bluuebunny/crossref_metadata_2025 huggingface dataset:
Laser Safety in Isotretinoin Use: A Survey of Expert Opinion and Practice
Authors: Prather Heidi B. , Alam Murad , Poon Emily , Arndt Kenneth A. , Dover Jeffrey S.
Published: December 2016

BACKGROUND

Reports of poor wound healing in the setting of isotretinoin treatment have created a conservative standard of care in which laser and phototherapy treatment of patients receiving isotretinoin is relatively contraindicated.

OBJECTIVE

A survey of 220 nationally recognized experts in cutaneous laser surgery was conducted to evaluate physician experience and opinion pertaining to laser and light procedures in patients treated with isotretinoin, including perceived risk and actual complications.

RESULTS

There was a 42% response rate. Seventy-six percent of respondents have never seen in their own clinical practices any cases of complications arising in patients treated with laser while receiving isotretinoin or within 6 months of completing a course of therapy. Almost half of respondents have treated patients in this subpopulation with laser, although only a small minority have done so with ablative devices. Common concerns among respondents regarding isotretinoin patients are the risks of poor wound healing and scarring, but the most often reported concern is medicolegal risk (74%).

CONCLUSION

It would seem that the risk of performing laser procedures on patients receiving isotretinoin or having recently completed a course, as estimated and observed by cutaneous laser experts, is lower than the currently perceived risk among the general medical community.
Comparison of Foam Sclerotherapy Alone or Combined With Stripping of the Great Saphenous Vein for Treating Varicose Veins
Authors: Ran Feng , Shi Yan , Qiao Tong , Shang Tao , Liu Zhao , Liu Chang-Jian
Published: December 2016

BACKGROUND

Varicose veins (VVs) have a substantial impact on patients' quality of life.

OBJECTIVE

The study aimed to retrospectively compare the short-term clinical outcomes of 2 treatment methods for VVs, namely high ligation and stripping (HL/S) of the great saphenous vein combined with foam sclerotherapy (FS), and FS alone.

MATERIALS AND METHODS

Totally, 180 patients with VVs were included and treated with FS alone or HL/S+FS. Assessments included the first injection efficacy, postoperative status, complications, operative time, and recovery time. A follow-up duration was performed. Patient satisfaction was also recorded.

RESULTS

No significant differences in the complete occlusion rate of the varicose tributaries, as well as in postoperative complications, were found between the treatment groups (p > 0.05). The complete occlusion rates of the varicose tributaries in the FS and HL/S+FS groups were 90% and 90%, respectively. Although mild phlebitis and local pigmentation were found in both groups, they disappeared during the follow-up period. Operative and recovery times were higher in the HL/S+FS group than in the FS group.

CONCLUSION

The HL/S+FS and FS alone showed equivalent efficacy for treating patients with VVs. Considering the increased operative and recovery times, FS alone is recommended to treat VVs in clinical practice.
Propofol Provides Cardiac Protection by Suppressing the Proteasome Degradation of Caveolin-3 in Ischemic/Reperfused Rat Hearts
Authors: Zhu Afang , Wei Xin , Zhang Yali , You Tao , Yao Shanglong , Yuan Shiying , Xu Haodong , Li Faqian , Mao Weike
Published: December 2016

The mechanisms underlying propofol's cardioprotective role remain elusive. Caveolin-3 (Cav-3) has been shown to mediate both opioids- and volatile anesthetics-induced cardioprotection against ischemia/reperfusion (I/R) injury. We hypothesize that the cardioprotective role of propofol is mediated through Cav-3 and its regulation of PI3K/Akt/GSK3β signal pathway. Rats or H9c2 cardiomyocytes were exposed to propofol before I/R or simulated ischemia/reperfusion (SI/R). Propofol pretreatment significantly decreased left ventricle infarct size in vivo (P < 0.05) and terminal deoxynucleotidyl transferase nick-end labeling-positive cells both in vivo and in vitro (P < 0.05), along with an increased Cav-3 protein expression and binding of Cav-3 to p85-subunit of PI3K. No significant change in Cav-3 mRNA expression in left ventricle tissues was found in either I/R or propofol-treated groups. Methyl-β-cyclodextrin or Cav-3 siRNA was used to knockdown Cav-3 expression in vitro, which virtually abolished propofol-induced cardiac protection and PI3K/Akt/GSK3β pathway activation. In contrast, MG132, a proteasome inhibitor, could significantly restore SI/R-induced Cav-3 decrease. It is concluded that Cav-3 mediates propofol-induced cardioprotection against I/R injury and the relevant PI3K/Akt/GSK3β activation. The downregulation of Cav-3 under SI/R may be caused by proteasome degradation, and this process can be prevented by propofol.
Respiratory Syncytial Virus Infection-associated Hospitalization Rates in Infants and Children With Cystic Fibrosis
Authors: Metz Jakob , Eber Ernst , Resch Bernhard
Published: December 2016

Background:

Infections with respiratory syncytial virus (RSV) are the leading cause for hospital admissions in infants and young children. The incidence of RSV-related hospitalizations in patients with cystic fibrosis (CF) is unclear. To date, no effective treatment for RSV infections is available. Thus, prophylaxis with the monoclonal antibody palivizumab is an important option.

