bluuebunny/crossref_metadata_2025 huggingface dataset:
Patellar-Trochlear Morphology in Pediatric Patients From 2 to 11 Years of Age: A Descriptive Analysis Based on Computed Tomography Scanning
Authors: Richmond Connor G. , Shea Kevin G. , Burlile Jessica F. , Heyer Ann M. , Ellis Henry B. , Wilson Philip L. , Arendt Elizabeth A. , Tompkins Marc A.
Published: May 2019

Background:

Despite the critical role the trochlea plays in patellofemoral (PF) pathology, the development of the trochlea is poorly understood. The purpose of this study was 2-fold: (1) Describe quantitative osseous and soft tissue anatomy of the patella and trochlea in skeletally immature cadaveric specimens utilizing known measurements used in PF instability, and (2) evaluate additional measurement techniques in the sagittal plane as they relate to PF morphologic development.

Methods:

Thirty-one skeletally immature fresh frozen cadaveric knees between the ages of 2 and 11 years old were evaluated using 0.625 mm computed tomography scans. In the axial plane, measurements included condylar height asymmetry, trochlear facet asymmetry, trochlear depth, osseous sulcus angle, cartilaginous sulcus angle, patella sulcus angle, and tibial tubercle-trochlear groove distance. In the sagittal plane, measurements included previously undescribed measurements of trochlear length and condylar height asymmetry which are based on the anterior femoral cortex.

Results:

Analysis of trochlear morphology using condylar height asymmetry (both axial and sagittal), trochlear facet asymmetry, and trochlear depth and length demonstrated an increase in the size of the medial and lateral trochlea as age increased. There was more variability in the change of size of the medial trochlea (height, length, and facet length) than the lateral trochlea. The osseous sulcus angle, cartilaginous sulcus angle, and patella sulcus angle decreased (became deeper) with age until after 8 years and then plateaued.

Conclusions:

This cadaveric analysis demonstrated that there is an increase in the medial and lateral trochlear height as age increased by all measurements analyzed. The findings also demonstrate that the shape of the patella and trochlea change concurrently, which suggests that there may be interplay between the 2 during development. These new sagittal measurement techniques evaluating the medial, central, and lateral trochlear height and length with respect to age may help guide clinicians when investigating patellar instability in skeletally immature patients.

Levels of Evidence:

Level IV.
Monocyte Distribution Width: A Novel Indicator of Sepsis-2 and Sepsis-3 in High-Risk Emergency Department Patients*
Authors: Crouser Elliott D. , Parrillo Joseph E. , Seymour Christopher W. , Angus Derek C. , Bicking Keri , Esguerra Vincent G. , Peck-Palmer Octavia M. , Magari Robert T. , Julian Mark W. , Kleven Jennifer M. , Raj Paarth J. , Procopio Gabrielle , Careaga Diana , Tejidor Liliana
Published: May 2019

Objectives:

Most septic patients are initially encountered in the emergency department where sepsis recognition is often delayed, in part due to the lack of effective biomarkers. This study evaluated the diagnostic accuracy of peripheral blood monocyte distribution width alone and in combination with WBC count for early sepsis detection in the emergency department.

Design:

An Institutional Review Board approved, blinded, observational, prospective cohort study conducted between April 2017 and January 2018.

Setting:

Subjects were enrolled from emergency departments at three U.S. academic centers.

Patients:

Adult patients, 18–89 years, with complete blood count performed upon presentation to the emergency department, and who remained hospitalized for at least 12 hours. A total of 2,212 patients were screened, of whom 2,158 subjects were enrolled and categorized per Sepsis-2 criteria, such as controls (n = 1,088), systemic inflammatory response syndrome (n = 441), infection (n = 244), and sepsis (n = 385), and Sepsis-3 criteria, such as control (n = 1,529), infection (n = 386), and sepsis (n = 243).

Interventions:

The primary outcome determined whether an monocyte distribution width of greater than 20.0 U, alone or in combination with WBC, improves early sepsis detection by Sepsis-2 criteria. Secondary endpoints determined monocyte distribution width performance for Sepsis-3 detection.

Measurements and Main Results:

Monocyte distribution width greater than 20.0 U distinguished sepsis from all other conditions based on either Sepsis-2 criteria (area under the curve, 0.79; 95% CI, 0.76–0.82) or Sepsis-3 criteria (area under the curve, 0.73; 95% CI, 0.69–0.76). The negative predictive values for monocyte distribution width less than or equal to 20 U for Sepsis-2 and Sepsis-3 were 93% and 94%, respectively. Monocyte distribution width greater than 20.0 U combined with an abnormal WBC further improved Sepsis-2 detection (area under the curve, 0.85; 95% CI, 0.83–0.88) and as reflected by likelihood ratio and added value analyses. Normal WBC and monocyte distribution width inferred a six-fold lower sepsis probability.

Conclusions:

An monocyte distribution width value of greater than 20.0 U is effective for sepsis detection, based on either Sepsis-2 criteria or Sepsis-3 criteria, during the initial emergency department encounter. In tandem with WBC, monocyte distribution width is further predicted to enhance medical decision making during early sepsis management in the emergency department.
What Proportion of Women Who Received Funding to Attend a Ruth Jackson Orthopaedic Society Meeting Pursued a Career in Orthopaedics?
Authors: Vajapey Sravya , Cannada Lisa K. , Samora Julie Balch
Published: May 2019

Background

Orthopaedic surgery has the lowest percentage of women residents and faculty of any medical and surgical specialty. Diversity in medicine has been shown to improve patient outcomes and satisfaction. Although some scholarships are designed to increase the exposure of women medical students to orthopaedic surgery, the impact of those scholarships is largely unknown.

