bluuebunny/crossref_metadata_2025 huggingface dataset:
Congenital Infantile Fibrosarcoma in the Premature Infant
Authors: Edwards Taryn M. , Duran Melissa S. , Meeker Tamara M.
Published: November 2017

Background:

Congenital infantile fibrosarcoma (CIF) is rare and represents less than 1% of all childhood cancers. It is a tumor that originates in the connective fibrous tissue found at the ends of long bones and then spreads to other surrounding soft tissues. These lesions are typically large, grow rapidly, and can often be mistaken for teratomas. Diagnosis is confirmed by pathology, where cellular proliferation of fibroblasts occurs. Imaging is an important part of the diagnosis, which includes the use of magnetic resonance imaging and/or computed tomography scan. Although surgical resection is the primary treatment, chemotherapeutic agents may be used as adjuvant therapy.

Purpose:

To describe modalities for accurate diagnosis and treatment of CIF.

Methods/Search Strategy:

PubMed was searched using terms “congenital infantile fibrosarcoma” and “infantile fibrosarcoma.” Eleven relevant, English language articles were identified and utilized in the preparation of this case presentation.

Findings/Results:

Complications addressed in this case presentation are prenatal diagnostic challenges, pharmacologic interventions in the setting of prematurity, immunosuppression, and acute liver and renal failure. Pharmacologic treatments will include chemotherapy agents, antimicrobial agents, as well as granulocyte colony-stimulating factor for immunosuppression. Nursing challenges included positioning and integumentary disturbances.

Implications for Practice:

Utilization of diagnostic imaging and pathology to accurately identify and diagnose CIF is essential.

Implications for Research:

Safety and efficacy of chemotherapeutic agents in premature infants with CIF need to be established.
Is an operation always needed for pediatric triplane fractures? Preliminary results
Authors: Ryu Seung Min , Park Jae Woo , Kim Se Dong , Park Chul Hyun
Published: November 2017

We compared the outcomes of nonoperative and operative treatments of triplane fractures. Thirty-three patients with triplane fractures were treated conservatively (n=19) or surgically (n=14). Bone union and postoperative complications were radiographically examined. The mean American Orthopedic Foot and Ankle Society scores were 100 (nonoperative group) and 98.1 (operative group) (P=0.304). The modified Weber protocol scores were excellent in both groups. One patient in each group showed a leg-length discrepancy of more than 10 mm at the last follow-up. According to our preliminary data, it appears that nonoperative treatment of triplane fracture may have comparable clinical and radiographic results to operative treatment. However, further studies are needed to corroborate our findings.
Relationship Between Initial Vancomycin Trough Levels and Early-Onset Vancomycin-Associated Nephrotoxicity in Critically Ill Patients
Authors: Chuma Masayuki , Makishima Makoto , Imai Toru , Tochikura Naohiro , Suzuki Shinichiro , Kuwana Tsukasa , Sawada Nami , Komatsu Tomohide , Sakaue Takako , Kikuchi Norikazu , Yoshida Yoshikazu , Kinoshita Kosaku
Published: November 2017

Background:

Appropriate initial dosing of vancomycin (VCM) is important in improving survival and in preventing nephrotoxicity in critically ill patients, but the potential relationship between initial VCM trough levels and early-onset nephrotoxicity remains unclear. We examined the relationship between initial VCM trough levels and early-onset VCM-associated nephrotoxicity.

Methods:

We performed a retrospective study of patients who had therapeutic drug monitoring of VCM with initial trough levels within 4 days after the beginning of VCM administration. We excluded patients who received renal replacement therapy from 2 days before to 7 days after the beginning of VCM administration, were younger than 18 years, or had renal dysfunction before the beginning of VCM administration. Early-onset VCM-associated nephrotoxicity was defined as an increase in serum creatinine level of ≥0.5 mg/dL (44.2 μmol/L) or 50% above baseline for 2 or more consecutive days within 7 days after the beginning of VCM administration.

Results:

Among 109 enrolled patients, 13 patients had early-onset VCM-associated nephrotoxicity. Its incidence rate was 31.3% in patients with initial trough levels of ≥20g/mL, which was significantly higher than 6.3% in patients with initial trough levels of <10 mg/L. Multiple logistic regression analysis demonstrated that early-onset VCM-associated nephrotoxicity was associated with initial trough levels of ≥20 mg/L (odds ratio, 5.0; 95% confidence interval, 1.3–19.1) and with vasopressor use (odds ratio, 5.0; 95% confidence interval, 1.3–19.1). Kaplan–Meier analysis showed that the probability of nonnephrotoxicity for patients with initial VCM trough levels of ≥20 mg/L was lower compared with patients with trough levels of <15 mg/L.

Conclusions:

Initial trough levels of ≥20 mg/L but not ≥15 mg/L were associated with early-onset VCM-associated nephrotoxicity in critically ill patients. Future prospective studies are needed to examine outcomes in critically ill patients achieving initial VCM trough levels of 15–20 mg/L.
Identification of the Infection Source of an Outbreak of Mycobacterium Chelonae Keratitis After Laser in Situ Keratomileusis
Authors: Nascimento Heloisa , Viana-Niero Cristina , Nogueira Christiane Lourenço , Martins Bispo Paulo José , Pinto Fernando , de Paula Pereira Uzam Camila , Matsumoto Cristianne Kayoko , Oliveira Machado Antônia Maria , Leão Sylvia Cardoso , Höfling-Lima Ana Luisa , de Freitas Denise
Published: November 2017

Purpose:

Nontuberculous mycobacteria keratitis is a rare but challenging complication of laser in situ keratomileusis (LASIK). This study was conducted to determine the source(s) of infection in a cluster of cases of keratitis after LASIK and to describe this outbreak and patients' outcomes.