Methods:

In a retrospective, single-center study at the Department of Pediatrics and Adolescent Medicine of the Medical University Graz, Austria, we analyzed all CF patients born between 1995 and 2012, who were admitted for respiratory problems between 1995 and 2014. We also defined a group of hypothetical RSV infections with the following criteria: admission caused by a respiratory infection during the first RSV season of life when no test for RSV was performed. Furthermore, we assessed the effectiveness of palivizumab as a prevention of RSV-related hospitalizations.

Results:

A total of 51 patients with CF were identified. The RSV-related hospitalization rate for the first RSV season was 0. Two patients (3.9%) were hospitalized 3 and 4 times, respectively, caused by RSV infections. The mean age at the time of admission was 12.4 ± 2.5 years. One case (1.9%) met our criteria for hypothetical RSV infections. There was no difference in RSV-related hospitalization rates between patients who received palivizumab and those who did not.

Conclusions:

We found a low rate of RSV-related hospitalizations and could not demonstrate a benefit of palivizumab prophylaxis regarding a decrease of RSV-related hospital admissions. The role of RSV reinfections in CF patients beyond infancy appears to be underestimated.
Cost-effectiveness Comparison of Monovalent C Versus Quadrivalent ACWY Meningococcal Conjugate Vaccination in Canada
Authors: De Wals Philippe , Zhou Zhou
Published: December 2016

Background:

In Quebec, 1 dose of monovalent C meningococcal conjugate vaccine (Men-C-Con) is offered at 12 months of age and a booster dose in grade 9 (14–15 years of age). In other Canadian provinces, a quadrivalent vaccine against serogroups ACWY (Men-4-Con) is increasingly used for adolescents. An economic analysis was performed to assess the value of a switch from Men-C-Con to Men-4-Con.

Methods:

A compartmental static simulation model was developed to assess the burden of invasive meningococcal disease due to serogroups AWY (AWY-IMD) in a cohort of 100,000 persons with different vaccination programs. Univariate and multivariate sensitivity analyses were performed, including variation in vaccine price difference ($12; range: $0–$20), AWY-IMD rate (0.08/100,000 to 0.28/100,000 person-years), level of herd immunity generated by adolescent vaccination (from zero to disease elimination) and discounting rate (0%, 3% or 6%).

Results:

In the low AWY-IMD rate base scenario, replacing Men-C-Con by Men-4-Con for adolescents would reduce disease burden by 16% (no herd effect) to 58% (moderate herd effect), with an incremental cost-effectiveness ratios between $445,000 per quality-adjusted life-year (QALY) and $167,000/QALY in a societal perspective. In the high AWY-IMD rate scenario, incremental cost-effectiveness ratio would be in the range of $97,000/QALY to $19,000/QALY.

Conclusion:

Based on the epidemiologic conditions in Quebec and in most other Canadian provinces, the benefits of Men-4-Con in reducing the burden of disease would be low for a high cost. The switch would, however, be more economically attractive with a much higher incidence rate (as in a few provinces) or with a reduced vaccine price in conditions assuming a moderate to high herd effect.
Role of Rifampin in Reducing Inflammation and Neuronal Damage in Childhood Bacterial Meningitis
Authors: Uppal Lipi , Singhi Sunit , Singhi Pratibha , Aggarwal Ritu
Published: December 2016

Background:

Treatment of acute bacterial meningitis in children with bactericidal antibiotics causes cell wall lysis and a surge in inflammatory cascade, which in turn contributes to neuronal damage and morbidity. Pretreatment with a nonbacteriolytic antibiotic, such as rifampin, has been shown to attenuate the inflammatory response in experimental models of bacterial meningitis. In a pilot study, in children with bacterial meningitis, we have studied markers of inflammatory response and neuronal damage in 2 groups of children with bacterial meningitis; one group received rifampin pretreatment with ceftriaxone and the other group received ceftriaxone alone.

Patients and Methods:

Forty children with bacterial meningitis, who were 3 months to 12 years of age, were randomly assigned to receive either a single dose rifampin (20 mg/kg) 30 minutes before ceftriaxone or ceftriaxone alone was given. The primary outcome variables were cerebrospinal fluid (CSF) concentrations of tumor necrosis factor alpha (TNFα), S100B and neuron-specific enolase on day 1 and day 5, and secondary outcome variables were the values of TNFα and interleukin 6 in serum on day 1 and day 5; hearing and neurologic sequelae at 3 months after recovery from the illness.

Results:

Children in rifampin pretreatment group had significantly lower CSF TNFα concentrations [median (interquartile range [IQR]): 15.5 (7.2–22.0) vs. 53.0 (9.0–87.5) pg/mL, P = 0.019] and S100B [median (IQR): 145.0 (54.7–450.0) vs. 447.5 (221.0–804.6) pg/mL, P = 0.033] on day 1 and S100B [median (IQR): 109.7 (64.0–287.0) vs. 322 (106.7–578.0) pg/mL, P = 0.048] and neuron-specific enolase [median (IQR): 8.6 (5–14.75) vs. 18.2 (7.0–28.75) ng/mL, P = 0.035] on day 5 when compared with ceftriaxone alone group. The rifampin-treated group also had reduced morbidity and neurologic sequelae; however, these were not statistically significant.

