bluuebunny/crossref_metadata_2025 huggingface dataset:
ZAP-VAP
Authors: Jacobs Pepin Breanna , Lesslie Debra , Berg Wendy , Spaulding Alicen B. , Pokora Thomas
Published: July 2019

Background:

Ventilator-associated pneumonia (VAP) is the second most frequent hospital-acquired infection in neonatal intensive care units (NICUs) and significantly affects neonatal morbidity and mortality. The population most at risk for VAP are extremely preterm infants.

Purpose:

The objectives of this quality improvement project were to create and evaluate the effectiveness of a VAP prevention bundle (“ZAP-VAP”) in reducing VAP.

Methods:

The development of the ZAP-VAP bundle and creation of audit tools were documented. A targeted gestational age less than 29 weeks was selected for this study. Electronic medical record review was used to determine the preintervention baseline for patient outcomes. Patient medical record data were analyzed retrospectively to measure patient outcomes preimplementation. VAP rates (number of VAP cases per 1000 ventilator days) were calculated pre- and postintervention. After implementation, data were analyzed prospectively to measure patient outcomes between neonates who developed VAP and those who did not.

Results:

The VAP rate significantly decreased from 8.5 (2010-2011) to 2.5 (P= .0004) postintervention (2016). Median mechanical ventilation days decreased among VAP cases (47 vs 33 days) and slightly increased among non-VAP cases (19 vs 24 days) during the intervention period. Median length of stay decreased for VAP cases (136 vs 100 days) but remained unchanged for non-VAP cases (85 vs 84 days).

Implications for Practice:

The intervention was implemented from 2012 to 2016. The protocol was readily accepted by our neonatal intensive care unit (NICU) team through education and practice changes. ZAP-VAP is an effective and straightforward protocol that improved VAP outcomes in our level IIIB NICU. An interdisciplinary team successfully implemented this intervention for mechanically ventilated infants of all gestational ages in our unit and has been a model for these practice changes in other units and other hospitals.

Implications for Research:

Future studies should focus on how to create sustainable interventions to decrease VAP in NICUs and to expand the approaches to other units in our hospital and other hospitals in our city among patients at risk for VAP.
Improving the Efficiency and Effectiveness of Parent Education in the Neonatal Intensive Care Unit
Authors: Gehl Melissa B. , Alter Caroline C. , Rider Nikki , Gunther Lori G. , Russell Rebecca B.
Published: July 2019

Background:

March of Dimes partners with hospitals across the country to implement NICU Family Support (NFS) Core Curriculum, a program providing education to parents in neonatal intensive care units (NICUs) across the country.

Purpose:

This NFS project's goal was to increase the efficiency and effectiveness of NICU parent education by establishing consistency, improving quality, and identifying best practices.

Methods/Search Strategy:

A 5 topic curriculum was developed and implemented across NFS program sites. The project studied 4 main outcomes of interest related to efficiency and effectiveness: increase in parenting confidence, parent learning, knowledge change, and satisfaction. Data were collected from speakers and attendees immediately following educational sessions. Analytical approaches included descriptive statistics such as frequency, percentage, and response rate, and inferential approaches such as t test, χ2, and analysis of variance.

Findings/Results:

Findings suggest that the NFS Core Curriculum improved both program efficiency and effectiveness. Sessions fully implemented according to recommended strategies had better outcomes than sessions not fully implemented according to recommended strategies (P < .0001). Across the 3648 attendees at 41 sites, 77% of parents reported learning “a lot” at the session they attended and 85% of attendees reported increased confidence. Attendees also reported positive knowledge change and high satisfaction.

Implications for Practice:

Parent education best practices identified through this initiative can be utilized for future NFS Core Curriculum topics and potentially generalized to all NICU parent education and family education in other hospital intensive care units.

Implications for Research:

Content and best practices identified through this project will require regular review to ensure medical accuracy and appropriateness of best practices as the physical design of NICUs evolves.
The Importance of the Biopsy Technique in the Diagnosis of Histoid Leprosy
Authors: Rodrigues Daxbacher Egon L. , Cabrera Pereira João P. , Ramos de Oliveira Suellen , Duarte Tortelly Violeta , Carneiro Sueli , Jeunon Thiago
Published: July 2019

Histoid leprosy (HL) was originally described by Wade in 1963 and is regarded as a rare variant of lepromatous leprosy (LL). These characteristic clinical lesions are firm, deeply adhered nodules with features reminiscent of dermatofibromas or keloids in a background of apparently healthy skin. The main histopathological findings described are the presence of spindle cell histiocytes immersed in a richly collagenized background, usually forming a nodular pattern of infiltration with sharply delimitation and positive staining for acid-fast bacilli. The classical form of HL lesions should be devoid of foam histiocytes and globi. However, we and other authors noticed that in most of the cases, despite characteristic clinical features, histopathology depicts a mixture of LL and HL patterns. Therefore, we present a case with clinical features similar to HL in which an excisional scalpel biopsy of a nodule demonstrated features of classical LL in the center of the lesion and features of HL in the periphery, highlighting that a proper biopsy technique could enhance the ability of the dermatopathologist to histopathologically diagnose cases of HL. In cases in which HL is clinically suspected, we advocate replacing the usual 4-mm incisional punch biopsy by a broader elliptical scalpel biopsy, encompassing the totality of the lesion whenever possible to achieve a reliable representation of the pathologic process.
Monitoring Perinatal Exposure to Cannabis and Synthetic Cannabinoids
Authors: Carlier Jeremy , Huestis Marilyn A. , Zaami Simona , Pichini Simona , Busardò Francesco P.
Published: July 2019

Purpose:

Drug use during pregnancy is a critical global challenge, capable of severe impacts on neonatal development. However, the consumption of cannabis and synthetic cannabinoids is on the rise in pregnant women. Obstetric complications with increased risks of miscarriage, fetal growth restriction, and brain development impairment have been associated with perinatal cannabis exposure, but data on synthetic cannabinoid use during pregnancy are limited.