Methods:

In this retrospective, case series, single-center study, 86 patients were included who underwent LASIK or photorefractive keratectomy between December 2011 and February 2012. Corneal scrapes from the affected eyes, samples of tap and distilled water, water from the reservoir of the distilling equipment, steamer, and autoclave cassette; antiseptic and anesthetic solutions and surgical instrument imprints were cultivated in liquid and on solid media. Gram-negative bacteria and yeasts were identified using automated systems and mycobacteria by polymerase chain reaction–restriction enzyme analysis of the hsp65 gene (PRA-hsp65) and DNA sequencing. Mycobacterial isolates were typed by pulsed-field gel electrophoresis. The cases and outcomes are described. The main outcome measure was identification of the source(s) of the mycobacterial infections.

Results:

Eight (15 eyes) of 86 patients (172 eyes) who underwent LASIK developed infections postoperatively; no patients who underwent photorefractive keratectomy developed infections. Mycobacterium chelonae was isolated from 4 eyes. The distilled water collected in the surgical facility contained the same M. chelonae strain isolated from the patients' eyes. Different gram-negative bacteria and yeasts were isolated from samples collected at the clinic but not from the patients' eyes.

Conclusions:

Tap water distilled locally in surgical facilities may be a source of infection after ocular surgery and its use should be avoided.
Microbial Keratitis After Accelerated Corneal Collagen Cross-Linking in Keratoconus
Authors: Maharana Prafulla K. , Sahay Pranita , Sujeeth M. , Singhal Deepali , Rathi Anubha , Titiyal Jeewan S. , Sharma Namrata
Published: November 2017

Purpose:

To assess the pattern of microbial keratitis after accelerated corneal collagen cross-linkage (aCXL) in patients with keratoconus.

Method:

The medical records of cases of keratoconus that underwent aCXL from June 2014 to May 2017 were reviewed. Cases that developed microbial keratitis after aCXL were included in the study. The clinical, microbiological profile and the treatment outcomes were evaluated.

Results:

Of 532 eyes that underwent aCXL, 7 cases developed microbial keratitis during the study period. Median age at presentation was 11 years (range 8–17). Association with vernal keratoconjunctivitis was noted in 57.1% of cases (n = 4/7). The median time at the onset of infection was 3 days after aCXL (range 1–4). Microbiological reports revealed mixed infection in 3 cases [coagulase-negative Staphylococcus (CoNS) + Aspergillus fumigatus, Staphylococcus aureus and Mucor spp., Staph. aureus and Acanthamoeba], Staph. aureus in 2 cases, and CoNS and Alternaria spp. in 1 case each. Resistance to fourth-generation fluoroquinolones was noted in 83.3% of cases of bacterial keratitis (n = 5/6). All cases were initially managed with empirical antibiotic treatment that was later tailored based on microbiological reports. One case eventually required therapeutic penetrating keratoplasty for corneal perforation. At 6 months, the corrected distance visual acuity was >6/60 in 3 cases while 4 cases had corrected distance visual acuity <6/60.

Conclusions:

Microbial keratitis after aCXL is rare; however, the infection tends to be severe with high preponderance of mixed infection and resistance to fourth-generation fluoroquinolones.
Development of the Adult Vulvar Lichen Sclerosus Severity Scale—A Delphi Consensus Exercise for Item Generation
Authors: Sheinis Michal , Selk Amanda
Published: November 2017

Objective

To generate a list of items through international expert consensus consisting of both symptoms and clinical signs for inclusion in an adult vulvar lichen sclerosus severity scale.

Methods

This study was carried out as a three-stage Delphi consensus exercise. After an extensive literature review, any items used to determine disease severity in previous clinical trials were compiled into a survey. The Delphi participants were recruited from the International Society for the Study of Vulvovaginal Disease most of whom were gynecologists and in practice for more than 20 years. Participants were asked to rate the importance of these items. Consensus was defined as 75% agreeing that an item was very important or essential toward determining disease severity. Participants were also asked to indicate preferred method of measurement for these items.

Results

Of approximately 400 members of the International Society for the Study of Vulvovaginal Disease, 66 participated in the study. Of the 14 symptoms presented, 7 reached consensus for inclusion. Of the 23 signs presented, 11 reached consensus for inclusion and 1 reached consensus for exclusion. Of the six architectural changes presented, all six reached consensus for inclusion. No consensus was reached regarding method of measurement for any of the symptoms and signs that reached consensus for inclusion.

Conclusion

International consensus was reached for a variety of items for use in an adult vulvar lichen sclerosus severity scale that will be further developed and tested. Ideally, this scale will be used in clinical practice and in research to allow for high-quality trials.
Prospective Evaluation of Patients Undergoing Translabyrinthine Excision of Vestibular Schwannoma with Concurrent Cochlear Implantation
Authors: Rooth Meredith A. , Dillon Margaret T. , Brown Kevin D.
Published: November 2017

Objective:

Translabyrinthine (TL) vestibular schwannoma (VS) resection may be accomplished with preservation of the cochlear nerve, permitting successful, concurrent cochlear implantation. In this single institution, Food and Drug Administration-approved feasibility study, we wished to determine the success and outcomes of concurrent cochlear implantation at the time of TL resection of VS.

