bluuebunny/crossref_metadata_2025 huggingface dataset:
Containment of Ebola and Polio in Low-Resource Settings Using Principles and Practices of Emergency Operations Centers in Public Health
Authors: Shuaib Faisal M. , Musa Philip F. , Muhammad Ado , Musa Emmanuel , Nyanti Sara , Mkanda Pascal , Mahoney Frank , Corkum Melissa , Durojaiye Modupeoluwa , Nganda Gatei wa , Sani Samuel Usman , Dieng Boubacar , Banda Richard , Ali Pate Muhammad
Published: August 2016

Emergency Operations Centers (EOCs) have been credited with driving the recent successes achieved in the Nigeria polio eradication program. EOC concept was also applied to the Ebola virus disease outbreak and is applicable to a range of other public health emergencies. This article outlines the structure and functionality of a typical EOC in addressing public health emergencies in low-resource settings. It ascribes the successful polio and Ebola responses in Nigeria to several factors including political commitment, population willingness to engage, accountability, and operational and strategic changes made by the effective use of an EOC and Incident Management System. In countries such as Nigeria where the central or federal government does not directly hold states accountable, the EOC provides a means to improve performance and use data to hold health workers accountable by using innovative technologies such as geographic position systems, dashboards, and scorecards.
Early Detection of Lymphatic Disorder and Treatment for Lymphedema following Breast Cancer
Authors: Akita Shinsuke , Nakamura Rikiya , Yamamoto Naohito , Tokumoto Hideki , Ishigaki Tatsuya , Yamaji Yoshihisa , Sasahara Yoshitaro , Kubota Yoshitaka , Mitsukawa Nobuyuki , Satoh Kaneshige
Published: August 2016

Background:

Upper extremity edema following surgical treatment for breast cancer does not always result in chronic breast cancer–related lymphedema. Changes in the findings of indocyanine green lymphography and upper extremity volume following breast cancer surgery were observed prospectively to understand the early changes in lymphatic function and to establish a new strategy for early diagnosis and treatment of breast cancer–related lymphedema.

Methods:

Lymphatic function for 196 consecutive breasts was examined using indocyanine green lymphography and bilateral upper extremity volume before surgery and 1, 3, 6, 9, and 12 months after surgery. When a “stardust,” “diffuse,” or “no flow” pattern was observed, patients were diagnosed with lymphatic disorder and subsequently underwent conservative treatments such as compression sleeve therapy.

Result:

In 35 patients, lymphatic disorder was observed after a mean of 5.2 ± 3.0 months after surgery. In 21 of these patients, no significant limb volume change was observed. In 14 patients, lymphatic disorder and volume change appeared simultaneously. In 11 of 35 patients, lymphatic function improved later, and compression therapy was discontinued. Lymph node dissection, radiation therapy to axillary lymph node, and the use of docetaxel chemotherapy were significant risk factors for lymphatic disorder. No patients experienced cellulitis during the study period.

Conclusions:

Lymphatic function disorder could be detected before volume changes. By early intervention with conservative treatments, lymphatic function improved in just under one-third of cases. Indocyanine green lymphography for high-risk patients may be useful for detecting lymphatic disorder early, thereby increasing the chance for disease cure.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Distance to a Plastic Surgeon and Type of Insurance Plan Are Independently Predictive of Postmastectomy Breast Reconstruction
Authors: Roughton Michelle C. , DiEgidio Paul , Zhou Lei , Stitzenberg Karyn , Meyer Anne Marie
Published: August 2016

Background:

The psychosocial benefits of postmastectomy breast reconstruction are well established; however, health care barriers persist. The authors evaluated statewide patient population to further identify obstacles to reconstruction.

Methods:

A linked data set combining the North Carolina Central Cancer Registry with administrative claims from Medicare, Medicaid, and private insurance plans identified women diagnosed with breast cancer from 2003 to 2006. For inclusion in the study, women must have had a mastectomy within 6 months of diagnosis and had continuous insurance enrollment at least 2 years postoperatively (n = 5381). Multivariable logistic regression was used to model odds of reconstruction.

Results:

Approximately 20 percent underwent reconstruction (n = 1130). Distance to a plastic surgeon—10 to 20 miles (OR, 0.78) and greater than 20 miles (OR, 0.73; p < 0.05)—was significantly predictive of no reconstruction, independent of other well-known disparities, including age, race, rural location, and lower household income. Women with government-funded health care, such as Medicare (OR, 0.58) and Medicaid (OR, 0.24; p < 0.001), were also significantly less likely to undergo reconstruction. Consistent with previous study, advanced cancer stage and receipt of radiation therapy decreased the likelihood of reconstruction. Furthermore, when the authors compared immediate to delayed reconstruction, rural location, chemotherapy, and radiation therapy were significantly predictive of delay.

Conclusions:

This is the first population-based study to demonstrate distance to care and insurance plan as significant predictors of receipt of reconstruction. Additional research is needed to understand health care barriers and to determine whether distance to a plastic surgeon can be ameliorated by outreach programs.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
A Comparison of Outcomes of Triceps Motor Branch–to–Axillary Nerve Transfer or Sural Nerve Interpositional Grafting for Isolated Axillary Nerve Injury
Authors: Baltzer Heather L. , Kircher Michelle F. , Spinner Robert J. , Bishop Allen T. , Shin Alexander Y.
Published: August 2016

Background:

Deltoid paralysis following isolated axillary nerve injury can be managed with triceps motor branch transfer or interpositional grafting. No consensus exists on the treatment that results in superior deltoid function. The purpose of this study was to review the authors’ experience with axillary nerve injury management and compare functional outcomes following these two treatment options.