Conclusions:

Pretreatment with single dose rifampin 30 minutes before ceftriaxone administration reduced the CSF concentrations of markers of inflammation and neuronal damage in children with bacterial meningitis.
Group B Streptococcal Colonization Among Pregnant Women in Delhi, India
Authors: Chaudhary Manu , Rench Marcia A. , Baker Carol J. , Singh Pushpa , Hans Charoo , Edwards Morven S.
Published: December 2016

Background:

Little is known regarding maternal group B streptococcal (GBS) colonization prevalence and capsular (CPS) serotype distribution among pregnant women in India. The objective of this prospective cohort study was to determine GBS recto-vaginal colonization prevalence in pregnant women at Dr. Ram Manohar Lohia Hospital in Delhi, India.

Methods:

Literature review identified reports from India assessing GBS colonization prevalence in pregnant women. Rectal and vaginal swabs were inoculated into Strep B Carrot Broth (Hardy Diagnostics, Santa Maria, CA) and subcultured onto GBS Detect plates (Hardy Diagnostics, Santa Maria, CA). Isolates were serotyped using ImmuLex Strep-B latex kits (Statens Serum Institut, Copenhagen, Denmark).

Results:

Thirteen studies were identified citing GBS colonization prevalence during pregnancy as 0.47%–16%. Among 300 pregnant women (mean age: 26.9 years; mean gestation: 34 weeks) enrolled (August 2015 to April 2016), GBS colonization prevalence was 15%. Fifteen percent of women had vaginal only, 29% had rectal only and 56% had both sites colonized. CPS types were Ia (13.3%), Ib (4.4%), II (20%), III (22.2%), V (20%) and VII (6.7%); 13.3% were nontypable. Fetal loss in a prior pregnancy at ≥20-weeks gestation was more common in colonized than noncolonized women (15.6% vs. 3.5%; P = 0.004). Employing recent census data for the birth cohort and estimating that 1%–2% of neonates born to colonized women develop early-onset disease, at least 39,000 cases of early-onset disease may occur yearly in India.

Conclusions:

Using optimal methods, 15% of third trimester pregnant women in India are GBS colonized. A multivalent vaccine containing 6 CPS types (Ia, Ib, II, III, V and VII) would encompass ~87% of GBS carried by pregnant women in India.
Subxiphoid Exchange of HeartMate II Left Ventricular Assist Device
Authors: Tchantchaleishvili Vakhtang , Luc Jessica G. Y. , Haswell Joshua , Hallian William , Massey H. Todd
Published: December 2016

With increasing use of left ventricular assist devices (LVADs) for long-term circulatory support comes a growing need for device exchange. The conventional surgical approach for device exchanges has been a reoperative median resternotomy. Less-invasive HeartMate II LVAD exchange via a nonmuscle-dividing subxiphoid incision as an alternative to a left subcostal incision may reduce pain burden and facilitate recovery. From November 2006 to June 2015, 292 patients underwent HeartMate II LVAD placement, of which 30 (10.3%) required an exchange. Twenty-four (80%) LVAD exchanges were performed through a subxiphoid sternal-sparing approach and six (20%) through reoperative sternotomy. Predominant indication for device exchange was suspected or confirmed pump thrombus (73.3%), followed by electromechanical pump dysfunction (16.7%). The subxiphoid approach resulted in significantly shorter median intensive care unit (7 vs. 37 days, p = 0.01) and hospital stay (29 vs. 107 days, p = 0.01) compared with reoperative sternotomy. Kaplan–Meier analysis showed comparable survival between the subgroups (p = 0.15) as well as between the patients with device exchange and the rest of the HeartMate II LVAD patients at our institution (p = 0.12). Subxiphoid device exchange is a viable option, resulting in low operative morbidity and mortality with no adverse effect on late survival.
Spectrum of Drug-induced Chronic Diarrhea
Authors: Philip Nissy A. , Ahmed Nazir , Pitchumoni Capecomorin S.
Published: December 2016

The evaluation of a patient with chronic diarrhea can be quite frustrating, as it is expensive and involves multiple diagnostic studies. Moreover, identification of a drug as a cause of chronic diarrhea is a challenge in patients taking multiple medications. The disease may either be associated with intestinal mucosal changes, mimicking diseases such as celiac disease, or purely functional, with no histopathologic change. Drug-induced diarrhea may or may not be associated with malabsorption of nutrients, and a clinical improvement may occur within days of discontinuation of the drug, or may take longer when associated with mucosal injury. Diarrhea in diabetics, often attributed to poor management and lack of control, may be due to oral hypoglycaemic agents. Chemotherapy can result in diffuse or segmental colitis, whereas olmesartan and a few other medications infrequently induce a disease that mimics celiac disease, but is not associated with gluten intolerance. In short, increased awareness of a drug, as a cause for diarrhea and a clear understanding of the clinical manifestations will help clinicians to solve this challenging problem. This article aims to review drug-induced diarrhea to (a) understand known pathophysiological mechanisms; (b) assess the risk associated with frequently prescribed medications, and discuss the pathogenesis; and (c) provide easily retrievable data in tables to help identify known offending medication/s and a list of top 100 prescribed medications in the United States as a useful comprehensive reference.
Value of the coronary artery disease consortium rule in patients with acute chest pain and negative troponins referred for exercise stress testing
Authors: Bouzas-Mosquera Alberto , Peteiro Jesús , Broullón Francisco J. , Calviño-Santos Ramón , Mosquera Víctor X. , Martínez Dolores , Yáñez Juan C. , Álvarez-García Nemesio , Vázquez-Rodríguez José M.
Published: December 2016

Objective

To assess the value of the pretest probability (PTP) of coronary artery disease (CAD) for predicting stress testing results and coronary events in patients with acute chest pain and negative troponins.

