bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapeutic Ultrasound for Chronic Pain Management in Joints: A Systematic Review
Authors: Aiyer Rohit , Noori Selaiman A , Chang Ke-Vin , Jung Boyoun , Rasheed Abdullah , Bansal Nitin , Ottestad Einar , Gulati Amitabh
Published: April 2019

Background

Treatments for joint pain and dysfunction focus on restoration of joint motion, improvement in pain and a return to the previous level of the patient's daily activity. Therapeutic ultrasound is a noninvasive modality widely utilized in the management of musculoskeletal disorders. The objective of this systematic review was to evaluate the effectiveness of therapeutic ultrasound in the management of patients with knee, shoulder and hip pain.

Methods

Using PRISMA guidelines, a search of the PubMed, CENTRAL (The Cochrane Library), Web of Science and Scopus databases was performed to retrieve randomized controlled trials (RCTs) that evaluated therapeutic ultrasound (continuous and pulsed) in patients with chronic knee, shoulder and hip pain.

Results

The search strategy identified 8 trials for knee, 7 trials for shoulder and 0 trials for hip that met the criteria for inclusion. All 8 trials showed improvement in knee pain, and of these studies 3 showed statistical significance improvement for therapeutic ultrasound versus the comparator. For shoulder pain, all 7 trials showed reduction in pain, but should be noted that 4 of studies demonstrated that therapeutic ultrasound is inferior to the comparator modality,

Conclusion

Therapeutic ultrasound is frequently used in the treatment of knee, shoulder and hip pain and is often combined with other physiotherapeutic modalities. The literature on knee arthritis is most robust, with some evidence supporting therapeutic ultrasound, though the delivery method of ultrasound (pulsed vs continuous) is controversial. As a monotherapy, ultrasound treatment may not have a significant impact on functional improvement but can be a reasonable adjunct to consider with other common modalities. In all three pain syndromes, especially for hip pain, further trials are needed to define the true effect of low-intensity ultrasound therapy knee, shoulder and hip pain. No conclusive recommendations may be made for optimal settings or session duration.
Total knee arthroplasty outcomes in lupus: a study using the US National Inpatient Sample
Authors: Singh Jasvinder A , Cleveland John D
Published: April 2019

Objective

To assess whether patients with lupus have more complications and/or health care utilization than patients without lupus after primary total knee arthroplasty (TKA).

Methods

We used diagnostic codes to identify lupus (710.0) in patients who underwent primary TKA (procedure code, 81.54) in the US National Inpatient Sample from 1998–2014. We performed separate logistic regression analyses to assess whether lupus was associated with each in-hospital post-primary TKA complication (implant infection, implant revision, transfusion, mortality) or health care utilization for the index hospitalization.

Results

Our study cohort consisted of 8 127 282 primary TKAs with a mean age of 66.4 years, 63% were female, 68% White, 97% with OA, and the Deyo-Charlson comorbidity score was zero in 51%; 30 912 TKAs were performed in people with lupus. In multivariable-adjusted analyses, lupus was independently associated with a significantly higher risk of transfusion, but no significant difference in implant infection, implant revision or mortality, with respective odds ratios [ORs] (95% confidence interval [CI]) of 1.34 (1.25, 1.42), 1.38 (0.73, 2.60), 1.35 (0.83, 2.19) and 0.83 (0.34, 2.03). Lupus was independently associated with a significantly higher risk of total hospital charges above the median, the length of hospital stay >3 days (median) and discharge to an inpatient facility, respective ORs (95% CI) were 1.42 (1.22, 1.66), 1.09 (1.04, 1.15) and 1.34 (1.27, 1.41).

Conclusion

Our finding of higher transfusion rate and health care utilization in lupus compared with non-lupus patients undergoing primary TKA informs surgeons, patients and policy makers regarding TKA outcomes in lupus, and can also guide appropriate resource allocation.
INTERCOMPARISON ON INTERNAL DOSE ASSESSMENT FOR NUCLEAR POWER PLANTS IN KOREA
Authors: Kim Si Young
Published: April 2019

The intercomparison test is a quality assurance activity performed for internal dose assessment. In Korea, the intercomparison test on internal dose assessment was carried out for nuclear facilities in May 2018. The test involved four nuclear facilities in Korea, and seven exposure scenarios were applied. These scenarios cover the intake of 131I, a uranium mixture, 60Co and tritium under various conditions. This paper only reviews the participant results of three scenarios pertinent to the operation of nuclear power plants and adopts the statistical evaluation method, used in international intercomparison tests, to determine the significance values of the results. Although no outliers were established in the test, improvements in the internal dose assessment procedure were derived. These included the selection of intake time, selection of lung absorption type according to the chemical form and consideration of the contribution of previous intake.
BEAGLE 3: Improved Performance, Scaling, and Usability for a High-Performance Computing Library for Statistical Phylogenetics
Authors: Ayres Daniel L , Cummings Michael P , Baele Guy , Darling Aaron E , Lewis Paul O , Swofford David L , Huelsenbeck John P , Lemey Philippe , Rambaut Andrew , Suchard Marc A
Published: April 2019

