potentially undiagnosed complication in patients who suffer traumatic brain injury (TBI). The identification of risk factors of hypopituitarism after TBI is vital to establish a rational testing approach for these patients.

Methods:

The authors retrospectively reviewed the case records of patients with TBI, who underwent pituitary function evaluation in our department between January 2014 and December 2016.

Results:

In all, 193 patients (66.3% male) hospitalized with TBI were included in this study. Anterior hypopituitarism was observed in 33 (17.1%) patients, with 4.7% of the patients having multiple pituitary axes dysfunction. Patients with hypopituitarism had a longer length of ICU stay (8.7 ± 5.5 versus 3.3 ± 4.6,P < 0.001), longer length of total hospital stay (28.7 ± 20.1 versus 21.0 ± 15.8,P = 0.011), and lower Glasgow coma scale (GCS) on admission (9.1 ± 3.5 versus 11.8 ± 3.6,P < 0.001) than those without the condition. Length of ICU stay (P = 0.004, OR = 1.253) and intracranial hypertension (P = 0.027, OR = 3.206) were independent risk factors for posttraumatic hypopituitarism.

Conclusions:

The prevalence of anterior hypopituitarism was estimated to be 17.1%. Patients with intracranial hypertension and longer length of ICU stay are at risk of hypopituitarism. Routine pituitary function evaluation is indicated for this group of patients.
Olfactory Bulb Microstructural Changes in Patients With Nasal Septum Deviation
Authors: Aslan Kerim , Saglam Dilek , Gunbey Hediye Pinar , Incesu Lutfi
Published: April 2019

Objective:

The aim of this study is to assess the microstructural changes to the olfactory bulb (OB) in patients with nasal septum deviation (NSD) using diffusion tensor imaging and to research the association between these changes and the degree of NSD.

Methods:

Ninety-six patients with NSD (46 males, 50 females) who received diffusion tensor imaging were assessed by 2 independent readers. The patients were separated into 3 groups according to the NSD angle. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the ipsilateral and contralateral OB were measured in all NSD patients by region of interest.

Results:

According to deviation side, there was significant difference between the right (R) and left (L) OB FA and ADC values across the 3 groups. In patients with left- and right- sided NSD, FA and ADC values for the left and right OB were significantly different between groups 1 and 3, and groups 2 and 3. There was negative correlation between L-FA (r = −0.481, P = 0.001; r = −0.496, P = 0.001) and R-FA (r = −0.705, P = 0.001; r = −0.286, P = 0.02) versus age and deviation angle. However, there was positive correlation between L-ADC versus age and deviation angle (r = 0.493, P = 0.001; r = 0.482, P = 0.001), as well as positive correlation between R-ADC versus age (r = 0.646, P = 0.001).

Conclusion:

This is the first study showing ADC increase and FA decrease associated with axonal damage and microstructural integrity loss based on the side of deviation in NSD patients. It has also shown that this abnormality is directly proportional with NSD degree.
Apart From Surgical Procedures, Another Important Point to Note in Lacrimal Canalicular Lacerations: Traumatic Retinal Tears
Authors: Demirel Soner , Dikci Seyhan , Firat Penpe Gül , Genç Oğuzhan , Mutlu Kayhan
Published: April 2019

Background:

To evaluate fundus examinations in terms of traumatic retinal tears or dialysis that may be related to canalicular lacerations (CLs).

Materials and Methods:

This retrospective study was conducted on patients with CL repair from June 1, 2009 to May 30, 2018. The authors collected the data from the patients’ medical records, including their demographic details, mechanism and setting of injury, associated ocular injuries, type of stent used, setting of repairs, duration of follow-up, complications, pre- or intraoperative findings of biomicroscopic and fundus examinations, refractive errors, postoperative follow-up of fundus examination, and management.

Results:

Sixty patients (43 males and 17 females) were included in the study. The mean age of all the patients was 27.50 ± 21.72 (min: 1–max: 94) years. Isolated CL was found in 38 patients. Nonisolated CL, which means with some additional pathologies, were found in 22 patients (37%, approximately 1/3). Retinal follow-up records were available in 49 patients with a mean follow-up period of 7.48 ± 9.82 months. Retinal tears were seen in 3 patients (0.05%) with no predisposing risk factors. Two of these tears were found in the follow-up period after the traumas.

