bluuebunny/crossref_metadata_2025 huggingface dataset:
Thromboembolic Events After Traumatic Vertebral Fractures
Authors: Samuel Andre M. , Diaz-Collado Pablo J. , Gala Raj J. , Webb Matthew L. , Lukasiewicz Adam M. , Basques Bryce A. , Bohl Daniel D. , Kim Han Jo , Grauer Jonathan N.
Published: March 2018

Study Design.

Retrospective cohort study

Objective.

To determine the rate of venous thromboembolism event (VTE) and risk factors for their occurrence in patients with vertebral fractures.

Summary of Background Data.

Deep vein thrombosis or pulmonary embolism (VTE) events are a significant source of potentially preventable morbidity and mortality in trauma patients. In patients with traumatic vertebral fractures, a common high-energy injury sometimes resulting in spinal cord injury, there is debate about what factors may be associated with such VTEs.

Methods.

All patients with vertebral fractures in the American College of Surgeons National Trauma Data Bank Research Data Set (NTDB RDS) from years 2011 and 2012 were identified. Multivariate logistic regression was used to determine factors associated with the occurrence of VTE while considering patient factors, injury characteristics, and hospital course.

Results.

A total of 190,192 vertebral fractures patients were identified. The overall rate of VTE was 2.5%. In multivariate analysis, longer inpatient length of stay was most associated with increased VTEs with an odds ratio (OR) of up to 96.60 (95% CI: 77.67 – 129.13) for length of stay longer than 28 days (compared to 0 – 3 days). Additional risk factors in order of decreasing odds ratios were older age (OR of up to 1.65 [95% CI: 1.45 – 1.87] for patients age 70 – 79 years [compared to age 18 – 29 years]), complete spinal cord injuries (OR: 1.49 [95% CI: 1.31 – 1.68]), cancer (OR: 1.37 [95% CI: 1.25 – 1.50]), and obesity (OR: 1.32 [95% CI: 1.18 – 1.48]). Multiple associated non-spinal injuries were also associated with increased rates of VTE.

Conclusion.

While the overall rate of VTE is relatively low after vertebral fractures, longer LOS and other defined factors to lesser extents were predisposing factors. By determining patients at greatest risk, protocols to prevent such adverse outcomes can be developed and optimized.

Level of Evidence: 3
Unsupervised Analysis of Transcriptomics in Bacterial Sepsis Across Multiple Datasets Reveals Three Robust Clusters
Authors: Sweeney Timothy E. , Azad Tej D. , Donato Michele , Haynes Winston A. , Perumal Thanneer M. , Henao Ricardo , Bermejo-Martin Jesús F. , Almansa Raquel , Tamayo Eduardo , Howrylak Judith A. , Choi Augustine , Parnell Grant P. , Tang Benjamin , Nichols Marshall , Woods Christopher W. , Ginsburg Geoffrey S. , Kingsmore Stephen F. , Omberg Larsson , Mangravite Lara M. , Wong Hector R. , Tsalik Ephraim L. , Langley Raymond J. , Khatri Purvesh
Published: March 2018

Objectives:

To find and validate generalizable sepsis subtypes using data-driven clustering.

Design:

We used advanced informatics techniques to pool data from 14 bacterial sepsis transcriptomic datasets from eight different countries (n = 700).

Setting:

Retrospective analysis.

Subjects:

Persons admitted to the hospital with bacterial sepsis.

Interventions:

None.

Measurements and Main Results:

A unified clustering analysis across 14 discovery datasets revealed three subtypes, which, based on functional analysis, we termed “Inflammopathic, Adaptive, and Coagulopathic.” We then validated these subtypes in nine independent datasets from five different countries (n = 600). In both discovery and validation data, the Adaptive subtype is associated with a lower clinical severity and lower mortality rate, and the Coagulopathic subtype is associated with higher mortality and clinical coagulopathy. Further, these clusters are statistically associated with clusters derived by others in independent single sepsis cohorts.

Conclusions:

The three sepsis subtypes may represent a unifying framework for understanding the molecular heterogeneity of the sepsis syndrome. Further study could potentially enable a precision medicine approach of matching novel immunomodulatory therapies with septic patients most likely to benefit.
Effects of Yoga on Attention, Impulsivity, and Hyperactivity in Preschool-Aged Children with Attention-Deficit Hyperactivity Disorder Symptoms
Authors: Cohen Samantha C. L. , Harvey Danielle J. , Shields Rebecca H. , Shields Grant S. , Rashedi Roxanne N. , Tancredi Daniel J. , Angkustsiri Kathleen , Hansen Robin L. , Schweitzer Julie B.
Published: March 2018

Objective:

Behavioral therapies are first-line for preschoolers with attention-deficit hyperactivity disorder (ADHD). Studies support yoga for school-aged children with ADHD; this study evaluated yoga in preschoolers on parent- and teacher-rated attention/challenging behaviors, attentional control (Kinder Test of Attentional Performance [KiTAP]), and heart rate variability (HRV).