Questions/purposes

To determine the proportion of medical students who received a scholarship to attend the Ruth Jackson Orthopaedic Society (RJOS) annual meeting and later pursued a career in orthopaedic surgery.

Methods

The RJOS scholarship was advertised through the RJOS website, current members, and newsletters. Any RJOS medical student member in good standing was eligible to receive the award. Eighty-one scholarship winners were selected from 2003 to 2016. From 2003 to 2010, there were two awards each year. Starting in 2011, 10 students were selected yearly, and these numbers increased annually secondary to increased industry financial support. Recipients received a check for USD 1500 and were able to attend both the RJOS and American Academy of Orthopaedic Surgeons annual meetings. We collected the names of all RJOS medical student scholarship winners from 2003 to 2016, and one author performed an internet search to determine whether these individuals are currently in an orthopaedic residency program or are orthopaedic surgeons. Secondary confirmation was performed to ensure accuracy by the RJOS administrative staff and the other two authors, independently, after the initial results were tabulated.

Results

Of the 81 scholarship winners, 65 women (80%) now either practice orthopaedic surgery or are in an orthopaedic surgery residency program. Of the applicants who were not selected as scholarship recipients from 2014-2016, 44.9% went on to pursue a career in orthopaedics.

Conclusions

The RJOS scholarship may have helped young women decide to pursue careers in orthopaedic surgery, although it is also possible that some scholarship winners were inclined to do so before receiving the funding. Based partly on these results, the RJOS continues to award this scholarship. Future studies evaluating the impact of such scholarships and comparing them with alternative recruitment methods such as summer camps might be useful in determining the most effective way of increasing minority representation in orthopaedics, a factor that has been shown to be clinically relevant and one that can contribute to patient satisfaction.

Level of Evidence

Level IV, therapeutic study.
Does Medial Patellofemoral Osteoarthritis Influence Outcome Scores and Risk of Revision After Fixed-bearing Unicompartmental Knee Arthroplasty?
Authors: Berger Y. , Ftaita S. , Thienpont E.
Published: May 2019

Background

Patellofemoral osteoarthritis (OA) and anterior knee pain sometimes are considered contraindications for unicompartmental knee arthroplasty (UKA). However, several studies have demonstrated excellent patient-reported outcome scores in patients with patellofemoral OA treated with medial mobile-bearing UKA. Because these studies assessed the outcome of mobile-bearing UKA only, we were interested to see whether that finding also applies to fixed-bearing medial UKA.

Questions/purposes

(1) Does patellofemoral OA influence patient-reported outcome scores after medial fixed-bearing UKA? (2) Does untreated medial patellofemoral OA increase the revision rate after medial fixed-bearing UKA?

Methods

Between 2008 and 2015, one surgeon performed 308 medial fixed-bearing UKAs of a single design. Of those, 80 (26%) had patellofemoral OA of at least moderate severity (ICRS III or IV), and 228 (74%) did not. During that period, the surgeon did not use patellofemoral OA as a contraindication to UKA. In all, 13 patients (10%) in the patellofemoral OA group were lost before 2-year minimum followup, and 20 (11%) in the control group (without patellofemoral OA) were lost; all other patients were available, seen in the last 5 years, and included in this retrospective study. Mean (± SD) followup in the patellofemoral OA group was 39 ± 25 months, and it was 41 ± 23 in the control group. There were 100 women and 120 men. Patients had a mean age ± SD of 65 ± 10 years and mean ± SD BMI of 29 ± 4.5 kg/m2.The intraoperative status of the patellofemoral joint was assessed using the International Cartilage Repair Society (ICRS) classification. The primary study endpoint was the Forgotten Joint Score (FJS-12); we also compared scores on the Lonner PatelloFemoral Score (LPFS), Oxford Knee Score (OKS) and Short-Form 12 (SF-12). With the numbers available, we had 80% power to detect a difference of 12.3 points on the Forgotten Joint Score. A secondary endpoint was femoral or tibial component revision for any reason verified over the phone for each included patient.

Results

With the numbers available, there was no difference in FJS-12 score between the UKA with patellofemoral OA group and the group without patellofemoral OA 71 ± 29 versus 77 ± 26, mean difference - 6; 95% CI, -16 to 4.5; p = 0.270). Likewise, with the numbers available, we saw no differences in LPFS, OKS and SF-12. There was no difference in survivorship from all-cause revision at 4 years between the patellofemoral OA group and the group without patellofemoral OA (98%; 95% CI, 85.8–99.7 versus 99.5%; 95% CI, 96.0–99.2%; p = 0.352).

Conclusions

Patients with medial osteoarthritis in this single-center study generally benefitted from medial fixed-bearing UKA with good-to-excellent outcomes scores at short term, whether or not medial patellofemoral wear is present.