Methods:

We reviewed studies that investigated the risks associated with cannabis and synthetic cannabinoid use and those that reported the concentrations of cannabinoids and synthetic cannabinoids in maternal (breast milk) and neonatal (placenta, umbilical cord, meconium, and hair) matrices during human pregnancy. A MEDLINE and EMBASE literature search to identify all relevant articles published in English from January 1998 to April 2019 was performed.

Results:

Cannabis use during pregnancy is associated with increased risks of adverse obstetrical outcomes, although neurobehavioral effects are still unclear. Analyses of cannabinoids in meconium are well documented, but further research on other unconventional matrices is needed. Adverse effects due to perinatal synthetic cannabinoid exposure are still unknown, and analytical data are scarce.

Conclusions:

Awareness of the hazards of drug use during pregnancy should be improved to encourage health care providers to urge pregnant women to abstain from cannabis and, if cannabis-dependent, seek treatment. Moreover, substances used throughout pregnancy should be monitored as a deterrent to cannabis use, and potential cannabis-dependent women should be identified, so as to limit cannabis-fetal exposure during gestation, and provided appropriate treatment.
Fractional CO2 laser versus promestriene and lubricant in genitourinary syndrome of menopause: a randomized clinical trial
Authors: Politano Carlos A. , Costa-Paiva Lucia , Aguiar Luiza B. , Machado Helymar C. , Baccaro Luiz F.
Published: July 2019

Objective:

The aim of this study was to compare the effects of fractional CO2 laser therapy, promestriene, and vaginal lubricants on genitourinary syndrome treatment and sexual function in postmenopausal women.

Methods:

We performed a randomized clinical trial including 72 postmenopausal women over the age of 50 years. The women were randomized into three intervention groups to receive one of the following treatments: three sessions of intravaginal fractional CO2 laser therapy; 10 mg of intravaginal promestriene cream 3 times a week; and vaginal lubricant application alone. Vaginal maturation, Vaginal Health Index (VHI) score, and Female Sexual Function Index (FSFI) were evaluated at baseline and after 14 weeks of therapy.

Results:

We observed an improvement in the vaginal elasticity, volume, moisture, and pH in the CO2 laser and promestriene groups. The VHI score at 14 weeks was higher in the CO2 laser group (mean score 18.68) than in the promestriene (15.11) and lubricant (10.44) groups (P < 0.001). Regarding vaginal maturation, basal cells were reduced and superficial cells were increased after treatment. This improvement was more significant in the CO2 laser group (P <0.001). The FSFI score only showed improvement in the desire and lubrication domains in the CO2 laser group. There were no differences in total FSFI score among the three treatment groups. There were no adverse effects associated with any of the treatments.

Conclusions:

The use of fractional CO2 laser therapy to treat genitourinary syndrome resulted in better short-term effects than those of promestriene or lubricant with respect to improving the vaginal health in postmenopausal women.
A Methodology For Studying Organizational Performance
Authors: Lasater Karen B. , Jarrín Olga F. , Aiken Linda H. , McHugh Matthew D. , Sloane Douglas M. , Smith Herbert L.
Published: July 2019

Background:

Rigorous measurement of organizational performance requires large, unbiased samples to allow inferences to the population. Studies of organizations, including hospitals, often rely on voluntary surveys subject to nonresponse bias. For example, hospital administrators with concerns about performance are more likely to opt-out of surveys about organizational quality and safety, which is problematic for generating inferences.

Objective:

The objective of this study was to describe a novel approach to obtaining a representative sample of organizations using individuals nested within organizations, and demonstrate how resurveying nonrespondents can allay concerns about bias from low response rates at the individual-level.

Methods:

We review and analyze common ways of surveying hospitals. We describe the approach and results of a double-sampling technique of surveying nurses as informants about hospital quality and performance. Finally, we provide recommendations for sampling and survey methods to increase response rates and evaluate whether and to what extent bias exists.

Results:

The survey of nurses yielded data on over 95% of hospitals in the sampling frame. Although the nurse response rate was 26%, comparisons of nurses’ responses in the main survey and those of resurveyed nonrespondents, which yielded nearly a 90% response rate, revealed no statistically significant differences at the nurse-level, suggesting no evidence of nonresponse bias.

Conclusions:

Surveying organizations via random sampling of front-line providers can avoid the self-selection issues caused by directly sampling organizations. Response rates are commonly misinterpreted as a measure of representativeness; however, findings from the double-sampling approach show how low response rates merely increase thepotential fornonresponse bias but do not confirm it.
The Surveillance Patterns of Incidentally Detected Pancreatic Cysts Vary Widely and Infrequently Adhere to Guidelines
Authors: Schenck Robert J. , Miller Frank H. , Keswani Rajesh N.
Published: July 2019

Objectives

We aimed to determine incidental pancreatic cyst (“cyst”) surveillance patterns, predictors of receiving surveillance, and guideline adherence.