Patients and methods

A total of 3527 patients without a history of CAD referred to our chest pain unit with suspected acute coronary syndromes, nondiagnostic ECGs, and negative troponin levels underwent exercise stress testing. PTP was estimated with the CAD consortium prediction rule, and was categorized as low (<15%), low–intermediate (15–65%), intermediate–high (66–85%), and high (>85%). The endpoints were the presence of signs of inducible myocardial ischemia on stress testing and the occurrence of coronary events within 6 months.

Results

The probability of exercise-induced myocardial ischemia was 2.6, 12.6, 42.9, and 82.1% in patients with low, low–intermediate, intermediate–high, and high PTP, respectively (P
trend<0.001). The cumulative rate of coronary events within 6 months was also significantly lower in patients with low PTP of CAD (0.8%) than in those with low–intermediate (6.9%), intermediate–high (32.5%), or high PTP (66.7%) (P
trend<0.001). Per 10% increment in PTP of CAD, the adjusted odds ratios for inducible myocardial ischemia and coronary events within 6 months were, respectively, 1.71 (95% confidence interval: 1.61–1.85) and 1.87 (95% confidence interval: 1.74–2.01).

Conclusion

PTP was associated strongly with the likelihood of exercise-induced myocardial ischemia and coronary events in patients with suspected acute coronary syndromes and negative troponins. The yield of stress testing in the subset of patients with low PTP was very low.
A randomized-controlled trial of a patient-centred intervention in high-risk discharged older patients
Authors: Arendts Glenn , Bullow Kate , Etherton-Beer Christopher , MacDonald Ellen , Dumas Sandra , Nagree Yusuf , Brown Simon G.A. , Almeida Osvaldo P.
Published: December 2016

Background

The risk of early reattendance after discharge has been proposed as a performance indicator for emergency departments (EDs), but is not uniform in all patients. Those individuals at the highest risk of reattendance may benefit from an intense intervention to reduce this risk, and our objective was to test this hypothesis in a clinical trial.

Methods

A randomized-controlled trial was conducted in the EDs of two hospitals. Very high-risk adults aged 65 years and older, identified using a validated risk-prediction nomogram and being discharged from ED, were randomized to receive a postdischarge patient-centred intervention or standard care. The intervention focused on identifying and supporting patients to address risk factors for future hospital presentation. The primary outcome measure was any unplanned ED reattendance within 28 days. Secondary outcomes included 28-day and 1-year hospital usage, institutionalization and death.

Results

We enrolled 164 patients, 82 in each study arm. There was an 8% absolute (95% confidence interval: −7%–20%) and a 20% relative risk reduction for an intervention patient making an unplanned ED reattendance within 28 days. This difference was not statistically significant (P=0.26).

Conclusion

This postdischarge intervention was associated with only small and nonsignificant reductions in ED reattendance.
Does lifestyle contribute to disease severity in patients with inherited lipid disorders?
Authors: Arsenault Benoit J. , Perrot Nicolas , Couture Patrick
Published: December 2016

Purpose of review

Patients with familial hypercholesterolemia, familial combined hyperlipidemia and hyperlipoprotein(a) are at high cardiovascular risk. Increasing evidence suggest that lifestyle-related risk factors such as physical inactivity, and poor diet quality could influence cardiovascular risk in these patients. Our objective is to review the evidence that supports the role of lifestyle-related factors in the prediction of cardiovascular risk in patients with inherited lipid disorders.

Recent findings

Recent studies have shown that smoking, a poor diet quality, physical inactivity, fitness levels, abdominal obesity, insulin resistance, and type 2 diabetes were associated with the presence of atherosclerosis and long-term cardiovascular outcomes in patients with familial hypercholesterolemia. Recent evidence also suggest that managing other cardiovascular risk factors such as cholesterol levels, obesity, glycemic control, blood pressure, smoking, physical inactivity, and diet quality could reduce long-term cardiovascular risk associated with hyperlipoprotein(a). Whether targeting these risk factors could ultimately decrease cardiovascular risk in these patients remains unknown.

Although reducing the number of atherogenic apolipoprotein-B containing particle with lipid-lowering therapy represents the cornerstone of treatment of patients with inherited lipid disorders, lifestyle-related risk factors such as physical inactivity and poor diet quality need to be targeted for the optimal management of these high-risk patients.
Avoiding complications in endoscopic skull base surgery
Authors: Constantinidis Jannis , Konstantinidis Iordanis
Published: December 2016

Purpose of review

Endoscopic skull base surgery has become an established approach for the removal of tumors and cerebrospinal fluid fistulae repair. Compared with external approaches, it provides better aesthetic results and quality of life postoperatively. However, as it becomes popular and expands its indications possible complications should be reassessed in terms of incidence and variability in order to confirm its efficacy and safety. This article reviews the recent literature describing the main categories of possible complications suggesting strategies to minimize their incidence.

Recent findings

Detailed preoperative planning based on imaging and histology can prevent major complications. Intraoperative use of image guidance and meticulous hemostasis provide the surgical field needed to avoid complications. Postoperative patient counseling, along with close and detailed nasal postoperative care are significant factors for an optimal outcome.