Methods:

Twenty-nine adult isolated axillary nerve injury patients that had either interpositional nerve grafting or triceps motor branch transfer with greater than 1 year of follow-up between 2002 and 2013 were reviewed for demographic and clinical factors and functional outcomes of deltoid reinnervation, including clinical examination (shoulder abduction and forward flexion graded by the Medical Research Council system) and electromyographic recovery. Disabilities of the Arm, Shoulder, and Hand scale grades were also compared.

Results:

Twenty-one patients had a triceps motor transfer and eight had interpositional nerve grafting. At a mean follow-up of 22 months, Medical Research Council scores were greater in the grafting group compared with the nerve transfer group (4.3 versus 3.0), and more graft patients achieved useful deltoid function (Medical Research Council score ≥3) recovery (100 percent versus 62 percent); however, both groups had similar improvement in self-reported disability: change in Disabilities of the Arm, Shoulder, and Hand score of 11 following nerve transfer versus 15 following nerve graft.

Conclusions:

Although the question of nerve transfer versus grafting for restoration of axillary nerve function is controversial, this study demonstrates that grafting can result in good objective functional outcomes, particularly during an earlier time course after injury. This question requires further investigation in a larger, prospective patient population.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Uneventful versus Successful Reconstruction and Outcome Pathways in Implant-Based Breast Reconstruction with Acellular Dermal Matrices
Authors: Qureshi Ali A. , Broderick Kristen P. , Belz Jessica , Funk Susan , Reaven Nancy , Brandt Keith E. , Tenenbaum Marissa M. , Margenthaler Julie A. , Aft Rebecca L. , Myckatyn Terence M.
Published: August 2016

Background:

Meaningful data to help guide resource allocation for staged tissue expander/implant-based breast reconstruction are currently lacking. The authors seek to differentiate uneventful from successful reconstruction and identify common outcome pathways and factors that portend a deviation from an uneventful, two-stage, two-operation course.

Methods:

A retrospective analysis of expander/implant reconstructions with or without acellular dermal matrix (2003 to 2009) was performed. Related postreconstructive events (including mastectomy flap necrosis, seroma, wound dehiscence, cellulitis, explantation, hematoma, and capsular revisions) were assessed for 2 years. Uneventful reconstruction was defined as exchange to breast implant within 2 years of tissue expander placement without complications, whereas successful reconstruction was defined as exchange to breast implant within 2 years with or without complications. Factors affecting reconstructive success were analyzed, and patterns of postreconstructive events were summarized as outcome pathways.

Results:

Four hundred thirteen patients (295 with acellular dermal matrix and 118 without), with 602 breasts (432 with acellular dermal matrix and 170 without) underwent reconstruction. Forty-six percent of patients (48 percent with acellular dermal matrix and 40 percent without), experienced uneventful reconstruction. Reconstructive success was achieved in 337 patients (82 percent; 82.0 percent with acellular dermal matrix and 80.5 percent without), with reconstructive failure occurring in 58 patients. Multiple logistic regression analyses determined that cellulitis, seroma, and skin necrosis (OR, 15.8, 7.7, and 8.4, respectively) were highly predictive of reconstructive failure. The authors identified 10 distinct pathways experienced by tissue expander/implant patients that were characterized by specific postreconstructive events.

Conclusion:

The present study will facilitate discussions among patients, providers, and payers by providing a framework for understanding the myriad outcome pathways in implant-based reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Industry Financial Relationships in Plastic Surgery: Analysis of the Sunshine Act Open Payments Database
Authors: Chao Albert H. , Gangopadhyay Noopur
Published: August 2016

Background:

Limited data exist regarding industry financial relationships in plastic surgery. The Sunshine Act Open Payments Database currently represents the largest repository of these data, but is limited primarily to queries of individual providers. The purpose of this study was to analyze these data and present them in a manner that better delineates these relationships, and to compare plastic surgery with other surgical subspecialties.

Methods:

A review of the Open Payments Database was performed for the period from January 1, 2014, to December 31, 2014. These data were analyzed with respect to types of payments, characteristics of plastic surgeons and companies, and comparison with other surgical subspecialties.

Results:

A total of 49,053 payments from 274 companies were identified that were made to 4812 plastic surgeons (475 academic and 4337 private practice). The total value of payments was $17,091,077. Food and beverage represented the most common type of payment (82.2 percent). Royalties and licensing represented the highest valued type of payment (35.7 percent), but were received by only a minority of plastic surgeons (0.5 percent). No significant differences were identified between academic and private practice plastic surgeons in the value or quantity of payments. Plastic surgery (54.5 percent) exhibited the lowest prevalence of industry financial relationships compared with otolaryngology (57.9 percent), orthopedics (62.4 percent), neurosurgery (87.8 percent), and urology (63.1 percent) (p < 0.001).