Methods

We performed a retrospective cohort study of all patients receiving longitudinal care at a single tertiary care center with a newly diagnosed incidental pancreatic cyst over a 2-year period (2010–2011). All follow-up care was abstracted over a 5-year period.

Results

Of 3241 eligible imaging studies reviewed, 100 patients with newly diagnosed incidental cysts eligible for surveillance were identified. A majority (53%) received no follow-up. We identified 4 predictors of cyst surveillance: radiology report conclusion mentioning the cyst (odds ratio [OR], 14.9; 95% confidence interval [CI], 1.9–119) and recommending follow-up (OR, 5.5; 95% CI, 2.1–13.9), pancreas main duct dilation (OR, 10.7; 95% CI, 1.3–89), and absence of multiple cysts (OR, 2.5; 95% CI, 1.1–10.0). Of the 47 patients who received surveillance, 66% met minimum surveillance imaging intervals of at least one guideline. Conversely, 21% of patients met the criteria for overutilization in at least one guideline.

Conclusions

Although guidelines recommend that surgically fit patients with incidental cysts undergo surveillance, most patients receive no follow-up. When follow-up occurs, surveillance patterns vary widely and infrequently conform to guidelines. Interventions to reduce care variation require study.
Significance of Lymph Node Metastasis in Resectable Well-differentiated Pancreatic Neuroendocrine Tumor
Authors: Harimoto Norifumi , Hoshino Kouki , Muranushi Ryo , Hagiwara Kei , Yamanaka Takahiro , Ishii Norihiro , Tsukagoshi Mariko , Igarashi Takamichi , Tanaka Hiroshi , Watanabe Akira , Kubo Norio , Araki Kenichirou , Hosouchi Yasuo , Suzuki Hideki , Arakawa Kazuhisa , Hirai Keitarou , Fukazawa Takaharu , Ikota Hayato , Shirabe Ken
Published: July 2019

Objectives

Understanding the effect of lymph node metastasis (LNM) on prognosis in pancreatic neuroendocrine neoplasm is helpful for surgery and follow-up. In this study, we investigated the significance of LNM in well-differentiated pancreatic neuroendocrine tumors (PanNETs) according to the World Health Organization 2017 classification.

Methods

We retrospectively collected data for 95 consecutive patients with PanNET who underwent pancreatic resection with curative intent between January 2008 and December 2017 at 6 institutions. The clinicopathological factors were compared in patients with and without LNM, and prognostic factors were analyzed.

Results

Lymph node metastasis was significantly associated with malignant potential of PanNET, such as larger tumor size, higher Ki-67 index, higher tumor grade, and higher incidence of lymphatic, vessel, and neural invasion. Lymph node metastasis was also associated with disease-free but not overall survival. Multivariate analysis identified NET grade 2 (G2) and G3 as independent risk factors for recurrence after curative resection.

Conclusions

World Health Organization 2017 classification was the most independent prognostic factor in patients with resectable well-differentiated PanNETs. Patients with G2 and higher-grade tumors require lymph node dissection to improve prognosis.
Endogenous Gastrin Collaborates With Mutant KRAS in Pancreatic Carcinogenesis
Authors: Nadella Sandeep , Burks Julian , Huber Matthew , Wang Juan , Cao Hong , Kallakury Bhaskar , Tucker Robin D. , Boca Simina M. , Jermusyck Ashley , Collins Irene , Vietsch Eveline E. , Pierobon Mariaelena , Hodge K. Alex , Cui Waxing , Amundadottir Laufey T. , Petricoin Emanuel , Shivapurkar Narayan , Smith Jill P.
Published: July 2019

Objective

TheKRASgene is the most frequently mutated gene in pancreatic cancer, and no successful anti-Ras therapy has been developed. Gastrin has been shown to stimulate pancreatic cancer in an autocrine fashion. We hypothesized that reactivation of the peptide gastrin collaborates with KRAS during pancreatic carcinogenesis.

Methods

LSL-KrasG12D/+;P48-Cre(KC) mutant KRAS transgenic mice were crossed with gastrin-KO (GKO) mice to develop GKO/KC mice. Pancreata were examined for 8 months for stage of pancreatic intraepithelial neoplasia lesions, inflammation, fibrosis, gastrin peptide, and microRNA expression. Pancreatic intraepithelial neoplasias from mice were collected by laser capture microdissection and subjected to reverse-phase protein microarray, for gastrin and protein kinases associated with signal transduction. Gastrin mRNA was measured by RNAseq in human pancreatic cancer tissues and compared to that in normal pancreas.

Results

In the absence of gastrin, PanIN progression, inflammation, and fibrosis were significantly decreased and signal transduction was reversed to the canonical pathway with decreased KRAS. Gastrin re-expression in the PanINs was mediated by miR-27a. Gastrin mRNA expression was significantly increased in human pancreatic cancer samples compared to normal human pancreas controls.