Level of Evidence

Level III, therapeutic study.
Value-Driven Care in Developmental-Behavioral Pediatrics, Part 1: The Value Proposition of Developmental-Behavioral Pediatrics
Authors: Sandler Adrian D.
Published: May 2019

The drive to improve quality and reduce cost of health care is leading to a value-driven transformation of the US health care landscape. This is the first of a 2-part series on value-driven care and its implications for developmental-behavioral pediatrics (DBP). Tools derived from business/manufacturing models have been applied with some success to health care to better understand and enhance value. Value can be defined most simply as health outcomes achieved per dollar spent, but there are challenges in accounting for the full cost of a cycle or episode of care. When taking into account the “five Ds”—Development, Dependency, Differential Epidemiology, Demographics, and Dollars—the potential value of pediatric care is brought into sharper focus. The field of DBP in particular has the potential to add value through prevention, integration, efficiency, standardization, and innovation. The value proposition of DBP is illustrated by focusing on particular conditions or cycles of care commonly encountered in DBP practice: (1) children 0 to 3 years of age identified as having global developmental delay, (2) recent diagnosis of complex attention-deficit hyperactivity disorder (ADHD) (ADHD plus comorbid conditions), and (3) children with autism spectrum disorder and disruptive behavior. The second part of the series focuses on quality of care, emphasizing the important challenges that lie ahead for the field of DBP in measuring outcomes of care. With a discussion of national trends and a local example of a DBP program's response to these trends, the series is intended to provoke discussion and action in the field, contribute to the demonstration of value of a DBP approach to care, and help to chart a course toward growth and sustainability of DBP in an era of value-based care.
Early Shared Reading Is Associated with Less Harsh Parenting
Authors: Jimenez Manuel E. , Mendelsohn Alan L. , Lin Yong , Shelton Patricia , Reichman Nancy
Published: May 2019

Objective:

Shared reading is believed to enhance parent-child relationships, but the extent to which it reduces harsh parenting is understudied. Associations between early shared reading and subsequent harsh parenting were investigated.

Methods:

Data from a national urban birth cohort were used to estimate associations between mother-reported shared reading at ages 1 and 3 years and harsh parenting—based on a composite of psychological and physical aggression subscales of a validated self-report instrument—when the children were at ages 3 and 5 years. The authors used multivariable linear regression and generalized estimating equations to account for repeated observations. Given potential inverse associations between shared reading and child disruptive behaviors, which can trigger harsh parenting, the authors investigated the extent to which children's behavior at age 3 years mediated the association between shared reading at age 1 year and harsh parenting at age 5 years.

Results:

This study included 2165 mother-child dyads. Thirty-four percent and 52% of mothers reported daily reading at ages 1 and 3 years. In adjusted models, shared reading at age 1 year was associated with less harsh parenting at age 3 years. Similarly, shared reading at age 3 years was associated with less harsh parenting at age 5 years. These associations remained significant in lagged repeated-measures models. Decreased disruptive behaviors partially mediated the association between shared reading at age 1 year and harsh parenting at age 5 years.

Conclusion:

Shared reading predicted less harsh parenting in a national urban sample. These findings suggest that shared reading contributes to an important aspect of the parent-child relationship and that some of the association operates through enhanced child behaviors.
Anterior Chamber Rebubbling With Perfluoropropane (C3F8) After Failed Rebubbling Attempts for Persistent Descemet Membrane Endothelial Keratoplasty Graft Detachments
Authors: Keshet Yariv , Nahum Yoav , Bahar Irit , Livny Eitan
Published: May 2019

Purpose:

To describe the clinical outcomes of using C3F8 as a tamponade agent for the attachment of partially detached Descemet membrane endothelial keratoplasty (DMEK) grafts after failure of previous rebubbling attempts.

Methods:

Interventional case series. We reviewed the medical records of all DMEK surgeries performed at Rabin Medical Center (Petach Tikva, Israel) between January 2016 and December 2018 in which 10% C3F8 tamponade was used for graft reattachments. Patient demographic details, indication for surgery, early postoperative endothelial cell loss, postoperative visual acuity, intraoperative and postoperative complications as well as graft survival were noted.

Results:

Five patients were included in this case series. Indications for DMEK were pseudophakic bullous keratopathy (n = 3), failed penetrating graft (n = 1), and Fuchs endothelial dystrophy (n = 1). In 4 of 5 cases, SF6 tamponade was used at the end of the initial DMEK surgery. In 1 case, air tamponade was used. In all cases, partial graft detachment was seen 1 to 2 weeks postoperatively, and anterior chamber rebubbling was performed using 20% SF6 gas. A second C3F8-assisted rebubbling was performed 10 to 70 days after the primary DMEK surgery. In all cases, complete graft attachment was achieved, and the corneas cleared. Early endothelial cell loss rates averaged at 44% ± 26% (range 20%–74%). One case which had a previous trabeculectomy with chronic preoperative and postoperative hypotony had failed 6 months after surgery. All the other grafts were clear at last visit.

Conclusions:

Tamponade using nonexpansile 10% C3F8 gas can attach partially detached DMEK grafts after the failure of previous air- or SF6-assisted rebubbling attempts.
A Clinical Score to Support Antiretroviral Management of HIV-exposed Infants on the Day of Birth
Authors: Nesheim Steven R. , Rose Charles , Pan Yi , Mahle Gray Kristen , Rao Shubha , Singh Sonia , Lampe Margaret
Published: May 2019

Background:

The benefits of combination antiretroviral (ARV) prophylaxis for infants whose HIV exposure is recognized near birth have been established, and the benefits of early ARV therapy are well known. Decisions about ARVs can be supported by the probability that the child has acquired HIV.

