bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Complications and Costs During Overlapping Transsphenoidal Surgery in the Treatment of Pituitary Adenoma
Authors: Karsy Michael , Bowers Christian A , Scoville Jonathan , Kundu Bornali , Azab Mohammed A , Gee J Michael , Guan Jian , Couldwell William T
Published: May 2018

BACKGROUND

Pituitary adenomas are among the most common primary brain tumors. Recently, overlapping surgery has been curbed in many institutions because of the suggestion there might be more significant adverse events, despite several studies showing that complication rates are equivalent.

OBJECTIVE

To assess complications and costs associated with overlapping surgery during the transsphenoidal resection of pituitary adenomas.

METHODS

A single-center, retrospective cohort study was performed to evaluate the cases of patients who underwent a transsphenoidal approach for pituitary tumor resection. Patient, surgical, complication, and cost (value-driven outcome) variables were analyzed.

RESULTS

A total of 629 patients (302 nonoverlapping, 327 overlapping cases) were identified. No significant differences in age (P = .6), sex (P = .5), tumor type (P = .5), or prior rates of pituitary adenoma resection (P = .5) were seen. Similar presenting symptoms were observed in the 2 groups, and follow-up length was comparable (P = .3). No differences in tumor sizes (P = .5), operative time (P = .4), fat/fascia use (P = .4), or cerebrospinal fluid diversion (P = .8) were seen between groups. The gross total resection rate was not significantly different (P = .9), and no difference in recurrence rate was seen (P = .4). A comparable complication rate was seen between groups (P = .6). No differences in total or subtotal costs were seen either.

CONCLUSION

The results of this study offer additional evidence that overlapping surgery does not result in worsened complications, lengthened surgery, or increased patient cost for patients undergoing transsphenoidal resection of pituitary adenomas. Thus, studies and policy aiming to improve patient safety and cost should focus on optimizing other aspects of healthcare delivery.
Balloon Occlusion Testing to Assess Retinal Collateral and Predict Visual Outcomes in the Management of a Fusiform Intraorbital Ophthalmic Artery Aneurysm: Technical Note and Literature Review
Authors: Sattur Mithun G , Welz Matthew E , Bendok Bernard R , Miller Jeffrey W
Published: May 2018

BACKGROUND AND IMPORTANCE

Aneurysms of the ophthalmic artery (OA) within the orbit and optic canal are extremely rare. Given the peripheral location of these aneurysms and the fact that most are fusiform, parent artery occlusion is preferred for symptomatic aneurysms. However, the impact of OA occlusion on vision is not always innocuous. Balloon occlusion testing (BOT) of the OA has the potential to gauge the possibility of visual compromise, in addition to assessing collaterals. While BOT has been assessed for carotid artery occlusion, its role in OA occlusion has not been well defined.

CLINICAL PRESENTATION

We describe a patient with a 6-mm intracanalicular OA aneurysm who was treated with endovascular coil embolization of the aneurysm and occlusion of the parent artery. We performed a 30-min balloon occlusion test, in which we verified intact visual and neurological function. Collateral vascularity was confirmed. Complete occlusion was achieved and the patient recovered with intact visual and neurological function. We provide a review of literature pertaining to parent artery occlusion of OA aneurysms that occur within optic canal and orbit. A brief note on anatomy of OA and collaterals is provided.

CONCLUSION

Endovascular parent artery occlusion is an effective treatment for OA aneurysms that occur in optic canal and orbit. Assessment of effect of occlusion on vision is important. BOT can assess this and provide valuable information. Recovery or preservation of visual function is highly dependent on preoperative visual status.
Innovation and Top Income Inequality
Authors: Aghion Philippe , Akcigit Ufuk , Bergeaud Antonin , Blundell Richard , Hemous David
Published: May 2018

In this article, we use cross-state panel and cross-U.S. commuting-zone data to look at the relationship between innovation, top income inequality and social mobility. We find positive correlations between measures of innovation and top income inequality. We also show that the correlations between innovation and broad measures of inequality are not significant. Next, using instrumental variable analysis, we argue that these correlations at least partly reflect a causality from innovation to top income shares. Finally, we show that innovation, particularly by new entrants, is positively associated with social mobility, but less so in local areas with more intense lobbying activities.
Prevalence and Incidence of Yellow Dwarf Viruses Across a Climatic Gradient: A Four-Year Field Study in Southeastern Australia
Authors: Nancarrow Narelle , Aftab Mohammad , Freeman Angela , Rodoni Brendan , Hollaway Grant , Trębicki Piotr
Published: May 2018

Yellow dwarf viruses (YDVs) form a complex of economically important pathogens that affect cereal production worldwide, reducing yield and quality. The prevalence and incidence of YDVs including barley yellow dwarf viruses (BYDV-PAV and BYDV-MAV) and cereal yellow dwarf virus (CYDV-RPV) in cereal fields in Victoria, Australia were measured. As temperature decreases and rainfall increases from north to south in Victoria, fields in three geographical regions were evaluated to determine potential differences in virus prevalence and incidence across the weather gradient. Cereal samples randomly collected from each field during spring for four consecutive years (2014–2017) were tested for BYDV-PAV, BYDV-MAV, and CYDV-RPV using tissue blot immunoassay. BYDV-PAV was the most prevalent YDV species overall and had the highest overall mean incidence. Higher temperature and lower rainfall were associated with reduced prevalence and incidence of YDVs as the northern region, which is hotter and drier, had a 17-fold decrease in virus incidence compared with the cooler and wetter regions. Considerable year-to-year variation in virus prevalence and incidence was observed. This study improves our understanding of virus epidemiology, which will aid the development of more targeted control measures and predictive models. It also highlights the need to monitor for YDVs and their vectors over multiple years to assess the level of risk and to make more informed and appropriate disease management decisions.
Spatial Analysis of Rice Blast in China at Three Different Scales
Authors: Guo Fangfang , Chen Xinglong , Lu Minghong , Yang Li , Wang Shiwei , Wu Bo Ming
Published: May 2018