Conclusions:

Approximately half of all plastic surgeons have industry financial relationships. The prevalence of these relationships is comparatively less than in other surgical subspecialties.
Technical Maneuvers to Decrease Warping of Peripheral Costal Cartilage Grafts
Authors: Farkas Jordan P. , Lee Michael R. , Rohrich Rod J.
Published: August 2016

Background:

Cartilage warping has plagued reconstructive and cosmetic rhinoplasty since the introduction of extraanatomical cartilage use. The authors’ group theorized that, rather than focusing on the prevention of the innate tendency of rib graft warping, it may be possible to redirect the stressors toward themselves and use these forces with oppositional suturing techniques to compensate for these intrinsic characteristics.

Methods:

Fresh cadaver cartilage was obtained from the costosternal junction of two rib cages (aged 77 and 99 years). The cartilage was cut manually into 4 × 2.5 × 20-mm cross-sections from the cephalic edges of each of the harvested specimens. The specimens from the right chest were used as the control and the left segments underwent an oppositional suturing technique (n = 10) of the cephalic peripheral segment of the cartilage.

Results:

Overall, the control group experienced a 724.2 percent increase in the mean degree of warping (p < 0.001). In contrast, the oppositional suturing group experienced a mean decrease in warping angle relative to baseline of only 35.7 percent. At 1 month, the oppositional suturing group displayed significantly decreased warping compared with the control group.

Conclusions:

This is a novel cadaveric study evaluating the benefit of oppositional suturing techniques in peripheral costal cartilage grafts. Multiple techniques and maneuvers have been borne out of the frustration of these inherent characteristics of costal cartilage grafts. Oppositional suturing techniques are a useful tool available to surgeons performing nasal reconstruction and revision rhinoplasty to maximize the amount of useful costal cartilage graft.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Risk for Incident Hypertension Associated With Posttraumatic Stress Disorder in Military Veterans and the Effect of Posttraumatic Stress Disorder Treatment
Authors: Burg Matthew M. , Brandt Cynthia , Buta Eugenia , Schwartz Joseph , Bathulapalli Harini , Dziura James , Edmondson Donald E. , Haskell Sally
Published: August 2016

Objective

Posttraumatic stress disorder (PTSD) increases cardiovascular disease and cardiovascular mortality risk. Neither the prospective relationship of PTSD to incident hypertension risk nor the effect of PTSD treatment on hypertension risk has been established.

Methods

Data from a nationally representative sample of 194,319 veterans were drawn from the Veterans Administration (VA) roster of United States service men and women. This included veterans whose end of last deployment was from September 2001 to July 2010 and whose first VA medical visit was from October 1, 2001 to January 1, 2009. Incident hypertension was modeled as 3 events: (1) a new diagnosis of hypertension and/or (2) a new prescription for antihypertensive medication, and/or (3) a clinic blood pressure reading in the hypertensive range (≥140/90 mm Hg, systolic/diastolic). Posttraumatic stress disorder diagnosis was the main predictor. Posttraumatic stress disorder treatment was defined as (1) at least 8 individual psychotherapy sessions of 50 minutes or longer during any consecutive 6 months and/or (2) a prescription for selective serotonin reuptake inhibitor medication.

Results

Over a median 2.4-year follow-up, the incident hypertension risk independently associated with PTSD ranged from hazard ratio (HR), 1.12 (95% confidence interval [CI], 1.08–1.17; p < .0001) to HR, 1.30 (95% CI, 1.26–1.34; p < .0001). The interaction of PTSD and treatment revealed that treatment reduced the PTSD-associated hypertension risk (e.g., from HR, 1.44 [95% CI, 1.38–1.50; p < .0001] for those untreated, to HR, 1.20 [95% CI, 1.15–1.25; p < .0001] for those treated).

Conclusions

These results indicate that reducing the long-term health impact of PTSD and the associated costs may require very early surveillance and treatment.
Low-Grade Inflammation and Ambulatory Cortisol in Adolescents: Interaction Between Interviewer-Rated Versus Self-Rated Acute Stress and Chronic Stress
Authors: Schreier Hannah M.C. , Chen Edith
Published: August 2016

Objective

To determine whether the association between self-rated or interviewer-rated recent acute stress exposures and low-grade inflammation and daily cortisol production in adolescents is moderated by chronic stress ratings.

Methods

Acute and chronic stress exposures were assessed in 261 adolescents aged 13 to 16 years using a semistructured life stress interview. The negative impact of acute stressors was independently rated by both adolescents (self-rated) and interviewers (interviewer-rated). Markers of inflammation (interleukin (IL)-6, IL-1ra, C-reactive protein) were measured from peripheral blood samples obtained via antecubital venipuncture. Participants collected 4 saliva samples at home on each of 6 consecutive days for the analysis of diurnal salivary cortisol profiles.

Results

There were no main effects of acute stressors (self- and interviewer-rated) and chronic family or peer stress on adolescent inflammation markers and cortisol (p values > .10). However, the interaction between interviewer-rated acute stress and chronic family stress was significantly associated with adolescent inflammation markers (IL-6, IL-1ra). Specifically, as chronic family stress increased, the association between acute stressor impact (interviewer-rated) and inflammation markers became more positive (IL-6 (B = .054, SE = .023, p = .022); IL-1ra (B = .030, SE = .014, p = .034)). Interactions between self-rated acute stress and chronic family stress were not associated with any biological measures (p values > .10). Interactions between acute stressor impact (both self- and interviewer-rated) and chronic peer stress were also not significantly associated with any biological measures (p values > .05).

