bluuebunny/crossref_metadata_2025 huggingface dataset:
A generic workflow for effective sampling of environmental vouchers with UUID assignment and image processing
Authors: Triebel Dagmar , Reichert Wolfgang , Bosert Simone , Feulner Martin , Okach Daniel Osieko , Slimani Abderachid , Rambold Gerhard
Published: December 2017

Sampling of biological and environmental vouchers in the field is rather challenging, particularly under adverse habitat conditions and when various activities need to be handled simultaneously. The workflow described here includes five procedural steps, which result in professional sampling and the generation of universally identifiable data. In preparation for the field campaign, sample containers need to be labelled with universally unique identifier (UUID)-QR-codes. At the collection site, labelled containers, sampled material and attached supplementary information are imaged using a GNSS- respectively GPS-enabled smartphone or camera. Image processing, tagging and data storage as CSV text file is subsequently achieved in a field station or laboratory. For this purposes, the newly implemented tool DiversityImageInspector (URL: http://diversityworkbench.net/Portal/DiversityImageInspector) is used. It addresses combined image and data processing in such a context including the extraction of the QR-coded UUID from the image content and the extraction of geodata and time information from the Exif image header. The import of the resulting data files into a relational database or other kind of data management systems is optional but recommended. If applied, the import might be guided by a data transformation tool with compliant schema as described here. The new approach is discussed also with regard to implications for virtual research environments and data publication networks.

Database URL: http://diversityworkbench.net/Portal/DiversityImageInspector
PCOSBase: a manually curated database of polycystic ovarian syndrome
Authors: Afiqah-Aleng Nor , Harun Sarahani , A-Rahman Mohd Rusman Arief , Nor Muhammad Nor Azlan , Mohamed-Hussein Zeti-Azura
Published: December 2017

Polycystic ovarian syndrome (PCOS) is one of the main causes of infertility and affects 5–20% women of reproductive age. Despite the increased prevalence of PCOS, the mechanisms involved in its pathogenesis and pathophysiology remains unclear. The expansion of omics on studying the mechanisms of PCOS has lead into vast amounts of proteins related to PCOS resulting to a challenge in collating and depositing this deluge of data into one place. A knowledge-based repository named as PCOSBase was developed to systematically store all proteins related to PCOS. These proteins were compiled from various online databases and published expression studies. Rigorous criteria were developed to identify those that were highly related to PCOS. They were manually curated and analysed to provide additional information on gene ontologies, pathways, domains, tissue localizations and diseases that associate with PCOS. Other proteins that might interact with PCOS-related proteins identified from this study were also included. Currently, 8185 PCOS-related proteins were identified and assigned to 13 237 gene ontology vocabulary, 1004 pathways, 7936 domains, 29 disease classes, 1928 diseases, 91 tissues and 320 472 interactions. All publications related to PCOS are also indexed in PCOSBase. Data entries are searchable in the main page, search, browse and datasets tabs. Protein advanced search is provided to search for specific proteins. To date, PCOSBase has the largest collection of PCOS-related proteins. PCOSBase aims to become a self-contained database that can be used to further understand the PCOS pathogenesis and towards the identification of potential PCOS biomarkers.

Database URL: http://pcosbase.org
The safety and efficacy of radiofrequency ablation following endoscopic submucosal dissection for Barrett's neoplasia
Authors: Subramaniam S , Kandiah K , Chedgy F , Meredith P , Longcroft-Wheaton G , Bhandari P
Published: December 2017

The current standard of treating early Barrett's neoplasia is resection of visible lesions using endoscopic mucosal resection (EMR) followed by ablative therapy to the Barrett's segment. There is increasing evidence to support the use of endoscopic submucosal dissection (ESD) where en-bloc resection and lower recurrence rates may be achieved. However, ESD is associated with deep submucosal dissection when compared to EMR. This may increase the risk of complications including stricture formation with subsequent radiofrequency ablation (RFA) therapy. The aim of this study is to compare the safety and efficacy of RFA following EMR and ESD as well as when RFA was used without prior endoscopic resection. The primary outcome measure was complication rates. Clearance of dysplasia (CRD) and clearance of intestinal metaplasia (CRIM) were secondary outcomes. A retrospective analysis of a cohort of 91 patients referred for RFA from a single academic tertiary center was performed. The choice of endoscopic resection method was tailored according to the lesion type and morphology. Focal and circumferential ablation was performed after initial follow up endoscopy postresection. Patients proceeded straight to RFA in the absence of any visible lesions. In this study, the ESD group had a higher proportion of cancers compared to the EMR cohort (74.1% vs. 30.2%, P < 0.01) prior to RFA. All complications post RFA occurred in the groups with previous endoscopic resection. There was no significant difference in the total complication rate (7.4% vs. 9.3%, P = 0.78) and stricture formation rate (3.7% vs. 9.3%, P = 0.38) between the ESD and EMR groups. CRD was achieved in 96.3% in the ESD group, 88.4% in the EMR group, and all patients in the RFA alone group. CRIM rates were similar in the EMR and ESD groups (81.4% vs. 85.2%) but higher in the RFA alone group (90.5%). In conclusion, RFA following ESD is very effective and not associated with an increased risk of complications compared to EMR. This supports the application of RFA in the treatment algorithm of patients undergoing ESD for Barrett's neoplasia.
Cost-effectiveness Analysis of Intraoperative Cell Salvage for Obstetric Hemorrhage
Authors: Lim Grace , Melnyk Vladyslav , Facco Francesca L. , Waters Jonathan H. , Smith Kenneth J.
Published: December 2017

Background

Cost-effectiveness analyses on cell salvage for cesarean delivery to inform national and societal guidelines on obstetric blood management are lacking. This study examined the cost-effectiveness of cell salvage strategies in obstetric hemorrhage from a societal perspective.