Conclusion:

Consequent retinal tears after canalicular lacerations were not strongly addressed in previous works. In this study, the authors aimed to view CL from a different perspective. Canalicular laceration is also an ocular trauma that may threaten vision. The authors emphasized that performing detailed fundus examinations and follow-up in all canalicular traumas is necessary.
The Management of Giant Cerviofacial Lymphatic Malformations in Children
Authors: Li Wanpeng , Xu Hongming , Zhao Liming , Li Xiaoyan
Published: April 2019

Objective:

Lymphatic malformations (LMs) are rare and benign diseases. This article aimed to present a series of surgically treated giant cervicofacial LMs in children.

Methods:

A retrospective analysis of giant cervicofacial LMs (tumor diameter greater than 10 cm) in children over the past 8 years was performed in our department.

Results:

The 10 patients included 4 males and 6 females. Macrocystic lesion presented in 4 patients, mixed cystic lesion presented in 4 patients, and microcystic lesion presented in 2 patients. All the patients underwent surgical resection combined with bleomycin sclerotherapy. Despite the wide range of lesions, most patients (7/10, 70%) received only a single treatment, 3 patients had a recurrent lesion. Seven patients experienced complete or almost complete resolution of the disease with an average follow-up time of 26.4 months.

Conclusions:

Surgical resection is the preferred method for the treatment of giant LMs, combination of bleomycin sclerotherapy can reduce the recurrence rate. The curative effect of macrocystic disease is relatively enhanced compared with microcystic and mixed cystic diseases.
Treatment of Rhinophyma With Surgical Excision and Amniotic Membrane
Authors: Yoo Jason J. , Thaller Seth R.
Published: April 2019

Rhinophyma is a phenotypic subtype of rosacea affecting the nose. It is characterized by phymatous changes, skin thickening/fibrosis, glandular hyperplasia, and chronic inflammation. Treatment of severe rhinophyma is predominantly surgical excision with closure by secondary intention. Amniotic membrane has been used to promote wound healing, fibrosis, and inflammation. In this case study, the authors present a 63-year-old male with longstanding rhinophyma treated with surgical excision with intraoperative placement of amniotic membrane.
The Incidence of Sleep Disordered Breathing One Week After Primary Palatoplasty: Evaluation With Overnight Pulse Oximetry
Authors: Nakajima Yukari , Hikosaka Makoto , Kuwahara Kosuke , Kaneko Tsuyoshi , Ito Sukeyuki , Morimoto Noriko
Published: April 2019

Background:

Sleep disordered breathing (SDB) is defined as a series of disorders including snoring, obstructive sleep apnea, and hypopnea. Few studies investigated the incidence of SDB following primary palatoplasty with objective testing. The aims of this study were to elucidate the prevalence and degree of SDB approximately 1 week following primary palatoplasty with objective testing and to clarify the risk factors.

Method:

A retrospective review was performed on children who underwent primary palatoplasty between April 2013 and July 2017 at National Center for Child Health and Development, Tokyo, Japan. As a national center, the authors accept many syndromic patients. The authors keep all patients after palatoplasty intubated and observe them overnight in intensive care unit to reduce the risks of respiratory events. Patients were evaluated with overnight pulse oximetry on 5 to 7 days postoperatively.

Results:

Forty-four patients were included, and 30% of the patients were associated with congenital anomaly. Thirteen patients (30%) were diagnosed with SDB. None of the patients required additional treatment after the evaluation. Laryngomalacia and postoperative oxygen requirement significantly correlated with postoperative SDB.

Conclusion:

Approximately one-third of the patients may be at the risk of SDB 1 week after primary palatoplasty. Patients with history of laryngomalacia or those who required oxygen support for prolonged time after primary palatoplasty should be cared for significantly high risk of postoperative SDB.
The Preferred Catheter Type After Prolapse Surgery: A Survey Study of Surgeons
Authors: Kulkarni Anjali , McDermott Colleen D.
Published: April 2019

Objective

The aim of this study was to determine surgeon preference for catheter type in the management of postoperative urinary retention after prolapse surgery, specifically comparing transurethral indwelling catheters (TIC), clean intermittent self-catheterization (CISC), and suprapubic tubes (SPT).

Methods

Electronic surveys were sent to 1182 urogynecologists and urologists through the American Urogynecologic Society and the Canadian Society of Pelvic Medicine.

Results

A total of 247 (21%) surveys were completed, where 53% of the respondents ranked TIC as the best catheter option, compared with 42% for CISC and 4% for SPT (P < 0.0001). Most (75%) of the respondents stated they do not offer their patients a choice in catheter selection. Most (43%) of the respondents ranked ease of use for the patient as the most important catheter characteristic. For ease of use for the patient, 71% of the respondents ranked TIC as the best, compared with CISC and SPT. For all other characteristics (pain/discomfort, infection, catheter malfunction, and return of bladder function), CISC was ranked as the best by the majority.