Conclusions

Among adolescents, interviewer-based ratings of acute stressor impact may allow for better prediction of health-relevant inflammation markers than adolescents' own ratings.
Implementation and Operational Research: Population-Based Active Tuberculosis Case Finding During Large-Scale Mobile HIV Testing Campaigns in Rural Uganda
Authors: Ssemmondo Emmanuel , Mwangwa Florence , Kironde Joel L. , Kwarisiima Dalsone , Clark Tamara D. , Marquez Carina , Charlebois Edwin D. , Petersen Maya L. , Kamya Moses R. , Havlir Diane V. , Chamie Gabriel ,   the SEARCH Collaboration
Published: August 2016

Background:

Active tuberculosis (TB) screening outside clinics and in communities may reduce undiagnosed TB.

Methods:

To determine the yield of TB screening during community-based HIV testing campaigns (CHC) in 7 rural Ugandan communities within an ongoing cluster-randomized trial of universal HIV testing and treatment (SEARCH, NCT:01864603), we offered sputum microscopy to participants with prolonged cough (>2 weeks). We determined the number of persons needed to screen to identify one TB case, and the number of cases identified that linked to clinic and completed TB treatment.

Results:

Of 36,785 adults enumerated in 7 communities, 27,214 (74%) attended CHCs, and HIV testing uptake was >99%, with 941 (3.5%) HIV-infected adults identified. Five thousand seven hundred eighty-six adults (21%) reported cough and 2876 (11%) reported cough >2 weeks. Staff obtained sputum in 1099/2876 (38%) participants with prolonged cough and identified 10 adults with AFB-positive sputum; 9 new diagnoses and 1 known case already under treatment. The number needed to screen to identify one new TB case was 3024 adults overall: 320 adults with prolonged cough and 80 HIV-infected adults with prolonged cough. All 9 newly diagnosed AFB+ participants were linked to TB care within 2 weeks and were initiated TB treatment.

Conclusions:

In a rural Ugandan setting, TB screening as an adjunct to large-scale mobile HIV testing campaigns provides an opportunity to increase TB case detection.
Using CD4 Data to Estimate HIV Incidence, Prevalence, and Percent of Undiagnosed Infections in the United States
Authors: Song Ruiguang , Hall H. Irene , Green Timothy A. , Szwarcwald Célia L. , Pantazis Nikos
Published: August 2016

Introduction:

The incidence and prevalence of HIV infection are important measures of HIV trends; however, they are difficult to estimate because of the long incubation period between infection and symptom development and the relative infrequency of HIV screening. A new method is introduced to estimate HIV incidence, prevalence, and the number of undiagnosed infections in the United States using data from the HIV case surveillance system and CD4 test results.

Methods:

Persons with HIV diagnosed during 2006–2013 and their CD4 test results were used to estimate the distribution of diagnosis delay from HIV infection to diagnosis based on a well-characterized CD4 depletion model. This distribution was then used to estimate HIV incidence, prevalence, and the number of undiagnosed infections.

Results:

Applying this method, we estimated that the annual number of new HIV infections decreased after 2007, from 48,300 (95% confidence interval [CI]: 47,300 to 49,400) to 39,000 (95% CI: 36,600 to 41,400) in 2013. Prevalence increased from 923,200 (95% CI: 914,500 to 931,800) in 2006 to 1,104,600 (95% CI: 1,084,300 to 1,124,900) in 2013, whereas the proportion of undiagnosed infections decreased from 21.0% in 2006 (95% CI: 20.2% to 21.7%) to 16.4% (95% CI: 15.7% to 17.2%) in 2013.

Conclusions:

HIV incidence, prevalence, and undiagnosed infections can be estimated using HIV case surveillance data and information on first CD4 test result after diagnosis. Similar to earlier findings, the decreases in incidence and undiagnosed infections are encouraging but intensified efforts for HIV testing and treatment are needed to meet the goals of the National HIV/AIDS Strategy.
Reduced IL-7R T Cell Expression and Increased Plasma sCD127 in Late Presenting HIV-Infected Individuals
Authors: Hartling Hans J. , Jespersen Sofie , Gaardbo Julie C. , Sambleben Camilla , Thorsteinsson Kristina , Gerstoft Jan , Ullum Henrik , Nielsen Susanne D.
Published: August 2016

Background:

Late presentation of HIV infection is associated with reduced chance of optimal immune recovery after initiating combination antiretroviral therapy (cART). Interleukin-7 (IL-7) and the corresponding receptor, IL-7 receptor (IL-7R) made up of CD127 and CD132, are crucial for T cell homeostasis. This study aimed to describe IL-7R and IL-7 before and after initiation of cART in late presenting HIV-infected individuals, and the impact on immune recovery and T cell subset distribution after initiation of cART.

Methods:

A total of 100 HIV-infected individuals initiating cART were included in a prospective study. Samples were collected at baseline and after 6, 12, and 24 months of cART. Proportion and expression {[median fluorescence intensity (MFI)]} of IL-7R on T cells, and plasma concentrations of soluble CD127 (sCD127) and IL-7 were determined.