BEAGLE is a high-performance likelihood-calculation library for phylogenetic inference. The BEAGLE library defines a simple, but flexible, application programming interface (API), and includes a collection of efficient implementations for calculation under a variety of evolutionary models on different hardware devices. The library has been integrated into recent versions of popular phylogenetics software packages including BEAST and MrBayes and has been widely used across a diverse range of evolutionary studies. Here, we present BEAGLE 3 with new parallel implementations, increased performance for challenging data sets, improved scalability, and better usability. We have added new OpenCL and central processing unit-threaded implementations to the library, allowing the effective utilization of a wider range of modern hardware. Further, we have extended the API and library to support concurrent computation of independent partial likelihood arrays, for increased performance of nucleotide-model analyses with greater flexibility of data partitioning. For better scalability and usability, we have improved how phylogenetic software packages use BEAGLE in multi-GPU (graphics processing unit) and cluster environments, and introduced an automated method to select the fastest device given the data set, evolutionary model, and hardware. For application developers who wish to integrate the library, we also have developed an online tutorial. To evaluate the effect of the improvements, we ran a variety of benchmarks on state-of-the-art hardware. For a partitioned exemplar analysis, we observe run-time performance improvements as high as 5.9-fold over our previous GPU implementation. BEAGLE 3 is free, open-source software licensed under the Lesser GPL and available at https://beagle-dev.github.io.
Sexual Dichromatism Drives Diversification within a Major Radiation of African Amphibians
Authors: Portik Daniel M , Bell Rayna C , Blackburn David C , Bauer Aaron M , Barratt Christopher D , Branch William R , Burger Marius , Channing Alan , Colston Timothy J , Conradie Werner , Dehling J Maximilian , Drewes Robert C , Ernst Raffael , Greenbaum Eli , Gvoždík Václav , Harvey James , Hillers Annika , Hirschfeld Mareike , Jongsma Gregory F M , Kielgast Jos , Kouete Marcel T , Lawson Lucinda P , Leaché Adam D , Loader Simon P , Lötters Stefan , Meijden Arie Van Der , Menegon Michele , Müller Susanne , Nagy Zoltán T , Ofori-Boateng Caleb , Ohler Annemarie , Papenfuss Theodore J , Rößler Daniela , Sinsch Ulrich , Rödel Mark-Oliver , Veith Michael , Vindum Jens , Zassi-Boulou Ange-Ghislain , McGuire Jimmy A
Published: April 2019

Theory predicts that sexually dimorphic traits under strong sexual selection, particularly those involved with intersexual signaling, can accelerate speciation and produce bursts of diversification. Sexual dichromatism (sexual dimorphism in color) is widely used as a proxy for sexual selection and is associated with rapid diversification in several animal groups, yet studies using phylogenetic comparative methods to explicitly test for an association between sexual dichromatism and diversification have produced conflicting results. Sexual dichromatism is rare in frogs, but it is both striking and prevalent in African reed frogs, a major component of the diverse frog radiation termed Afrobatrachia. In contrast to most other vertebrates, reed frogs display female-biased dichromatism in which females undergo color transformation, often resulting in more ornate coloration in females than in males. We produce a robust phylogeny of Afrobatrachia to investigate the evolutionary origins of sexual dichromatism in this radiation and examine whether the presence of dichromatism is associated with increased rates of net diversification. We find that sexual dichromatism evolved once within hyperoliids and was followed by numerous independent reversals to monochromatism. We detect significant diversification rate heterogeneity in Afrobatrachia and find that sexually dichromatic lineages have double the average net diversification rate of monochromatic lineages. By conducting trait simulations on our empirical phylogeny, we demonstrate that our inference of trait-dependent diversification is robust. Although sexual dichromatism in hyperoliid frogs is linked to their rapid diversification and supports macroevolutionary predictions of speciation by sexual selection, the function of dichromatism in reed frogs remains unclear. We propose that reed frogs are a compelling system for studying the roles of natural and sexual selection on the evolution of sexual dichromatism across micro- and macroevolutionary timescales.
Minding the Form That Transforms: Using Kegan’s Model of Adult Development to Understand Personal and Professional Identity Formation in Medicine
Authors: Lewin Linda Orkin , McManamon Alyssa , Stein Michael T.O. , Chen Donna T.
Published: April 2019

The formation of a physician’s professional identity is a dynamic process shaped by and intertwined with the development of that person’s larger adult identity. Constructive-developmentalist Robert Kegan’s model of adult development describes four mental lenses used for meaning-making and the trajectory through which they transform over time. These lenses determine the way people take in and integrate complex influences into forming their adult identities.

When people use a particular lens to construct meaning, Kegan describes them as being “subject” to that lens: The lens “has them,” and they are unaware of the ways it shapes their world. Transformations occur when individuals are able to take a lens to which they were subject and regard it objectively. Kegan’s lenses that are relevant to medical educators are called instrumental—focused on rules and rewards; socialized—attending to social norms and expectations; self-authoring—seeking to build internal values; and self-transforming—seeing gaps in one’s closely held value systems and being open to those of others.

When individuals have difficulty facing current challenges, they begin to grow a more complex lens. Subsequent lenses bring the ability to deal with more complexity but also bring their own challenges. Familiarity with Kegan’s model can help educators provide more effective support to groups of learners as well as individuals, support learners’ transformational growth through the challenging situations inherent in medical education, and supply a common language for many important areas of medical education, including competencies and entrustable professional activities, remediation, leadership development, and curriculum planning.
Preoperative Chronic Opioid Therapy Negatively Impacts Long-term Outcomes Following Cervical Fusion Surgery
Authors: Kalakoti Piyush , Volkmar Alexander J. , Bedard Nicholas A. , Eisenberg Joshua M. , Hendrickson Nathan R. , Pugely Andrew J.
Published: April 2019

Study Design.