Methods:

Using 2005–2010 data from Enhanced Perinatal Surveillance of the Centers for Disease Control and Prevention, we developed a tool for use at birth to help predict HIV acquisition of HIV-exposed infants to support ARV management. A logistic regression model, fit using a fully Bayesian approach, was used to determine maternal variables predictive of infant HIV acquisition. We created a score index from these variables, established the sensitivity and specificity of each possible score, and determined the distribution of scores among infants, with and without HIV, in our study population.

Results:

Multivariable analysis of data from 8740 HIV-exposed infants (176 infected and 8564 uninfected) yielded 4 maternal variables in the perinatal HIV acquisition prediction model: sexually transmitted infection, substance use, last HIV viral load before delivery and ARV use. Using the regression coefficient estimates, we rescaled each possible score to make the maximum score equal to 100. For each score, sensitivity and specificity were determined; the area under the receiver operating characteristic curve was 0.79. Median index scores for infants with HIV and without HIV were 43 (first quartile 27 and third quartile 60), and 12 (first quartile, 0 and thirs quartile, 29), respectively.

Conclusions:

Decisions to begin infants on 3 ARVs—whether considered therapeutic or prophylactic—can be supported by data available on the day of birth.
Skin Cancer Knowledge and Prevention Practices Among Young Adult Athletes
Authors: Orsimarsi Gianna
Published: May 2019

The Skin Cancer Foundation defines skin cancer as uncontrolled growth of abnormal skin cells (The Skin Cancer Foundation, 2016b). Skin cancer risk factors include ultraviolet radiation and sun exposure (American Cancer Society, 2016b). Young adult outdoor athletes are frequently exposed to the sun and are at an increased risk of developing skin cancer. Research found young adult athletes average 1,000 hours in the sun annually for their sport (Wysong et al., 2012). This article examines current literature and studies that have researched young adult athletes on their knowledge of being at an increased skin cancer risk as well as their attitudes and sun protective behaviors in regard to skin cancer and prevention. The purpose is to evaluate as a whole whether frequent sun exposure influences young adult athletes’ use of preventative measures such as sunscreen or protective clothing. Results found that most athletes were knowledgeable of sunscreen use being a preventative measure for sun protection and skin cancer; however, sunscreen was not always applied (Lawler et al., 2012; Walker et al., 2014; Wysong et al., 2012). Results indicate that skin cancer and preventative practices among young adult athletes continue to be a concern, and therefore research should focus on addressing ways to promote skin cancer prevention practices as well as screening, management, and treatment strategies (U.S. Department of Health and Human Services, 2014).
Intermittent or continuous feeding: any difference during the first week?
Authors: Van Dyck Lisa , Casaer Michaël P.
Published: May 2019

Purpose of review

To balance theoretical pros and cons of intermittent feeding, in light of the current nutritional management early during critical illness.

Recent findings

Less aggressive nutrient administration is clinically superior in acute critical illness. This counterintuitive clinical finding may be explained by nutrient restriction activating autophagy, a process that clears intracellular damage. Intermittent feeding holds numerous theoretical benefits, such as activation of autophagy, preservation of the circadian rhythm, increased protein synthesis, and enhanced endogenous fatty acids release. RCTs investigating intermittent feeding in the ICU, however, are the most often limited to evaluation of gastrointestinal complications. Current guidelines advocate against the use of intermittent feeding, based on lack of benefit and increased risk of diarrhea, as revealed by a meta-analysis.

Benefits of intermittent feeding in the ICU are today speculative, yet its potential impact may reach far beyond the gastrointestinal tract. Only adequately powered RCTs, evaluating both gastrointestinal tolerance, metabolic impact and patient-centered effects of intermittent feeding will allow to adopt or abort this nutritional strategy.
An overview of international cardiogenic shock guidelines and application in clinical practice
Authors: van Diepen Sean , Thiele Holger
Published: May 2019

Purpose of review

In this review, we compare central differences in cardiogenic shock recommendations in international clinical practice guidelines, scientific statements, and the strength of the supporting evidence. Furthermore, we discuss their associations with adherence to guidelines in registry studies.

Recent findings

The evidence base underpinning American Heart Association/American College of Cardiology's and European Society of Cardiology's recommendations for an early invasive approach is relatively strong, but adherence to these recommendations is poor in registry and population-based studies. There is little evidence supporting the use of temporary mechanical circulatory support or pulmonary arterial catherization in cardiogenic shock, and international guidelines provide weak and conflicting recommendations, yet studies show mechanical circulatory support use is rising exponentially while pulmonary arterial catherization use remains low. Guidelines provide conflicting information on the optimal first-line vasoactive agent and norepinephrine remains the most widely used agent.

There are some inconsistencies between individual guideline recommendations, but there are no consistent associations between the strength of underlying evidence, weight of guideline recommendations, and adherence to guidelines in clinical practice. Improved knowledge translation of recommendations with a strong evidence base, together with research efforts to address priority cardiogenic shock research needs, could serve-to-harmonize recommendations and improve patient outcomes.
The Incremental Health Care Costs of Frailty Among Home Care Recipients With and Without Dementia in Ontario, Canada
Authors: Mondor Luke , Maxwell Colleen J. , Hogan David B. , Bronskill Susan E. , Campitelli Michael A. , Seitz Dallas P. , Wodchis Walter P.
Published: May 2019

Objective:

In this study, we investigated the incremental 1-year direct costs of health care associated with frailty among home care recipients in Ontario with and without dementia.