Conclusions

This study supports the mitogenic role of gastrin in activation of KRAS during pancreatic carcinogenesis.
Emotional Intelligence in Neonatal Intensive Care Unit Nurses: Decreasing Moral Distress in End-of-Life Care and Laying a Foundation for Improved Outcomes
Authors: Lewis Stephanie Lacefield
Published: July 2019

End-of-life care in the neonatal intensive care unit (NICU) is one of the most challenging practices for nurses. Negative emotions associated with moral distress often cause care to be incomplete or nurse disengagement. Emotional intelligence in nurses holds potential to address this issue, while improving patient outcomes. The purpose of this study was to critically appraise the evidence about emotional intelligence in nursing and to explore the relationship between emotional intelligence, moral distress in NICU nurses, end-of-life care, and other priority nurse and patient outcomes. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses)–structured integrative review was conducted, and CINAHL, Ovid, PubMed, and other databases were searched. Twelve studies were identified as relevant to this review after exclusion criteria were applied. Evidence supports the efficacy of emotional intelligence in bedside nurses as a method of improving key nurse and patient outcomes. Additionally, research suggests that emotional intelligence can be improved by training interventions. Clinical educators should integrate emotional intelligence concepts and strategies into staff training. Further research is recommended to validate previous findings in the NICU setting. Exploration of the relationship between emotional intelligence and moral distress in NICU nurses would provide a foundation for experimental designs to evaluate the effectiveness of emotional intelligence training interventions.
High Rate of Repeat Sexually Transmitted Diseases Among Men Who Have Sex With Men in South Africa: A Prospective Cohort Study
Authors: van Liere Geneviève A.F.S. , Kock Marleen M. , Radebe Oscar , Struthers Helen E. , Morre Servaas , McIntyre James A. , Peters Remco P.H.
Published: July 2019

We observed a high rate of incident sexually transmitted diseases within 55 days (median) of follow-up (78% retention) among symptomatic men who have sex with men (n = 78) in South Africa (188 per 100 person-years; 95% confidence interval, 1.2–2.7); 16 newly acquired and 10 with persistent positivity. This highlights the need to strengthen prevention efforts, whereas introduction of diagnostics is urgently warranted.
Comparison of Wavefront-guided and Best Conventional Scleral Lenses after Habituation in Eyes with Corneal Ectasia
Authors: Hastings Gareth D. , Applegate Raymond A. , Nguyen Lan Chi , Kauffman Matthew J. , Hemmati Roxana T. , Marsack Jason D.
Published: July 2019

SIGNIFICANCE

Visual performance with wavefront-guided (WFG) contact lenses has only been reported immediately after manufacture without time for habituation, and comparison has only been made with clinically unrefined predicate conventional lenses. We present comparisons of habitual corrections, best conventional scleral lenses, and WFG scleral lenses after habituation to all corrections.

PURPOSE

The purpose of this study was to compare, in a crossover design, optical and visual performance of eyes with corneal ectasias wearing dispensed best conventional scleral lens corrections and dispensed individualized WFG scleral lens corrections.

METHODS

Ten subjects (20 eyes) participated in a randomized crossover study where best conventional scleral lenses and WFG scleral lenses (customized through the fifth radial order) were worn for 8 weeks each. These corrections, as well as each subject's habitual correction and normative data for normal eyes, were compared using (1) residual higher-order aberrations (HORMS), (2) visual acuity (VA), (3) letter contrast sensitivity (CS), and (4) visual image quality (logarithm of the visual Strehl ratio, or logVSX). Correlations were performed between Pentacam biometric measures and gains provided by WFG lenses.

RESULTS

Mean HORMS was reduced by 48% from habitual to conventional and 43% from conventional to WFG. Mean logMAR VA improved from habitual (+0.12) to conventional (−0.03) and further with WFG (−0.09); six eyes gained greater than one line with WFG over conventional. Area under the CS curve improved by 26% from habitual to conventional and 14% from conventional to WFG. The percentage of the eyes achieving normal levels were as follows: HORMS, 40% for conventional and 85% for WFG; VA, 50% for conventional and 85% for WFG; and CS, 60% for conventional and 90% for WFG. logVSX improved by 16% from habitual to conventional and 25% further with WFG. Reduction in aberrations with WFG lenses best correlated with posterior cornea radius of curvature.

CONCLUSIONS

Visual performance was superior to that reported with nonhabituated WFG lens wear. With WFG lenses, HORMS and logVSX significantly improved, allowing more eyes to reach normal levels of optical and visual performance compared with conventional lenses.
Innovation in Central Venous Access Device Security: A Pilot Randomized Controlled Trial in Pediatric Critical Care
Authors: Ullman Amanda J. , Long Debbie , Williams Tara , Pearson Kylie , Mihala Gabor , Mattke Adrian C. , Macfarlane Fiona , Rickard Claire M.
Published: July 2019

Objectives:

Central venous access devices enable many treatments during critical illness; however, 25% of pediatric central venous access devices fail before completion of treatment due to infection, thrombosis, dislodgement, and occlusion. This is frequently attributed to inadequate securement and dressing of the device; however, high-quality research evaluating pediatric central venous access device securement innovation to prevent central venous access device failure is scarce. This study aimed to establish the feasibility of a definitive randomized control trial examining the effectiveness of current and new technologies to secure central venous access devices in pediatrics.

Design:

Single-center, parallel group, superiority, pilot randomized control trial.