Monitoring of complications after endoscopic skull base surgery is necessary in order to standardize protocols of management and improve our surgical techniques. The presence of late onset complications underlines the need of a special focus in postoperative care and follow-up.
Paliperidone Palmitate Once-Monthly Treatment in Recent Onset and Chronic Illness Patients With Schizoaffective Disorder
Authors: Bossie Cynthia A. , Turkoz Ibrahim , Alphs Larry , Mahalchick Lucy , Fu Dong-Jing
Published: December 2016

Data from a multiphase schizoaffective disorder study (NCT01193153) were used to examine the effects of paliperidone palmitate once-monthly (PP1M) by subjects' illness duration, defined as recent onset (≤5 years since first psychiatric diagnosis; n = 206) and chronic illness (>5 years; n = 461). Symptom and functioning scores, as measured during open-label PP1M acute and stabilization treatment phases, improved in both subpopulations, with greater improvements in recent onset than chronic illness subjects (p ≤ 0.022). Relapse rates, examined during the double-blind, placebo-controlled phase, were higher with placebo than PP1M: 30.0% vs. 10.2% (p = 0.014; hazard ratio [HR]: 2.8; 95% confidence interval [CI]: 1.11–7.12; p = 0.029) in the recent onset subpopulation and 35.5% vs. 18.1% (p = 0.001; HR: 2.38; 95% CI: 1.37–4.12; p = 0.002) in the chronic illness subpopulation. Growing evidence in the treatment of schizophrenia and schizoaffective disorder supports early intervention with long-acting antipsychotics.
Comparison of β-Catenin and LEF1 Immunohistochemical Stains in Desmoid-type Fibromatosis and its Selected Mimickers, With Unexpected Finding of LEF1 Positivity in Scars
Authors: Zou Youran , Zhang Yaxia , Church James , Liu Xiuli
Published: December 2016

β-catenin immunohistochemical stain can be useful in the diagnosis of many tumors including desmoid-type fibromatosis (DTF). Lymphoid enhancer-factor 1 (LEF1), a recently emerged marker, is part of the Wnt pathway with β-catenin but has not been studied in DTF. We performed LEF1 and β-catenin immunohistochemistry in DTF (n=26), superficial fibromatosis (n=19), sclerosing mesenteritis (n=12), gastrointestinal stromal tumor (n=17), and cutaneous scar (n=14) using tissue microarray and whole sections. The staining intensity was scored as strong (visible at ×2 objective, value of 3), moderate (visible at ×4, value of 2), weak (visible at ×10, value of 1), and negative (not visible at ×10, value of 0). The percentage of positive nuclei was recorded in 10% increment. Histologic scores were generated by multiplying numerical value of intensity and percentage of positive nuclei. A score of at least 10 was defined as positive. Eighteen of the 25 DTF were positive for LEF1 while 12 of 25 were positive for β-catenin (1 excluded due to loss of tissue). Gastrointestinal stromal tumor cases were negative for both markers. All superficial fibromatoses were negative except 2 cases with weak positivity for LEF1 but not β-catenin. Only 2 case of sclerosing mesenteritis were weakly positive for LEF1 but negative for β-catenin. Ten of 14 scars were positive for LEF1 but only 1 of them was weakly positive for β-catenin. In conclusion, this study demonstrated that LEF1 may be a useful marker in the differential diagnosis of DTF in certain contexts. However, caution should be exercised since LEF1 positivity can also be seen in scars.
Amiodarone Versus Lidocaine for Pediatric Cardiac Arrest Due to Ventricular Arrhythmias: A Systematic Review
Authors: McBride Mary E. , Marino Bradley S. , Webster Gregory , Lopez-Herce Jesús , Ziegler Carolyn P. , De Caen Allan R. , Atkins Dianne L.
Published: December 2016

Objective:

We performed a systematic review as part of the International Liaison Committee on Resuscitation process to create a consensus on science statement regarding amiodarone or lidocaine during pediatric cardiac arrest for the 2015 International Liaison Committee on Resuscitation’s Consensus on Science and Treatment Recommendations.

Data Sources:

Studies were identified from comprehensive searches in PubMed, Embase, and the Cochrane Library.

Study Selection:

Studies eligible for inclusion were randomized controlled and observational studies on the relative clinical effect of amiodarone or lidocaine in cardiac arrest.

Data Extraction:

Studies addressing the clinical effect of amiodarone versus lidocaine were extracted and reviewed for inclusion and exclusion criteria by the reviewers. Studies were rigorously analyzed thereafter.

Data Synthesis:

We identified three articles addressing lidocaine versus amiodarone in cardiac arrest: 1) a prospective study assessing lidocaine versus amiodarone for refractory ventricular fibrillation in out-of-hospital adults; 2) an observational retrospective cohort study of inpatient pediatric patients with ventricular fibrillation or pulseless ventricular tachycardia who received lidocaine, amiodarone, neither or both; and 3) a prospective study of ventricular tachycardia with a pulse in adults. The first study showed a statistically significant improvement in survival to hospital admission with amiodarone (22.8% vs 12.0%;p= 0.009) and a lack of statistical difference for survival at discharge (p= 0.34). The second article demonstrated 44% return of spontaneous circulation for amiodarone and 64% for lidocaine (odds ratio, 2.02; 1.36–3.03) with no statistical difference for survival at hospital discharge. The third article demonstrated 48.3% arrhythmia termination for amiodarone versus 10.3% for lidocaine (p< 0.05). All were classified as lower quality studies without preference for one agent.