In this study, spatial analyses were conducted at three different scales to better understand the epidemiology of rice blast, a major rice disease caused by Magnaporthe oryzae. At the regional scale, across the major rice production regions in China, rice blast incidence was monitored on 101 dates at 193 stations from 10 June to 10 September during 2009 to 2014, and surveyed in 143 fields in September 2016; at the county scale, three surveys were done covering one to five counties in 2015 to 2016; and, at the field scale, blast was evaluated in six fields in 2015 to 2016. Spatial cluster and hot spot analyses were conducted in the geographic information system on the geographical pattern of the disease at regional scale, and geostatistical analysis was performed at all three scales. Cluster and hot spot analyses revealed that high-disease areas were clustered in mountainous areas in China. Geostatistical analyses detected spatial dependence of blast incidence with influence ranges of 399 to 1,080 km at regional scale and 5 to 10 m at field scale but not at county scale. The spatial patterns at different scales might be determined by inherent properties of rice blast and environmental driving forces, and findings from this study provide helpful information to sampling and management of rice blast.
Trauma in pregnancy
Authors: Scannell Meredith
Published: May 2018

We give you the information you need to care for pregnant patients who've sustained a traumatic injury.
Decision Making for Skeletal Reconstruction Options in the Growing Child
Authors: Wooldridge Adam N. , Anderson Colin J. , Scarborough Mark T.
Published: May 2018

There are numerous options for limb salvage surgery in the growing child following resection of tumor. Despite advances in endoprosthetic and allograft reconstruction, each option presents unique challenges and sequela. A thorough understanding of the potential complications and need for future surgeries is of paramount importance in preoperative physician-family decision making. Disease-specific and patient-specific factors help facilitate the surgical choice. While pediatric patients have excellent healing potential and plasticity, final limb-length discrepancies must be considered. The surgical choice should provide a functional and durable reconstruction that limits limb-length inequality. Within this article, the decision-making process and results of reconstruction with allograft, endoprostheses, and rotationplasty are reviewed.
Co-Occurrence of Post-Intensive Care Syndrome Problems Among 406 Survivors of Critical Illness*
Authors: Marra Annachiara , Pandharipande Pratik P. , Girard Timothy D. , Patel Mayur B. , Hughes Christopher G. , Jackson James C. , Thompson Jennifer L. , Chandrasekhar Rameela , Ely Eugene Wesley , Brummel Nathan E.
Published: May 2018

Objectives:

To describe the frequency of co-occurring newly acquired cognitive impairment, disability in activities of daily livings, and depression among survivors of a critical illness and to evaluate predictors of being free of post-intensive care syndrome problems.

Design:

Prospective cohort study.

Setting:

Medical and surgical ICUs from five U.S. centers.

Patients:

Patients with respiratory failure or shock, excluding those with preexisting cognitive impairment or disability in activities of daily livings.

Interventions:

None.

Measurements and Main Results:

At 3 and 12 months after hospital discharge, we assessed patients for cognitive impairment, disability, and depression. We categorized patients into eight groups reflecting combinations of cognitive, disability, and mental health problems. Using multivariable logistic regression, we modeled the association between age, education, frailty, durations of mechanical ventilation, delirium, and severe sepsis with the odds of being post-intensive care syndrome free. We analyzed 406 patients with a median age of 61 years and an Acute Physiology and Chronic Health Evaluation II of 23. At 3 and 12 months, one or more post-intensive care syndrome problems were present in 64% and 56%, respectively. Nevertheless, co-occurring post-intensive care syndrome problems (i.e., in two or more domains) were present in 25% at 3 months and 21% at 12 months. Post-intensive care syndrome problems in all three domains were present in only 6% at 3 months and 4% at 12 months. More years of education was associated with greater odds of being post-intensive care syndrome free (p < 0.001 at 3 and 12 mo). More severe frailty was associated with lower odds of being post-intensive care syndrome free (p = 0.005 at 3 mo and p = 0.048 at 12 mo).