Methods

Markov decision analysis modeling compared the cost-effectiveness of three strategies: use of cell salvage for every cesarean delivery, cell salvage use for high-risk cases, and no cell salvage. A societal perspective and lifetime horizon was assumed for the base case of a 26-yr-old primiparous woman presenting for cesarean delivery. Each strategy integrated probabilities of hemorrhage, hysterectomy, transfusion reactions, emergency procedures, and cell salvage utilization; utilities for quality of life; and costs at the societal level. One-way and Monte Carlo probabilistic sensitivity analyses were performed. A threshold of $100,000 per quality-adjusted life-year gained was used as a cost-effectiveness criterion.

Results

Cell salvage use for cases at high risk for hemorrhage was cost-effective (incremental cost-effectiveness ratio, $34,881 per quality-adjusted life-year gained). Routine cell salvage use for all cesarean deliveries was not cost-effective, costing $415,488 per quality-adjusted life-year gained. Results were not sensitive to individual variation of other model parameters. The probabilistic sensitivity analysis showed that at the $100,000 per quality-adjusted life-year gained threshold, there is more than 85% likelihood that cell salvage use for cases at high risk for hemorrhage is favorable.

Conclusions

The use of cell salvage for cases at high risk for obstetric hemorrhage is economically reasonable; routine cell salvage use for all cesarean deliveries is not. These findings can inform the development of public policies such as guidelines on management of obstetric hemorrhage.
Antifibrinolytic Therapy and Perioperative Considerations
Authors: Levy Jerrold H. , Koster Andreas , Quinones Quintin J. , Milling Truman J. , Key Nigel S.
Published: December 2017

Fibrinolysis is a physiologic component of hemostasis that functions to limit clot formation. However, after trauma or surgery, excessive fibrinolysis may contribute to coagulopathy, bleeding, and inflammatory responses. Antifibrinolytic agents are increasingly used to reduce bleeding, allogeneic blood administration, and adverse clinical outcomes. Tranexamic acid is the agent most extensively studied and used in most countries. This review will explore the role of fibrinolysis as a pathologic mechanism, review the different pharmacologic agents used to inhibit fibrinolysis, and focus on the role of tranexamic acid as a therapeutic agent to reduce bleeding in patients after surgery and trauma.
Ultrasound Diagnosis and Treatment of Breast Lumps after Breast Augmentation with Autologous Fat Grafting
Authors: Shida Masaaki , Chiba Akihiko , Ohashi Masanori , Yamakawa Masayuki
Published: December 2017

Background:

Breast augmentation with autologous fat has been performed in Japan for over 30 years. However, complications include breast lumps and oil cysts. Such breast lumps greatly reduce patient satisfaction, and are currently difficult to diagnose and treat for many cosmetic surgery clinics. This study aimed to elucidate the effectiveness of ultrasound diagnosis and treatment of patients with breast lumps after breast augmentation with autologous fat grafting.

Methods:

We used diagnostic and therapeutic ultrasound to examine 256 patients with breast lumps between April 2012 and April 2017. We determined the nature, size, and location of the maximal lump. Breast lumps were classified into five types: cystic, complex, solid, calcification, and unclassifiable. The method of treatment (including fine-needle aspiration, VASER liposuction, lumpectomy, and extended lumpectomy) was selected according to the lump type, and the efficacy of treatment was determined by postoperative palpation and ultrasound.

Results:

A total of 198 patients (198/256, 77%) requested treatment. Cystic lumps (79/256, 31%) were treated by fine-needle aspiration. VASER liposuction was used to treat complex (64/256, 25%) and solid lumps (50/256, 19%). Calcification (58/256, 23%) and unclassifiable lumps (5/256, 2%) were removed via periareolar incision. There were no serious complications. In all cases, the lumps were no longer palpable after treatment, and ultrasound showed that they had either contracted or disappeared.

Conclusions:

The appropriate treatment for breast lumps after breast augmentation with autologous fat grafting must be selected according to the nature of the lumps. Ultrasound is essential for diagnosing the breast lump type and determining the best treatment.
Preliminary Work Toward a Transuranic Activity Estimation Method for Rapid Discrimination of Anthropogenic from Transuranic Activity in Alpha Air Samples
Authors: Cope S. Joseph , Hayes Robert B.
Published: December 2017

Radon (222Rn) and thoron (220Rn) progeny (primarily bismuth and polonium) are known interferents when rapid evaluation of transuranic content on air filters is of interest. These complexities stem from the overlapping energies of the progeny alpha particles onto the transuranic region of interest (3–5.5 MeV) where naturally-occurring alpha emitters can overwhelm the spectra. Due to the immediacy of the alpha counting methods employed, coupled with the half-life of thoron progeny dominated by 212Pb (t1/2=10.6 h), a conservative transuranic activity estimate with rigorous uncertainty is being sought. A successful transuranic activity estimation method will incorporate any thoron progeny present on the filter providing 95% confidence decision levels in which a filter may be evaluated for emergency response applications. Twenty-three pairs of samples of various duration having no transuranic content were taken over a 2‐mo period. The resulting filters were counted in a time series before non-linear least squares decay curve fitting was applied to the decay profile. For the samples considered, a transuranic activity estimator decision level was determined at 0.2 Bq for the given geographic location and months analyzed. Validation of this method for other seasonal and geographic regions could provide enhanced emergency response capability when the presence of transuranic activity is suspected.
Clinical Outcomes and Intraocular Pressure Control After Scleral-glued Intraocular Lens Insertion in Eyes With Pseudoexfoliation
Authors: Ragam Ashwinee , Ritterband David C. , Waisbren Emily C. , Mathew-Padiyedathu Julia , Kang Joann , Seedor John A.
Published: December 2017

Purpose:

To analyze clinical outcomes and intraocular pressure control following scleral-glued intraocular lens (IOL) fixation in eyes with pseudoexfoliation (PXF).