Retrospective, observational.

Objective.

The aim of this study was to define the impact of preoperative chronic opioid therapy (COT) on outcomes following cervical spine fusions.

Summary of Background Data.

Opioid therapy is a commonly practiced method to control acute postoperative pain. However, concerns exist relating to use of prescription opioids, including inherent risk of abuse, tolerance, and inferior outcomes following major surgery.

Methods.

A commercial dataset was queried from 2007 to 2015 for patients undergoing primary cervical spine arthrodesis [ICD-9 codes 81.01-81.03]. Primary outcome measures were 1-year and 2-year reoperation rates, emergency department (ED) visits, adverse events, and prolonged postoperative opioid use. Secondary outcomes included short-term outcomes including 90-day complications (cardiac, renal, neurologic, infectious, etc.). COT was defined as a history of opioid prescription filling within 3 months before surgery and was the primary exposure variable of interest. Generalized linear models investigated the association of preoperative COT on primary/secondary endpoints following risk-adjustment.

Results.

Overall, 20,730 patients (51.3% female; 85.9% >50 years) underwent primary cervical spine arthrodesis. Of these, 10,539 (n = 50.8%) met criteria for COT. Postoperatively, 75.3% and 29.8% remained on opioids at 3 months and 1 year. Multivariable models identified an association between COT and an increased risk of 90-day ED visit [odds ratio (OR): 1.25; P < 0.001] and wound complications (OR: 1.24; P = 0.036). At 1 year, COT was strongly associated with reoperations (OR: 1.17; P = 0.043), ED visits (OR: 1.31; P < 0.001), and adverse events including wound complications (OR: 1.32; P < 0.001), infections (OR: 1.34; P = 0.042), constipation (OR: 1.11; P = 0.032), neurological complications (OR: 1.44; P = 0.01), acute renal failure (OR: 1.24; P = 0.004), and venous thromboembolism (OR: 1.20; P = 0.008). At 2 years, COT remained a significant risk factor for additional long-term negative outcomes such as reoperations, including adjacent segment disc disease (OR: 1.21; P = 0.005), ED visits (OR: 1.32; P < 0.001), and other adverse events. Preoperative COT was associated with prolonged postoperative narcotic use at 3 months (OR: 1.30; P < 0.001), 1 year (OR: 5.17; P < 0.001), and at 2 years (OR: 5.75; P < 0.001) after cervical arthrodesis.

Conclusion.

Preoperative COT is a modifiable risk factor that is strongly associated with prolonged postoperative opioid use. In addition, COT was associated with inferior short-term and long-term outcomes after cervical spine fusion.

Level of Evidence: 3
The Conundrum of Diagnosing Cutaneous Composite Lymphoma in the Molecular Age
Authors: Ahmed Aadil , Aragao Alessa P. , Mudaliar Kumaran , Wilcox Rebecca , Vardiman James , Anastasi John , Mirza Kamran
Published: April 2019

Introduction:

Cutaneous composite lymphoma (CCL) is extremely rare. When 2 potentially distinct lymphoid lesions occur at one skin site, distinguishing between one neoplastic clone and a secondary reactionary lymphoid response versus a second neoplasm is difficult. In this study, we describe a unique case of CCL along with a review of reported cases in literature to identify clues and discuss issues that are relevant to the diagnosis of CCL.

Design:

Review of a CCL case from our institution and a systematic review of reported cases of CCL in the literature.

Results:

A total of 18 studies describing 22 cases and a case report from our institution are included. The mean age at diagnosis was 68 years. Most cases herein presented with multiple skin lesions (67%) and reported a history of immune suppression (76%). Nineteen cases (83%) had a combination of T-cell and B-cell neoplasms, whereas the remaining cases had 2 distinct B-cell clones. Clonal differentiation was confirmed based on morphology and immunohistochemistry in all cases, and by polymerase chain reaction studies in 19 cases. Complete remission was achieved in only one quarter of reported cases.

Conclusion:

Diagnosing CCL can be challenging because accurate differentiation of 2 or more clonal populations at 1 site is tedious. A stepwise approach and integration of clinical, morphologic, immunohistochemistry, and molecular data along with an understanding of the prognosis of the lymphomas in question is essential for an accurate diagnosis and necessary because of therapeutic and prognostic implications.
The Effect of Inhaler Aromatherapy on Invasive Pain, Procedure Adherence, Vital Signs, and Saturation During Port Catheterization in Oncology Patients
Authors: İlter Sümeyra Mihrap , Ovayolu Özlem , Ovayolu Nimet
Published: April 2019