Conclusions:

In this multicenter cohort study, one or more post-intensive care syndrome problems were present in the majority of survivors, but co-occurring problems were present in only one out of four. Education was protective from post-intensive care syndrome problems and frailty predictive of the development of post-intensive care syndrome problems. Future studies are needed to understand better the heterogeneous subtypes of post-intensive care syndrome and to identify modifiable risk factors.
Unmet information needs of patients with melanoma in Germany
Authors: Brütting Julia , Bergmann Maike , Garzarolli Marlene , Rauschenberg Ricarda , Weber Christiane , Berking Carola , Tilgen Wolfgang , Schadendorf Dirk , Meier Friedegund
Published: May 2018

There is a scarcity of available data on unmet information needs (UINs) of melanoma patients (MPs) from Germany and of MPs with clinical stage IV. In a multicenter cross-sectional survey, we explored the UINs of 529 MPs by applying a standardized questionnaire. Subgroup differences in scope and contents of UINs were determined by univariate analyses. Predictors of the presence of UINs were identified by binary logistic regression. Overall, 55% of MPs reported UINs. Most MPs felt poorly or not informed about psychosocial support (24–31%). In MPs currently receiving medical treatment [odds ratio (OR): 1.9; P=0.017], MPs aging of at least 55 years (OR: 1.7; P=0.029), and in MPs who generally had a high need for information on their condition (OR: 2.4; P=0.001), the presence of UINs was significantly more likely than in post-treatment MPs, MPs more than 55 years of age, and those whose general information need was low. Most UINs concerned treatment-related information and were reported by MPs with tumor progression. Presence and scope of UINs did not differ significantly between metastatic and nonmetastatic MPs (57 vs. 53%; P=0.436). We highlighted differences in the presence, scope, and contents of UINs between MP subgroups, which should be considered when educating them in medical consultations and providing information via media. In particular, MPs felt insufficiently informed about psychosocial support and desired more treatment information.
A Metabolomic Serum Signature from Nonhuman Primates Treated with a Radiation Countermeasure, Gamma-tocotrienol, and Exposed to Ionizing Radiation
Authors: Pannkuk Evan L. , Laiakis Evagelia C. , Fornace Albert J. , Fatanmi Oluseyi O. , Singh Vijay K.
Published: May 2018

The search for and development of radiation countermeasures to treat acute lethal radiation injury has been underway for the past six decades, resulting in the identification of multiple classes of radiation countermeasures. However, to date only granulocyte colony-stimulating factor (Neupogen) and PEGylated granulocyte colony-stimulating factor (Neulasta) have been approved by the U.S. Food and Drug Administration for the treatment of hematopoietic acute radiation syndrome. Gamma-tocotrienol has demonstrated radioprotective efficacy in murine and nonhuman primate models. Currently, this agent is under advanced development as a radioprotector, and the authors are trying to identify its efficacy biomarkers. In this study, global metabolomic changes were analyzed using ultraperformance liquid chromatography quadrupole time-of-flight mass spectrometry. The pilot study using 16 nonhuman primates (8 nonhuman primates each in gamma-tocotrienol- and vehicle-treated groups), with samples obtained from gamma-tocotrienol-treated and irradiated nonhuman primates, demonstrates several metabolites that are altered after irradiation, including compounds involved in fatty acid beta-oxidation, purine catabolism, and amino acid metabolism. The machine-learning algorithm, Random Forest, separated control, irradiated gamma-tocotrienol‐treated, and irradiated vehicle-treated nonhuman primates at 12 h and 24 h as evident in a multidimensional scaling plot. Primary metabolites validated included carnitine/acylcarnitines, amino acids, creatine, and xanthine. Overall, gamma-tocotrienol administration reduced high fluctuations in serum metabolite levels, suggesting an overall beneficial effect on animals exposed to radiation. This initial assessment also highlights the utility of metabolomics in determining underlying physiological mechanisms responsible for the radioprotective efficacy of gamma-tocotrienol.
Use of Proteomic and Hematology Biomarkers for Prediction of Hematopoietic Acute Radiation Syndrome Severity in Baboon Radiation Models
Authors: Blakely William F. , Bolduc David L. , Debad Jeff , Sigal George , Port Matthias , Abend Michael , Valente Marco , Drouet Michel , Hérodin Francis
Published: May 2018

Use of plasma proteomic and hematological biomarkers represents a promising approach to provide useful diagnostic information for assessment of the severity of hematopoietic acute radiation syndrome. Eighteen baboons were evaluated in a radiation model that underwent total-body and partial-body irradiations at doses of 60Co gamma rays from 2.5 to 15 Gy at dose rates of 6.25 cGy min-1 and 32 cGy min-1. Hematopoietic acute radiation syndrome severity levels determined by an analysis of blood count changes measured up to 60 d after irradiation were used to gauge overall hematopoietic acute radiation syndrome severity classifications. A panel of protein biomarkers was measured on plasma samples collected at 0 to 28 d after exposure using electrochemiluminescence-detection technology. The database was split into two distinct groups (i.e., “calibration,” n = 11; “validation,” n = 7). The calibration database was used in an initial stepwise regression multivariate model-fitting approach followed by down selection of biomarkers for identification of subpanels of hematopoietic acute radiation syndrome-responsive biomarkers for three time windows (i.e., 0–2 d, 2–7 d, 7–28 d). Model 1 (0–2 d) includes log C-reactive protein (p < 0.0001), log interleukin‐13 (p < 0.0054), and procalcitonin (p < 0.0316) biomarkers; model 2 (2–7 d) includes log CD27 (p < 0.0001), log FMS-related tyrosine kinase 3 ligand (p < 0.0001), log serum amyloid A (p < 0.0007), and log interleukin‐6 (p < 0.0002); and model 3 (7–28 d) includes log CD27 (p < 0.0012), log serum amyloid A (p < 0.0002), log erythropoietin (p < 0.0001), and log CD177 (p < 0.0001). The predicted risk of radiation injury categorization values, representing the hematopoietic acute radiation syndrome severity outcome for the three models, produced least squares multiple regression fit confidences of R
2 = 0.73, 0.82, and 0.75, respectively. The resultant algorithms support the proof of concept that plasma proteomic biomarkers can supplement clinical signs and symptoms to assess hematopoietic acute radiation syndrome risk severity.
Successful Teaching of Radiobiology Students in the Medical Management of Acute Radiation Effects From Real Case Histories Using Clinical Signs and Symptoms and Taking Advantage of Recently Developed Software Tools
Authors: Majewski Matthäus , Combs Stephanie E. , Trott Klaus-Rüdiger , Abend Michael , Port Matthias
Published: May 2018