Methods:

A retrospective chart review and outcome analysis was performed on a series of eyes undergoing glue-assisted, scleral-fixated (scleral-glued) IOL insertion in the setting of PXF and poor or absent capsular support.

Results:

In total, 28 eyes were included in the study. The indications for scleral-glued IOL fixation included late endocapsular IOL dislocation (21/28, 75%), exchange for iris-fixated IOL due to complication (4/28, 14%), subluxed crystalline lens (2/28, 7%), and aphakia after complicated cataract surgery (1/28, 4%). In total, 15/28 (54%) eyes had diagnosed preexisting glaucoma at the time of scleral-glued surgery. The most common postoperative complication was ocular hypertension requiring escalation of medical management, which occurred in 8/28 (29%) eyes. At final follow-up, corrected distance visual acuity was equivalent to or improved from preoperative measurements in 25/28 (89%) eyes.

Conclusions:

The scleral-glued surgery is a good option for fixating an IOL in eyes with PXF and poor zonular integrity or absent capsular support. Special attention should be placed on intraocular pressure control following surgery, which can be less predictable in PXF eyes with or without preexisting glaucoma.
Clinical Characteristics and Risk Factors of Long-term Central Venous Catheter–associated Bloodstream Infections in Children
Authors: Moon Hye Min , Kim Suji , Yun Ki Wook , Kim Hyun-young , Jung Sung Eun , Choi Eun Hwa , Lee Hoan Jong
Published: December 2017

Background:

Central line–associated bloodstream infections (CLABSIs) account for significant morbidity and mortality in patients with long-term central venous catheters (CVCs). This study was performed to identify the characteristics and risk factors of CLABSIs among children with long-term CVCs.

Methods:

A retrospective review of children who had a long-term CVC in Seoul National University Children’s Hospital between 2011 and 2015 was performed. Data on patient demographics, the isolated pathogens and the status of CVC placement were collected. Clinical variables were compared between subjects with and without CLABSIs to determine the risk factors for CLABSIs.

Results:

A total of 629 CVCs were inserted in 499 children during the 5-year period. The median age at insertion was 6.0 years (14 days–17.9 years), and hemato-oncologic disease was the most common underlying condition (n = 497, 79.0%). A total of 235 CLABSI episodes occurred in 155 children, with a rate of 0.93 per 1,000 catheter days. The most common pathogens were Klebsiella pneumoniae (n = 64, 27.2%), coagulase-negative staphylococci (n = 40, 17.0%) and Staphylococcus aureus (n = 28, 12.0%). In the univariate analysis, the gender, underlying disease, catheter characteristics and insertion technique did not increase the risk for CLABSI. In both the univariate and logistic regression analyses, patients with prior BSIs (odds ratio 1.66; 95% confidence interval: 1.090–2.531; P = 0.018) were more likely to have a CLABSI.

Conclusions:

CLABSI prevention is of particular concern for children with a prior BSI. Furthermore, the antimicrobial resistance of major pathogens should be monitored to enable the empiric selection of appropriate antibiotics in patients with long-term CVCs.
Undergraduate Nursing Students’ Perceptions of Individuals With Drug Use Problems
Authors: Mahmoud Khadejah F. , Terhorst Lauren , Lindsay Dawn , Puskar Kathryn R. , Mitchell Ann M.
Published: December 2017

The Drug and Drug Problems Perception Questionnaire (DDPPQ) is a multidimensional instrument that measures healthcare providers’ attitudes toward working with patients who use drugs. Five- and six-subscale versions of the DDPPQ have been published. Although the reliability of the DDPPQ subscales was reported to be satisfactory, the factor structure of either version was not validated by a confirmatory factor analysis. The aim of this study was to examine the internal factor structure of the 22-item DDPPQ instrument using a sample of undergraduate nursing students. This study was a secondary analysis that utilized baseline data from the Addiction Training for Nurses using Screening, Brief Intervention, and Referral to Treatment Program. The DDPPQ was administrated during the undergraduate nursing students’ junior year in a single university setting in southwestern Pennsylvania. A sample of 473 students was used in this study. The sample was split equally to conduct both principal component analysis (n = 237) and confirmatory factor analysis (n = 236). On average, the sample had a mean age of 22.9 years and was predominantly female (87.2%) and Caucasian (90.9%). A principal component analysis revealed that a five-factor structure had the best fit after the removal of two items. Reliabilities of the five subscales ranged from α = .696 to α = .904. Thus, a five-factor structure with removal of Items 9 and 19 is recommended when using the DDPPQ with undergraduate nursing students.
Analysis of Health Behavior Theories for Clustering of Health Behaviors
Authors: Choi Seung Hee , Duffy Sonia A.
Published: December 2017

Objectives:

The objective of this article was to review the utility of established behavior theories, including the Health Belief Model, Theory of Reasoned Action, Theory of Planned Behavior, Transtheoretical Model, and Health Promotion Model, for addressing multiple health behaviors among people who smoke. It is critical to design future interventions for multiple health behavior changes tailored to individuals who currently smoke, yet it has not been addressed.