Methods:

This randomized waitlist-controlled trial tested a 6-week yoga intervention in preschoolers with ≥4 ADHD symptoms on the ADHD Rating Scale-IV Preschool Version. Group 1 (n = 12) practiced yoga first; Group 2 (n = 11) practiced yoga second. We collected data at 4 time points: baseline, T1 (6 weeks), T2 (12 weeks), and follow-up (3 months after T2).

Results:

At baseline, there were no significant differences between groups. At T1, Group 1 had faster reaction times on the KiTAP go/no-go task (p= 0.01, 95% confidence interval [CI], −371.1 to −59.1,d= −1.7), fewer distractibility errors of omission (p= 0.009, 95% CI, −14.2 to −2.3,d= −1.5), and more commission errors (p= 0.02, 95% CI, 1.4–14.8,d= 1.3) than Group 2. Children in Group 1 with more severe symptoms at baseline showed improvement at T1 versus control on parent-rated Strengths and Difficulties Questionnaire hyperactivity-inattention (β = −2.1,p= 0.04, 95% CI, −4.0 to −0.1) and inattention on the ADHD Rating Scale (β = −4.4,p= 0.02, 95% CI, −7.9 to −0.9). HRV measures did not differ between groups.

Conclusion:

Yoga was associated with modest improvements on an objective measure of attention (KiTAP) and selective improvements on parent ratings.
Media Exposure in Low-Income Preschool-Aged Children Is Associated with Multiple Measures of Self-Regulatory Behavior
Authors: Munzer Tiffany G. , Miller Alison L. , Peterson Karen E. , Brophy-Herb Holly E. , Horodynski Mildred A. , Contreras Dawn , Sturza Julie , Lumeng Julie C. , Radesky Jenny
Published: March 2018

Objective:

Excessive screen media exposure in childhood is associated with parent-reported self-regulation difficulties. No studies have used laboratory-based or teacher-reported measures of child self-regulatory behaviors. This study examines cross-sectional associations between preschooler screen media exposure and multiple measures of self-regulatory behaviors.

Methods:

Preintervention data were used from 541 preschoolers in the Growing Healthy study, an obesity prevention trial (2011–2015). Screen media exposure was measured by daily screen media exposure (hr/d), television (TV) in the bedroom, frequency of background TV, and TV with meals (1 = rarely/never, 4 = frequently). Child self-regulatory behaviors were measured by the following: child ability to delay gratification, a standardized waiting paradigm; teacher-reported Social Competence and Behavior Evaluation; and parent-reported difficult temperament on the Child Behavior Questionnaire (CBQ). Multivariate regression analyses modeled screen media exposure predicting each self-regulatory measure, adjusting for child age, sex, parent age, education, marital status, income-to-needs ratio, number of adults in household, parent depressive symptoms, and sensitivity.

Results:

Children were aged 4.1 years (SD = 0.5), parents were aged 29.6 years (SD = 6.8), 48% had high school education or less, and 67% were married. Daily screen media exposure and background TV were associated with weaker observed self-regulation (β: −10.30 seconds for each hr/d media, −12.63 seconds for 1-point increase, respectively). Background TV and TV with meals were associated with greater parent-reported difficult temperament (β: 0.04 and 0.05 CBQ, respectively, for 1-point increase).

Conclusion:

Greater screen media exposure had small but significant associations with weaker observed and parent-reported, but not teacher-reported, self-regulatory behaviors. Longitudinal studies are needed to determine the directionality of associations.
Assaults on Days of Campaign Rallies During the 2016 US Presidential Election
Authors: Morrison Christopher N. , Ukert Benjamin , Palumbo Aimee , Dong Beidi , Jacoby Sara F. , Wiebe Douglas J.
Published: March 2018

Background:

This study investigates whether assault frequency increased on days and in cities where candidates Donald Trump and Hillary Clinton held campaign rallies prior to the 2016 US Presidential election.

Methods:

We calculated city-level counts of police-reported assaults for 31 rallies for Donald Trump and 38 rallies for Hillary Clinton. Negative binomial models estimated the assault incidence on rally days (day 0) relative to that on eight control days for the same city (days -28, -21, -14, -7, +7, +14, +21, and +28).