In 2015, the Bundeswehr Institute of Radiobiology organized a North Atlantic Treaty Organization exercise to examine the significance of clinical signs and symptoms for the prediction of late-occurring acute radiation syndrome. Cases were generated using either the Medical Treatment Protocols for Radiation Accident Victims (METREPOL, n = 167) system or using real-case descriptions extracted from a database system for evaluation and archiving of radiation accidents based on case histories (SEARCH, n = 24). The cases ranged from unexposed [response category 0 (RC 0, n = 89)] to mild (RC 1, n = 45), moderate (RC 2, n = 19), severe (RC 3, n = 20), and lethal (RC 4, n = 18) acute radiation syndrome. During the previous exercise, expert teams successfully predicted hematological acute radiation syndrome severity, determined whether hospitalization was required, and gave treatment recommendations, taking advantage of different software tools developed by the North Atlantic Treaty Organization teams. The authors provided the same data set to radiobiology students who were introduced to the medical management of acute effects after radiation exposure and the software tools during a class lasting 15 h. Corresponding to the previous results, difficulties in the discrimination between RC 0/RC 1 and RC 3/RC 4, as well as a systematic underestimation of RC 1 and RC 2, were observed. Nevertheless, after merging reported response categories into clinically relevant groups (RC 0–1, RC 2–3, and RC 3–4), it was found that the majority of cases (95.2% ± 2.2 standard deviations) were correctly identified and that 94.7% (±2.6 standard deviations) developing acute radiation syndrome and z96.4% (±1.6 standard deviations) requiring hospitalization were identified correctly. Two out of three student teams also provided a dose estimate. These results are comparable to the best-performing team of the 2015 North Atlantic Treaty Organization exercise (response category: 92.5%; acute radiation syndrome: 95.8%; hospitalization: 96.3%).
Investigation of Spatial Organization of Chromosome Territories in Chromosome Exchange Aberrations After Ionizing Radiation Exposure
Authors: Balajee Adayabalam S. , Sanders Jacob T. , Golloshi Rosela , Shuryak Igor , McCord Rachel Patton , Dainiak Nicholas
Published: May 2018

Higher-order organization of the human genome is well established with chromosomes occupying distinct domains or territories in the interphase nucleus. Spatial organization of chromosome territories in the interphase nucleus occurs in a cell-type-specific manner. Since both stable and unstable aberrations induced by ionizing radiation involve the exchange of material between two or more chromosomes, this study investigated the role of spatial organization of chromosome domains in ionizing-radiation-induced chromosome translocation events. Using multicolor fluorescence in situ hybridization, the study characterized the positioning of each human chromosome relative to its neighborhood territories in the interphase nucleus of lymphocytes and B-lymphoblastoid cells before ionizing radiation and compared this interphase positioning with the spectrum of exchanges observed after ionizing radiation in the metaphase chromosomes. In addition to multicolor fluorescence in situ hybridization, the genome-wide chromosome conformation capture technique (Hi-C) was also performed in mock and x-ray-irradiated human B-lymphoblastoid and fibroblast cells to characterize the interactions among chromosomes and to assess the genome reorganization changes, if any, after ionizing radiation exposure. On average, 35–50% of the total translocations induced by x rays and neutrons correlated with proximity of chromosome territories detected by multicolor fluorescence in situ hybridization in both lymphocytes and lymphoblastoid cells. The translocation rate observed in proximally positioned chromosome territories was consistently higher than distally located territories and was found to be statistically significant (p = 0.01) in human lymphoblastoid cells after x rays. The interchromosome interaction frequencies detected by Hi-C correlate fairly well with ionizing-radiation-induced translocations detected by multicolor fluorescence in situ hybridization, suggesting the importance of chromosome proximity effects in ionizing-radiation-induced chromosomal translocation events.
Influence of Confounding Factors on Radiation Dose Estimation Using In Vivo Validated Transcriptional Biomarkers
Authors: Cruz-Garcia Lourdes , O’Brien Grainne , Donovan Ellen , Gothard Lone , Boyle Sue , Laval Antoine , Testard Isabelle , Ponge Lucyna , Woźniak Grzegorz , Miszczyk Leszek , Candéias Serge M. , Ainsbury Elizabeth , Widlak Piotr , Somaiah Navita , Badie Christophe
Published: May 2018