Methods:

Five health behavior theories/models were analyzed and critically evaluated. A review of the literature included a search of PubMed and Google Scholar from 2010 to 2016. Two hundred sixty-seven articles (252 studies from the initial search and 15 studies from the references of initially identified studies) were included in the analysis.

Result:

Most of the health behavior theories/models emphasize psychological and cognitive constructs that can be applied only to one specific behavior at a time, thus making them not suitable to address multiple health behaviors. However, the Health Promotion Model incorporates “related behavior factors” that can explain multiple health behaviors among persons who smoke.

Conclusion:

Future multiple behavior interventions guided by the Health Promotion Model are necessary to show the utility and applicability of the model to address multiple health behaviors.
Psychosocial Factors Affecting Smartphone Addiction in University Students
Authors: Aker Servet , Şahin Mustafa Kürşat , Sezgin Serap , Oğuz Gülay
Published: December 2017

Smartphone addiction is a recent concern that has resulted from the dramatic increase in worldwide smartphone use. The purpose of this cross-sectional study was to evaluate psychosocial factors affecting smartphone addiction in university students. The study was performed among students at the Ondokuz Mayis University Samsun School of Health (Samsun, Turkey) on October–December 2015. Four hundred ninety-four students possessing smartphones and agreeing to participate were included. A sociodemographic data form produced by the authors and consisting of 10 questions was administered together with a questionnaire involving the Smartphone Addiction Scale-Short Version (SAS-SV), the Flourishing Scale, the General Health Questionnaire, and the Multidimensional Scale of Perceived Social Support. The questionnaires were applied in a class environment at face-to-face interviews. SAS-SV scores of 6.47% of students were “significantly higher” than the participating group mean SAS-SV score. Multiple regression analysis revealed that depression, anxiety and insomnia, and familial social support statistically, significantly predicted smartphone addiction. Further studies of smartphone addiction in different age groups and with different educational levels are now needed.
Designing a New Model for Clinical Education
Authors: Shaffer Kathryn , Swan Beth Ann , Bouchaud Mary
Published: December 2017

To keep pace with the ever-changing health care delivery system, it is important to transform the way future nurses are educated, both in classroom and in clinical settings, to care for people along the life and care continuum, not only in acute-care settings. The purpose of this article is to describe a new approach to educating baccalaureate nursing students using immersion practicums that expose students to population health, transitions of care, care coordination, and the multiple roles a nurse engages in along the continuum. The curriculum includes 5 immersions, each with a specific life and care continuum focus to develop anticipatory thinkers.
Cervical Injuries in Drowning Cases
Authors: Boussaid Maroua , Mesrati Mohamed Amin , Mahjoub Yosra , Haj Salem Nidhal , Zakhama Abdelfateh , Chadly Ali , Moussa Adnen , Aissaoui Abir
Published: December 2017

Discovery of bruises in the muscles of the neck and a fracture of the hyoid bone in a body recovered from water makes the diagnosis and the determination of the manner of death difficult.

The aims of this work are to report a case of a drowned body with cervical injuries and to highlight the importance of interpreting these findings accurately.

A 39-year-old woman was found dead face down in a 6-m deep well with a 3-m water level. She was mentally disturbed and had a history of suicide attempts. In fact, she had previously attempted to jump into that well in an attempt to put an end to her life. The autopsy revealed bruises in the muscles of the neck and a bruise associated with a fracture of the left horn of the hyoid bone.

The mechanism for the origin of drowning-related neck injuries will be discussed.
Evaluating the Implementation Barriers of an Intranasal Fentanyl Pain Pathway for Pediatric Long-Bone Fractures
Authors: Arnautovic Tamara , Sommese Kathryn , Mullan Paul C. , Frazier Steven Barron , Vazifedan Turaj , Ramirez Dana Erikson
Published: December 2017

Objectives

This study aimed to assess physician comfort, knowledge, and implementation barriers regarding the use of intranasal fentanyl (INF) for pain management in patients with long-bone fractures in a pediatric emergency department (ED) with an INF pain pathway.

Methods

A retrospective chart review was conducted of patients, 3 to 21 years old, in our ED with an International Classification of Diseases-9th Revision code for a long-bone fracture from September 1, 2013, to August 31, 2015. Patients were divided into 4 groups: (1) received INF on the pathway appropriately; (2) “missed opportunities” to receive INF, defined as either INF was ordered and then subsequently canceled (for pain ratings, ≥6/10), or INF was ordered, cancelled, and intravenous (IV) morphine given, or INF was not ordered and a peripheral IV line was placed to give IV morphine as first-line medication; (3) peripheral IV established upon ED arrival; (4) no pain medication required. Additionally, a survey regarding practice habits for pain management was completed to evaluate physician barriers to utilization of the pathway.

Results

A total of 1374 patients met the inclusion criteria. Missed opportunities were identified 41% of the time. Neither younger patient age nor more years of physician experience in the ED were associated with increased rates of missed opportunities. The survey (95% response rate) revealed greater comfort with and preference for IV morphine over INF.