Study Design:

Prospective cohort.

Setting:

Tertiary referral center.

Patients:

Patients with small VS less than 1.5 cm in size.

Intervention:

Concurrent TL VS resection and cochlear implantation.

Main Outcome Measure:

Sound localization and speech understanding.

Results:

All cochlear nerves were anatomically preserved. Five out of seven patients had auditory precepts at the time of activation. At 1 month following surgery, AzBio scores (0 dB SNR, with sound front, noise to normal ear) were improved by an average of 10% with implant on, persisting to 6 months out from surgery. Localization 1 month after surgery was markedly improved with root mean square 78 degrees ±13 in the “implant off” condition and 41 ± 9 degrees in the “implant on” condition. Average tinnitus severity was reduced in subjects and speech and spatial hearing was improved on speech, spatial and qualities of hearing scale (SSQ).

Conclusions:

These data demonstrate preservation of electrical hearing in TL VS surgery is consistently possible, and although speech outcomes do not achieve the same levels seen with other etiologies of hearing loss, excellent improvement in sound localization, improved speech understanding, and substantial reductions in tinnitus are achieved.
Outcomes with the Tandem Protek Duo Dual-Lumen Percutaneous Right Ventricular Assist Device
Authors: Ravichandran Ashwin K. , Baran David A. , Stelling Kelly , Cowger Jennifer A. , Salerno Christopher T.
Published: November 2017

Recently, a percutaneous right ventricular assist device (RVAD) called the TandemLife Protek Duo (TPD; TandemLife, Pittsburgh, PA) has been introduced. The Protek Duo (TPD) is a temporary RVAD placed via the right internal jugular vein, capable of providing up to 4.5 L of flow. We report a two-center experience using the TPD in 17 patients with right ventricular (RV) failure, 12 of whom were post-left ventricular assist device (LVAD) implantation.
Single Versus Multidrug Regimen for Surgical Infection Prophylaxis in Left Ventricular Assist Device Implantation
Authors: Aburjania Nana , Ertmer Brennan M. , Farid Saira , Berg Melody , Nienaber Juhsien J. C. , Tchantchaleishvili Vakhtang , Stulak John M. , Baddour Larry M. , Sohail Muhammad R.
Published: November 2017

Infection is a serious complication of left ventricular assist device (LVAD) therapy. However, an optimal antimicrobial surgical infection prophylaxis (SIP) regimen for LVAD implantation is not well established. We retrospectively reviewed all adults who underwent continuous-flow LVAD implantation from February 2007 to March 2015 at Mayo Clinic Rochester. Left ventricular assist device infection (LVADI) was defined using criteria published by the International Society for Heart and Lung Transplant. Patients excluded from the analysis included those who did not have HeartMate II or HeartWare device, patients with incomplete documentation of SIP, and those with an actively treated infection at the time of LVAD implantation. We compared risk of LVAD-specific and LVAD-related infections and all-cause mortality between SIP regimens at postoperative day 90 and 1 year using Kaplan–Meier time-to-event analyses. During study period, 239 adults underwent continuous-flow LVAD implantation at our institution where 199 patients received single-drug and 40 received multidrug SIP regimen. Median patient age was 62 years. Left ventricular assist device infection occurred in three patients (1.5%) in the single-drug group versus two patients (5.0%) in the multidrug group at 90 days (p = 0.4). There was no difference in infection-free (p = 0.4) and overall survival (p = 0.9) between two groups at 1 year. In conclusion, there was no clear benefit of using multidrug regimen as it did not impact infection-free survival or all-cause mortality compared with single-drug regimen. Prospective clinical trials are needed to further define the optimal SIP regimen for LVAD implantation.
Management of Chronic Hepatitis C in End-stage Renal Disease
Authors: Angulo-Diaz Veronica , Lim Joseph K. , Martin Paul , Liapakis AnnMarie
Published: November 2017

Treatment for chronic viral hepatitis C has advanced dramatically to current standard of care all-oral direct-acting antiviral regimens with relatively short treatment duration and high efficacy. Patients with comorbid end-stage renal disease have constituted a “special patient population” with data and treatment options lagging behind that of the broader population of patients with chronic hepatitis C until recently. Herein we review the current evidence base for direct-acting antiviral therapy in this population. We provide a suggested algorithm for the evaluation of such patients for therapy. We highlight special considerations in regards to the choice of regimen, duration, and timing in regards to potential kidney transplantation.
Associations of Insulin Resistance and Glycemia With Liver Enzymes in Hispanic/Latino Youths
Authors: Parrinello Christina M. , Rudolph Bryan J. , Lazo Mariana , Gallo Linda C. , Thyagarajan Bharat , Cotler Scott J. , Qi Qibin , Seeherunvong Tossaporn , Vidot Denise C. , Strickler Howard D. , Kaplan Robert C. , Isasi Carmen R.
Published: November 2017

Background:

Associations of insulin resistance and hyperglycemia with a panel of liver enzymes have not been well studied in a young, heterogenous Hispanic/Latino population. We aimed to assess the associations of insulin resistance and glycemia with nonalcoholic fatty liver disease (NAFLD), as measured by liver enzymes and the pediatric NAFLD fibrosis index (PNFI), and whether these associations are modified by body mass index and mediated by inflammation or endothelial dysfunction.