Methods:

We conducted a cohort study of 159,570 home care clients aged 50 years and older in Ontario, Canada in 2014/2015. At index home care assessment, we ascertained dementia status using a validated algorithm and frailty level (robust, prefrail, frail) based on the proportion of accumulated to potential health deficits. Clients were followed for 1-year during which we obtained direct overall and sector-specific publicly-funded health care costs (in 2015 Canadian dollars). We estimated the incremental effect of frailty level on costs using a 3-part survival- and covariate-adjusted estimator. All analyses were stratified by dementia status.

Results:

Among those with dementia (n=42,828), frailty prevalence was 32.1% and the average 1-year cost was $30,472. The incremental cost of frailty (vs. robust) was $10,845 [95% confidence interval (CI): $10,112–$11,698]. Among those without dementia (n=116,742), frailty prevalence was 25.6% and the average 1-year cost was $28,969. Here, the incremental cost of frailty (vs. robust) was $12,360 (95% CI: $11,849–$12,981). Large differences in survival between frailty levels reduced incremental cost estimates, particularly for the dementia group (survival effect: −$2742; 95% CI: −$2914 to −$2554).

Conclusions:

Frailty was associated with greater 1-year health care costs for persons with and without dementia. This difference was driven by a greater intensity of health care utilization among frail clients. Mortality differences across the frailty levels mitigated the association especially among those with dementia.
Using genomic data for selecting the treatment of lymphoma patients
Authors: Batlevi Connie Lee , Shah Gunjan , Forlenza Christopher , Intlekofer Andrew
Published: May 2019

Purpose of review

Genomic profiling platforms provide unprecedented genetic information of lymphoma biology, yet information has yet to be readily integrated into clinical medicine. This review summarizes the important concepts of utilizing genomics to aide disease management.

Recent findings

A wide range of clinical grade genetic sequencing platforms are available, therefore the selection of sequencing platform should ideally be based on biological and clinical questions, as well as the strength and weaknesses of individual platform. Different evidence-based guidelines exist to aide clinical judgment; however, few have well curated, easy to search platforms. Using one guideline proposed by several regulatory groups, our review summarizes genetic alterations with diagnostic, prognostic and therapeutic potential in the major subtypes of lymphoma.

A comprehensive database of genetic alterations that contribute to clinical care in lymphoma is needed. Ideally, a database which accounts for single and pathway-based genetic alterations may be developed to guide development and interventions for management of lymphoma.
Maternal and Breast Milk Influences on the Infant Gut Microbiome, Enteric Health and Growth Outcomes of Rhesus Monkeys
Authors: Rendina Danielle Nicole , Lubach Gabriele R. , Phillips Gregory J. , Lyte Mark , Coe Christopher L.
Published: May 2019

Objectives:

Gut bacteria play an essential role during infancy and are strongly influenced by the mode of birth and feeding. A primate model was used to investigate the benefits of exposure to the mother or conversely the negative impact of early nursery rearing on microbial colonization.

Method:

Rectal swabs were obtained from rhesus macaques born vaginally and mother‐reared (MR, N = 35) or delivered primarily via cesarean‐section and human‐reared (HR, N = 19). Microbiome composition was determined by rRNA gene amplicon sequencing at 2, 4, and 8 weeks of age and Kyoto Encyclopedia of Genes and Genomes (KEGG) orthologs used to assess influences on functional metabolic pathways in the gut. Growth trajectories and incidence of diarrheic symptoms were evaluated.

Results:

The microbial community structure was different between MR and HR infants with respect to phylogeny and abundance at all 3 ages. When examining dominant phyla, HR infants had a higher Firmicutes‐to‐Bacteroidetes ratio. At the genus level, breast milk‐dependent commensal taxa and adult‐typical genera were more abundant in MR infants. This difference resulted in a corresponding shift in the predicted metabolic effects, specifically for microbial genes associated with metabolism and immune function. HR infants had faster growth trajectories (P < 0.001), but more diarrheic symptoms by 6 months postnatal (P = 0.008).

Conclusions:

MR infants acquired adult‐typical microbiota more quickly, and had higher levels of several beneficial commensal taxa. Cesarean‐delivered and formula‐fed infants had different developmental trajectories of bacterial colonization. Establishment of the gut microbiome was associated with an infant's growth trajectory, and implicated in the subsequent vulnerability to Campylobacter infections associated with diarrhea in infant monkeys.
Comparison of Imported European and US Infant Formulas
Authors: DiMaggio Dina M. , Du Nan , Scherer Corey , Brodlie Susan , Shabanova Veronika , Belamarich Peter , Porto Anthony F.
Published: May 2019

Objective:

Infant formula in the United States is highly regulated. The American Academy of Pediatrics (AAP) has reported concerns over the use of non‐Food and Drug Administration (FDA)‐registered imported infant formulas. The purpose of this study is to identify Internet purchased and recommended imported European infant formulas and compare them with FDA labeling and nutrient requirements.