Setting:

Anesthetic and intensive care departments of a tertiary pediatric hospital

Subjects:

One-hundred eighty pediatric patients with nontunneled central venous access device

Interventions:

Participants were randomized to receive central venous access device securement via standard care (bordered polyurethane dressing, with prolene sutures, chlorhexidine gluconate disc), tissue adhesive (Histoacryl, B Braun, Melsungen, Germany) in addition to standard care; or integrated dressing securement (SorbaView SHIELD [Centurion Medical Products, Franklin, MA], with prolene sutures and chlorhexidine gluconate disc). Outcomes: Primary: Feasibility (including effect size estimates, acceptability); central venous access device failure; central venous access device complications; secondary: individual central venous access device complications, skin damage, dressing performance, and product cost.

Measurements and Main Results:

Feasibility criteria were achieved as recruitment occurred with acceptable eligibility, recruitment, missing data, and attrition rates, as well as good protocol adherence. Family members and staff-reported comparable levels of acceptability between study arms; however, tissue adhesive was reported as the most difficult to apply. Overall, 6% of central venous access devices failed, including 6% (3/54; incident rate, 13.2 per 1,000 catheter days) standard care, 2% (1/56; incident rate, 3.65 per 1,000 catheter days) integrated, and 8% (5/59; 25.0 per 1,000 catheter days) tissue adhesive.

Conclusions:

It is feasible to conduct an efficacy randomized control trial of the studied interventions. Further research is required to definitively identify clinical, cost-effective methods to prevent central venous access device failure by examining new dressing and securement technologies and techniques.
Anti–N-Methyl-d-Aspartate Receptor Encephalitis
Authors: Zhao Bailey , Nelson David G.
Published: July 2019

Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is an underdiagnosed disease that has been described thus far only in case series. Patients, the majority of which are females, develop neuropsychiatric symptoms that can often be misdiagnosed as purely psychiatric illness. Although teratomas are nearly pathognomonic for anti-NMDAR encephalitis, these are less common in children and males. This case illustrates some common features of anti-NMDAR encephalitis and some of the challenges in diagnosis.
Deep Learning Algorithm to Predict Need for Critical Care in Pediatric Emergency Departments
Authors: Kwon Joon-myoung , Jeon Ki-Hyun , Lee Myoungwoo , Kim Kyung-Hee , Park Jinsik , Oh Byung-Hee
Published: July 2019

Background and Objectives

Emergency department (ED) overcrowding is a national crisis in which pediatric patients are often prioritized at lower levels. Because the prediction of prognosis for pediatric patients is important but difficult, we developed and validated a deep learning algorithm to predict the need for critical care in pediatric EDs.

Methods

We conducted a retrospective observation cohort study using data from the Korean National Emergency Department Information System, which collected data in real time from 151 EDs. The study subjects were pediatric patients who visited EDs from 2014 to 2016. The data were divided by date into derivation and test data. The primary end point was critical care, and the secondary endpoint was hospitalization. We used age, sex, chief complaint, symptom onset to arrival time, arrival mode, trauma, and vital signs as predicted variables.

Results

The study subjects consisted of 2,937,078 pediatric patients of which 18,253 were critical care and 375,078 were hospitalizations. For critical care, the area under the receiver operating characteristics curve of the deep learning algorithm was 0.908 (95% confidence interval, 0.903–0.910). This result significantly outperformed that of the pediatric early warning score (0.812 [0.803–0.819]), conventional triage and acuity system (0.782 [0.773–0.790]), random forest (0.881 [0.874–0.890]), and logistic regression (0.851 [0.844–0.858]). For hospitalization, the deep-learning algorithm (0.782 [0.780–0.783]) significantly outperformed the other methods.

Conclusions

The deep learning algorithm predicted the critical care and hospitalization of pediatric ED patients more accurately than the conventional early warning score, triage tool, and machine learning methods.
Combining Prostate Imaging Reporting and Data System, Histogram Analysis, and Prostate-Specific Antigen Density to Determine the Risk of Prostate Cancer in Patients With Prostate-Specific Antigen of 4 to 20 ng/mL
Authors: Liu Xiaohang , Deng Lin , Zhou Liangping , Peng Weijun
Published: July 2019

Objective

To develop regression models using Prostate Imaging Reporting and Data System (PI-RADS), histogram analysis, and prostate-specific antigen density (PSAD) to predict prostate cancer (PCa) and clinically significant PCa (CSPCa) in patients with prostate-specific antigen of 4 to 20 ng/mL.

Methods

In total, 195 PCa and 386 noncancer patients with prostate-specific antigen of 4 to 20 ng/mL were divided into development and validation cohorts. Magnetic resonance imaging results of them were assessed by PI-RADS scores and histogram analysis–corrected PI-RADS (PI-RADSh) scores. Diagnostic efficiencies for PCa and CSPCa of these scores plus PSAD were evaluated with logistic regression and receiver operating characteristic curve analysis.

Results

Prostate-specific antigen density + PI-RADSh score showed significantly higher area under the receiver operating characteristic curve for PCa (0.956) and CSPCa (0.960), which were higher than PI-RADS (0.909 and 0.926), PI-RADSh (0.921 and 0.940), and PSAD + PI-RADS (0.943 and 0.949) (all P < 0.05).