Materials and Methods:

We conducted a cross-sectional study of 1317 boys and girls aged 8 to 16 years from the Hispanic Community Children’s Health Study/Study of Latino Youth. We used Poisson regression to assess the associations of fasting glucose, hemoglobin A1c, and homeostasis model assessment of insulin resistance (HOMA-IR) with elevated alanine aminotransferase (ALT) (>25 U/L in boys, >22 U/L in girls), aspartate aminotransferase (AST) (≥37 U/L), gamma-glutamyl transpeptidase (GGT) (≥17 U/L), and PNFI (≥9; a function of age, waist circumference, and triglyceride level).

Results:

HOMA-IR was associated with elevated ALT, AST, GGT, and PNFI [prevalence ratios (95% confidence intervals) for each 1-unit increase in the natural log of HOMA-IR: 1.99 (1.40-2.81), 2.15 (1.12-4.12), 1.70 (1.26-2.30), and 1.98 (1.43-2.74), respectively]. Associations were observed in overweight/obese children, but not in normal weight children (P-interaction=0.04 for AST and P-interaction=0.07 for GGT). After further adjustment for adiponectin, high-sensitivity C-reactive protein, e-selectin, and PAI-1, associations of HOMA-IR with liver enzymes and PNFI were attenuated, but remained statistically significant for AST and PNFI.

Conclusion:

Insulin resistance was associated with NAFLD in overweight/obese Hispanic/Latino youth, and this association may be partially mediated by inflammation and endothelial dysfunction.
Data mining of routine laboratory tests can predict liver disease progression in Egyptian diabetic patients with hepatitis C virus (G4) infection: a cohort study of 71 806 patients
Authors: Saad Yasmin , Awad Abobakr , Alakel Wafaa , Doss Wahid , Awad Tahany , Mabrouk Mahasen
Published: November 2017

Objectives

Hepatitis C virus (HCV) and diabetes mellitus (DM) are prevalent diseases worldwide, associated with significant morbidity, mortality, and mutual association. The aims of this study were as follows: (i) find the prevalence of DM among 71 806 Egyptian patients with chronic HCV infection and its effect on liver disease progression and (ii) using data mining of routine tests to predict hepatic fibrosis in diabetic patients with HCV infection.

Patients and methods

A retrospective multicentered study included laboratory and histopathological data of 71 806 patients with HCV infection collected by Egyptian National Committee for control of viral hepatitis. Using data mining analysis, we constructed decision tree algorithm to assess predictors of fibrosis progression in diabetic patients with HCV.

Results

Overall, 12 018 (16.8%) patients were diagnosed as having diabetes [6428: fasting blood glucose ≥126 mg/dl (9%) and 5590: fasting blood glucose ≥110–126 mg/dl (7.8%)]. DM was significantly associated with advanced age, high BMI and α-fetoprotein (AFP), and low platelets and serum albumin (P≤0.001). Advanced liver fibrosis (F3–F4) was significantly correlated with DM (P≤0.001) irrespective of age. Of 16 attributes, decision tree model for fibrosis showed AFP was most decisive with cutoff of 5.25 ng/ml as starting point of fibrosis. AFP level greater than cutoff in patients was the first important splitting attribute; age and platelet count were second important splitting attributes.

Conclusion

(i) Chronic HCV is significantly associated with DM (16.8%). (ii) Advanced age, high BMI and AFP, low platelets count and albumin show significant association with DM in HCV. (iii) AFP cutoff of 5.25 is a starting point of fibrosis development and integrated into mathematical model to predict development of liver fibrosis in diabetics with HCV (G4) infection.
Characteristics of Liver Disease in 100 Individuals With Joubert Syndrome Prospectively Evaluated at a Single Center
Authors: Strongin Anna , Heller Theo , Doherty Dan , Glass Ian A. , Parisi Melissa A. , Bryant Joy , Choyke Peter , Turkbey Baris , Daryanani Kailash , Yildirimli Deniz , Vemulapalli Meghana , Mullikin Jim C. ,   NISC Comparative Sequencing Program, Malicdan May C. , Vilboux Thierry , Gahl William A. , Gunay‐Aygun Meral
Published: November 2017

Background and Aims:

Joubert Syndrome (JS) is a rare, inherited, ciliopathy defined by cerebellar and brainstem malformations and is variably associated with liver, kidney, and ocular dysfunction. This study characterizes the hepatic findings in JS and identifies factors associated with probable portal hypertension.

Methods:

Hundred individuals with JS were prospectively evaluated at the National Institutes of Health Clinical Center. Laboratory tests, imaging, and DNA sequencing were performed. Patients were stratified based on the spleen length/patient height ratio as a marker of splenomegaly, used as a surrogate for probable portal hypertension.

Results:

Forty‐three patients (43%) had liver involvement based on elevated liver enzymes and/or liver hyperechogenicity and/or splenomegaly. None of the patients had macroscopic liver cysts or bile duct dilatation. Based on the spleen length/patient height ratio, 13 patients were stratified into a probable portal hypertension group. We observed significant elevations in alkaline phosphatase (269 vs 169 U/L, P ⩽ 0.001), alanine aminotransferase (92 vs 42 U/L, P = 0.004), aspartate aminotransferase (77 vs 40 U/L, P = 0.002), and gamma‐glutamyl transferase (226 vs 51 U/L, P ⩽ 0.001) in the probable portal hypertension group. Platelets were lower in the probable portal hypertension cohort (229 vs 299 × 103 cells/μL, P = 0.008), whereas synthetic function was intact in both groups. Probable portal hypertension was also more prevalent in patients with kidney disease (P = 0.001) and colobomas (P = 0.02), as well as mutations in the TMEM67 gene (P = 0.001).