Study Design:

We searched “European infant formulas” in Google and DuckDuckGo to identify vendors of European formulas and blogs discussing these formulas to determine the most frequently purchased and recommended brands. We then compared the identified European formula's label and listed nutrients to FDA labeling and nutrient requirements.

Results:

Thirteen of 18 vendors responded to our inquiry of their top selling formula and 17 blogs were reviewed. Sixteen formulas were identified. None met all FDA label requirements. Listed nutrients fell within FDA requirements in 15 of 16 formulas.

Conclusions:

Non‐FDA‐registered imported European formulas do not meet all FDA‐labeling requirements. Although linoleic acid, which was not listed on all of the European formulas, could not be evaluated, all formulas except one met the remaining FDA nutrient requirements. These European infant formulas are being imported into the United States via third party vendors and are not FDA‐regulated, limiting the notable consumer protections set by the FDA that ensure infant formula safety. Pediatric gastroenterologists and healthcare providers need to understand the composition, labelling and lack of FDA regulation and safety concerns of these formulas in order to better counsel parents.
Lateral Osteotomy Fixation Technique in Rhinoplasty
Authors: Uraloğlu Muhammet , Efe Gökhan , Karaçal Rahşan
Published: May 2019

Rhinoplasty is the most challenging facial aesthetic surgical procedure according to many plastic surgeons. Nasal bone osteotomies, especially lateral osteotomies, have a complicated history. If lateral osteotomy is not stable after osteotomy during intraoperative period, stabilization is attempted with internal and external nasal splints but it is not possible to be confident about the stabilization since it is not fully fixed and cannot be observed directly. The authors presented the technique stabilization of the lateral osteotomy inferior tip with cerclage wire, if there is a stabilization problem or step-off deformity after lateral osteotomy.
Screening and treating hospitalized trauma survivors for posttraumatic stress disorder and depression
Authors: deRoon-Cassini Terri A. , Hunt Joshua C. , Geier Timothy J. , Warren Ann Marie , Ruggiero Kenneth J. , Scott Kamela , George Jessica , Halling Meredith , Jurkovich Gregory , Fakhry Samir M. , Zatzick Douglas , Brasel Karen J.
Published: May 2019

Traumatic injury affects over 2.6 million U.S. adults annually and elevates risk for a number of negative health consequences. This includes substantial psychological harm, the most prominent being posttraumatic stress disorder (PTSD), with approximately 21% of traumatic injury survivors developing the disorder within the first year after injury. Posttraumatic stress disorder is associated with deficits in physical recovery, social functioning, and quality of life. Depression is diagnosed in approximately 6% in the year after injury and is also a predictor of poor quality of life. The American College of Surgeons Committee on Trauma suggests screening for and treatment of PTSD and depression, reflecting a growing awareness of the critical need to address patients' mental health needs after trauma. While some trauma centers have implemented screening and treatment or referral for treatment programs, the majority are evaluating how to best address this recommendation, and no standard approach for screening and treatment currently exists. Further, guidelines are not yet available with respect to resources that may be used to effectively screen and treat these disorders in trauma survivors, as well as who is going to bear the costs. The purpose of this review is: (1) to evaluate the current state of the literature regarding evidence-based screens for PTSD and depression in the hospitalized trauma patient and (2) summarize the literature to date regarding the treatments that have empirical support in treating PTSD and depression acutely after injury. This review also includes structural and funding information regarding existing postinjury mental health programs. Screening of injured patients and timely intervention to prevent or treat PTSD and depression could substantially improve health outcomes and improve quality of life for this high-risk population.

LEVEL OF EVIDENCE

Review, level IV.
Acute Isolated Sixth Nerve Palsy Caused by Unruptured Intradural Saccular Aneurysm
Authors: Walter Eyal , Liao Eric A. , De Lott Lindsey B. , Trobe Jonathan D.
Published: May 2019

Background:

Unruptured intracranial aneurysms that cause isolated sixth nerve palsies are usually located extradurally in the cavernous sinus or intradurally as part of fusiform enlargement of the parent artery. Intradural saccular aneurysms of the vertebrobasilar circulation are a rare but life-threatening cause of isolated sixth nerve palsy. We provide documentation of 2 such cases.

Methods:

Case records of the Neuro-ophthalmology Clinics at the University of Michigan.

Results:

A 56-year-old woman with an arteriosclerotic risk profile reported new diplopia and had an isolated left sixth nerve palsy caused by an unruptured saccular aneurysm of the anterior inferior cerebellar artery. It was successfully coiled, and the sixth nerve palsy markedly improved. A 62-year-old woman with an arteriosclerotic risk profile and new diplopia had an isolated right sixth nerve palsy caused by a large unruptured vertebral artery aneurysm. It was coiled and later stented and recoiled. These procedures isolated the aneurysm and relieved the sixth nerve palsy.

Conclusions:

Isolated sixth nerve palsies in these 2 older adult patients with arteriosclerotic risk profiles were caused by unruptured intradural vertebrobasilar aneurysms. This report adds documentation to a rare phenomenon that must be taken into consideration in deciding whether brain imaging is needed in isolated sixth nerve palsy.
Magnetic Resonance Imaging of Idiopathic Intracranial Hypertension: Before and After Treatment
Authors: Batur Caglayan Hale Z. , Ucar Murat , Hasanreisoglu Murat , Nazliel Bijen , Tokgoz Nil
Published: May 2019

Background:

This study aimed to identify the reversibility of MRI findings indicative of increased intracranial hypertension in idiopathic intracranial hypertension (IIH) patients after treatment.