Conclusions

This study showed that surgeons have a significant preference for TIC over CISC and SPT for the management of postoperative urinary retention, and the majority of surgeons do not offer their patients a choice with regard to catheter type.
Ultrasound-guided in Utero Transplantation of Placental Stem Cells into the Liver of Crigler–Najjar Syndrome Model Rat
Authors: Grubbs Brendan H. , Ching Mc Millan , Parducho Kevin R. , Chmait Ramen H. , Miki Toshio
Published: April 2019

Background.

Advances in prenatal screening and early diagnosis of genetic disease will potentially allow for preemptive treatment of anticipated postnatal disease by in utero cell transplantation (IUCT). This strategy carries potential benefits over postnatal treatment, which might allow for improved engraftment and function of the transplanted cells. Congenital metabolic disorders may be an ideal target for this type of therapy, as in most cases, they require replacement of a single deficient hepatic enzyme, and multiple small-animal models exist for preclinical testing.

Methods.

The Gunn rat, a Crigler–Najjar syndrome model animal lacking UDP-glucuronosyltransferase (UGT1A1), was used as recipient. Human amniotic epithelial cells (hAECs), which possess hepatic differentiation potential, were transplanted into the midgestation fetal Gunn rat liver via ultrasound-guided IUCT. The impact of IUCT on live birth and postnatal survival was evaluated. Human cell engraftment was immunohistochemically analyzed on postnatal day 21.

Results.

Ultrasound-guided IUCT was conducted in rat fetuses on embryonic day 16. Following IUCT, the antihuman mitochondria-positive cells were detected in the liver of recipient rats at postnatal day 21.

Conclusions.

Here, we have introduced ultrasound-guided IUCT of hAEC using a small-animal model of a congenital metabolic disorder without immunosuppression. The immunological advantage of IUCT was demonstrated with xenogeneic IUCT. This procedure is suitable to conduct preclinical studies for exploring the feasibility and efficacy of ultrasound-guided transuterine cell injection using rodent disease models.
Donor Age Predicts Calcineurin Inhibitor Induced Neurotoxicity After Liver Transplantation
Authors: Lué Alberto , Martinez Elena , Navarro Mercedes , Laredo Viviana , Lorente Sara , Jose Araiz Juan , Agustin Garcia-Gil Francisco , Serrano Maria Trinidad
Published: April 2019

Background.

Calcineurin inhibitor-induced neurotoxicity (CIIN) is a common and debilitating side effect after liver transplantation (LT). Risk factors and impact on patient outcomes are not well defined. Our aim was to assess the incidence, risk factors, and clinical outcomes of CIIN.

Methods.

We retrospectively analyzed 175 LTs performed at our center between January 2010 and September 2016. Donor and recipient demographics as well as clinical variables pre-LT, intra-LT, and post-LT were assessed. All patients were on once-daily prolonged-release tacrolimus.

Results.

CIIN was described in 37 (21.4%) recipients. In univariate analysis, history of hepatic encephalopathy (P = 0.033), immunosuppressant treatment protocol (P = 0.041), donor age (P = 0.002), and pre-LT sodium serum levels (P = 0.004) were associated with CIIN. Patients undergoing LT for hepatocellular carcinoma had lower rates of CIIN (P = 0.040). In multivariate analysis, hepatic encephalopathy (odds ratio [OR], 2.728; 95% confidence interval [CI], 1.098-6.779; P = 0.031), pre-LT serum sodium levels (OR, 1.118 per mEq/L increase, 95% CI, 1.021-1.224; P = 0.016), and donor age (OR, 1.032 per y increase; 95% CI, 1.004-1.062; P = 0.027) were independent risk factors for developing CIIN. In the CIIN group, patients had longer intensive care unit (P = 0.024) and hospital (P = 0.008) stays and more changes in immunosuppressive treatment (54.1% vs 20.4%; P < 0.001).

Conclusions.