Conclusions:

In JS, probable portal hypertension is associated with abnormal hepatic enzymes, as well as presence of kidney disease, coloboma, and/or mutation in TMEM67. These findings may allow early identification of JS patients who have or are more likely to develop liver disease.
Prevalence of Rectal Chlamydial and Gonococcal Infections: A Systematic Review
Authors: Dewart Courtney M. , Bernstein Kyle T. , DeGroote Nicholas P. , Romaguera Raul , Turner Abigail Norris
Published: November 2017

We undertook a systematic review to examine rectal Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (Ng) infections in women and men who have sex with men (MSM). English-language publications measuring rectal Ct or Ng prevalence using nucleic acid amplification tests were eligible. Searching multiple electronic databases, we identified 115 eligible reports published between January 2000 and November 2016. Overall, the prevalence of rectal Ct (9%) was higher than that of rectal Ng (4.7%). Rectal Ct prevalence was similar in MSM (9%) and women (9.2%), whereas rectal Ng prevalence was higher in MSM (6.1%) than in women (1.7%). Generally, rectal Ct prevalence was similar in sexually transmitted disease clinics (9.1%) and nonsexual health clinics (8.6%), whereas rectal Ng prevalence was somewhat lower in sexually transmitted disease clinics (4.5%) than in nonsexual health clinics (6%). These infections seem to be relatively common across a range of populations and clinical settings, highlighting the need for additional research on these preventable, treatable conditions.
Short-Term Propofol Infusion and Associated Effects on Serum Lactate in Pediatric Patients
Authors: Indra Sean , Haddad Haitham , O'Riordan Mary Ann
Published: November 2017

Objectives

This study aimed to determine if short-duration procedural sedation in children with propofol is related to an adverse metabolic stress response measured by serum lactate. Propofol infusion syndrome is associated with high-dose and long-duration infusion. It has not been studied with short-duration, outpatient propofol administration.

Methods

This was a prospective, longitudinal study that included 50 patients between the ages of 2 and 18 years who were undergoing outpatient procedural sedation with propofol at a pediatric sedation unit. Patients received bolus or bolus and continuous infusion doses of propofol. Serum lactate values were obtained before and after the patients' sedated procedures.

Results

The average length of procedure was 40.3 minutes, and the mean dose of propofol per patient was 8.2 mg/kg. The highest measured lactate value was 1.8 mmol/L. The average (SD) preprocedure and postprocedure lactate values were 1.0 (0.3) and 0.7 (0.2) mmol/L, respectively, resulting in an overall significant decrease in lactate of −0.3 (0.3) mmol/L (P < 0.001). There was a significant (P = 0.01) positive relationship between age and postprocedure lactate value, when controlling for the length of the procedure in a multivariable regression. No significant association was found between propofol dosage and length of the procedure with lactate values.

Conclusion

In this study, we did not find a significant increase in metabolic stress, measured by serum lactate. Using propofol for short-duration procedural sedation may not carry similar risks for propofol infusion syndrome to those for long-duration/high-dose infusion therapy.
Onychomadesis as a Late Complication of Hand-Foot-Mouth Disease
Authors: Kuehnel Nicholas A. , Thach Sokunthirith , Thomas Danny G.
Published: November 2017

Hand-foot-mouth disease is a viral illness frequently caused by enterovirus and coxsackievirus. Traditionally, this disease initially causes malaise, fever, and rash with vesicles in the mouth, as well as on the hands and feet. Occasionally, more severe presentations and late postinfectious sequelae occur, including onychomadesis, nail matrix arrest. We describe a series of 4 cases of onychomadesis and its evaluation following recent hand-foot-mouth disease during this current enteroviral season as a way to ensure appropriate clinician diagnosis and guidance.
Congenital Diaphragmatic Hernia in a Child With Abdominal Pain and Respiratory Distress
Authors: Sanh William , Langer Jacob C. , Ratnapalan Savithiri
Published: November 2017

We report a case of late presentation of congenital diaphragmatic hernia in a child who presented to the emergency department with abdominal pain and respiratory distress. The usual and unusual presentations of congenital diaphragmatic hernia in older children and their possible complications are discussed.
Thrombelastography early amplitudes in bleeding and coagulopathic trauma patients: Results from a multicenter study
Authors: Laursen Thomas H. , Meyer Martin A.S. , Meyer Anna Sina P. , Gaarder Tina , Naess Paal A. , Stensballe Jakob , Ostrowski Sisse R. , Johansson Pär I.
Published: November 2017

BACKGROUND

Early amplitudes in the viscoelastic hemostatic assays, thrombelastography (TEG) and rotation thromboelastometry (ROTEM), provide fast results, which is critical in the resuscitation of bleeding patients. This study investigated associations between TEG early amplitudes and standard TEG variables in a large multicenter cohort of moderately to severely injured trauma patients admitted at three North European Level I Trauma Centers.