Methods:

This retrospective, observational study included demographic and clinical data from 10 patients with IIH and 10 controls. Brain MRI findings in IIH patients were recorded twice: once when patients had papilledema and again after resolution of papilledema. Neuroradiologists graded MRI findings in both groups based on an imaging grading scale.

Results:

After resolution of papilledema, all patients showed improvement in 2 or more of the MRI characteristics of IIH. This was especially the case for the height of the midsagittal pituitary gland and optic nerve sheath thickness (ONST), which were significantly different in all pairwise group comparisons. Sellar configuration, globe configuration, and horizontal orbital optic nerve tortuosity were different between the IIH pre-treatment group and controls, but not between controls and the IIH post-treatment group. We found no difference in optic nerve head hyperintensity or optic nerve thickness among the 3 groups.

Conclusions:

We demonstrated that several morphometric MRI characteristics in IIH are reversible to a certain extent after treatment. Enlarged subarachnoid spaces filled with cerebrospinal fluid seem to remain reduced, and the ONST and height of the pituitary gland are not fully normalized after treatment.
Use of whole genome sequencing in surveillance for antimicrobial-resistant Shigella sonnei infections acquired from domestic and international sources
Authors: Abelman Rebecca L. , M'ikanatha Nkuchia M. , Figler Hillary M. , Dudley Edward G.
Published: May 2019

Shigella

species are a major cause of gastroenteritis worldwide, and

Shigella sonnei

is the most common species isolated within the United States. Previous surveillance work in Pennsylvania documented increased antimicrobial resistance (AMR) in

S. sonnei

associated with reported illnesses. The present study examined a subset of these isolates by whole genome sequencing (WGS) to determine the relationship between domestic and international isolates, to identify genes that may be useful for identifying specific Global Lineages of

S. sonnei

and to test the accuracy of WGS for predicting AMR phenotype. A collection of 22 antimicrobial-resistant isolates from patients infected within the United States or while travelling internationally between 2009 and 2014 was chosen for WGS. Phylogenetic analysis revealed both international and domestic isolates were one of two previously defined Global Lineages of

S. sonnei

, designated Lineage II and Lineage III. Twelve of 17 alleles tested distinguish these two lineages. Lastly, genome analysis was used to identify AMR determinants. Genotypic analysis was concordant with phenotypic resistance for six of eight antibiotic classes. For aminoglycosides and trimethoprim, resistance genes were identified in two and three phenotypically sensitive isolates, respectively. This article contains data hosted by Microreact.
Rare microbes from diverse Earth biomes dominate community activity
Authors: Sachdeva Rohan , Campbell Barbara J. , Heidelberg John F.
Published: May 2019

Microbes are the Earth’s most numerous organisms and are instrumental in driving major global biological and chemical processes. Microbial activity is a crucial component of all ecosystems, as microbes have the potential to control any major biochemical process. In recent years, considerable strides have been made in describing the community structure,i.e. diversity and abundance, of microbes from the Earth’s major biomes. In virtually all environments studied, a few highly abundant taxa dominate the structure of microbial communities. Still, microbial diversity is high and is concentrated in the less abundant, or rare, fractions of the community,i.e. the “long tail” of the abundance distribution. The relationship between microbial community structure and activity, specifically the role of rare microbes, and its connection to ecosystem function, is not fully understood. We analyzed 12.3 million metagenomic and metatranscriptomic sequence assemblies and their genes from environmental, human, and engineered microbiomes, and show that microbial activity is dominated by rare microbes (96% of total activity) across all measured biomes. Further, rare microbial activity was comprised of traits that are fundamental to ecosystem and organismal health,e.g. biogeochemical cycling and infectious disease. The activity of rare microbes was also tightly coupled to temperature, revealing a link between basic biological processes,e.g. reaction rates, and community activity. Our study provides a broadly applicable and predictable paradigm that implicates rare microbes as the main microbial drivers of ecosystem function and organismal health.
A light-dependent molecular link between competition cues and defense responses in plants
Authors: Fernández-Milmanda G. L. , Crocco C. D. , Reichelt M. , Mazza C. A. , Köllner T. G. , Zhang T. , Cargnel M. D. , Lichy M. Z. , Koo A. J. , Austin A. T. , Gershenzon J. , Ballaré C. L.
Published: May 2019

One of the principal internal signals controlling plant growth and defense is jasmonate (JA), a potent growth inhibitor that is simultaneously a central regulator of plant immunity to herbivores and pathogens. When shade-intolerant plants perceive the proximity of competitors using the photoreceptor phytochrome B (phyB), they accelerate growth and down-regulate JA responses. However, the mechanisms by which photoreceptors relay light cues to the JA signaling pathway are not understood. Here we identify a sulfotransferase (ST2a) that is strongly up-regulated by plant proximity perceived by phyB via the phyB-Phytochrome Interacting Factor (PIF) signaling module. By catalyzing the formation of a sulfated JA derivative, ST2a acts to degrade bioactive forms of JA and represents a direct molecular link between photoreceptors and hormone signaling in plants. The enzyme provides a molecular mechanism for prioritizing shade avoidance over defense under close plant competition.
Decoding images in the mind’s eye: The temporal dynamics of visual imagery
Authors: Shatek Sophia M. , Grootswagers Tijl , Robinson Amanda K. , Carlson Thomas A.
Published: May 2019