Results:

Cities experienced an increase in assaults (incidence rate ratio [IRR] = 1.12, 95% CI: 1.03–1.22) on the days of Donald Trump’s rallies, and no change in assaults on the days of Hillary Clinton’s rallies (IRR = 1.00; 95% CI: 0.94–1.06).

Conclusion:

Assaults increased on days when cities hosted Donald Trump’s rallies during the 2016 Presidential election campaign.
Challenges in the assessment of adverse drug reactions in children and neonates
Authors: Bracken Louise , Nunn Anthony , Peak Matthew , Turner Mark
Published: March 2018

Adverse drug reactions (ADRs) are common in children and it is often difficult to distinguish ADRs from other underlying conditions. Children range from preterm neonates to adolescents with changing patterns of disease, pharmacokinetics and pharmacodynamics. The continuous development during childhood presents a challenge to developing, prescribing and administering age-appropriate medicines. Paediatric ADRs can be difficult to characterize. There is a lack of agreed definitions, which are needed so that data on ADRs can be consistently reported and reliably interpreted. Many of the adult tools to assess causality and avoidability are difficult to apply in paediatrics. Paediatric ADRs are under-reported in spontaneous reporting systems, and there is little research. Steps addressing the challenges include the Liverpool causality and avoidability assessment tools, improved definitions and more paediatric drug research following the introduction of Paediatric Regulation in 2007, requirement for risk assessment and after marketing surveillance. Advances in assessing susceptibility through pharmacogenomics offer hope of avoiding ADRs.
Tryptophan catabolites along the indoleamine 2,3-dioxygenase pathway as a biological link between depression and cancer
Authors: Barreto Francisco S. , Chaves Filho Adriano J.M. , de Araújo Márcia C.C.R. , de Moraes Manoel O. , de Moraes Maria E.A. , Maes Michael , de Lucena David F. , Macedo Danielle S.
Published: March 2018

Both depression and cancer are related to a dysregulation of inflammatory and immune pathways. Indeed, depression is associated with increased expression of interferon-γ, interleukin-1β, and tumor necrosis factor α (TNF-α). In contrast, reductions of the activity of major histocompatibility complex protein molecules – class I and class II and natural killer cells are also observed. Similarly, cancers present elevated levels of TNF-α, reduced major histocompatibility complex class I and II, and natural killer cells. Indoleamine 2,3-dioxygenase (IDO), the rate-limiting enzyme of the tryptophan catabolite (TRYCAT) pathway, is induced by interferon-γ, interleukin-6, TNF-α, and oxidative stress. IDO catabolizes tryptophan, the amino acid precursor of serotonin and melatonin, to the metabolites collectively called TRYCATs. TRYCAT pathway activation is accompanied by downregulation of immune cell proliferation, function, and survival. The increase in IDO activity in tumor microenvironments is related to tumor cell escape from immune surveillance. Despite the evidence of inflammatory mechanisms underlying cancer and depression, it is important to emphasize that both diseases are heterogeneous and, as such, inflammatory mechanisms may not be relevant to all patients. Thus, the purpose of this review is to examine whether detrimental TRYCATs – synthesis of which increases in depression and cancer – are a pathophysiological link between the two diseases, and whether IDO is a potential pharmacological target for the treatment of the comorbid depression and cancer.
Painful neurotrophins and their role in visceral pain
Authors: López-Pérez Ana E. , Nurgali Kulmira , Abalo Raquel
Published: March 2018

Beyond their well-known role in embryonic development of the central and peripheral nervous system, neurotrophins, particularly nerve growth factor and brain-derived neurotrophic factor, exert an essential role in pain production and sensitization. This has mainly been studied within the framework of somatic pain, and even antibodies (tanezumab and fasinumab) have recently been developed for their use in chronic somatic painful conditions, such as osteoarthritis or low back pain. However, data suggest that neurotrophins also exert an important role in the occurrence of visceral pain and visceral sensitization. Visceral pain is a distressing symptom that prompts many consultations and is typically encountered in both ‘organic’ (generally inflammatory) and ‘functional’ (displaying no obvious structural changes in routine clinical evaluations) disorders of the gut, such as inflammatory bowel disease and irritable bowel syndrome, respectively. The present review provides a summary of neurotrophins as a molecular family and their role in pain in general and addresses recent investigations of the involvement of nerve growth factor and brain-derived neurotrophic factor in visceral pain, particularly that associated with inflammatory bowel disease and irritable bowel syndrome.
Early signs of colonic inflammation, intestinal dysfunction, and olfactory impairments in the rotenone-induced mouse model of Parkinson’s disease
Authors: Morais Lívia H. , Hara Daniela B. , Bicca Maíra A. , Poli Anicleto , Takahashi Reinaldo N.
Published: March 2018