The study was conducted to evaluate the effect of inhaler aromatherapy on invasive pain, procedure adherence, vital signs, and saturation during port catheter insertion among patients diagnosed with cancer. The study was conducted in a nonrandomized controlled trial. Sixty patients including 30 patients in the intervention group and 30 patients in the control group, who were subjected with the same local anesthetic protocol, were included in the study. Aromatic mixture prepared by diluting orange, chamomile, and lavender oil in 70 mL distilled water was inhaled by the intervention group during the procedure. The data of the study were collected by using questionnaire, vital follow-up form, and visual analog scale. The patients in the intervention and control groups were similar in terms of sociodemographic and disease characteristics (P > .05). It was determined that inhaler aromatherapy applied to patients in the intervention group decreased pain experienced during the procedure and facilitated the procedure adherence (P < .05); however, it did not affect vital signs and saturation (P > .05). It can be recommended to administer inhaler aromatherapy with pharmacological therapies during catheterization procedure since it decreases invasive pain and facilitates the procedure adherence.
Comparison of Single and Combined Effects of Nature Sounds and Foot Sole Reflexology Massage on the Level of Consciousness in Traumatic Comatose Patients
Authors: Bahonar Elahe , Najafi Ghezeljeh Tahereh , Haghani Hamid
Published: April 2019

Consciousness disturbances are the most common posttraumatic complications. The purpose of this study was to compare the single and combined effects of nature sounds and foot sole reflexology massage on level of consciousness in traumatic comatose patients. This randomized controlled clinical trial was conducted in 2 teaching hospitals in an urban area of Iran. Samples were 120 traumatic comatose patients who were randomly assigned into control, nature sounds, foot reflexology massage, and nature sounds plus foot sole reflexology massage groups. Patients in all groups received routine care. Interventions were performed twice a day for 2 weeks, each time for 30 minutes. The patients' level of consciousness was assessed using the Glasgow Coma Scale before, 1 week, and 2 weeks after the intervention. The groups had no significant differences in the mean scores of the consciousness level before, 1 week after, and the last day of the intervention. Also, there was a significant difference in the number of patients who regained full consciousness (P= .001) in the intervention groups compared with the control group. Significant differences in the number of days of consciousness were reported in at least one of the groups compared with other groups (P= .001). This difference was significant in the control group compared with the foot reflexology massage group (P= .032), as well as the nature sounds plus foot sole reflexology massage group (P= .001). Single or combined interventions can increase the level of consciousness in comatose patients and reduce the duration of coma.
Assessing the outcome of organ allocation: choosing metrics
Authors: Schold Jesse D.
Published: April 2019

Purpose of review

Organ allocation is a highly complex process with significant impact on outcomes of donor organs and end-stage organ disease patients. Policies governing allocation must incorporate numerous factors to meet stated objective. There have been significant alterations and ongoing discussion about changes in allocation policy for all solid organs in the United States. As with any policy change, rigorous evaluation of the impact of changes is important.

Recent findings

This manuscript discusses metrics to consider to evaluate the impact of organ allocation policy that may be monitored on an ongoing basis including examples of research evaluating current policies. Potential metrics to evaluate allocation policy include the effectiveness, efficiency, equity, costs, donor rates, and transparency associated with the system.

Ultimately, policies will often need to adapt to secular changes in donor and patient characteristics, clinical and technological advances, and overarching healthcare polices. Providing objective empirical evaluation of the impact of policies is a critical component for assessing quality of the allocation system and informing the effect of changes. The foundation of organ transplantation is built upon public trust and the dependence on the gift of donor organs, as such the importance of the most appropriate organ allocation policies cannot be overstated.
Psychological Outcomes and Quality of Life in Relation to Pancreatectomy
Authors: Lounis Léna , Aurran-Schleinitz Thérèse , Turrini Olivier , Delpero Jean-Robert , Bréjard Vincent
Published: April 2019

This review aimed to inventory and analyze previous studies regarding quality of life (QoL) and psychological outcomes in relation to pancreatectomy. PubMed and PsycInfo databases were reviewed using the Preferred Reporting Items for Systematic review and Meta-Analysis guidelines. Thirteen studies were selected, 9 of which focused on the QoL after surgery. Quality of life significantly improved 3 to 6 months after surgery. Regarding the postoperative experience, one study reported high fear of recurrence of cancer, whereas another emphasized various expressions of patient needs. One study explained how strategy and ability to adapt are not related to the type, the cause, nor the physical condition, but are mainly influenced by the age and the subjective experience of the patients. A last study showed that depression did not affect survival rate after surgery. Our systematic review found only few studies regarding the psychological condition after pancreatectomy and highlights the need to describe and characterize the patients' psychological characteristics in this setting.
Measurement and Validation of Primary Care Nursing Indicators Based on a Wound Care Tracer Condition
Authors: Dufour Émilie , Duhoux Arnaud , Contandriopoulos Damien
Published: April 2019

Background:

Access to both valid and reliable nursing-sensitive indicators is currently limited in primary care.

Purpose:

The objectives were to (1) measure primary care nursing indicators using a wound care tracer condition and (2) study the associations between process and outcome indicators.

Methods:

We conducted a longitudinal study in an ambulatory care clinic in Quebec, Canada. The sample included 482 episodes of care. We studied 5 indicators related to processes and 3 to outcomes.

Results:

Performance levels were moderately high for indicators of initial assessment and duration and low for those of continuity and education. Associations between nursing follow-up and continuity indicators and 3 outcome indicators were highly significant.