For triage purposes following a nuclear accident, blood-based gene expression biomarkers can provide rapid dose estimates for a large number of individuals. Ionizing-radiation-responsive genes are regulated through the DNA damage-response pathway, which includes activation of multiple transcription factors. Modulators of this pathway could potentially affect the response of these biomarkers and consequently compromise accurate dose estimation calculations. In the present study, four potential confounding factors were selected: cancer condition, sex, simulated bacterial infection (lipopolysaccharide), and curcumin, an anti-inflammatory/antioxidant agent. Their potential influence on the transcriptional response to radiation of the genes CCNG1 and PHPT1, two biomarkers of radiation exposure ex vivo, was assessed. First, both CCNG1 and PHPT1 were detected in vivo in blood samples from radiotherapy patients and as such were validated as biomarkers of exposure. Importantly, their basal expression level was slightly but significantly affected in vivo by patients’ cancer condition. Moreover, lipopolysaccharide stimulation of blood irradiated ex vivo led to a significant modification of CCNG1 and PHPT1 transcriptional response in a dose- and time-dependent manner with opposite regulatory effects. Curcumin also affected CCNG1 and PHPT1 transcriptional response counteracting some of the radiation induction. No differences were observed based on sex. Dose estimations calculated using linear regression were affected by lipopolysaccharide and curcumin. In conclusion, several confounding factors tested in this study can indeed modulate the transcriptional response of CCNG1 and PHPT1 and consequently can affect radiation exposure dose estimations but not to a level which should prevent the biomarkers’ use for triage purposes.
Hemisensory disturbances in patients with complex regional pain syndrome
Authors: Drummond Peter D. , Finch Philip M. , Birklein Frank , Stanton-Hicks Michael , Knudsen Lone F.
Published: May 2018

Sensory disturbances often spread beyond the site of injury in complex regional pain syndrome (CRPS) but whether this applies equally to CRPS I and II, or changes across the course of the disease, is unknown. Establishing this is important, because different symptom profiles in CRPS I and II, or in acute vs chronic CRPS, might infer different pathophysiology and treatment approaches. To explore these questions, sensory disturbances were assessed in the limbs and forehead of 71 patients with CRPS I and 33 patients with CRPS II. Pain had persisted up to 12 months in 32 patients, for 13 to 36 months in 29 patients, and for longer than this in 43 patients. Patients with CRPS I were more likely to be female, and pain was more likely to be present in an additional limb, than patients with CRPS II. Conversely, pain was more likely to be associated with sensory deficits and allodynia in patients with CRPS II than CRPS I. Nevertheless, heightened sensitivity, allodynia, and/or hyperalgesia to mechanical and thermal stimuli were detected in a hemisensory distribution ipsilateral to the affected limb in both forms of CRPS. Some of these hemisensory disturbances strengthened with chronicity of pain. These findings suggest that heightened excitability of nociceptive pathways in CRPS spreads to hemisensory convergence points in the brainstem or higher brain centres, possibly in association with compromised pain controls. The similarity of symptom profiles in chronic CRPS I and II implies shared mechanisms despite different triggers.
Effect of Patient and Provider Education on Antibiotic Overuse for Respiratory Tract Infections
Authors: Chiswell Erin , Hampton Debra , Okoli Chizimuzo T.C.
Published: May 2018

Antibiotic overuse for respiratory tract infections (RTIs) in primary care (PC) is a known important contributor to the serious health threat of antibiotic resistance, yet remains a difficult problem to improve. The purpose of the study was to assess the effects of a combination patient and provider education program on antibiotic prescribing in RTIs in a rural primary care clinic. Utilizing a quasi-experimental pretest-posttest design, a retrospective electronic medical record review was conducted to determine if a patient and provider education program changed the rates of antibiotics being prescribed (immediate or delayed) during a visit for RTI for 207 randomly selected patients during the established evaluation time periods. The antibiotic prescription rate for the preintervention group was 56.3% compared to 28.8% for the postintervention group (p < .01). Immediate antibiotics were ordered in the preintervention group 31.1% of the time compared to 13.5% for the postintervention group (p < .05). The results of this study demonstrate that educational interventions can be effective in rural settings and that changes in antibiotic prescribing are possible.
Metacognition, Formative Assessment, and Student Perspective: Learning About Metacognition Through In-Class Comparison of Response Systems
Authors: Brady Melanie , Forest Christopher P.
Published: May 2018

Purpose

Educators influence learning context through, among other things, triadic reciprocal causation—a behavioral model used in social cognitive theory. Eliciting responses from learners during instruction may contribute to learning by engaging their metacognition. In this study, metacognition was examined based on learners’ experience with 2 different polling methods: student response systems (SRS), commonly known as “clickers,” and a low-technology response system (LTRS), where students raise labeled signs, each with a different response. Scale item results are reported.

Methods

Scales measuring the influence of metacognition from polling methods were administered, following treatment (SRS) and comparison method (LTRS), to first-year physician assistant (PA) students (n = 54). Statistical tests of significance and effect size for each item were compared.

Results

Performance outcomes suggest that the SRS enhances learning experiences more than low-technology polling. Self-reported surveys indicate that self-monitoring, note-taking, and understanding during lectures are significantly improved with the use of clickers. Peer and social comparison items did not demonstrate significance collectively, but survey results indicate that candidates compared themselves to their peers significantly more with the LTRS than with the SRS.