The factors that trigger the pathophysiology of Parkinson’s disease (PD) are unknown. However, it is suggested that environmental factors, such as exposure to pesticides, play an important role, in addition to genetic predisposition and aging. Early signs of PD can appear in the gastrointestinal (GI) tract and in the olfactory system, preceding the onset of motor impairments by many years. The present study assessed the effects of oral rotenone administration (30 mg/kg) in inducing GI and olfactory dysfunctions associated with PD in mice. Here we show that rotenone transiently increased myeloperoxidase activity within 24 h of administration. Leucocyte infiltration in the colon, associated with histological damage and disrupted GI motility, were observed following treatment with rotenone for 7 days. Moreover, 7 days of treatment with rotenone disrupted olfactory discrimination in mice without affecting social recognition ability. The presence of specific deficits in olfactory function occurred with a concomitant decrease in tyrosine hydroxylase-positive neurons and an increase in serotonin (5-hydroxytryptamine) turnover in the olfactory bulb. These findings suggest that in Swiss mice, exposure to rotenone induces GI and olfactory dysfunction involving immunological and neurotransmitter alterations, similar to early signs of PD. This provides further evidence for the involvement of the gut–brain axis in PD.
Pedicled Descending Branch Latissimus Dorsi Mini-flap for Repairing Partial Mastectomy Defect: A New Technique
Authors: Cai Ruizhao , Xie Zeming , Zhou Lihuan , Wang Jin , Li Xing , Huang Junhao , Wang Yan , Yang Mingtian , Chang Edward I. , Tang Jun
Published: March 2018

Volume loss is 1 of the major factors influencing cosmetic outcomes of breast after partial mastectomy (PM), especially for smaller breasts, and therefore, volume replacement is critical for optimizing the final aesthetic outcome. We present a novel technique of raising a pedicled descending branch latissimus dorsi (LD) mini-flap for reconstruction of PM defects via an axillary incision. After PM, the LD mini-flap is harvested through the existing axillary incision of the axillary dissection or the sentinel lymph node biopsy. The descending branches of thoracodorsal vessels and nerve are carefully identified and isolated. The transverse branches are protected to maintain muscle innervation and function. The LD muscle is then undermined posteriorly and inferiorly to create a submuscular pocket and a subcutaneous pocket between LD muscle and superficial fascia. Once the submuscular plane is created, the muscle is divided along the muscle fibers from the deep surface including a layer of fat above the muscle. Finally, the LD mini-flap is transferred to the breast defect. Given the limited length and mobility of the LD mini-flap, this approach is best utilized for lateral breast defects. However, for medial defects, the lateral breast tissue is rearranged to reconstruct the medial breast defect, and an LD mini-flap is then used to reconstruct the lateral breast donor site. This technique can therefore be employed to reconstruct all quadrants of the breast and can provide aesthetic outcomes without scars on the back, with minimal dysfunction of LD muscle.
Perineal Reconstruction with a Diamond-shaped Perforator Flap: A Case Report
Authors: Deskoulidi Parthena I. , Diamantopoulos Pantelis K. , Maltzaris Nikolaos A. , Kotrotsiou Maria D. , Benetatos Konstantinos M. , Stavrianos Spiros D.
Published: March 2018

Reconstruction of perineal defects is a challenging procedure. Various surgical techniques have been proposed. Compared with traditional myocutaneous flaps, pedicled perforator flaps are believed to be a less invasive option for perineal reconstruction, with better functional and cosmetic results. We present the case of a 47-year-old woman with a perianal Paget’s disease who underwent surgical excision of the lesion. The reconstructive technique was a pedicled flap based on an internal pudendal skin perforator artery. The flap was designed in a diamond-shaped pattern. Six months after the operation, the patient is disease-free with successful aesthetic and functional results. A polygonal diamond-shaped flap is an easy and reliable choice for perineal reconstruction, offering better adjustment in the perianal region and avoidance of the curvilinear perianal incision (which often leads to anal stenosis).
Use of the Masquerade Flap in Ablepharon–Macrostomia Syndrome: A Case Report
Authors: Hollanders Karolien , Casteels Ingele , Vandelanotte Sylvie , Reyniers Rudolf , Segers Katarina , Nevens Thomas , Mombaerts Ilse
Published: March 2018

Purpose:

To report a case of ablepharon–macrostomia syndrome and surgical treatment options.