Conclusions:

The confidence in effect estimates is so low that International Liaison Committee on Resuscitation felt that a recommendation to use of amiodarone over lidocaine is too speculative; we suggest that amiodarone or lidocaine can be used in the setting of pulseless ventricular tachycardia/ventricular fibrillation in infants and children.
Brief Report: Increased Expression of the Type I Interferon Receptor on CD4+ T Lymphocytes in HIV-1–Infected Individuals
Authors: Killian M. Scott , Fujimura Sue H. , Sudhagoni Ramu G.
Published: December 2016

Background:

Type I interferons (IFN1s; eg, interferon-alpha and interferon-beta) are potent cytokines that inhibit the replication of human immunodeficiency virus-1 (HIV-1) and other viruses. The antiviral and immunoregulatory activities of IFN1 are mediated through ligand–receptor interactions with the IFN1 receptor complex (IFNAR). Variation in the cell-surface density of IFNAR could play a role in HIV-1 pathogenesis.

Methods:

In this cross-sectional study of fresh whole blood, we used flow cytometry to evaluate the expression of IFNAR2 on lymphocyte subsets from HIV-1–infected (n = 33) and HIV-1–uninfected (n = 22) individuals.

Results:

In comparison with healthy blood bank donors, we observed that the HIV-1–infected individuals, particularly those having advanced to disease, exhibited the increased expression of IFNAR2 on CD4+ T cells (relative fluorescence intensity 6.9 vs. 9.0; P = 0.027). The CD4+:CD4neg T-cell IFNAR2 expression-level ratio provides an internally standardized measure of this alteration. The observed increased expression of IFNAR2 was largely restricted to CD4+ T cells that expressed the chemokine receptor CXCR4 and lacked the expression of CCR5.

Conclusions:

HIV-1–infected individuals exhibit an increased expression of the IFN1 receptor on CD4+ T cells. The level of IFNAR2 expression seems to increase with disease progression. These findings provide insight for the immunologic alterations associated with HIV-1 infection and possibly new therapeutic approaches.
Serious Gaming in Medical Education
Authors: Olszewski Aleksandra E. , Wolbrink Traci A.
Published: December 2016

Summary Statement

Serious games are increasingly being used for medical education. However, the design and development of serious games for the education of health professionals is highly variable, and very few articles report the development process used for game development. There are many established processes for software development that can improve and streamline development, and incorporating the best practices from educational pedagogy and software development may enhance teamwork and communication, decrease development costs, and improve the quality of serious games. In this article, we review and summarize the literature for serious game development for medical education, and combining the best practices, we propose a structured three-phase iterative development framework for serious game development.
Electroconvulsive Therapy (ECT) and Race
Authors: Williams Julie , Chiu Lawrence , Livingston Robin
Published: December 2016

Objectives

Minimal research on race and other sociodemographic disparities in patients receiving electroconvulsive therapy (ECT) exists. One previously noted national trend reveals whites receiving ECT disproportionately more than other races. The aim of this study is to determine whether a county ECT program demonstrates similar disparities observed at the state and national levels.

Methods

This study examined 21 years of ECT data, between 1993 and 2014, provided by the Texas Department of State Health Services, focusing on race, sex, age, and payer source and 2.5 years of the same variables from a Harris County hospital ECT program. In addition, population demographic data for Harris County and the state of Texas during the same period were obtained from the Department of State Health Services Web site.

Results

Despite an overall decrease in the population of whites countywide and statewide, whites continue to use more ECT than African Americans, Latinos, and Asians in both Harris County and Texas. However, the rates of ECT use in minorities increased overall. Both countywide and statewide, ECT was used more than twice as often in women than men. Statewide, elderly patients (>65 years old) saw decreases in ECT use, and there was an increase in private third-party payer source.

Conclusions

Electroconvulsive therapy remains underused among African Americans, Latinos, and Asians. Hypotheses and areas for future study include cultural beliefs, stigma, patient and provider knowledge of ECT, and access to care. Despite this, the general use of ECT in Texas has increased overall, and minority use is slowly on the rise.
Time Trends and Variations in Electroconvulsive Treatment in Denmark 2008 to 2014
Authors: Hundrup Eva , Osler Merete , Jørgensen Martin Balslev
Published: December 2016

Objective

The aim of this study was to determine status and variations in the practice of electroconvulsive treatment (ECT) in Denmark in patient characteristics, indications, treatment patterns, and hospital region.

Method

All 140,627 ECTs registered in the Danish National Patient Registry between 2008 and 2014 were retrieved together with information on patient characteristics. Annual treated person rates were calculated for sex, age, admission diagnosis, and region.

Results

The overall ECT treatment rate was 36 (95% confidence interval, 34–38) per 100,000 resident population during the study period. The rate was highest in women and increased with age. There were modest, however, stable regional differences in rates (extremal quotient = 1.4). Electroconvulsive treatment was most commonly used in patients with depression with (19.4%) or without (54.9%) psychotic symptoms. The median number of ECTs administered per patient was 10 and highest in patients with schizophrenia, schizoaffective, or bipolar disorders. A total of 51%, 14%, and 33% of ECTs were administered with bilateral, unilateral, and unspecified electrode placement, respectively. There were regional differences in electrode placement specification and use.