Neurotoxicity remains frequent in patients on once-daily prolonged-release tacrolimus. Antecedents of hepatic encephalopathy, pre-LT sodium serum levels, and donor age are independent risk factors for developing CIIN after LT. CIIN is associated with longer hospital stays and changes in immunosuppressive treatment.
Membranous Nephropathy Posttransplantation: An Update of the Pathophysiology and Management
Authors: Leon Juliette , Pérez-Sáez María José , Batal Ibrahim , Beck Laurence H. , Rennke Helmut G. , Canaud Guillaume , Legendre Christophe , Pascual Julio , Riella Leonardo V.
Published: April 2019

Membranous nephropathy (MN) is a common cause of nephrotic syndrome after transplantation and is associated with an increased risk of allograft loss. MN may occur either as a recurrent or as a de novo disease. As in native kidneys, the pathophysiology of the MN recurrence is in most cases associated with antiphospholipid A2 receptor antibodies. However, the posttransplant course has some distinct features when compared with primary MN, including a lower chance of spontaneous remission and a greater requirement for adjuvant immunosuppressive therapy to induce complete remission. Although the efficacy of rituximab in primary MN is now well established, no randomized studies have assessed its effectiveness in MN after transplant, and there are no specific recommendations for the management of these patients. This review aims to synthesize and update the pathophysiology of posttransplant MN, as well as to address unsolved issues specific to transplantation, including the prognostic value of antiphospholipid A2 receptor, the risk of living-related donation, the link between de novo MN and rejection, and different therapeutic strategies so far deployed in posttransplant MN. Lastly, we propose a management algorithm for patients with MN who are planning to receive a kidney transplant, including pretransplant considerations, posttransplant monitoring, and the clinical approach after the diagnosis of recurrence.
A polygenic risk score for breast cancer in U.S. Latinas and Latin-American women
Authors: Shieh Yiwey , Fejerman Laura , Lott Paul C. , Marker Katie , Sawyer Sarah D. , Hu Donglei , Huntsman Scott , Torres Javier , Echeverry Magdalena , Bohorquez Mabel E. , Martínez-Chéquer Juan Carlos , Polanco-Echeverry Guadalupe , Estrada-Florez Ana P. ,   the COLUMBUS Consortium, Haiman Christopher A. , John Esther M. , Kushi Lawrence H. , Torres-Mejía Gabriela , Vidaurre Tatianna , Weitzel Jeffrey N. , Zambrano Sandro Casavilca , Carvajal-Carmona Luis G. , Ziv Elad , Neuhausen Susan L.
Published: April 2019

Background

Over 180 single nucleotide polymorphisms (SNPs) associated with breast cancer susceptibility have been identified; these SNPs can be combined into polygenic risk scores (PRS) to predict breast cancer risk. Since most SNPs were identified in predominantly European populations, little is known about the performance of PRS in non-Europeans. We tested the performance of a 180-SNP PRS in Latinas, a large ethnic group with variable levels of Indigenous American, European, and African ancestry.

Methods

We conducted a pooled case-control analysis of U.S. Latinas and Latin-American women (4,658 cases, 7,622 controls). We constructed a 180-SNP PRS consisting of SNPs associated with breast cancer risk (p < 5 × 10−8). We evaluated the association between the PRS and breast cancer risk using multivariable logistic regression and assessed discrimination using area under the receiver operating characteristic curve (AUROC). We also assessed PRS performance across quartiles of Indigenous American genetic ancestry.

Results

Of 180 SNPs tested, 142 showed directionally consistent associations compared with European populations, and 39 were nominally significant (p < 0.05). The PRS was associated with breast cancer risk, with an odds ratio (OR) per standard deviation increment of 1.58 (95% CI 1.52 to 1.64) and AUCROC of 0.63 (95% CI 0.62 to 0.64). The discrimination of the PRS was similar between the top and bottom quartiles of Indigenous American ancestry.

Conclusions

The 180-SNP PRS predicts breast cancer risk in Latinas, with similar performance as reported for Europeans. The performance of the PRS did not vary substantially according to Indigenous American ancestry.
Socio-behavioural characteristics and HIV: findings from a graphical modelling analysis of 29 sub-Saharan African countries
Authors: Baranczuk Zofia , Estill Janne , Blough Sara , Meier Sonja , Merzouki Aziza , Maathuis Marloes H. , Keiser Olivia
Published: April 2019

Introduction

Socio-behavioural factors may contribute to the wide variance in HIV prevalence between and within sub-Saharan African (SSA) countries. We studied the associations between socio-behavioural variables potentially related to the risk of acquiring HIV.

Methods

We used Bayesian network models to study associations between socio-behavioural variables that may be related to HIV. A Bayesian network consists of nodes representing variables, and edges representing the conditional dependencies between variables. We analysed data from Demographic and Health Surveys conducted in 29 SSA countries between 2010 and 2016. We predefined and dichotomized twelve variables, including factors related to age, literacy, HIV knowledge, HIV testing, domestic violence, sexual activity, and women’s empowerment. We analysed data on men and women for each country separately and then summarised the results across the countries. We conducted a second analysis including also the individual HIV status in a subset of 23 countries where this information was available. We presented summary graphs showing associations that were present in at least six countries (five in the analysis with HIV status).