METHODS

Prospective observational study of 404 trauma patients with clinical suspicion of severe injury from London, UK, Copenhagen, Denmark and Oslo, Norway. Biochemistry and clinical data including outcome and TEG parameters were recorded upon arrival. Kaolin TEG, Rapid TEG, and TEG functional fibrinogen curves were extracted, and early amplitudes A5 and A10 (amplitude at 5 and 10 minutes) were registered. Patients were stratified according to international normalized ratio of 1.2 or less or greater than 1.2, as well as transfusion requirements (nontransfused, 1–9 red blood cell units and ≥10 red blood cell units in 12 hours).

RESULTS

In total, 404 patients were included, median Injury Severity Score was 13. There were strong positive correlations between A5/A10 and maximum amplitude in all investigated assays. All TEG values except rTEG maximum amplitude and kTEG maximum amplitude correlated significantly with mortality in transfused patients. Time from initiation of assay to A5 and A10 were lowest for rapid TEG and TEG functional fibrinogen compared with kaolin TEG. Rapid TEG A5 reduced time to result with greater than 50% compared with rapid TEG maximum amplitude.

CONCLUSION

We found strong associations between TEG early amplitudes A5/A10 and maximum amplitude in rapid TEG, kaolin TEG, and TEG functional fibrinogen across trauma patients with coagulopathy and massive transfusion requirements. Introducing the use of early amplitudes can reduce time to diagnosis of coagulopathy and may be used in TEG monitoring of trauma patient. Further randomized controlled trials evaluating the role of TEG in guiding hemostatic resuscitation are warranted.

Level of evidence

Prognostic study, level III.
Ocular Motor Dysfunction Due to Brainstem Disorders
Authors: Lee Seung-Han , Kim Hyo-Jung , Kim Ji-Soo
Published: November 2017

Background:

The brainstem contains numerous structures including afferent and efferent fibers that are involved in generation and control of eye movements.

Evidence Acquisition:

These structures give rise to distinct patterns of abnormal eye movements when damaged. Defining these ocular motor abnormalities allows a topographic diagnosis of a lesion within the brainstem.

Results:

Although diverse patterns of impaired eye movements may be observed in lesions of the brainstem, medullary lesions primarily cause various patterns of nystagmus and impaired vestibular eye movements without obvious ophthalmoplegia. By contrast, pontine ophthalmoplegia is characterized by abnormal eye movements in the horizontal plane, while midbrain lesions typically show vertical ophthalmoplegia in addition to pupillary and eyelid abnormalities.

Conclusions:

Recognition of the patterns and characteristics of abnormal eye movements observed in brainstem lesions is important in understanding the roles of each neural structure and circuit in ocular motor control as well as in localizing the offending lesion.
Spatial Topography of Individual-Specific Cortical Networks Predicts Human Cognition, Personality and Emotion
Authors: Kong Ru , Li Jingwei , Orban Csaba , Sabuncu Mert R , Liu Hesheng , Schaefer Alexander , Sun Nanbo , Zuo Xi-Nian , Holmes Avram J. , Eickhoff Simon B. , Yeo B.T. Thomas
Published: November 2017

Resting-state functional magnetic resonance imaging (rs-fMRI) offers the opportunity to delineate individual-specific brain networks. A major question is whether individual-specific network topography (i.e., location and spatial arrangement) is behaviorally relevant. Here, we propose a multi-session hierarchical Bayesian model (MS-HBM) for estimating individual-specific cortical networks and investigate whether individual-specific network topography can predict human behavior. The multiple layers of the MS-HBM explicitly differentiate intra-subject (within-subject) from inter-subject (between-subject) network variability. By ignoring intra-subject variability, previous network mappings might confuse intra-subject variability for inter-subject differences. Compared with other approaches, MS-HBM parcellations generalized better to new rs-fMRI and task-fMRI data from the same subjects. More specifically, MS-HBM parcellations estimated from a single rs-fMRI session (10 minutes) showed comparable generalizability as parcellations estimated by two state-of-the-art methods using five sessions (50 minutes). We also showed that behavioral phenotypes across cognition, personality and emotion could be predicted by individual-specific network topography with modest accuracy, comparable to previous reports predicting phenotypes based on connectivity strength. Network topography estimated by MS-HBM was more effective for behavioral prediction than network size, as well as network topography estimated by other parcellation approaches. Thus, similar to connectivity strength, individual-specific network topography might also serve as a fingerprint of human behavior.
Complementary metrics of human auditory nerve function derived from compound action potentials
Authors: Harris Kelly C. , Vaden Kenneth I. , McClaskey Carolyn M. , Dias James W. , Dubno Judy R.
Published: November 2017

Declines in auditory nerve (AN) function contribute to suprathreshold auditory processing and communication deficits in individuals with normal hearing, hearing loss, hyperacusis, and tinnitus. Procedures to characterize AN loss or dysfunction in humans are limited. We report several novel complementary metrics to characterize AN function noninvasively in humans using the compound action potential (CAP), a direct measure of summated AN activity. We examined how these metrics change with stimulus intensity, and interpreted these changes within a framework of known physiological properties of the basilar membrane and AN. Our results reveal how neural synchrony and the recruitment of AN fibers with later first-spike latencies likely contribute to the CAP, affect auditory processing, and differ with noise exposure history in younger adults despite normal pure-tone thresholds. Moving forward, these new metrics, when applied to patient populations, can provide a means to characterize cochlear synaptopathy and other deficits in AN function in humans.