Results:

The IL-7R expression was reduced in late presenters with CD4 cell count <200 cells per microliter compared with nonlate presenters and healthy controls as demonstrated by lower proportion of CD127 + CD132 + T cells and lower CD127 MFI. In contrast, plasma sCD127 was higher. These differences were partly reversed after suppressive cART. Interestingly, the CD127 MFI on CD4+ T cells was found to be a predictor of increased thymic output after 24 months of suppressive cART.

Conclusions:

Severely altered IL-7R expression was found in late presenters, and associations between IL-7R expression and thymic output after 24 months of suppressive cART indicate an impact of a IL-7 response for the long term de novo production from thymus.
Clostridial Gas Gangrene of the Abdominal Wall After Laparoscopic Cholecystectomy: A Case Report and Review
Authors: Harmsen Annelieke M. K. , van Tol Erik , Giannakopoulos Georgios F. , de Brauw L. Maurits
Published: August 2016

Clostridial gas gangrene is a rare, yet severe, complication after laparoscopic cholecystectomy. We present a case report of a 48-year-old man with obesity, coronary artery disease, and diabetes, who developed clostridial gas gangrene of the abdominal wall after an uncomplicated laparoscopic cholecystectomy. Although the diagnosis was missed initially, successful radical surgical debridement was performed and the patient survived. Pathogenesis, symptoms, prognostic factors, and the best treatment are discussed.
A Cross-sectional Study of Shared Attention by Children With Autism and Typically Developing Children in an Inclusive Preschool Setting
Authors: Rice Catherine E. , Adamson Lauren B. , Winner Ellen , McGee Gail G.
Published: August 2016

This study examined the ways in which young children with autism and typical children focus their engagement with objects and people (peers and adults) in an inclusive preschool setting. A cross-sectional analysis was conducted of 30 typical children and 30 children with autism, with 10 different children from each group at 3 different ages (2, 3, and 4 years), interacting with both adults and peers available as partners. By the age of 3 years, typically developing children engaged in coordinated joint attention (CJA) with others at a stable rate. At 4 years, children with autism exhibited more sharing attention to objects and events with others compared with groups with autism at 2 and 3 years. However, episodes of shared engagement remained low, and joint engagement involved more episodes of supported joint engagement compared to typical peers, with an adult as their primary partner. Typical children at 4 years of age showed a trend toward increasing their shared attention with peers. Individual children in both groups had a great deal of variability in their joint engagement with others. Children with autism were much less likely to initiate joint episodes and were much more likely to engage in a joint state for instrumental purposes than were their typical peers. These patterns of engagement are likely to have significant impact on the learning opportunities available to these groups of children.
Shift in Emergency Department Provider Attitudes Toward Patients With Sickle Cell Disease
Authors: Freiermuth Caroline E. , Silva Susan , Cline David M. , Tanabe Paula
Published: August 2016

Patients with sickle cell disease frequently seek care in the emergency department. They have reported experiencing negative attitudes from emergency providers. This study was undertaken to evaluate change in emergency provider attitudes toward patients with sickle cell disease over a 2.5-year time period when several educational efforts were ongoing. The General Perceptions about Sickle Cell Disease Patients Scale was used to measure emergency provider attitudes at 2 emergency departments at baseline, 6 months, and 30 months into the project. Analyses of covariance were used to test for effects of site, time, and provider type, as well as their interactions, on Negative attitudes, Uneasiness With Care, and Positive Attitudes subscale scores, after controlling for years of provider experience. The number of surveys returned at the 3 time points was 216, 182, and 113, respectively. The mean Negative Attitudes subscale scores decreased significantly over time, with significantly higher mean Negative Attitudes subscale scores reported by nurses than by physicians. The mean Uneasiness With Care subscale scores did not differ significantly over time, but the mean score was significantly higher for physicians than for nurses. The mean Positive Attitudes subscale scores significantly improved over time, with physicians tending to have a higher mean Positive Attitudes subscale scores than nurses. During the observation period, there was improvement in attitudes, with a decline in mean Negative Attitudes subscale scores and increase in mean Positive Attitudes subscale scores. Physicians reported better attitudes than nurses.
Normothermic Machine Perfusion of Deceased Donor Liver Grafts Is Associated With Improved Postreperfusion Hemodynamics
Authors: Angelico Roberta , Perera M. Thamara P. R , Ravikumar Reena , Holroyd David , Coussios Constantin , Mergental Hynek , Isaac John R. , Iqbal Asim , Cilliers Hentie , Muiesan Paolo , Friend Peter J. , Mirza Darius F.
Published: August 2016

Background

Graft reperfusion poses a critical challenge during liver transplantation and can be associated with hemodynamic instability/postreperfusion syndrome. This is sequel to ischemia-reperfusion injury and normothermic machine preservation (NMP) may affect hemodynamic changes. Herein, we characterize postreperfusion hemodynamics in liver grafts after NMP and traditional cold preservation.

Materials and methods

Intraoperative records of patients receiving grafts after NMP (n = 6; NMP group) and cold storage (CS) (n = 12; CS group) were compared. The mean arterial pressure (MAP) was defined as the average pressure in the radial artery during 1 cardiac cycle by invasive monitoring. Postreperfusion syndrome was defined as MAP drop greater than 30% of baseline, lasting for 1 minute or longer within the first 5 minutes from graft reperfusion.