Conclusions

Incorporation of PSAD and histogram analysis raised the diagnosis efficiencies of PI-RADS for PCa and CSPCa.
Individualized Delay for Abdominal Computed Tomography Angiography Bolus-Tracking Based on Sequential Monitoring: Increased Aortic Contrast Permits Decreased Injection Rate and Lower Iodine Dose
Authors: Gutjahr Ralf , Fletcher Joel G. , Lee Yong S. , Halaweish Ahmed F. , Suresh Vighnesh , Weber Nikkole M. , Vrtiska Terri J. , Williamson Eric E. , Schmidt Bernhard , McCollough Cynthia H.
Published: July 2019

Objective

The aim of this study was to determine if computed tomography (CT) angiography using an individualized transition delay (CTA-ID) would facilitate reductions in injection rate and iodine dose.

Methods

The CTA-ID was performed in 20 patients with routine injection rate and iodine dose; 20 patients with injection rate lowered by 1 mL/s; and 40 patients with injection rate lowered by 1 mL/s with 29% less iodine. Routine CTAs in the same or size-matched patients served as controls. Diagnostic image quality and intra-arterial CT numbers were assessed.

Results

The median transition delay between aortic threshold and CTA-ID image acquisition was significantly longer than with conventional bolus tracking (mean increase, 13.3 seconds; P < 0.0001), with image quality being the same or better. Intra-arterial CT numbers were 200 Hounsfield units or greater for 80 of 80 CTA-ID, but not for 6 of 49 (12%) internal control or for 11 of 80 (14%) size-matched control patients.

Conclusion

The CTA-ID bolus-tracking software alters transition delays to permit diagnostic CTA examinations despite slower injection rate and less iodine.
Nonhemorrhagic Adrenal Infarction in Pregnancy: Magnetic Resonance Imaging and Computed Tomography Evaluation
Authors: Hynes Daniel , Jabiev Azad , Catanzano Tara
Published: July 2019

We present the case of unilateral nonhemorrhagic adrenal infarct in a 29-week pregnant 21-year-old woman. The patient presented with right upper quadrant pain, nausea, and vomiting. Ultrasonography of the right upper quadrant and appendix was negative for pathology. Magnetic resonance imaging of the abdomen demonstrated a right nonhemorrhagic adrenal infarct, subsequently confirmed with limited computed tomography of the upper abdomen. This case discusses the clinical presentation and pertinent imaging findings of adrenal infarction in pregnancy.
An optogenetic analogue of second-order reinforcement inDrosophila
Authors: König Christian , Khalili Afshin , Niewalda Thomas , Gao Shiqiang , Gerber Bertram
Published: July 2019

In insects, odours are coded by the combinatorial activation of ascending pathways, including their third-order representation in mushroom body Kenyon cells. Kenyon cells also receive intersecting input from ascending and mostly dopaminergic reinforcement pathways. Indeed, inDrosophila, presenting an odour together with activation of the dopaminergic mushroom body input neuron PPL1-01 leads to a weakening of the synapse between Kenyon cells and the approach-promoting mushroom body output neuron MBON-11. As a result of such weakened approach tendencies, flies avoid the shock-predicting odour in a subsequent choice test. Thus, increased activity in PPL1-01 stands forpunishment, whereas reduced activity in MBON-11 stands forpredicted punishment. Given that punishment-predictors can themselves serve as punishments of second order, we tested whether presenting an odour together with the optogenetic silencing of MBON-11 would lead to learned odour avoidance, and found this to be the case. In turn, the optogenetic activation of MBON-11 together with odour presentation led to learned odour approach. Thus, manipulating activity in MBON-11 can be an analogue of predicted, second-order reinforcement.
Context learning before birth: evidence from the chick embryo
Authors: Turatto Massimo , Dissegna Andrea , Chiandetti Cinzia
Published: July 2019

Learning contextual information to form associative memories with stimuli of interest is an important brain function in both human and non-human animals. Intuitively, one would expect that such a sophisticated cognitive skill develops postnatally, as the organism starts exploring the surrounding environment to search for significant contingencies among stimuli. Here we show, instead, that even before hatching, domestic chicks are capable of forming associative memories between discrete alerting sounds and the surrounding context, as attested by the fact that habituation of the freezing response to the sounds is affected by the context of stimulation. This finding indicates that, while in the egg, chicks recognize and learn the context in which they are stimulated. Hence, context learning in chicks is an innate brain function already active before birth, which can provide an immediate survival advantage to the newborns of this precocial avian species.
Radio-tracking reveals how wind and temperature influence the pace of daytime insect migration
Authors: Knight Samantha M. , Pitman Grace M. , Flockhart D. T. Tyler , Norris D. Ryan
Published: July 2019

Insects represent the most diverse and functionally important group of flying migratory animals around the globe, yet their small size makes tracking even large migratory species challenging. We attached miniaturized radio transmitters (less than 300 mg) to monarch butterflies (Danaus plexippus) and common green darner dragonflies (Anax junius) and tracked their autumn migratory movements through southern Ontario, Canada and into the United States using an automated array of over 100 telemetry towers. The farthest estimated distance a monarch travelled in a single day was 143 km at a wind-assisted groundspeed of 31 km h−1(8.7 m s−1) and the farthest estimated distance a green darner travelled in a single day was 122 km with a wind-assisted groundspeed of up to 77 km h−1(21.5 m s−1). For both species, increased temperature and wind assistance positively influenced the pace of migration, but there was no effect of precipitation. While limitations to tracking such small animals remain, our approach and results represent a fundamental advance in understanding the natural history of insect migration and environmental factors that govern their movements.
Colour plasticity in response to social context and parasitic infection in a self-fertilizing fish
Authors: Pawluk Rebecca Jane , Garcia de Leaniz Carlos , Cable Joanne , Tiddeman Bernard , Consuegra Sofia
Published: July 2019