Conclusion:

Continuity and nursing follow-up are associated with improved outcomes. Increasing these indicators' performance level can improve both nursing processes and patient outcomes.
Pulmonary Alveolar Proteinosis
Authors: Feld Lance , Jennings John , Fiorino Elizabeth K. , Harris Matthew
Published: April 2019

The profoundly hypoxemic child presents an interesting set of diagnostic and management challenges in the pediatric emergency department. While common pathologies including pneumonia, asthma, bronchiolitis, and pneumothoraces are managed using evidence-based algorithms, more enigmatic pathologies may present the treating physician with less diagnostic and therapeutic clarity. We present the case of a profoundly hypoxemic 16-year-old girl who presented in minimal distress, with oxyhemoglobin saturation of 63% on room air.
Current US Guidelines for Prescribing HIV Pre-exposure Prophylaxis (PrEP) Disqualify Many Women Who Are at Risk and Motivated to Use PrEP
Authors: Calabrese Sarah K. , Willie Tiara C. , Galvao Rachel W. , Tekeste Mehrit , Dovidio John F. , Safon Cara B. , Blackstock Oni , Taggart Tamara , Kaplan Clair , Caldwell Abigail , Kershaw Trace S.
Published: April 2019

Background:

US Centers for Disease Control and Prevention clinical guidelines for HIV pre-exposure prophylaxis (PrEP) are widely used to assess patients' PrEP eligibility. The guidelines include 2 versions of criteria—guidance summary criteria and recommended indications criteria—that diverge in a potentially critical way for heterosexually active women: Both require women's knowledge of their own risk behavior, but the recommended indications also require women's knowledge of their partners' HIV risk or recognition of a potentially asymptomatic sexually transmitted infection. This study examined women's PrEP eligibility according to these 2 different versions of criteria across risk and motivation categories.

Setting/Methods:

HIV-negative women (n = 679) recently engaged in care at Connecticut Planned Parenthood centers were surveyed online in 2017. The survey assessed PrEP eligibility by both versions of Centers for Disease Control and Prevention criteria, HIV risk indicators, PrEP motivation indicators, and sociodemographic characteristics.

Results:

Participants were mostly non-Hispanic white (33.9%) or black (35.8%) and had low income (<$30,000/year; 58.3%). Overall, 82.3% were eligible for PrEP by guidance summary criteria vs. 1.5% by recommended indications criteria. Women disqualified by recommended indications criteria included those reporting condomless sex with HIV-positive or serostatus-unknown male partners (n = 27, 11.1% eligible); 1 or more recent sexually transmitted infection(s) (n = 53, 3.8% eligible); multiple sex partners (n = 168, 3.0% eligible); intended PrEP use (n = 211, 2.8% eligible); and high self-perceived risk (n = 5, 0.0% eligible).

Conclusion:

Current guidelines disqualify many women who could benefit from PrEP and may lead to discrepant assessments of eligibility. Guideline reform is needed to improve clarity and increase women's PrEP access and consequent HIV protection.
Flexor Tendon Reconstruction
Authors: Al-Qattan Mohammad M.
Published: April 2019

Purpose

In the first stage of flexor tendon reconstruction, a silicon rod is fixed distally to the remnant of the flexor tendon at the distal phalanx. The proximal end of the rod is left free (unsutured) in the distal forearm. Hence, the rod insertion is not expected to result in any active flexion of the finger. The author reports on a case series in which adhesions have occurred between the rod and the adjacent flexor tendons in the distal forearm.

Methods

A retrospective study of 110 patients who underwent 2-stage flexor tendon reconstruction by the author revealed 5 patients in which the fingers were actively moving good enough after the insertion of the silicone rod to the extent that patients refused to undergo the second grafting procedure. Complications, range of motion, strength, and patient satisfaction were documented.

Results

There were no complications related to the surgery or the presence of the rod for several years. Using the Strickland criteria, all patients qualified for a good outcome. Grip strength of the affected hand averaged 85% of the contralateral normal hand, and the pinch strength of the affected finger against the thumb averaged 68% compared with the contralateral side. All patients/parents were satisfied. Ultrasound imaging confirmed the presence of adhesions between the proximal end of the silicone rod and the adjacent flexor tendons.

Conclusions

Our series documents a very unusual “desirable” event following the first-stage flexor tendon reconstruction. The study also documents the lack of silicone rod–related complications on long-term follow-up. The results may also encourage the use of permanent implants in flexor tendon reconstruction.
Surgical Site Infection Risk Factor Analysis in Postbariatric Patients Undergoing Body Contouring Surgery
Authors: Wiser Itay , Plonski Lori , Shimon Nitai , Friedman Tali , Heller Lior
Published: April 2019

Background

Surgical site infections (SSIs) following body-contouring plastic surgery pose a significant burden on patients and caregivers, possibly leading to undesired surgical outcomes. Surgical site infection incidence following body-contouring plastic surgery ranges from 2% to 7%, but is estimated much higher among postbariatric massive weight loss (MWL) patients.

Objective

The aim of this study was to evaluate SSI rate, risk and protective factors among postbariatric MWL patients following body-contouring plastic surgery.

Methods

This was a nested case-control study of MWL patients who underwent body-contouring plastic surgery at the Department of Plastic Surgery at Assaf Harofeh Medical Center, between 2007 and 2014. Data were obtained from medical records. Surgical site infection was defined according to the Centers for Disease Control and Prevention criteria. Logistic regression was conducted to assess independent risk factors for SSIs.