Conclusions

The high rate of missed opportunities, despite the implementation of an INF pain pathway, indicates the need for further exploration of the barriers to utilization of the INF pain pathway.
Burnout Rates in Pediatric Emergency Medicine Physicians
Authors: Patterson Jasmine , Gardner Alison
Published: December 2017

Objective

Burnout is a syndrome in which a reduced sense of personal accomplishment, depersonalization, and emotional exhaustion develop in response to prolonged stress. It is well known that physicians suffer high rates of burnout; emergency medicine physicians experience significantly increased rates of burnout, whereas physicians in other specialties, like pediatrics, may be spared. Pediatric emergency medicine physicians are on the frontline of care for the critically ill child, which could put them at high risk for burnout. This study evaluates the rate of burnout in pediatric emergency medicine physicians.

Methods

We conducted a survey assessing burnout using a sample of pediatric emergency medicine physicians who subscribe to an open Listserv server maintained by Brown University. Burnout was measured using a validated instrument, the Maslach Burnout Inventory-Human Services Survey, which was distributed by e-mail to the study group.

Results

Respondents averaged a score of 9 (95% confidence interval [CI], 8–10), 23 (95% CI, 21–25), and 39 (95% CI, 38–40) in the subscales of depersonalization, emotional exhaustion, and personal accomplishment, respectively. This placed our cohort into the average range for all subscales. The percentage of respondents who scored in the high levels of burnout (moderate to high scores in both depersonalization and emotional exhaustion and low to moderate scores in personal accomplishment) was 25% (95% CI, 18–32).

Conclusions

Unlike previous literature showing burnout prevalence in excess of 60% in emergency medicine physicians and 38% in pediatricians, our pediatric emergency medicine physicians fared better with only 25% (95% CI, 18–32), showing elevated levels of burnout.
The Predictors for Positive Yield Abdominal Computed Tomography in Pediatric Abdominal Trauma
Authors: Alzahem Abdulrahman M. , Soundappan Soundappan S.V. , Cass Daniel T.
Published: December 2017

Objectives

Abdominal computed tomography (ACT) use in the initial evaluation of pediatric abdominal trauma is liberal in most instances. The aim of this study was to identify the predictors for a positive yield ACT scan in this population.

Methods

A prospective, cohort, single-center observational study was conducted at Children’s Hospital at Westmead, New South Wales, from January 2008 to June 2015 on 240 pediatric abdominal trauma patients who had abdominal computed tomography. Clinical, laboratory, imaging, and interventional variables were explored with univariate and multivariate analyses among children who sustained abdominal trauma.

Results

Of 240 patients, positive ACT scans were found in 161 patients (67%), 112 patients (47%) had intra-abdominal injury, and 20 patients (8%) required invasive therapeutic interventions. Mortality rate was 1.7% (4 patients) due to nonabdominal causes. Multivariate analyses revealed that increasing age (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.02–1.24; P = 0.024), high injury severity score (OR, 1.14; 95% CI, 1.07–1.21; P < 0.001), abnormal abdominal examination (OR, 5.95; 95% CI, 2.08–17.01; P = 0.001), elevated alanine aminotransferase greater than 125 IU/L (OR, 46.28; 95% CI, 2.81–762.49; P = 0.007), abnormal pelvic radiograph (OR, 14.03; 95% CI, 2.39–82.28; P = 0.003), presence of gross hematuria (OR, 4.14; 95% CI, 1.04–18.23; P = 0.044), low initial hematocrit level (less than 30%) (OR, 8.51; 95% CI, 1.14–63.70; P = 0.037), and positive focused assessment with sonography for trauma (OR, 2.61; 95% CI, 1.01–7.28; P = 0.048) remained significantly associated with abnormal ACT scan. In contrast, those who required scanning of other body region(s) were less likely to have abnormal ACT scan (OR, 0.34; 95% CI, 0.14–0.86; P =0.022).

Conclusions

Integrating the abdominal examination findings, relevant laboratory values, and focused assessment with sonography for trauma results with the physicians’ suspicion may aid in stratifying patients for ACT scan. Further efforts should be made to decrease number of normal ACT scans; yet not to increase the number of delayed or missed injures with its inherent morbidity and mortality.
Recurrent Lower Eyelid Ectropion After Graft Surgery Using Autogenous Palmaris Longus Tendon
Authors: Komatsu Koji , Matsuda Hiromichi , Takahashi Yasuhiro , Nakano Tadashi
Published: December 2017

A 78-year-old male experienced right lower eyelid ectropion following right facial trauma from a fall 5 years ago, for which he underwent autogenous palmaris longus tendon graft surgery at another clinic. Recurrence was noted 3 years after surgery. On first examination, there was outward turning of the lateral half of the right lower eyelid margin. We performed a lateral tarsal strip procedure with removal of the graft. Intraoperatively, the lateral part of the graft was located along the inferior tarsal border, whereas the medial part was located on the tarsal surface. The lateral stump had bifurcated; 1 branch had passed through a bony hole drilled at the base of the rim; and both branches had been ligated together on the rim surface. The medial side had been fixed to the medial canthal tendon. Postoperatively, the apposition of eyelid and ocular surface was good, and the patient experienced no recurrence after 1 year.
Noncompliance with American College of Surgeons Committee on Trauma recommended criteria for full trauma team activation is associated with undertriage deaths
Authors: Tignanelli Christopher J. , Vander Kolk Wayne E. , Mikhail Judy N. , Delano Matthew J. , Hemmila Mark R.
Published: December 2017

BACKGROUND

The appropriate triage of acutely injured patients within a trauma system is associated with improved rates of mortality and optimal resource utilization. The American College of Surgeons Committee on Trauma (ACS-COT) put forward six minimum criteria (ACS-6) for full trauma team activation (TTA). We hypothesized that ACS-COT–verified trauma center compliance with these criteria is associated with low undertriage rates and improved overall mortality.