Many animal species rely on changes in body coloration to signal social dominance, mating readiness and health status to conspecifics, which can in turn influence reproductive success, social dynamics and pathogen avoidance in natural populations. Such colour changes are thought to be controlled by genetic and environmental conditions, but their relative importance is difficult to measure in natural populations, where individual genetic variability complicates data interpretation. Here, we studied shifts in melanin-related body coloration in response to social context and parasitic infection in two naturally inbred lines of a self-fertilizing fish to disentangle the relative roles of genetic background and individual variation. We found that social context and parasitic infection had a significant effect on body coloration that varied between genetic lines, suggesting the existence of genotype by environment interactions. In addition, individual variation was also important for some of the colour attributes. We suggest that the genetic background drives colour plasticity and that this can maintain phenotypic variation in inbred lines, an adaptive mechanism that may be particularly important when genetic diversity is low.
Influences of sodium and glycosaminoglycans on skin oedema and the potential for ulceration: a finite-element approach
Authors: Pan Wu , Roccabianca Sara , Basson Marc D. , Bush Tamara Reid
Published: July 2019

Venous ulcers are chronic transcutaneous wounds common in the lower legs. They are resistant to healing and have a 78% chance of recurrence within 2 years. It is commonly accepted that venous ulcers are caused by the insufficiency of the calf muscle pump, leading to blood pooling in the lower legs, resulting in inflammation, skin oedema, tissue necrosis and eventually skin ulceration. However, the detailed physiological events by which inflammation contributes to wound formation are poorly understood. We therefore sought to develop a model that simulated the inflammation, using it to determine the internal stresses and pressure on the skin that contribute to venous ulcer formation. A three-layer finite-element skin model (epidermis, dermis and hypodermis) was developed to explore the roles in wound formation of two inflammation identifiers: glycosaminoglycans (GAG) and sodium. A series of parametric studies showed that increased GAG and sodium content led to oedema and increased tissue stresses of 1.5 MPa, which was within the reported range of skin tissue ultimate tensile stress (0.1–40 MPa). These results suggested that both the oedema and increased fluid pressure could reach a threshold for tissue damage and eventual ulcer formation. The models presented here provide insights to the pathological events associated with venous insufficiency, including inflammation, oedema and skin ulceration.
Reproductive skew affects social information use
Authors: Smolla Marco , Rosher Charlotte , Gilman R. Tucker , Shultz Susanne
Published: July 2019

Individuals vary in their propensity to use social learning, the engine of cultural evolution, to acquire information about their environment. The causes of those differences, however, remain largely unclear. Using an agent-based model, we tested the hypothesis that as a result of reproductive skew differences in energetic requirements for reproduction affect the value of social information. We found that social learning is associated with lower variance in yield and is more likely to evolve in risk-averse low-skew populations than in high-skew populations. Reproductive skew may also result in sex differences in social information use, as empirical data suggest that females are often more risk-averse than males. To explore how risk may affect sex differences in learning strategies, we simulated learning in sexually reproducing populations where one sex experiences more reproductive skew than the other. When both sexes compete for the same resources, they tend to adopt extreme strategies: the sex with greater reproductive skew approaches pure individual learning and the other approaches pure social learning. These results provide insight into the conditions that promote individual and species level variation in social learning and so may affect cultural evolution.
Neuroimaging supports the representational nature of the earliest human engravings
Authors: Mellet E. , Salagnon M. , Majkić A. , Cremona S. , Joliot M. , Jobard G. , Mazoyer B. , Tzourio Mazoyer N. , d'Errico F.
Published: July 2019

The earliest human graphic productions, consisting of abstract patterns engraved on a variety of media, date to the Lower and Middle Palaeolithic. They are associated with anatomically modern and archaic hominins. The nature and significance of these engravings are still under question. To address this issue, we used functional magnetic resonance imaging to compare brain activations triggered by the perception of engraved patterns dating between 540 000 and 30 000 years before the present with those elicited by the perception of scenes, objects, symbol-like characters and written words. The perception of the engravings bilaterally activated regions along the ventral route in a pattern similar to that activated by the perception of objects, suggesting that these graphic productions are processed as organized visual representations in the brain. Moreover, the perception of the engravings led to a leftward activation of the visual word form area. These results support the hypothesis that these engravings have the visual properties of meaningful representations in present-day humans, and could have served such purpose in early modern humans and archaic hominins.
Fracture failure of granite after varied durations of thermal treatment: an experimental study
Authors: Feng Gan , Kang Yong , Wang Xiao-chuan
Published: July 2019

Energy extraction from nuclear materials produces high-level radioactive waste. In geological nuclear waste storage repositories, the decay of radioactive elements generates heat, exposing the reservoir rocks to high-temperature conditions for long periods. To explore the effects of these conditions, this study examines the ability of granite to resist fracturing after thermal treatment for 10 h, 10 days, 30 days and 60 days. The results show that the fracture toughness of the granite remained basically unchanged for up to 10 days of thermal treatment. After thermal treatment for 60 days, the mode I, mode II and mixed-mode (I + II) fracture toughness decreased by 15.39%, 18.09% and 15.17%, respectively, compared with samples heated for 10 h. The change trends of the ability of granite to resist tensile, shear and mixed (tensile + shear) failure with an increased thermal treatment duration were basically consistent. Moreover, there was little change in its brittle fracturing characteristics with an increase in heating duration. Changes caused to the internal microstructure of the granite by high temperature were ongoing even up to 60 days.
Intraspecific sequence and gene expression variation contribute little to venom diversity in sidewinder rattlesnakes (Crotalus cerastes)
Authors: Rautsaw Rhett M. , Hofmann Erich P. , Margres Mark J. , Holding Matthew L. , Strickland Jason L. , Mason Andrew J. , Rokyta Darin R. , Parkinson Christopher L.
Published: July 2019