Results

Donor, recipient, demographics, and surgical parameters were evenly matched. Normothermic machine preservation grafts were perfused for 525 minutes (395-605 minutes) after initial cold ischemic time of 91 minutes (73-117 minutes), whereas in CS group cold ischemic time was 456 minutes (347-685 minutes) (P = 0.001). None developed postreperfusion syndrome in the NMP group against n = 2 (16.7%) in CS group (P = 0.529). Normothermic machine preservation group had better intraoperative MAP at 90 minutes postreperfusion (P = 0.029), achieved with a significantly less vasopressor requirement (P = <0.05) and less transfusion of blood products (P = 0.030) compared with CS group.

Conclusions

Normothermic machine perfusion is associated with a stable intraoperative hemodynamic profile postreperfusion, requiring significantly less vasopressor infusions and blood product transfusion after graft reperfusion and may have benefit to alleviate ischemia-reperfusion injury in liver transplantation.
Congenital myasthenic syndromes: recent advances
Authors: Beeson David
Published: August 2016

Purpose of review

Congenital myasthenic syndromes (CMS) are a group of heterogeneous inherited disorders caused by mutations in genes encoding proteins essential for the integrity of neuromuscular transmission. This review updates the reader on recent findings that have expanded the phenotypic spectrum and suggested improved treatment strategies.

Recent findings

The use of next-generation sequencing is continuing to unearth new genes in which mutations can give rise to defective neuromuscular transmission. The defective transmission may be part of an overall more complex phenotype in which there may be muscle, central nervous system or other involvement. Notably, mutations in series of genes encoding presynaptic proteins are being identified. Further work on mutations found in the AGRN-MUSK acetylcholine receptor clustering pathway has helped characterize the role of LRP4 and broadened the phenotypic spectrum for AGRN mutations. Mutations in another extracellular matrix protein, collagen 13A1 and in GMPPB have also been found to cause a CMS. Finally, there are an increasing number of reports for the beneficial effects of treatment with β2-adrenergic receptor agonists.

Recent studies of the CMS illustrate the increasing complexity of the genetics, pathophysiological mechanisms and the need to tailor therapy for the genetic disorders of the neuromuscular junction.
Next-generation sequencing in neuromuscular diseases
Authors: Efthymiou Stephanie , Manole Andreea , Houlden Henry
Published: August 2016

Purpose of review

Neuromuscular diseases are clinically and genetically heterogeneous and probably contain the greatest proportion of causative Mendelian defects than any other group of conditions. These disorders affect muscle and/or nerves with neonatal, childhood or adulthood onset, with significant disability and early mortality. Along with heterogeneity, unidentified and often very large genes require complementary and comprehensive methods in routine molecular diagnosis. Inevitably, this leads to increased diagnostic delays and challenges in the interpretation of genetic variants.

Recent findings

The application of next-generation sequencing, as a research and diagnostic strategy, has made significant progress into solving many of these problems. The analysis of these data is by no means simple, and the clinical input is essential to interpret results.

In this review, we describe using examples the recent advances in the genetic diagnosis of neuromuscular disorders, in research and clinical practice and the latest developments that are underway in next-generation sequencing. We also discuss the latest collaborative initiatives such as the Genomics England (Department of Health, UK) genome sequencing project that combine rare disease clinical phenotyping with genomics, with the aim of defining the vast majority of rare disease genes in patients as well as modifying risks and pharmacogenomics factors.
American Clinical Neurophysiology Society: EEG Guidelines Introduction
Authors: Tsuchida Tammy N. , Acharya Jayant N. , Halford Jonathan J. , Kuratani John D. , Sinha Saurabh R. , Stecker Mark M. , Tatum William O. , Drislane Frank W.
Published: August 2016

This revision to the EEG Guidelines is an update incorporating current EEG technology and practice. “Standards of practice in clinical electroencephalography” (previously Guideline 4) has been removed. It is currently undergoing revision through collaboration among multiple medical societies and will become part of “Qualifications and Responsibilities of Personnel Performing and Interpreting Clinical Neurophysiology Procedures.” The remaining guidelines are reordered and renumbered.
American Clinical Neurophysiology Society Guideline 2: Guidelines for Standard Electrode Position Nomenclature
Authors: Acharya Jayant N. , Hani Abeer , Cheek Janna , Thirumala Partha , Tsuchida Tammy N.
Published: August 2016

This revision to the EEG Guidelines is an update incorporating current electroencephalography technology and practice and was previously published as Guideline 5. While the 10-10 system of electrode position nomenclature has been accepted internationally for almost two decades, it has not been used universally. The reasons for this and clinical scenarios when the 10-10 system provides additional localizing information are discussed in this revision. In addition, situations in which AF1/2, AF5/6, PO1/2 and PO5/6 electrode positions may be utilized for EEG recording are discussed.
American Clinical Neurophysiology Society Guideline 3: A Proposal for Standard Montages to Be Used in Clinical EEG
Authors: Acharya Jayant N. , Hani Abeer J. , Thirumala Partha D. , Tsuchida Tammy N.
Published: August 2016