New and noteworthy

Loss or inactivity of auditory nerve (AN) fibers is thought to contribute to suprathreshold auditory processing deficits, but evidence-based methods to assess these effects are not available. We describe several novel metrics that may be used to quantify neural synchrony and characterize AN function.
The latent geometry of the human protein interaction network
Authors: Alanis-Lobato Gregorio , Mier Pablo , Andrade-Navarro Miguel A.
Published: November 2017

To mine valuable information from the complex architecture of the human protein interaction network (hPIN), we require models able to describe its growth and dynamics accurately. Here, we present evidence that uncovering the latent geometry of the hPIN can ease challenging problems in systems biology. We embedded the hPIN to hyperbolic space, whose geometric properties reflect the characteristic scale invariance and strong clustering of the network. Interestingly, the inferred hyperbolic coordinates of nodes capture biologically relevant features, like protein age, function and cellular localisation. We also realised that the shorter the distance between two proteins in the embedding space, the higher their connection probability, which resulted in the prediction of plausible protein interactions. Finally, we observed that proteins can efficiently communicate with each other via a greedy routeing process, guided by the latent geometry of the hPIN. When analysed from the appropriate biological context, these efficient communication channels can be used to determine the core members of signal transduction pathways and to study how system perturbations impact their efficiency.
Effects of the veterinary anthelmintic moxidectin on dung beetle survival and ecosystem functioning
Authors: Manning Paul , Lewis Owen T. , Beynon Sarah A.
Published: November 2017

Macrocyclic lactones (MLs) are a class of chemical compounds administered to livestock for parasite control. These compounds are poorly metabolized and are predominately excreted in dung.

When coprophagous insects such as dung beetles (Coleoptera: Scarabaeoidea) are exposed to ML residues, lethal and sublethal effects are often observed. Indirectly this can lead to ML residues impairing ecosystem functions that underpin production. A strategy to reduce these negative effects involves selecting compounds that offer lower risk to non-target invertebrates such as the ML moxidectin.

Considering two dung beetle species with differing sensitivities to agricultural intensification, we asked whether exposure to moxidectin residues influenced survival, reproductive output, and functioning (short- and long-term estimates of dung removal).

When exposed to moxidectin, adults of the sensitive species (Geotrupes spinigerMarsham) experienced a 43% reduction in survival. In contrast, survival of the non-sensitive species (Aphodius rufipesL.) was unaffected. We were unable to determine whether exposure affected reproductive output of either species.

We found little evidence to suggest moxidectin impaired dung removal. We found however, that high densities of a species with relatively low functional importance (A. rufipes) can compensate for the loss of a functionally dominant species (G. spiniger). Over a longer timeframe, earthworms fully decomposed dung irrespective of moxidectin residues.
The Improvement of TSP Fertilizer Production & Quality
Authors: Chaouqi N. , Gharous M. El , Bouzziri M.
Published: November 2017

Results obtained showed that some essential manufacturing factors needs to be respected throughout the production loop. These factors will help obtaining a slurry exits with the desired chemical characteristics of P2O5SE (33%), Al (10%), P2O5SE + Citrate (34.5%), H2O (22%), P2O5total (39%)). It is necessary to keep a temperature within 100 ± 5 ° C., with a vapor pressure of 6 to 7 bars, an average density of H3PO4 (1470 g/l) and the solid rate in the feed acid less than 2%. After the reaction phase, the slurry is conveyed to the granulator where it is mixed with the recycled product at a recycling rate (RT) close to 3 and a K ratio between 0.1 and 0.2. This parameter is very important to be monitored to ensure a Good penetration of heat into the next phase in a relatively short time. During the drying process, the product humidity at the outlet must be in the range of 3.5% to 5% to allow the reaction to continue during the developing period. At the exit of the drying tube, the product is in very variable grains diameter (D), the objective of the following step is to extract the grain size range between 2 and 4 mm. To do so we changed the mesh size of the lower webs to 3/50 and 3.2 / 30 mm, which reduces the quantity of particle size less than 2%. Thus, the particles of diameter more than 3.15 mm must be continuously controlled to reach 64%. This portion will ensure conformity of the product for D50 and for the two intervals [2-3.15 mm] and [3.15-4 mm]. In the Storage Hall the reaction continues, the unconverted phosphate will be attacked by the unreacted H3PO4, and according to a monitoring of the evolution of the chemical composition of the final product (TSP). The required ripening time is limited to 21 days. During this study, we were able to identify and modify a number of parameters in different production phases to improve the quality of TSP according to AFCOME, knowing that each phase of the process is a client of the previous phase and supplier of the next one.
Evidence that PV+ cells enhance temporal population codes but not stimulus-related timing in auditory cortex
Authors: Krause Bryan M. , Murphy Caitlin A. , Uhlrich Daniel J. , Banks Matthew I.
Published: November 2017

Spatio-temporal cortical activity patterns relative to both peripheral input and local network activity carry information about stimulus identity and context. GABAergic interneurons are reported to regulate spiking at millisecond precision in response to sensory stimulation and during gamma oscillations; their role in regulating spike timing during induced network bursts is unclear. We investigated this issue in murine auditory thalamo-cortical (TC) brain slices, in which TC afferents induced network bursts similar to previous reports in vivo. Spike timing relative to TC afferent stimulation during bursts was poor in pyramidal cells and SOM+ interneurons. It was more precise in PV+ interneurons, consistent with their reported contribution to spiking precision in pyramidal cells. Optogenetic suppression of PV+ cells unexpectedly improved afferent-locked spike timing in pyramidal cells. In contrast, our evidence suggests that PV+ cells do regulate the spatio-temporal spike pattern of pyramidal cells during network bursts, whose organization is suited to ensemble coding of stimulus information. Simulations showed that suppressing PV+ cells reduces the capacity of pyramidal cell networks to produce discriminable spike patterns. By dissociating temporal precision with respect to a stimulus versus internal cortical activity, we identified a novel role for GABAergic cells in regulating information processing in cortical networks.
Continuum Approximation of Invasion Probabilities
Authors: Borchering Rebecca K. , McKinley Scott A.
Published: November 2017

In the last decade there has been growing criticism of the use of Stochastic Differential Equations (SDEs) to approximate discrete state-space, continuous-time Markov chain population models. In particular, several authors have demonstrated the failure of Diffusion Approximation, as it is often called, to approximate expected extinction times for populations that start in a quasi-stationary state.