Traits can evolve rapidly through changes in gene expression or protein-coding sequences. However, these forms of genetic variation can be correlated and changes to one can influence the other. As a result, we might expect traits lacking differential expression to preferentially evolve through changes in protein sequences or morphological adaptation. Given the lack of differential expression across the distribution of sidewinder rattlesnakes (Crotalus cerastes), we tested this hypothesis by comparing the coding regions of genes expressed in the venom gland transcriptomes and fang morphology. We calculated Tajima'sDandFSTacross four populations comparing toxin and nontoxin loci. Overall, we found little evidence of directional selection or differentiation between populations, suggesting that changes to protein sequences do not underlie the evolution of sidewinder venom or that toxins are under extremely variant selection pressures. Although low-expression toxins do not have higher sequence divergence between populations, they do have more standing variation on which selection can act. Additionally, we found significant differences in fang length among populations. The lack of differential expression and sequence divergence suggests sidewinders—given their generalist diet, moderate gene flow and environmental variation—are under stabilizing selection which functions to maintain a generalist phenotype. Overall, we demonstrate the importance of examining the relationship between gene expression and protein-coding changes to understand the evolution of complex traits.
SEXUAL BEHAVIOURS AND EXPERIENCE OF SEXUAL COERCION AMONG IN-SCHOOL FEMALE ADOLESCENT IN SOUTHWESTERN NIGERIA
Authors: Samuel Babatunde Owolodun , Sanusi R.A
Published: July 2019

Most people begin their sexual relationship during adolescence and some get involved in risky life threatening behaviors such as unwanted pregnancies, abortions and sexually transmitted infections. This study was therefore designed to understand the patterns of female adolescents sexual behaviours and sexual coercion experience.

A descriptive cross-sectional study was carried out among 1227 in-school adolescents in the three senatorial district of Osun State, Southwestern Nigeria. Multi-stage sampling technique was used to select the respondents, and data were collected with pre-tested, semi-structured questionnaires. The data collected were analysed using Statistical Package for Social Sciences (SPSS version 21).

Three hundred and thirty seven (27.5%) were sexually exposed with a mean age of sexual initiation of 14.88±2. 46 years. Of the 337 that were sexually exposed 153(56.5%) initiated sex early between the ages of 10-15 years, while (4.7%) had uses drugs or take alcohol before sexual intercourse. Findings revealed that of those that were sexually exposed, 122(11%) were forced to have sex, 101(9.1%) played sex willingly, while 29(2.6%) felt threatened and 3(0.3%) were convinced with money. The proportion of the respondent who reported rape and abduction was (2.6%).

Finding from this study is consistent with earlier studies conducted in many other Nigerian cities which showed that in-school adolescents to be sexually active. There is the need to step up campaigns to address this noticed lapse in behavior among the students in order to arrest the usual consequences of such risky sexual behavior.
Heterozygous variants in the mechanosensitive ion channelTMEM63Aresult in transient hypomyelination during infancy
Authors: Yan Huifang , Helman Guy , Murthy Swetha E. , Ji Haoran , Crawford Joanna , Kubisiak Thomas , Bent Stephen J. , Xiao Jiangxi , Taft Ryan J. , Coombs Adam , Wu Ye , Pop Ana , Li Dongxiao , de Vries Linda S. , Jiang Yuwu , Salomons Gajja S. , van der Knaap Marjo S. , Patapoutian Ardem , Simons Cas , Burmeister Margit , Wang Jingmin , Wolf Nicole I.
Published: July 2019

Mechanically activated (MA) ion channels convert physical forces into electrical signals. Despite the importance of this function, the involvement of mechanosensitive ion channels in human disease is poorly understood. Here we report heterozygous missense mutations in the gene encoding the MA ion channel TMEM63A that result in an infantile disorder resembling a hypomyelinating leukodystrophy. Four unrelated individuals presented with congenital nystagmus, motor delay, and deficient myelination on serial scans in infancy, prompting the diagnosis of Pelizaeus-Merzbacher (like) disease. Genomic sequencing revealed all four individuals carry heterozygous missense variants in the pore-forming domain of TMEM63A. These variants were confirmed to have arisende novoin three of the four individuals. While the physiological role of TMEM63A is incompletely understood, it is highly expressed in oligodendrocytes and it has recently been shown to be a mechanically activated (MA) ion channel. Using patch clamp electrophysiology, we demonstrated that each of the modelled variants results in strongly attenuated stretch-activated currents when expressed in naïve cells. Unexpectedly, the clinical evolution of all four individuals has been surprisingly favorable, with substantial improvements in neurological signs and developmental progression. In the three individuals with follow-up scans after four years of age, the myelin deficit had almost completely resolved. Our results suggest a previously unappreciated role for mechanosensitive ion channels in myelin development.