Results

From a cohort of 172 patients, 86 were included in the study. Surgical site infection rate was 20% (n = 17). Significant SSI risk factors included lifetime maximal weight and lifetime maximal body mass index (P = 0.039 and P = 0.002, respectively), body mass index loss prior to surgery (P = 0.032), estimated blood loss during surgery (P = 0.002), and gynecomastia repair procedure (P = 0.038). Independent SSI-associated factors included thigh lift procedure (odds ratio, 4.66; 95% confidence interval, 1.13–19.28) and preoperative antimicrobial prophylaxis (odds ratio, 0.04; 95% confidence interval, 0.03–0.61).

Conclusions

Although not required by current guidelines for body-contouring plastic surgery, preoperative antimicrobial prophylaxis in our study demonstrated a significant protective effect against SSIs. Further research may reveal its true contribution to SSI prevention in body-contouring plastic surgery.
Quality of Reporting on Guideline, Protocol, or Algorithm Implementation in Adult Trauma Centers
Authors: Gotlib Conn Lesley , Nathens Avery B. , Perrier Laure , Haas Barbara , Watamaniuk Aaron , Daniel Pereira Diego , Zwaiman Ashley , Javidan Arshia P. , Soobiah Charlene , Strauss Rachel , da Luz Luis Teodoro
Published: April 2019

Objective:

To appraise the quality of reporting on guideline, protocol, and algorithm implementations in adult trauma settings according to the Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0).

Background:

At present we do not know if published reports of guideline implementations in trauma settings are of sufficient quality to facilitate replication by other centers wishing to implement the same or similar guidelines.

Methods:

A systematic review of the literature was conducted. Articles were identified through electronic databases and hand searching relevant trauma journals. Studies meeting inclusion criteria focused on a guideline, protocol, or algorithm that targeted adult trauma patients ≥18 years and/or trauma patient care providers, and evaluated the effectiveness of guideline, protocol, or algorithm implementation in terms of change in clinical practice or patient outcomes. Each included study was assessed in duplicate for adherence to the 18-item SQUIRE 2.0 criteria. The primary endpoint was the proportion of studies meeting at least 80% (score ≥15) of SQUIRE 2.0.

Results:

Of 7368 screened studies, 74 met inclusion criteria. Thirty-nine percent of studies scored ≥80% on SQUIRE 2.0. Criteria that were met most frequently were abstract (93%), problem description (93%), and specific aims (89%). The lowest scores appeared in the funding (28%), context (47%), and results (54%) criteria. No study indicated using SQUIRE 2.0 as a guideline to writing the report.

Conclusions:

Significant opportunity exists to improve the utility of guideline implementation reports in adult trauma settings, particularly in the domains of study context and the implications of context for study outcomes.
A resource-efficient tool for mixed model association analysis of large-scale data
Authors: Jiang Longda , Zheng Zhili , Qi Ting , Kemper Kathryn E. , Wray Naomi R. , Visscher Peter M. , Yang Jian
Published: April 2019

The genome-wide association study (GWAS) has been widely used as an experimental design to detect associations between genetic variants and a phenotype. Two major confounding factors, population stratification and relatedness, could potentially lead to inflated GWAS test-statistics and thereby spurious associations. Mixed linear model (MLM)-based approaches can be used to account for sample structure. However, genome-wide association (GWA) analyses in biobank samples such as the UK Biobank (UKB) often exceed the capability of most existing MLM-based tools especially if the number of traits is large. Here, we developed an MLM-based tool (called fastGWA) that controls for population stratification by principal components and relatedness by a sparse genetic relationship matrix for GWA analyses of biobank-scale data. We demonstrated by extensive simulations that fastGWA is reliable, robust and highly resource-efficient. We then applied fastGWA to 2,173 traits on 456,422 array-genotyped and imputed individuals and 2,048 traits on 46,191 whole-exome-sequenced individuals in the UKB.
Revisiting G3BP-S149 phosphorylation and its impact on stress granule assembly
Authors: Panas Marc D. , Kedersha Nancy , Schulte Tim , Branca Rui M. , Ivanov Pavel , Anderson Paul
Published: April 2019

Stress granules (SGs) are cytoplasmic, non-membranous RNA/protein structures that assemble in response to environmental stress. G3BP is a critical SG-nucleating protein, and its ability to regulate SGs has been reported to be regulated by serine 149 phosphorylation. We now report that the constructs engineered to contain non-phosphorylatable and phosphomimetic (G3BP1-S149A and G3BP1-S149E, respectively) mutations used in many studies include additional unintended mutations (A54T/S149A and S99P/S149E) one of which (S99P) is responsible for the effects on SG assembly attributed to S149E. Specifically, the S99P mutation alone reduces SG nucleation and impairs the ability to rescue SG assembly in ΔΔG3BP1/2 U2OS KO cells, challenging the widely-stated conclusion that de-phosphorylation of serine 149 in G3BP1 promotes SG assembly. We used comparative mass spectrometry analysis of both (1) ectopically expressed GFP-G3BP1 in ΔΔG3BP1/2 U2OS KO and (2) endogenous G3BP1 in wild-type U2OS, with and without sodium arsenite treatment, in an attempt to reproduce earlier findings, but found no significant changes in S149 phosphorylation that correlate with arsenite-induced SG formation.
Coheritability and Coenvironmentability as Concepts for Partitioning the Phenotypic Correlation
Authors: Vasquez-Kool Jorge
Published: April 2019