METHODS

Data from a state-wide collaborative quality initiative was used. We used data collected from 2014 through 2016 at 29 ACS verified Level I and II trauma centers. Inclusion criteria are: adult patients (≥16 years) and Injury Severity Score of 5 or less. Quantitative data existed to analyze four of the ACS-6 criteria (emergency department systolic blood pressure ≤ 90 mm Hg, respiratory compromise/intubation, central gunshot wound, and Glasgow Coma Scale score < 9). Patients were considered to be undertriaged if they had major trauma (Injury Severity Score > 15) and did not receive a full TTA.

RESULTS

51,792 patients were included in the study. Compliance with ACS-6 minimum criteria for full TTA varied from 51% to 82%. The presence of any ACS-6 criteria was associated with a high intervention rate and significant risk of mortality (odds ratio, 16.7; 95% confidence interval, 15.2–18.3; p < 0.001). Of the 1,004 deaths that were not a full activation, 433 (43%) were classified as undertriaged, and 301 (30%) had at least one ACS-6 criterion present. Undertriaged patients with any ACS-6 criteria were more likely to die than those who were not undertriaged (30% vs. 21%, p = 0.001). Glasgow Coma Scale score less than 9 and need for emergent intubation were the ACS-6 criteria most frequently associated with undertriage mortality.

CONCLUSION

Compliance with ACS-COT minimum criteria for full TTA remains suboptimal and undertriage is associated with increased mortality. These data suggest that the most efficient quality improvement measure around triage should be ensuring compliance with the ACS-6 criteria. This study suggests that practice pattern modification to more strictly adhere to the minimum ACS-COT criteria for full TTA will save lives.

LEVEL OF EVIDENCE

Care management, level III.
Impact of venorrhaphy and vein ligation in isolated lower-extremity venous injuries on venous thromboembolism and edema
Authors: Manley Nathan R. , Magnotti Louis J. , Fabian Timothy C. , Croce Martin A. , Sharpe John P.
Published: December 2017

BACKGROUND

Following venous injury, venorrhaphy can restore outflow, although it risks thrombosis and venous thromboembolism (VTE). Vein ligation is a faster option, although it potentially risks extremity edema. The purpose of this study was to evaluate the management of venous injury on VTE and extremity edema in patients with isolated lower-extremity venous injuries.

METHODS

Patients with common iliac, external iliac, and femoral venous injuries over a 10-year period were stratified by age, shock, management of venous injury, injury severity, and timing and type of anticoagulation. Outcomes included development of extremity edema and VTE (pulmonary embolism, deep venous thrombosis). Outcomes were then evaluated to determine risk factors for symptomatic lower-extremity edema and VTE by the management of venous injuries.

RESULTS

Eighty-four patients were identified: 20 common iliac, 27 external iliac, 37 femoral. Forty-nine underwent vein repair and 35 underwent vein ligation. Ninety-three percent were male with a mean Injury Severity Score and Glasgow Coma Scale score of 17 and 14, respectively. Venous thromboembolism occurred in 18 (21%), 15 (18%) deep venous thrombosis, and 4 (5%) pulmonary embolisms. Thirty-two (38%) patients developed lower-extremity edema. Those who underwent vein ligation had a greater degree of shock on presentation (RBC transfusions, 14 vs. 8 units; p = 0.03) and were more likely to receive prophylactic fasciotomies (60% vs. 33%, p = 0.01). There was no difference in time to or type of chemoprophylaxis between patients who underwent vein repair and those who received vein ligation. However, patients with vein ligation had fewer episodes of VTE (9% vs. 31%, p = 0.02) with no difference in symptomatic lower-extremity edema (37% vs. 39%, p = 0.88) or amputation rates (0% vs. 2%, p = 0.99).

CONCLUSION

Vein repair had a higher incidence of VTE while providing no additional benefit in reducing symptomatic extremity edema compared to ligation in patients suffering venous injury. Ligation of most extremity venous injuries can be performed without increasing patient morbidity.

LEVEL OF EVIDENCE

Therapeutic study, level IV.
Hereditary thrombophilia in trauma patients with venous thromboembolism: Is routine screening necessary?
Authors: Cannon Kathleen A. , Badiee Jayraan , Brill Jason B. , Olson Erik J. , Sise Michael J. , Bansal Vishal , Sise C.Beth , Shackford Steven R.
Published: December 2017

BACKGROUND

Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), remains a common complication following trauma. The role of hereditary thrombophilia (HT) in posttraumatic VTE is unknown. In the general population with a first-time DVT, Factor V Leiden (FVL) and prothrombin G20210A mutation (PGM) are the most common types of HT with an incidence of 20% to 25% and 6% to 18%, respectively. The objective of this study was to identify the incidence of FVL and PGM in posttraumatic VTE to determine whether routine screening for HT in trauma should be performed.

METHODS

We conducted a prospective observational study at our Level I trauma center from 2013 to 2016 when 70 patients with posttraumatic DVT and PE were screened for FVL and PGM. Demographics, injury characteristics, and established risk factors for VTE were collected for each patient. Statistical analysis was performed to compare patients with and without HT.

RESULTS

The incidence of FVL and PGM in posttraumatic VTE was 1.4% and 5.7%, respectively. All HT-positive patients had a DVT and one had an associated PE. Both the individual risk factors and the total number of risk factors for VTE were similar between the HT-positive group and the HT-negative group.