Conclusion

Findings support the practice of using an electronic SRS to poll PA students and enhance learning.
A locus at 7p14.3 predisposes to refractory celiac disease progression from celiac disease
Authors: Hrdlickova Barbara , Mulder Chris J. , Malamut Georgia , Meresse Bertrand , Platteel Mathieu , Kamatani Yoichiro , Ricaño-Ponce Isis , van Wanrooij Roy L.J. , Zorro Maria M. , Jan Bonder Marc , Gutierrez-Achury Javier , Cellier Christophe , Zhernakova Alexandra , Nijeboer Petula , Galan Pilar , Withoff Sebo , Lathrop Mark , Bouma Gerd , Xavier Ramnik J. , Jabri Bana , Bensussan Nadine C. , Wijmenga Cisca , Kumar Vinod
Published: May 2018

Background

Approximately 5% of patients with celiac disease (CeD) do not respond to a gluten-free diet and progress to refractory celiac disease (RCD), a severe progression that is characterized by infiltration of intraepithelial T lymphocytes. Patients with RCD type II (RCDII) show clonal expansions of intraepithelial T lymphocytes that result in a poor prognosis and a high mortality rate through development of aggressive enteropathy-associated T-cell lymphoma. It is not known whether genetic variations play a role in severe progression of CeD to RCDII.

Patients and methods

We performed the first genome-wide association study to identify the causal genes for RCDII and the molecular pathways perturbed in RCDII. The genome-wide association study was performed in 38 Dutch patients with RCDII, and the 15 independent top-associated single nucleotide polymorphism (SNP) variants (P<5×10−5) were replicated in 56 independent French and Dutch patients with RCDII.

Results

After replication, SNP rs2041570 on chromosome 7 was significantly associated with progression to RCDII (P=2.37×10−8, odds ratio=2.36) but not with CeD susceptibility. SNP rs2041570 risk allele A was associated with lower levels of FAM188B expression in blood and small intestinal biopsies. Stratification of RCDII biopsies based on rs2041570 genotype showed differential expression of innate immune and antibacterial genes that are expressed in Paneth cells.

Conclusion

We have identified a novel SNP associated with the severe progression of CeD to RCDII. Our data suggest that genetic susceptibility to CeD might be distinct from the progression to RCDII and suggest a role for Paneth cells in RCDII progression.
Effects of Scleral-lens Tear Clearance on Corneal Edema and Post-lens Tear Dynamics: A Pilot Study
Authors: Tan Bo , Zhou Yixiu , Yuen Tiffany L. , Lin Kristina , Michaud Langis , Lin Meng C.
Published: May 2018

SIGNIFICANCE

The present study with small-diameter scleral lenses (SLs) revealed that post-lens tear thickness (PoLTT) was significantly associated with post-lens tear mixing, but not with central corneal edema, after short-term SL wear.

PURPOSE

The aim of this study was to investigate the influence of SL tear clearance (PoLTT) on central corneal thickness and post-lens tear dynamics during 5-hour lens wear.

METHODS

Neophytes with no active ocular disease were fitted bilaterally with SLs (hofocon A; 15.6-mm diameter; ~438-μm thickness; 97 Dk; 1.44 refractive index) with various initial PoLTT values ranging from 74 to 543 μm. Central corneal thickness and PoLTT were measured using optical coherence tomography during lens wear. Tear mixing was assessed using fluorogram and “out-in” method.

RESULTS

The mean central corneal edema after 5-hour lens wear was 1.51% (95% confidence interval, 1.26 to 1.76%; P < .001), reached its peak at 2-hour post-lens insertion (1.65% [95% confidence interval, 1.45 to 1.85%]), and was independent of PoLTT. The fastest fluorescence decay of the post-lens tear film was observed superiorly. The fluorescence decay rate increased from center to periphery in all quadrants except superiorly. An inverse relationship was found between PoLTT and fluorescence decay rate at both 20-minute and 5-hour wear after lens insertion (P < .05). Excluding observations with out-in time exceeding 5 minutes, we found a direct relationship between PoLTT at 20 minutes after lens insertion and out-in time (P = .047). The % change in the PoLTT after 5-hour wear was greater with a thinner initial tear clearance than those with a thicker one (P = .034).

CONCLUSIONS

Within our study parameters, a thinner PoLTT under a small-diameter SL was associated with faster PoLTT mixing. However, there was no relationship between PoLTT and central corneal thickness during 5-hour SL wear.
A Random Dot Computer Video Game Improves Stereopsis
Authors: Portela-Camino Juan A. , Martín-González Santiago , Ruiz-Alcocer Javier , Illarramendi-Mendicute Igor , Garrido-Mercado Rafaela
Published: May 2018

SIGNIFICANCE

Currently, treatments for amblyopia are occlusion or penalization of the stronger fellow eye. Fewer than 30% of patients improve stereoacuity using these treatments. In order to improve these outcomes, this group proposes a treatment to stimulate the stereoacuity through perceptual learning in a game format for use at home.

PURPOSE

The aim of this study was to determine whether perceptual learning with random dot stimuli (RDS) in the form of a computer video game improves stereopsis in patients with a history of amblyopia.

METHODS

Thirty-two stereo-deficient patients (7 to 14 years old) previously treated for amblyopia participated in a prospective, randomized, double-blind study. Participants followed a perceptual learning program at home using RDS software. In the experimental group, the demand of stereopsis was increased, until reaching the lowest detectable disparity. In the comparison group, the stimulation interval was a constant (840 to 750”). Stereoacuity was evaluated with the Randot Preschool Stereoacuity Test (RPST) and the Wirt Circles.