Central to the study of joint inheritance of quantitative traits is the determination of the degree of association between two phenotypic characters, and to quantify the relative contribution of shared genetic and environmental components influencing such relationship. One way to approach this problem builds on classical quantitative genetics theory, where the phenotypic correlationbetween two traits is modelled as the sum of a genetic component called the coheritability (hx,y), which reflects the degree of shared genetics influencing the phenotypic correlation, and an environmental component, namely the coenvironmentability (ex,y) that accounts for all other factors that exert influence on the observed trait-trait association. Here a mathematical and statistical framework is presented on the partition of the phenotypic correlation into these components. I describe visualization tools to analyzeandex,yconcurrently, in the form of a three-dimensional (3DHER-plane) and a two-dimensional (2DHER-field) plots. A large data set of genetic parameter estimates (heritabilities, genetic and phenotypic correlations) was compiled from an extensive literature review, from which coheritability and coenvironmentability were derived, with the object to observe patterns of distribution, and tendency. Illustrative examples from a diverse set of published studies show the value of applying this partition to generate hypotheses proposing the differential contribution of shared genetics and shared environment to an observed phenotypic relationship between traits.
Prior physical synchrony enhances rapport and inter-brain synchronization during subsequent educational communication
Authors: Nozawa Takayuki , Sakaki Kohei , Ikeda Shigeyuki , Jeong Hyeonjeong , Yamazaki Shohei , dos Santos Kawata Kelssy Hitomi , dos Santos Kawata Natasha Yuriko , Sasaki Yukako , Kulason Kay , Hirano Kanan , Miyake Yoshihiro , Kawashima Ryuta
Published: April 2019

Physical synchrony has been suggested to have positive effects on not only concurrent but also subsequent communication, but the underlying neural processes are unclear. Using functional near-infrared spectroscopy (fNIRS) hyperscanning, we tested the effects of preceding physical synchrony on subsequent dyadic teaching-learning communication. Thirty-two pairs of participants performed two experimental sessions. In each session, they underwent a rhythmic arm movement block with synchronous or asynchronous conditions, and then taught/learned unknown words to/from each other according to a given scenario. Neural activities in their medial and left lateral prefrontal cortex (PFC) were measured and inter-brain synchronization (IBS) during the teaching-learning blocks was evaluated. Participants rated their subjective rapport during the teaching-learning blocks, and took a word memory test. The analyses revealed that (1) prior physical synchrony enhanced teacher-learner rapport; (2) prior physical synchrony also enhanced IBS in the lateral PFC; and (3) IBS changes correlated positively with rapport changes. Physical synchrony did however not affect word memory performance. These results suggest that IBS can be useful to measure the effects of social-bonding facilitation activities for educational communication.
Focused screening reveals functional effects of microRNAs differentially expressed in colorectal cancer
Authors: Sastre Danuta , Baiochi João , de Souza Lima Ildercilio Mota , dos Santos Schiavinato Josiane Lilian , Covas Dimas Tadeu , Panepucci Rodrigo Alexandre
Published: April 2019

Background

Colorectal cancer (CRC) is still a leading cause of death worldwide. Recent studies have pointed to an important role of microRNAs carcinogenesis. In fact, several microRNAs have been described as aberrantly expressed in CRC tissues and in the serum of patients. More specifically, microRNAs with dual roles in both cancer and stem cell survival represent a potential source of novel molecular targets in CRC due to their described functions in normal and deregulated proliferation. However, the functional outcomes of microRNA aberrant expression still need to be explored at the cellular level. Here, we aimed to investigate the effects of microRNAs involved in the control of pluripotency of stem cells in the proliferation and cell death of a colorectal cancer cell line.

Methods

We performed transfection of 31 microRNA mimics in HCT116 CRC cells. Cell proliferation and cell death were measured after 4 days of treatment using fluorescence staining in a high content screening platform. Total number of live and dead cells were automatically counted and analyzed. To reveal mRNA targets, we used an oligonucleotide microarray. Functional classification of targets was done using DAVID tool. Gene expression of potential mRNA targets was performed by qPCR.

Results

Twenty microRNAs altered the proliferation of HCT116 cells in comparison to control. Three microRNAs significantly repressed cell proliferation and induced cell death simultaneously (miR-22-3p, miR-24-3p, and miR-101-3p). Interestingly, all anti-proliferative microRNAs in our study had been previously described as poorly expressed in the CRC samples and were implicated in the disease. Microarray analysis of miR-101-3p targets revealed Wnt and cancer as pathways regulated by this microRNA. Specific repression of anti-apoptotic isoform of MCL-1, a member of the BCL-2 family, was also identified as a possible mechanism for miR-101-3p anti-proliferative/pro-apoptotic effect.

Conclusions

microRNAs described as upregulated in CRC tend to induce proliferation in vitro, whereas microRNAs described as poorly expressed in CRC halt proliferation and induce cell death in vitro. Selective inhibition of anti-apoptotic MCL-1 contributes to anti-tumoral activity of miR-101-3p.
Targeted gene sequencing in 6994 individuals with neurodevelopmental disorder with epilepsy
Authors: Heyne Henrike O. , Artomov Mykyta , Battke Florian , Bianchini Claudia , Smith Douglas R. , Liebmann Nora , Tadigotla Vasisht , Stanley Christine M. , Lal Dennis , Rehm Heidi , Lerche Holger , Daly Mark J. , Helbig Ingo , Biskup Saskia , Weber Yvonne G. , Lemke Johannes R.
Published: April 2019

Purpose

We aimed to gain insight into frequencies of genetic variants in genes implicated in neurodevelopmental disorder with epilepsy (NDD+E) by investigating large cohorts of patients in a diagnostic setting.