Conclusions

Although some variation was seen across hospital regions and electrode placement, ECT in Denmark was provided with relative stability over time and indications compared with most other countries in Europe and North America.
Two loci contribute epistastically to heterospecific pollen rejection, a postmating isolating barrier between species
Authors: Hamlin Jennafer A. P. , Sherman Natasha A. , Moyle Leonie C.
Published: December 2016

Recognition and rejection of heterospecific male gametes occurs in a broad range of taxa, although the complexity and redundancy of mechanisms underlying this postmating cryptic female choice is poorly understood. In plants, the arena for these interactions is the female reproductive tract (pistil), within which heterospecific pollen tube growth can be arrested via active molecular recognition. Unilateral incompatibility (UI) is one such pistil-mediated barrier in which pollen rejection occurs in only one direction of an interspecific cross. We investigated the genetic basis of pistil-side UI betweenSolanumspecies, with the specific goal of understanding the role and magnitude of epistasis between UI QTL. Using heterospecific introgression lines (ILs) betweenSolanum pennelliiandS. lycopersicum,we assessed the individual and pairwise effects of three chromosomal regions (ui1.1, ui3.1,andui12.1) previously associated with interspecific UI amongSolanumspecies. Specifically, we pyramidedui12.1with each ofui1.1andui3.1, and assessed the strength of UI pollen rejection in pyramided (double introgression) lines, compared to single introgression genotypes. We found that none of the three QTL individually showed UI rejection phenotypes, but lines combiningui3.1andui12.1showed significant pistil-side pollen rejection. Furthermore, double introgression lines that combined different chromosomal regions overlappingui3.1differed significantly in their rate of UI, consistent with at least two genetic factors on chromosome three contributing quantitatively to interspecific pollen rejection. Together, our data indicate that loci on both chromosomes 3 and 12 are jointly required for the expression of UI betweenS. pennelliiandS. lycopersicumsuggesting that coordinated molecular interactions among a relatively few loci underlying the expression of this postmating prezygotic barrier. In addition, in conjunction with previous data, at least one of these loci appears to also contribute to conspecific self-incompatibility, consistent with a partially shared genetic basis between inter- and intraspecific mechanisms of postmating prezygotic female choice.
Flexible statistical methods for estimating and testing effects in genomic studies with multiple conditions
Authors: Urbut Sarah M. , Wang Gao , Carbonetto Peter , Stephens Matthew
Published: December 2016

We introduce new statistical methods for analyzing genomic datasets that measure many effects in many conditions (e.g., gene expression changes under many treatments). These new methods improve on existing methods by allowing for arbitrary correlations in effect sizes among conditions. This flexible approach increases power, improves effect estimates, and allows for more quantitative assessments of effect-size heterogeneity compared to simple “shared/condition-specific” assessments. We illustrate these features through an analysis of locally-acting variants associated with gene expression (“cis eQTLs”) in 44 human tissues. Our analysis identifies more eQTLs than existing approaches, consistent with improved power. We show that while genetic effects on expression are extensively shared among tissues, effect sizes can still vary greatly among tissues. Some shared eQTLs show stronger effects in subsets of biologically related tissues (e.g., brain-related tissues), or in only one tissue (e.g., testis). Our methods are widely applicable, computationally tractable for many conditions, and available online.
A network theory of the origin of life
Authors: Hoffmann Geoffrey W.
Published: December 2016

The origin of life may have been a low probability event that involved both RNA and polypeptides. While such an event would occur with low probability, the probability is not too low in the context of the number of nucleation opportunities on the primitive Earth. The probability for the nucleation event is too small if needed components occur as frequently as disruptive components do, without specific interactions between the two classes. However, if many of the needed components contribute by inhibiting otherwise disruptive components, a high probability for a complex nucleation as the beginning of life event emerges. RNA interference and long non-coding RNAs are ascribed roles in inhibiting components that would otherwise be disruptive in the context of a nucleation event. The theory likewise provides an inhibitory role for the large fraction of proteins (35% to 40%) that have no known function in both prokaryotes and eukaryotes. It is suggested that volcanic ash could provide the large number of random shapes needed as the basis for the nucleation event. Experiments based on that hypothesis are proposed.
Vitamin D3 derivatives, alone or in combination with glucocorticoids, suppress streptococcal pyrogenic enterotoxin A‐stimulated proliferation of peripheral blood mononuclear cells in patients with psoriasis
Authors: Usui Kae , Okubo Yukari , Hirano Toshihiko , Tsuboi Ryoji
Published: December 2016