RESULTS

Median compliance was 100% (interquartile range [IQR] = 78.50 to 100). Log10 stereoacuity outcomes were significantly different between groups (RPST, P = .041; Wirt Circles Test, P = .009). Median stereoacuity improvement with RPST was 50% (IQR = 0.00 to 75%) and 0% (IQR = 0.00 to 7.5%), respectively, for experimental and comparison groups (P = .008). Wirt Circles improvement was 46.42% (IQR = 6.25 to 73.75%) and 0% (IQR = 0.00 to 57.50%), respectively, for experimental and comparison groups (P = .089). Stereoacuity improvement was not different between groups when success was considered a 70% gain in RPST (P = .113); it was statistically different when success was considered a gain of two levels on Wirt Circles and stereoacuity 140” or less (P = .023). Stereoacuity remained stable after 6 months when measured with RPST, whereas it worsened in two subjects when measured with Wirt Circles.

CONCLUSIONS

Direct stimulation of stereopsis at home using RDS in a game environment improves the stereoacuity in stereo-deficient subjects with a history of amblyopia.
Case Report: Optical Coherence Tomography Angiography in Morning Glory Disc Anomaly
Authors: Romano Francesco , Giuffrè Chiara , Arrigo Alessandro , Corbelli Eleonora , Battaglia Parodi Maurizio , Bandello Francesco
Published: May 2018

SIGNIFICANCE

Morning glory disc anomaly is a congenital abnormality of the optic disc. Optical coherence tomography angiography shows vascular rarefaction of the superficial and deep capillary plexuses and increased vascularity of the radial peripapillary capillary plexus. We hypothesize that this congestion represents a compensatory mechanism to an abnormal vasculogenesis.

PURPOSE

The aim of this study was to describe the optic disc vascular alterations occurring at choriocapillaris and retinal vascular plexuses in a patient affected by bilateral morning glory disc anomaly with optical coherence tomography angiography.

CASE REPORT

A 24-year-old white man presented for clinical evaluation to our Department of Ophthalmology (San Raffaele Hospital, Milan) complaining of reduced vision in his left eye. Whereas his right eye was unremarkable (20/20), the visual acuity in the left one was limited to 20/30 Snellen equivalent. Funduscopic examination revealed bilateral funnel-shaped optic disc excavation, with a central mass of glial tissue and straight retinal vessels radially emerging from the disc margin, more evident in the left eye; this presentation was considered compatible with bilateral morning glory disc anomaly. Optical coherence tomography angiography of the optic disc disclosed prominent vascular rarefaction of the peripapillary superficial and deep capillary plexuses and choriocapillaris, with an increased vascularity of the radial peripapillary capillary network.

CONCLUSIONS

Based on these observations, we hypothesize that the congestion of the radial peripapillary capillary plexus might be a compensatory mechanism to the abnormal vasculogenesis occurring in the optic disc of patients affected by morning glory disc anomaly.
Catalyzing Novel Approaches to Rapid, Accurate, and Affordable Early Cancer Detection
Authors: Dhar Asif , Meagher Beth , Ryscavage Andrew
Published: May 2018

Inspired by the Cancer Moonshot, a dedicated team of professionals worked with leaders across the cancer ecosystem to look for an opportunity to radically reduce cancer mortality globally by focusing on early cancer detection. After an initial survey of cancer innovation, progress, and pitfalls, the team believed that if new rapid, affordable, and accurate early detection solutions were appropriately brought to market, it would be possible to intervene earlier when cancer is most treatable.

An extensive process began, informed by dozens of experts in the cancer ecosystem. The Cancer XPRIZE team designed a prize competition where “the winning team will develop a means to rapidly, accurately, and affordably screen for early cancers where intervention can reduce human suffering.”

The following outlines the Cancer XPRIZE's experience using a powerful approach—the radical prize design—to catch more cancers in time to make a difference saving lives, dollars, and suffering.
The First Year of the Food and Drug Administration Oncology Center of Excellence
Authors: Goldberg Kirsten B. , Blumenthal Gideon M. , Pazdur Richard
Published: May 2018

The Food and Drug Administration formally established the Oncology Center of Excellence (OCE) in January 2017, as authorized by the 21st Century Cures Act, to expedite the development and review of certain drugs, biologics, and devices for the treatment of cancer. In its first year, the OCE conducted the clinical reviews for several products, including the first 2 chimeric antigen receptor T-cell therapies approved for the treatment of advanced hematologic malignancies and an in vitro diagnostic next-generation sequencing panel, FoundationOne CDx. The OCE also worked with professional societies and patient advocates on efforts to modernize clinical trial eligibility criteria, resulting in recommendations regarding minimal age, brain metastases, organ dysfunction, and human immunodeficiency virus coinfection. Altogether in 2017, the Food and Drug Administration approved 16 new drug and biologic applications, 30 supplemental drug and biologic applications, and 2 biosimilar applications in oncology.
Therapeutic Effects of Human Adipose-Derived Products on Impaired Wound Healing in Irradiated Tissue
Authors: Wu Szu-Hsien , Shirado Takako , Mashiko Takanobu , Feng Jingwei , Asahi Rintaro , Kanayama Koji , Mori Masanori , Chi Daekwan , Sunaga Ataru , Sarukawa Shunji , Yoshimura Kotaro
Published: May 2018

Background:

Clinical sequelae of irradiation result in tissue devitalization (e.g., ischemia, fibrosis, and atrophy) where wound healing capacity is impaired. Fat-derived products may work to treat such pathology.