CONCLUSION

There was a lower incidence of FVL and PGM in patients with posttraumatic DVT than in patients with a first-time DVT in the general population. HT does not appear to significantly contribute to posttraumatic VTE in our trauma population. Further research is warranted to determine whether routine screening for HT in trauma should be performed.

LEVEL OF EVIDENCE

Epidemiological study, level III; Care management/therapeutic study, level IV.
Predicting CTCF-mediated chromatin interactions by integrating genomic and epigenomic features
Authors: Kai Yan , Andricovich Jaclyn , Zeng Zhouhao , Zhu Jun , Tzatsos Alexandros , Peng Weiqun
Published: December 2017

The CCCTC-binding zinc finger protein (CTCF)-mediated network of long-range chromatin interactions is important for genome organization and function. Although this network has been considered largely invariant, we found that it exhibits extensive cell-type-specific interactions that contribute to cell identity. Here we present Lollipop—a machine-learning framework—which predicts CTCF-mediated long-range interactions using genomic and epigenomic features. Using ChIA-PET data as benchmark, we demonstrated that Lollipop accurately predicts CTCF-mediated chromatin interactions both within and across cell-types, and outperforms other methods based only on CTCF motif orientation. Predictions were confirmed computationally and experimentally by Chromatin Conformation Capture (3C). Moreover, our approach reveals novel determinants of CTCF-mediated chromatin wiring, such as gene expression within the loops. Our study contributes to a better understanding about the underlying principles of CTCF-mediated chromatin interactions and their impact on gene expression.
Diverse functions of closely homologous actin isoforms are defined by their nucleotide, rather than their amino acid sequence
Authors: Vedula P. , Kurosaka S. , Leu N. A. , Wolf Y. I. , Shabalina S. , Wang J. , Sterling S. , Dong D. W. , Kashina A.
Published: December 2017

β- and γ-cytoplasmic-actin are nearly indistinguishable in their amino acid sequence, but are encoded by different genes that play non-redundant biological roles. The key determinants that drive their functional distinction are unknown. Here we tested the hypothesis that β- and γ-actin functions are defined by their nucleotide, rather than their amino acid sequence, using targeted editing of the mouse genome. Although previous studies have shown that disruption of β-actin gene critically impacts cell migration and mouse embryogenesis, we demonstrate here that generation of a mouse lacking β-actin protein by editing β-actin gene to encode γ-actin protein, and vice versa, does not affect cell migration and/or organism survival. Our data suggest that the essentialin vivofunction of β-actin is provided by the gene sequence independent of the encoded protein isoform. We propose that this regulation constitutes a global “silent code” mechanism that controls the functional diversity of protein isoforms.
Annihilation of Methicillin-resistant Staphylococcus aureus via Photobleaching of Staphyloxanthin
Authors: Dong Pu-Ting , Mohammad Haroon , Wang Xiaoyu , Hui Jie , Li Junjie , Liang Lijia , Seleem Mohamed N. , Cheng Ji-Xin
Published: December 2017

Given that the dearth of new antibiotic development loads an existential burden on successful infectious disease therapy1, health organizations are calling for alternative approaches to combat methicillin-resistant Staphylococcus aureus (MRSA) infections. Here, we report a drug-free photonic approach to eliminate MRSA through photobleaching of staphyloxanthin, an indispensable membrane-bound antioxidant of S. aureus2-5. The photobleaching process, uncovered through a transient absorption imaging study and quantitated by absorption spectroscopy and mass spectrometry, decomposes staphyloxanthin and sensitizes MRSA to reactive oxygen species attack. Consequently, staphyloxanthin bleaching by low-level blue light eradicates MRSA synergistically with external or internal reactive oxygen species. The effectiveness of this synergistic therapy is validated in MRSA culture, MRSA-infected macrophage cells, S. aureus biofilms, and a mouse wound infection model. Collectively, these findings highlight broad applications of staphyloxanthin photobleaching for treatment of MRSA infections.
Warning SINEs:Aluelements, evolution of the human brain, and the spectrum of neurological disease
Authors: Larsen Peter A. , Hunnicutt Kelsie E. , Larsen Roxanne J. , Yoder Anne D. , Saunders Ann M.
Published: December 2017

Aluelements are a highly successful family of primate-specific retrotransposons that have fundamentally shaped primate evolution, including the evolution of our own species.Alus play critical roles in the formation of neurological networks and the epigenetic regulation of biochemical processes throughout the central nervous system (CNS), and thus are hypothesized to have contributed to the origin of human cognition. Despite the benefits thatAlusprovide, deleteriousAluactivity is associated with a number of neurological and neurodegenerative disorders. In particular, neurological networks are potentially vulnerable to the epigenetic dysregulation ofAluelements operating across the suite of nuclear-encoded mitochondrial genes that are critical for both mitochondrial and CNS function. Here, we highlight the beneficial neurological aspects ofAluelements as well as their potential to cause disease by disrupting key cellular processes across the CNS. We identify at least 37 neurological and neurodegenerative disorders wherein deleteriousAluactivity has been implicated as a contributing factor for the manifestation of disease and, for many of these disorders, this activity is operating on genes that are essential for proper mitochondrial function. We conclude that the epigenetic dysregulation ofAluelements can ultimately disrupt mitochondrial homeostasis within the CNS. This mechanism is a plausible source for the incipient neuronal stress that is consistently observed across a spectrum of sporadic neurological and neurodegenerative disorders.