Mental imagery is the ability to generate images in the mind in the absence of sensory input. Both perceptual visual processing and internally generated imagery engage large, overlapping networks of brain regions. However, it is unclear whether they are characterized by similar temporal dynamics. Recent magnetoencephalography work has shown that object category information was decodable from brain activity during mental imagery, but the timing was delayed relative to perception. The current study builds on these findings, using electroencephalography to investigate the dynamics of mental imagery. Sixteen participants viewed two images of the Sydney Harbour Bridge and two images of Santa Claus. On each trial, they viewed a sequence of the four images and were asked to imagine one of them, which was cued retroactively by its temporal location in the sequence. Time-resolved multivariate pattern analysis was used to decode the viewed and imagined stimuli. Our results indicate that the dynamics of imagery processes are more variable across, and within, participants compared to perception of physical stimuli. Although category and exemplar information was decodable for viewed stimuli, there were no informative patterns of activity during mental imagery. The current findings suggest stimulus complexity, task design and individual differences may influence the ability to successfully decode imagined images. We discuss the implications of these results for our understanding of the neural processes underlying mental imagery.
Assortative mating in hybrid zones is remarkably ineffective in promoting speciation
Authors: Irwin Darren E.
Published: May 2019

Assortative mating and other forms of partial prezygotic isolation are often viewed as being more important than partial postzygotic isolation (low fitness of hybrids) early in the process of speciation. Here I simulate secondary contact between two populations (‘species’) to examine effects of pre- and postzygotic isolation in preventing blending. A small reduction in hybrid fitness (e.g., 10%) produces a narrower hybrid zone than a strong but imperfect mating preference (e.g., 10x stronger preference for conspecific over heterospecific mates). This is because, in the latter case, rare F1 hybrids find each other attractive (due to assortative mating), leading to the gradual buildup of a full continuum of intermediates between the two species. The cline is narrower than would result from purely neutral diffusion over the same number of generations, largely due to the frequency-dependent mating disadvantage of individuals of rare mating types. Hybrids tend to pay this cost of rarity more than pure individuals, meaning there is an induced postzygotic isolation effect of assortative mating. These results prompt a questioning of the concept of partial prezygotic isolation, since it is not very isolating unless there is also postzygotic isolation.
Single-cell Transcriptome Mapping Identifies Common and Cell-type Specific Genes Affected by Acute Delta9-tetrahydrocannabinol in Humans
Authors: Hu Ying , Ranganathan Mohini , Shu Chang , Liang Xiaoyu , Ganesh Suhas , Yan Chunhua , Zhang Xinyu , Aouizerat Bradley E , Krystal John H , D’Souza Deepak C. , Xu Ke
Published: May 2019

Delta 9-tetrahydrocannabinol (THC), the principal psychoactive constituent of cannabis, is also known to modulate immune response in peripheral cells. The mechanisms of THC’s effects on gene expression in human immune cells remains poorly understood. Combining a within-subject design with single cell transcriptome mapping, we report that administration of THC acutely alters gene expression in 15,973 human blood immune cells. Controlled for high inter-individual transcriptomic variability, we identified 294 transcriptome-wide significant genes among eight cell types including 69 common genes and 225 cell-type specific genes affected by acute THC administration, including those genes involving not only in immune response, cytokine production, but signal transduction, and cell proliferation and apoptosis. We revealed distinct transcriptomic sub-clusters affected by THC in major immune cell types where THC perturbed cell type-specific intracellular gene expression correlations. Gene set enrichment analysis further supports the findings of THC’s common and cell-type specific effects on immune response and cell toxicity. We found that THC alters the correlation of cannabinoid receptor gene, CNR2, with other genes in B cells, in which CNR2 showed the highest level of expression. This comprehensive cell-specific transcriptomic profiling identified novel genes regulated by THC and provides important insights into THC’s acute effects on immune function that may have important medical implications.
Resolving the 3D landscape of transcription-linked mammalian chromatin folding
Authors: Hsieh Tsung-Han S. , Slobodyanyuk Elena , Hansen Anders S. , Cattoglio Claudia , Rando Oliver J. , Tjian Robert , Darzacq Xavier
Published: May 2019

Chromatin folding below the scale of topologically associating domains (TADs) remains largely unexplored in mammals. Here, we used a high-resolution 3C-based method, Micro-C, to probe links between 3D-genome organization and transcriptional regulation in mouse stem cells. Combinatorial binding of transcription factors, cofactors, and chromatin modifiers spatially segregate TAD regions into “microTADs” with distinct regulatory features. Enhancer-promoter and promoter-promoter interactions extending from the edge of these domains predominantly link co-regulated loci, often independently of CTCF/Cohesin. Acute inhibition of transcription disrupts the gene-related folding features without altering higher-order chromatin structures. Intriguingly, we detect “two-start” zig-zag 30-nanometer chromatin fibers. Our work uncovers the finer-scale genome organization that establishes novel functional links between chromatin folding and gene regulation.

ONE SENTENCE SUMMARY

Transcriptional regulatory elements shape 3D genome architecture of microTADs.