This revision to the EEG Guidelines is an update incorporating current electroencephalography technology and practice and was previously published as Guideline 6. A discussion of methodology for the appropriate selection of reference electrodes is added. In addition, montages are added to assist with localization of abnormal activity in mesial frontal and anterior temporal regions.
American Clinical Neurophysiology Society Guideline 4: Recording Clinical EEG on Digital Media
Authors: Halford Jonathan J. , Sabau Dragos , Drislane Frank W. , Tsuchida Tammy N. , Sinha Saurabh R.
Published: August 2016

Digital EEG recording systems are now widely available and relatively inexpensive. They offer multiple advantages over previous analog/paper systems, such as higher fidelity recording, signal postprocessing, automated detection, and efficient data storage. This document provides guidance for the creation of digital EEG recordings including (1) documentation of patient information, (2) notation of information during the recording, (3) digital signal acquisition parameters during the recording, (4) storage of digital information, and (5) display of digital EEG signals.
Phase Synchronization Analysis of Natural Wake and Sleep States in Healthy Individuals Using a Novel Ensemble Phase Synchronization Measure
Authors: Nayak Chetan S. , Bhowmik Aakash , Prasad Pradeep D. , Pati Sandipan , Choudhury Kalyan K. , Majumdar Kaushik K.
Published: August 2016

Purpose:

Electrical activity in the brain is presumed to arise from a combination of tonic asynchronous neuronal firing during wake and a synchronized, burst-pause firing of large number of neurons during sleep. This study aims to compare the phase synchronization index (SI) across multiple channels during wake and various sleep stages on scalp electroencephalographic recordings.

Methods:

Forty healthy subjects were subjected to overnight polysomnography using 8-channel electroencephalography. Electroencephalographic phase synchronization during awake, non–rapid eye movement (N1, N2, N3), and rapid eye movement sleep states was studied using ensemble measure (multichannel measure across all the eight channels based on Hilbert transformation between any two pairs).

Results:

With the progression of states of wakefulness to non–rapid eye movement sleep, there was progressive increase in phase SI in delta band while SI decreased in alpha band (P < 0.001). The SI in delta band during rapid eye movement was comparable with that of awake state (P < 0.001). In theta band, SI tends to decrease in N2 and increase in N3 (P < 0.001). In beta band, there was progressive increase in SI from awake to non–rapid eye movement stages that decreased in rapid eye movement stage (P < 0.001).

Conclusions:

This is the first study that has used an ensemble measure to assess the long-range cortical phase synchronization during awake and various sleep stages. The findings support the previous view of increased delta synchrony during non–rapid eye movement sleep and alpha synchrony during wakefulness. Rapid eye movement stage was characterized by marked desynchrony in all frequency bands. These findings suggest the possible role of cortical synchronization in influencing the occurrence of epileptic activity during sleep and awake states.
Unilateral Mu Rhythm and Associated Cortical Lesions on Brain MRI
Authors: Yamak Wissam R. , Beydoun Ahmad A. , Dirani Maya M. , Toufaili Hassan A. , El Hajj Taghrid I. , Nasreddine Wassim M.
Published: August 2016

Purpose:

The purpose of this study was to assess the frequency of occurrence of a unilateral mu rhythm and the associated neuroimaging findings on dedicated epilepsy protocol brain MRI.

Methods:

We retrospectively reviewed the EEG reports database at the American University of Beirut Medical Center between 2011 and 2014 searching for the presence of a unilateral mu rhythm. For patients with a unilateral mu rhythm, we recorded the patients' demographics, number of EEGs performed, characteristics of the mu activity, and the findings on the epilepsy protocol brain MRIs.

Results:

A total of 7986 patients underwent 9,509 EEG between 2011 and 2014. Four patients (0.05%) aged between 19 and 55 years had evidence of a unilateral mu rhythm. Three patients were diagnosed with localization-related epilepsy and one with syncope. The brain MRIs showed cortical lesions involving the parietal cortex, ipsilateral to the unilateral mu rhythm in the three patients with epilepsy.

Conclusions:

A unilateral mu rhythm is a rare phenomenon on the scalp EEG that should prompt a search for an ipsilateral lesion, even in the absence of additional EEG abnormalities.
Measuring the Severity of Neonatal Seizures: Temporal-Spatial Burden
Authors: Smith Douglas M. , Dicker Lee H. , Davis Malcolm J. , Clancy Robert R.
Published: August 2016

Purpose:

The American Clinical Neurophysiology Society recommends measuring neonatal seizures' severity by their frequency (number of seizures-anywhere per hour), burden (percentage of time with seizures-anywhere), or on a region-by-region, temporal-spatial basis. This study compares two reduced-channel montages for temporal-spatial seizure burden analyses and examines the agreement of seizures' quantification among these three methodologies.

Methods:

A convenience sample of 10 neonatal electroencephalograms was annotated for the beginnings and ends of seizures, which appeared anywhere in the full neonatal montage, then repeated on a more precise, region-by-region basis using 2 reduced-channel montages A and B. Seizure severity was measured by seizures-anywhere frequency, seizures-anywhere burden, and temporal-spatial seizure burdens using montages A and B. The results were compared by measuring their correlation and by linear regression modeling.