List of Abbreviations

A-to-I

adenosine-to-inosine

AD

Alzheimer’s Disease

ADAR

adenosine deaminase acting on RNA

ALS

Amyotrophic Lateral Sclerosis

AMPA

α-amino-3-hydroxy-5methyl-4-isoxazole propionate

APP

amyloid precursor protein

circRNAs

circular RNAs

CNS

central nervous system

FLAM

free leftAlumonomer

LINE

long interspersed element

L1

long interspersed element-1

LTR

long-terminal repeat

mRNA

messenger RNA

PD

Parkinson’s Disease

pre-mRNA

precursor messenger RNA

SEDs

super-enhancer domains

SINE

short-interspersed element

TADs

topologically associating domains

TOMM

translocase of outer mitochondrial membrane
Full-Length Envelope Analyzer (FLEA): A tool for longitudinal analysis of viral amplicons
Authors: Eren Kemal , Weaver Steven , Ketteringham Robert , Valentyn Morné , Laird Smith Melissa , Kumar Venkatesh , Mohan Sanjay , Kosakovsky Pond Sergei L , Murrell Ben
Published: December 2017

Next generation sequencing of viral populations has advanced our understanding of viral population dynamics, the development of drug resistance, and escape from host immune responses. Many applications require complete gene sequences, which can be impossible to reconstruct from short reads. HIV-1 env, the protein of interest for HIV vaccine studies, is exceptionally challenging for long-read sequencing and analysis due to its length, high substitution rate, and extensive indel variation. While long-read sequencing is attractive in this setting, the analysis of such data is not well handled by existing methods. To address this, we introduce FLEA (Full-Length Envelope Analyzer), which performs end-to-end analysis and visualization of long-read sequencing data.

FLEA consists of both a pipeline (optionally run on a high-performance cluster), and a client-side web application that provides interactive results. The pipeline transforms FASTQ reads into high-quality consensus sequences (HQCSs) and uses them to build a codon-aware multiple sequence alignment. The resulting alignment is then used to infer phylogenies, selection pressure, and evolutionary dynamics. The web application provides publication-quality plots and interactive visualizations, including an annotated viral alignment browser, time series plots of evolutionary dynamics, visualizations of gene-wide selective pressures (such as dN /dS) across time and across protein structure, and a phylogenetic tree browser.

We demonstrate how FLEA may be used to process Pacific Biosciences HIV-1 env data and describe recent examples of its use. Simulations show how FLEA dramatically reduces the error rate of this sequencing platform, providing an accurate portrait of complex and variable HIV-1 env populations.

A public instance of FLEA is hosted at http://flea.datamonkey.org. The Python source code for the FLEA pipeline can be found at https://github.com/veg/flea-pipeline. The client-side application is available at https://github.com/veg/flea-web-app. A live demo of the P018 results can be found at http://flea.murrell.group/view/P018.
Modeling the Structural Origins of Drug Resistance to Isoniazid via key Mutations in Mycobacterium tuberculosis Catalase-Peroxidase, KatG
Authors: Marney Matthew W. , Metzger Robert P. , Hecht David , Valafar Faramarz
Published: December 2017

WHO reported 10.4 million new tuberculosis (TB) cases and 1.8 million deaths in 2015, making M. tuberculosis the most successful human pathogen with highest mortality among infectious diseases.[1,2] Drug-resistant TB is a major threat to global TB control.[2,3] Recently Torres et al. [4] identified 14 novel substitutions in M. tuberculosis-KatG (the enzyme associated with resistance to isoniazid—an important first-line anti-TB drug) and demonstrated that 12 of the 14 can cause INH-resistance in M. smegmatis. This study presents an in silico structure-based analysis of these 14 amino acid substitutions using homology models and x-ray crystal structures (when available) in M. tuberculosis. Our models demonstrate that several of these mutations cluster around three openings in the KatG tertiary structure which appear to initiate channels to the heme group at the catalytic center of the enzyme. We studied the effects of these mutations on the tertiary structure of KatG, focusing on conformational changes in the three channels in the protein structure. Our results suggest that the 14 novel mutations sufficiently restrict one or more of these access channels, thus potentially preventing INH from reaching the catalytic heme. These observations provide valuable insights into the structure-based origins of INH resistance and provide testable hypotheses for future experimental studies.
Crystal structure of a Zn complex with terephthalate and 1,6-bis(1,2,4-triazol-1-yl)hexane
Authors: Sukhikh Taisiya S. , Semitut Evgeny Yu. , Potapov Andrei S.
Published: December 2017

A new zinc coordination polymer with rigid benzene-1,4-dicarboxylate (bdc) and flexible 1,6-bis(1,2,4-triazol-1-yl)hexane (btrh), namely poly[[(μ2-benzene-1,4-dicarboxylato)[μ2-1,6-bis(1,2,4-triazol-1-yl)hexane]zinc] dimethylformamide monosolvate], [Zn(C8H4O4)(C10H16N6)]·C3H7NO, was synthesized. According to the single-crystal XRD analysis, the product crystallizes in theP-1 space group and has a layered structure. Analysis of the layered structure reveals {Zn(bdc)} chains which are connected by pairs of btrh ligands. The layers are packed tightly perpendicular to the [1-22] direction, separated by one non-disordered dimethylformamide solvent molecule per formula unit. According to thermogravimetric analysis, the product completely loses this solvent at 453 K; the desolvated compound is stable up to 503 K. As a result of the lack of hydrogen-donor groups, hydrogen bonds are not observed in the structure of the complex; however, an intermolecular C—H...π contact of 3.07 Å occurs.