Methods:

Nonlethal irradiation at various doses (5, 10, and 15 Gy) and frequencies (one to three times on sequential days) was delivered to dorsal skin of nude mice, and subsequent gross and microscopic changes were evaluated for up to 4 weeks. Cutaneous punch wounds were then created to compare wound healing in irradiated and nonirradiated states. Wounds were also locally injected with vehicle, cultured adipose-derived stem cells, centrifuged fat tissue, or micronized cellular adipose matrix, and the therapeutic impact was monitored for up to 15 days.

Results:

Nude mice given total doses greater than 15 Gy spontaneously developed skin ulcers, and radiation damage was dose-dependent; however, a fractionated irradiation protocol was able to reduce the damage. Histologic assessment revealed dose-dependent dermal fibrosis/thickening and subcutaneous atrophy. Dose-dependent (5 to 15 Gy) impairment of wound healing was also evident. At the highest dosage (15 Gy three times), open wounds persisted on day 15. However, wounds injected with cultured adipose-derived stem cells were nearly healed on day 12, and those treated with injection of centrifuged fat or micronized tissue healed faster than untreated controls (p < 0.05). There was no significant differences between treated groups.

Conclusions:

Tissue devitalization by irradiation was dose-dependent, although fractionated protocols helped to reduce it. Adipose-derived stem cells and other fat-derived products harboring adipose-derived stem cells successfully revitalized irradiated tissues and accelerated wound healing.
An Apparent Diffusion Coefficient Histogram Method Versus a Traditional 2-Dimensional Measurement Method for Identifying Non–Puerperal Mastitis From Breast Cancer at 3.0 T
Authors: Tang Qi , Li Qiang , Xie Dong , Chu Ketao , Liu Lidong , Liao Chengcheng , Qin Yunying , Wang Zheng , Su Danke
Published: May 2018

Purpose

This study aimed to investigate the utility of a volumetric apparent diffusion coefficient (ADC) histogram method for distinguishing non–puerperal mastitis (NPM) from breast cancer (BC) and to compare this method with a traditional 2-dimensional measurement method.

Materials and Methods

Pretreatment diffusion-weighted imaging data at 3.0 T were obtained for 80 patients (NPM, n = 27; BC, n = 53) and were retrospectively assessed. Two readers measured ADC values according to 2 distinct region-of-interest (ROI) protocols. The first protocol included the generation of ADC histograms for each lesion, and various parameters were examined. In the second protocol, 3 freehand (TF) ROIs for local lesions were generated to obtain a mean ADC value (defined as ADC-ROITF). All of the ADC values were compared by an independent-samples t test or the Mann-Whitney U test. Receiver operating characteristic curves and a leave-one-out cross-validation method were also used to determine diagnostic deficiencies of the significant parameters.

Results

The ADC values for NPM were characterized by significantly higher mean, 5th to 95th percentiles, and maximum and mode ADCs compared with the corresponding ADCs for BC (all P < 0.05). However, the minimum, skewness, and kurtosis ADC values, as well as ADC-ROITF, did not significantly differ between the NPM and BC cases.

Conclusions

Thus, the generation of volumetric ADC histograms seems to be a superior method to the traditional 2-dimensional method that was examined, and it also seems to represent a promising image analysis method for distinguishing NPM from BC.
Cost-effectiveness of Routine Postoperative Retrograde Voiding Trials Following Pelvic Surgeries
Authors: Wang Rui , Soeteman Djøra I. , Hacker Michele R. , Lefevre Roger
Published: May 2018

Objective

The aim of this study was to evaluate the cost-effectiveness of retrograde voiding trials in the management of postoperative voiding dysfunction.

Methods

We developed a disease simulation model to assess under which conditions routine retrograde voiding trial is the optimal strategy in terms of cost per quality-adjusted life-year and cost per case of chronic voiding dysfunction avoided. We varied the incidence of voiding dysfunction between 2% and 60%. We discounted future costs and utilities at 3% annually. We conducted 1- and 2-way sensitivity analyses on uncertain model parameters.

Results

The lifetime analysis showed that when the incidence of postoperative voiding dysfunction exceeded 12.2%, retrograde voiding trials were cost-effective, assuming a willingness-to-pay (WTP) for health of $100,000/quality-adjusted life-year. When the incidence exceeded 31.1%, retrograde voiding trials became the dominant strategy (less costly and more effective). For a simple hysterectomy with voiding dysfunction incidence of approximately 10%, lifetime cost is $230,069/case of chronic voiding dysfunction avoided; for a midurethral sling with voiding dysfunction incidence of approximately 20%, lifetime cost is $60,449/case avoided. Sensitivity analyses showed that WTP for health, the incidence of presentation to the emergency department (ED) for urinary retention and the incidence of chronic urinary retention following treatment in the ED had the greatest impact on the cost-effectiveness results.

Conclusions

Routine retrograde voiding trials following pelvic surgery can be cost-effective compared with expectant management when the incidence of voiding dysfunction exceeds 12.2%. These results were sensitive to WTP for health, incidence of ED visits for urinary retention, and incidence of chronic urinary retention following ED visits.