In this work we investigate a related, but distinct, population dynamics property for which Diffusion Approximation fails: invasion probabilities. We consider the situation in which a few individual are introduced into a population and ask whether their collective lineage can successfully invade. Because the population count is so small during the critical period of success or failure, the process is intrinsically stochastic and discrete. In addition to demonstrating how and why the Diffusion Approximation fails in the large population limit, we contrast this analysis with that of a sometimes more successful alternative WKB-like approach. Through numerical investigations, we also study how these approximations perform in an important intermediate regime. In a surprise, we find that there are times when the Diffusion Approximation performs well: particularly when parameters are near-critical and the population size is small to intermediate.
Generalized skew-symmetric interfacial probability distribution in reflectivity and small-angle scattering analysis
Authors: Jiang Zhang , Chen Wei
Published: November 2017

Generalized skew-symmetric probability density functions are proposed to model asymmetric interfacial density distributions for the parameterization of any arbitrary density profiles in the `effective-density model'. The penetration of the densities into adjacent layers can be selectively controlled and parameterized. A continuous density profile is generated and discretized into many independent slices of very thin thickness with constant density values and sharp interfaces. The discretized profile can be used to calculate reflectivities via Parratt's recursive formula, or small-angle scattering via the concentric onion model that is also developed in this work.
ECCI, EBSD and EPSC characterization of rhombohedral twinning in polycrystalline α-alumina deformed in a D-DIA apparatus
Authors: Kaboli Shirin , Burnley Pamela C.
Published: November 2017

Rhombohedral twinning in alumina (aluminium oxide, α-Al2O3) is an important mechanism for plastic deformation under high-temperature–pressure conditions. Rhombohedral twins in a polycrystalline alumina sample deformed in a D-DIA apparatus at 965 K and 4.48 GPa have been characterized. Three classes of grains were imaged, containing single, double and mosaic twins, using electron channeling contrast imaging (ECCI) in a field emission scanning electron microscope. These twinned grains were analyzed using electron backscatter diffraction (EBSD). The methodology for twin identification presented here is based on comparison of theoretical pole figures for a rhombohedral twin with experimental pole figures obtained with EBSD crystal orientation mapping. An 85°〈02{\overline 2}1〉 angle–axis pair of misorientation was identified for rhombohedral twin boundaries in alumina, which can be readily used in EBSD post-processing software to identify the twin boundaries in EBSD maps and distinguish the rhombohedral twins from basal twins. Elastic plastic self-consistent (EPSC) modeling was then used to model the synchrotron X-ray diffraction data from the D-DIA experiments utilizing the rhombohedral twinning law. From these EPSC models, a critical resolved shear stress of 0.25 GPa was obtained for rhombohedral twinning under the above experimental conditions, which is internally consistent with the value estimated from the applied load and Schmid factors determined by EBSD analysis.
Crystal structure and Hirshfeld surface analysis of (2E,2′E)-3,3′-(1,4-phenylene)bis[1-(2,4-difluorophenyl)prop-2-en-1-one]
Authors: Kwong Huey Chong , Sim Aijia , Chidan Kumar C. S. , Then Li Yee , Win Yip-Foo , Quah Ching Kheng , Naveen S. , Warad Ismail
Published: November 2017

The asymmetric unit of the title compound, C24H14F4O2, comprises of one and a half molecules; the half-molecule is completed by crystallographic inversion symmetry. In the crystal, molecules are linked into a three-dimensional network by C—H...F and C—H...O hydrogen bonds. Some of the C—H...F links are unusually short (< 2.20 Å). Hirshfeld surface analyses (dnormsurfaces and two-dimensional fingerprint plots) for the title compound are presented and discussed.
Crystal structure of (1S,2R)-2-hydroxy-1,2-diphenylethan-1-aminium (S)-2-azaniumylbutanedioate monohydrate
Authors: Fujii Isao
Published: November 2017

The title diastereomeric salt, formed between 2-amino-1,2-diphenylethanol (ADE) and aspartic acid (ASP), C14H16NO+·C4H6NO4−·H2O, crystallizes as a monohydrate. The 1,2-diphenylethyl group in the cation has acisconformation, and the aspartic acid anion is in the zwitterionic form. In the crystal, the ASP anions are linkedviaN—H...O hydrogen bonds to form a 21helix along theb-axis direction. The helices are linked by the ADE cationsviaO—H...O and N—H...O hydrogen bonds, forming layers parallel to thebcplane. There are channels in the layers that are occupied by water molecules, which link to both the anions and cationsviaOwater—H...O and N—H...Owaterhydrogen bonds. There are also C—H...O and C—H...π interactions present within the layers.