Results:

Seizures-anywhere frequency was correlated with seizures-anywhere burden (ρ = 0.77). However, a narrow range of seizures-anywhere frequencies corresponded with a broad range of seizures-anywhere burdens. Although there was high correlation between seizures-anywhere burdens and temporal-spatial seizure burdens (ρ = 0.92 montage A, ρ = 0.90 montage B), seizures-anywhere burdens were insensitive to variations in the spatial aspects of seizures, which were highly prevalent even in this small sample set. After adjusting for intrareader variability, the temporal-spatial seizure burdens measured by montages A and B were not significantly different (P = 0.56).

Conclusions:

The severity of neonatal seizures is poorly represented by simple measures such as seizures-anywhere frequencies or burdens. The use of temporal-spatial seizure burden measurements is supported in work where great precision in quantifying neonatal seizures is required.
Ab initio
infrared vibrational modes for neutral and charged small fullerenes (C
20
, C
24
, C
26
, C
28
, C
30
and C
60
)
Authors: Adjizian Jean-Joseph , Vlandas Alexis , Rio Jeremy , Charlier Jean-Christophe , Ewels Chris P.
Published: August 2016

We calculate the infrared (IR) absorption spectra using DFT B3LYP(6–311G) for a range of small closed-cage fullerenes, C

n

,
n
=20, 24, 26, 28, 30 and 60, in both neutral and multiple positive and negative charge states. The results are of use, notably, for direct comparison with observed IR absorption in the interstellar medium. Frequencies fall typically into two ranges, with C−C stretch modes around 1100–1500 cm
−1
(6.7–9.1 μm) and fullerene-specific radial motion associated with under-coordinated carbon at pentagonal sites in the range 600–800 cm
−1
(12.5–16.7 μm). Notably, negatively charged fullerenes show significantly stronger absorption intensities than neutral species. The results suggest that small cage fullerenes, and notably metallic endofullerenes, may be responsible for many of the unassigned interstellar IR spectral lines.

This article is part of the themed issue ‘Fullerenes: past, present and future, celebrating the 30th anniversary of Buckminster Fullerene’.
Tropical grassy biomes: linking ecology, human use and conservation
Authors: Lehmann Caroline E. R. , Parr Catherine L.
Published: August 2016

Tropical grassy biomes (TGBs) are changing rapidly the world over through a coalescence of high rates of land-use change, global change and altered disturbance regimes that maintain the ecosystem structure and function of these biomes. Our theme issue brings together the latest research examining the characterization, complex ecology, drivers of change, and human use and ecosystem services of TGBs. Recent advances in ecology and evolution have facilitated a new perspective on these biomes. However, there continues to be controversies over their classification and state dynamics that demonstrate critical data and knowledge gaps in our quantitative understanding of these geographically dispersed regions. We highlight an urgent need to improve ecological understanding in order to effectively predict the sensitivity and resilience of TGBs under future scenarios of global change. With human reliance on TGBs increasing and their propensity for change, ecological and evolutionary understanding of these biomes is central to the dual goals of sustaining their ecological integrity and the diverse services these landscapes provide to millions of people.

This article is part of the themed issue ‘Tropical grassy biomes: linking ecology, human use and conservation’.
The fishing and natural mortality of large, piscivorous Bull Trout and Rainbow Trout in Kootenay Lake, British Columbia (2008-2013)
Authors: Thorley Joseph L. , Andrusak Greg
Published: August 2016

Background

Estimates of fishing and natural mortality are important for understanding, and ultimately managing, commercial and recreational fisheries. High reward tags with fixed station acoustic telemetry provides a promising approach to monitoring mortality rates in large lake recreational fisheries. Kootenay Lake is a large lake which supports an important recreational fishery for large Bull Trout and Rainbow Trout.

Methods

Between 2008 and 2013, 88 large (≥ 500 mm) Bull Trout and 149 large (≥ 500 mm) Rainbow Trout were marked with an acoustic transmitter and/or high reward ($100) anchor tags in Kootenay Lake. The subsequent detections and angler recaptures were analysed using a Bayesian individual state-space Cormack-Jolly-Seber (CJS) survival model with indicator variable selection.

Results

The final CJS survival model estimated that the annual interval probability of being recaptured by an angler was 0.17 (95% CRI 0.11 - 0.23) for Bull Trout and 0.14 (95% CRI 0.09 - 0.19) for Rainbow Trout. The annual interval survival probability for Bull Trout was estimated to have declined from 0.91 (95% CRI 0.77 - 0.97) in 2009 to just 0.45 (95% CRI 0.24 - 0.73) in 2013. Rainbow Trout survival was most strongly affected by spawning. The annual interval survival probability was 0.77 (95% CRI 0.68 - 0.85) for a non-spawning Rainbow Trout compared to 0.42 (95% CRI 0.31 - 0.54) for a spawner. The probability of spawning increased with the fork length for both species and decreased over the course of the study for Rainbow Trout.

Discussion

Fishing mortality was relatively low and constant while natural mortality was relatively high and variable. The results are consistent with Kokanee abundance as opposed to angler effort as the primary driver of short-term population fluctations in Rainbow Trout abundance. Multi-species stock assessment models need to account for the fact that large Bull Trout are more abundant than large Rainbow Trout in Kootenay Lake.