Methods

We analyzed variants in NDD+E using epilepsy gene panel sequencing performed between 2013 and 2017 by two large diagnostic companies. We compared variant frequencies in 6,994 panels to other 8,588 recently published panels as well as exome-widede novovariants in 1,942 individuals with NDD+E and 10,937 controls.

Results

Genes with highest frequencies of ultra-rare variants in NDD+E comprisedSCN1A, KCNQ2, SCN2A, CDKL5, SCN8AandSTXBP1, concordant with the two other epilepsy cohorts we investigated. Only 46% of the analysed 262 dominant and X-linked panel genes contained ultra-rare variants in patients. Among genes with contradictory evidence of association with epilepsyCACNB4, CLCN2, EFHC1, GABRD, MAGI2andSRPX2showed equal frequencies in cases and controls.

Conclusion

We show that improvement of panel design increased diagnostic yield over time, but panels still display genes with low or no diagnostic yield. With our data, we hope to improve current diagnostic NDD+E panel design and provide a resource of ultra-rare variants in individuals with NDD+E to the community.
Completing missing MeSH code mappings in UMLS through alternative expert-curated sources
Authors: García del Valle Eduardo P. , Lagunes García Gerardo , Prieto Santamaría Lucia , Zanin Massimiliano , Rodríguez González Alejandro , Menasalvas Ruiz Ernestina
Published: April 2019

The increasing availability of biological, clinical and literary sources enables the study of diseases from a more comprehensive approach. However, the interoperability of these sources, particularly of the codes used to identify diseases, poses a major challenge. Because of its role as a hub of multiple medical vocabularies, the Unified Medical Language System (UMLS) has become one of the most widely used resources for mapping diseases from different classification systems. The coverage of these mappings, nevertheless, is still limited, so researchers must resort to other methods to fill these gaps. In this article we analyze the limitations in UMLS mappings for the main disease vocabularies and propose the exploitation of some alternative expert-curated sources to complete it. As a result, we demonstrate that this approach allows resolving more than 50% of the missing mappings for some vocabularies. All the findings are shared for validation and reuse.
Single cell transcriptome analysis reveals markers of naïve and lineage-primed hematopoietic progenitors derived from human pluripotent stem cells
Authors: Fidanza Antonella , Romanò Nicola , Ramachandran Prakash , Tamagno Sara , Lopez-Yrigoyen Martha , Taylor Alice Helen , Easterbrook Jennifer , Henderson Beth , Axton Richard , Henderson Neil Cowan , Medvinsky Alexander , Ottersbach Katrin , Forrester LM Lesley Margaret
Published: April 2019

During embryogenesis the hematopoietic system develops through distinct waves that generate progenitors with increasing lineage potential, ultimately producing haematopoietic stem cells (HSCs). In vitro differentiation of human pluripotent stem cells (hPSCs) follows the early steps of haematopoietic development but the production of HSCs has proven more challenging. To study the dynamics and heterogeneity of hematopoietic progenitor cells generated in vitro from hPSCs, we performed RNA sequencing of over 10000 CD235a-CD43+single cells. We identified the transcriptome of naïve progenitors and those primed toward erythroid, megakaryocyte and leukocyte lineages, and revealed their markers by clustering, trajectory analyses and functional assays. CD44 marks naïve clonogenic progenitors that express the transcription factor, LMO4 and can be expanded upon BMP4 stimulation. Naïve progenitors give rise to primed CD326+erythroid, ICAM2+CD9+megakaryocyte, and monocyte, neutrophil and eosinophil progenitors. We have generated an online dataset of human hematopoietic progenitors and their transcriptional remodelling upon lineage priming.
Multivariate GWAS of psychiatric disorders and their cardinal symptoms reveal two dimensions of cross-cutting genetic liabilities
Authors: Mallard Travis T. , Linnér Richard K. , Grotzinger Andrew D. , Sanchez-Roige Sandra , Seidlitz Jakob , Okbay Aysu , de Vlaming Ronald , Meddens S. Fleur W. ,   Bipolar Disorder Working Group of the Psychiatric Genomics Consortium, Palmer Abraham A. , Davis Lea K. , Tucker-Drob Elliot M. , Kendler Kenneth S. , Keller Matthew C. , Koellinger Philipp D. , Harden K. Paige
Published: April 2019

Understanding which biological pathways are specific versus general across diagnostic categories and levels of symptom severity is critical to improving nosology and treatment of psychopathology. Here, we combine transdiagnostic and dimensional approaches to genetic discovery for the first time, conducting a novel multivariate genome-wide association study (GWAS) of eight psychiatric symptoms and disorders broadly related to mood disturbance and psychosis. We identify two transdiagnostic genetic liabilities that distinguish between common forms of mood disturbance (major depressive disorder, bipolar II, and self-reported symptoms of depression, mania, and psychosis) versus rarer forms of serious mental illness (bipolar I, schizoaffective disorder, and schizophrenia). Biological annotation revealed divergent genetic architectures that differentially implicated prenatal neurodevelopment and neuronal function and regulation. These findings inform psychiatric nosology and biological models of psychopathology, as they suggest the severity of mood and psychotic symptoms present in serious mental illness may reflect a difference in kind, rather than merely in degree.