Bacterial colonization on skin or tonsil may influence the clinical response of patients with psoriasis to immunosuppressive drugs. However, few studies have investigated the effects of bacterial superantigens on therapy in these patients. Recently, combination therapy with topical glucocorticoids (GC) and vitamin D3 (VD3) appears to be more effective than GC or VD3 monotherapy for psoriasis. We evaluated the suppressive effects of betamethasone butyrate propionate (BBP), three VD3 derivatives (calcipotriol, maxacalcitol and tacalcitol), cyclosporin and BBP plus VD3, on concanavalin A (ConA)‐ or streptococcal pyrogenic enterotoxin A (SPEA)‐stimulated proliferation of peripheral blood mononuclear cells (PBMC) obtained from 35 psoriasis patients. Drug concentrations effecting 50% inhibition concentration of ConA‐ or SPEA‐stimulated PBMC proliferation were estimated. Cytokine levels of tumor necrosis factor‐α, γ‐interferon, interleukin‐1b, ‐2, ‐4, ‐5, ‐6, ‐8 ‐10 and ‐12p70 in PBMC culture supernatants were measured with bead‐array procedures. Suppression of PBMC proliferation by BBP was significantly lower when PBMC were stimulated by SPEA than when stimulated by ConA. In contrast, the suppressive effects of calcipotriol and tacalcitol increased significantly when PBMC were stimulated by SPEA than when stimulated by ConA. The suppressive effect of BBP on SPEA‐stimulated PBMC proliferation was improved significantly by adding 1–1000 ng/mL calcipotriol, compared with BBP alone. Cytokine levels in PBMC culture supernatants were not significantly different between ConA‐ and SPEA‐stimulated PBMC. Calcipotriol and BBP in combination markedly suppressed SPEA‐stimulated PBMC proliferation. SPEA produced by colonization of hemolytic streptococci may reduce the efficacy of BBP but not VD3 derivatives in the treatment of psoriasis.
Enclosed nests may provide greater thermal than nest predation benefits compared with open nests across latitudes
Authors: Martin Thomas E. , Boyce Andy J. , Fierro‐Calderón Karolina , Mitchell Adam E. , Armstad Connor E. , Mouton James C. , Bin Soudi Evertius E.
Published: December 2016

Nest structure is thought to provide benefits that have fitness consequences for several taxa. Traditionally, reduced nest predation has been considered the primary benefit underlying evolution of nest structure, whereas thermal benefits have been considered a secondary or even non‐existent factor. Yet, the relative roles of these factors on nest structures remain largely unexplored.

Enclosed nests have a constructed or natural roof connected to sides that allow a restricted opening or tube entrance that provides cover in all directions except the entrance, whereas open nests are cups or platforms that are open above. We show that construction of enclosed nests is more common among songbirds (Passeriformes) in tropical and southern hemisphere regions than in north temperate regions. This geographic pattern may reflect selection from predation risk, under long‐standing assumptions that nest predation rates are higher in southern regions and that enclosed nests reduce predation risk compared with open cup nests. We therefore compared nest predation rates between enclosed vs. open nests in 114 songbird species that do not nest in tree holes among five communities of coexisting birds, and for 205 non‐hole‐nesting species from the literature, across northern temperate, tropical, and southern hemisphere regions.

Among coexisting species, enclosed nests had lower nest predation rates than open nests in two south temperate sites, but not in either of two tropical sites or a north temperate site. Nest predation did not differ between nest types at any latitude based on literature data. Among 319 species from both our field studies and the literature, enclosed nests did not show consistent benefits of reduced predation and, in fact, predation was not consistently higher in the tropics, contrary to long‐standing perspectives.

Thermal benefits of enclosed nests were indicated based on three indirect results. First, species that built enclosed nests were smaller than species using open nests both among coexisting species and among species from the literature. Smaller species lose heat fastest and thereby may gain important thermal benefits from reduced convective cooling. Second, eggs were warmed by parents for less time in species with enclosed nests, as can be expected if egg cooling rates are slower. Finally, species using enclosed nests exhibited enhanced growth of mass and wings compared with species using open nests, suggesting reduced thermoregulatory costs allowed increased energy for growth.

Enclosed nests may therefore provide more consistent thermal than nest predation benefits, counter to long‐standing perspectives.

A lay summary is available for this article.
A phylogenetic comparative analysis reveals correlations between body feather structure and habitat
Authors: Pap Péter L. , Vincze Orsolya , Wekerle Beatrix , Daubner Timea , Vágási Csongor I. , Nudds Robert L. , Dyke Gareth J. , Osváth Gergely
Published: December 2016

Body feathers ensure both waterproofing and insulation in waterbirds, but how natural variation in the morphological properties of these appendages relates to environmental constraints remains largely unexplored. Here, we test how habitat and thermal condition affect the morphology of body feathers, using a phylogenetic comparative analysis of five structural traits [i.e., total feather length, the lengths of the pennaceous (distal) and plumulaceous (proximal) sections, barb density, and pennaceous barbule density] from a sample of 194 European bird species.

Body feather total length is shorter in aquatic than in terrestrial birds, and this difference between groups is due to the shorter plumulaceous feather section in aquatic birds. Indeed, a reduced plumulaceous section in feather length probably reflects the need to limit air trapped in the plumage to adjust the buoyancy of aquatic birds. In contrast, the high pennaceous barbule density of aquatic birds compared to their terrestrial counterparts reflects water resistance of the plumage in contact with water.

Our results show that birds living in environments with low ambient temperature have long plumulaceous feather lengths, low barb density, and low pennaceous barbule density. Data also suggest that plumage probably has limited function in reducing the heat absorption of species living in hot environments.

Our results have broad implications for understanding the suite of selection pressures driving the evolution of body feather functional morphology. It remains to be tested, however, how other feather traits, such as the density of plumage (feathers per unit area) and the relative number of different feather types, for example downy feathers, are distributed amongst birds with different water resistance and thermoinsulative needs.

Alay summaryis available for this article.