Results

We analysed data from 190,273 men (range across countries 2,295–17,359) and 420,198 women (6,621–38,948). The two variables with the highest total number of edges in the summary graphs were literacy and rural/urban location. Literacy was negatively associated with false beliefs about AIDS and, for women, early sexual initiation, in most countries. Literacy was also positively associated with ever being tested for HIV and the belief that women have the right to ask their husband to use condoms if he has a sexually transmitted infection. Rural location was positively associated with false beliefs about HIV and the belief that beating one’s wife is justified, and negatively associated with having been tested for HIV. In the analysis including HIV status, being HIV positive was associated with female-headed household, older age and rural location among women, and with no variables among men.

Conclusions

Literacy and urbanity were strongly associated with several factors that are important for HIV acquisition. Since literacy is one of the few variables that can be improved by interventions, this makes it a promising intervention target.
Widespread Sexual Dimorphism in the Transcriptome of Human Airway Epithelium in Response to Smoking
Authors: Yang Chen Xi , Shi Henry , Ding Irving , Yang Cheng Wei Tony , Kim Edward Kyoo-Hoon , Hackett Tillie-Louise , Leung Janice , Sin Don D. , Obeidat Ma’en
Published: April 2019

Epidemiological studies have shown that female smokers are at higher risk of chronic obstructive pulmonary disease (COPD). Female patients have worse symptoms and health status and increased risk of exacerbations. We determined the differences in the transcriptome of the airway epithelium between males and females at baseline and in response to smoking. We processed public gene expression data of human airway epithelium into a discovery cohort of 211 subjects (never smokers n=68; current smokers n=143) and two replication cohorts of 104 subjects (21 never, 52 current, and 31 former smokers) and 238 subjects (99 current and 139 former smokers. We analyzed gene differential expression with smoking status, sex, and smoking-by-sex interaction and used network approaches for modules’ level analyses. We identified and replicated two differentially expressed modules between the sexes in response to smoking with genes located throughout the autosomes and not restricted to sex chromosomes. The two modules were enriched in autophagy (up-regulated in female smokers) and response to virus and type 1 interferon signaling pathways which were down-regulated in female smokers compared to males. The results offer insights into the molecular mechanisms of the sexually dimorphic COPD risk and presentation potentially enabling a precision medicine approach to COPD.
Early transmission of sensitive strain slows down emergence of drug resistance in Plasmodium vivax
Authors: Ayala Mario J.C. , Villela Daniel A.M.
Published: April 2019

The spread of drug resistance of Plasmodium falciparum and Plasmodium vivax parasites is a challenge towards malaria elimination.P. falciparum has shown an early and severe drug resistance in comparison to P. vivax in various countries. In fact, these Plasmodium species differ in their life cycle and treatment in various factors: development and duration of sexual parasite forms differ, symptoms severity are unequal, relapses present only in P. vivax cases, and the Artemisinin-based combination therapy (ACT) is only mandatory in all P. falciparum cases. We compared the spread of drug resistance for both species through two compartmental models using ordinary differential equations. The model structure describes how sensitive and resistant parasite strains infect a human population treated with antimalarials. We found that the early transmission before treatment and the low effectiveness of drug coverage support the prevalence of sensitive parasites delaying the emergence of resistant P. vivax. These results imply that earlier attention of symptomatic and reservoirs of P. vivax accelerates the spread of drug resistance as P. falciparum.
PyMethylProcess - highly parallelized preprocessing for DNA methylation array data
Authors: Levy Joshua J. , Titus Alexander J. , Salas Lucas A. , Christensen Brock C.
Published: April 2019

The ability to perform high-throughput preprocessing of methylation array data is essential in large scale methylation studies. While R is a convenient language for methylation analyses, performing highly parallelized preprocessing using Python can accelerate data preparation for downstream methylation analyses, including large scale production-ready machine learning pipelines. Here, we present a methylation data preprocessing pipeline called PyMethylProcess that is highly reproducible, scalable, and that can be quickly set-up and deployed through Docker and PIP.

Availability and Implementation

Project Name: PyMethylProcess

Project Home Page:https://github.com/Christensen-Lab-Dartmouth/PyMethylProcess. Available on PyPI aspymethylprocess.

Available on DockerHub viajoshualevy44/pymethylprocess.

Help Documentation:https://christensen-lab-dartmouth.github.io/PyMethylProcess/

Operating Systems: Linux, MacOS, Windows (Docker)

Programming Language: Python, R

Other Requirements: Python 3.6, R 3.5.1, Docker (optional) License: MIT

Contact

joshua.j.levy.gr@dartmouth.edu