Methods:

Case report and literature review.

Results:

A prematurely born male baby presented with severe ablepharon, hypertelorism, macrostomia, low-set dysplastic ears, broad nasal bridge, coarse and redundant body skin, absent scalp and body hair, lax abdominal wall, absent nipples, camptodactyly, and ambiguous genitalia. Despite intensive ocular lubrication, severe exposure keratopathy developed within the first days after birth. The eyes were closed using masquerade flaps for 6 weeks. In a secondary procedure at the adjusted age of 3 weeks, the flaps were partially divided, and visual input and development were successfully achieved, while maintaining corneal protection.

Conclusions:

We present a rare case of a prematurely born infant with a severe phenotype of ablepharon–macrostomia syndrome, surgically treated with masquerade flaps to preserve corneal health and allow bilateral visual input.
Automated Detection and Classification of Corneal Haze Using Optical Coherence Tomography in Patients With Keratoconus After Cross-Linking
Authors: Dhaini Ahmad R. , Abdul Fattah Maamoun , El-Oud Sara Maria , Awwad Shady T.
Published: March 2018

Purpose:

To evaluate a proposed technology for offering objective grading and mapping of corneal haze as detected by corneal spectral domain optical coherence tomography after corneal cross-linking.

Methods:

This was a retrospective study to evaluate corneal optical coherence tomography images performed on 44 eyes of 44 patients who underwent corneal cross-linking between January 2014 and May 2015, at the American University of Beirut Medical Center.

Results:

Overall average brightness of the cornea was markedly increased from 43.4% (±6.0) at baseline to 50.2% (±4.4) at 1 month, 47.9% (±4.4) at 3 months, and 46.4% (±5.7) at 6 months with P <0.001, <0.001, and 0.005, respectively. In the anterior stroma, the average brightness significantly increased at 1, 3, and 6 months with values of 54.8% (±3.9), 52.5% (±5.2), and 49.7% (±6.9) with P <0.001, <0.001, and 0.003, respectively. In the mid stroma, the change was clinically significant at 1 and 3 months, whereas in the posterior stroma, it was only significant at 1 month compared with baseline (P = 0.003). Overall, haze was mostly present at 1 month after surgery in all regions, especially in the anterior (32.1%; ±19.2) and mid stromal regions (9.1%; ±18.8), P <0.001 and 0.001, respectively. In contrast, haze in the posterior stromal region peaks at 3 and 6 months after surgery.

Conclusions:

Anterior stromal haze was the greatest in intensity and area and it was present for a longer time span than mid and posterior stromal haze. At 12 months, the anterior stroma had still more haze intensity than preoperatively. This image-based software can provide objective and valuable quantitative measurements of corneal haze, which may impact clinical decision-making after different corneal surgeries.
Bivalirudin Dosing Requirements in Adult Patients on Extracorporeal Life Support With or Without Continuous Renal Replacement Therapy
Authors: Walker Elizabeth A. , Roberts A. Joshua , Louie Erin L. , Dager William E.
Published: March 2018

Systemic anticoagulation with unfractionated heparin is standard of care for patients receiving extracorporeal life support (ECLS); however, an alternative anticoagulant may be necessary when challenges with heparin therapy arise. Evidence for alternative anticoagulation in ECLS patients is limited. This retrospective analysis evaluated the dosing and outcomes associated with bivalirudin use in 14 adult ECLS patients. Indications for bivalirudin included heparin-induced thrombocytopenia, heparin resistance, or persistent clotting or bleeding while on heparin. The median initial bivalirudin dose to achieve target activated partial thromboplastin time was 0.15 mg/kg/h (range 0.04–0.26 mg/kg/h). Dosing requirements increased by 75–125% when renal replacement was included. Median time on bivalirudin was 5.2 days (range 0.9–28 days). Five patients (36%) required a circuit change while on bivalirudin because of clotting or failing oxygenation, and four (28.6%) had bleeding significant enough to require either reduction in activated partial thromboplastin time goals or temporary holding of anticoagulation. Bivalirudin appears to be a potential option for adult patients on ECLS who are unable to receive or fail heparin therapy; however, the wide variation in dosing suggests the need for careful management.
Ingestion of Fireworks
Authors: Yüksekkaya Hasan , Gumus Meltem , Yucel Aylin , Energin Meltem , Demirci Serafettin
Published: March 2018

Background

Mistaken ingestion of all manner of toxic matter is common in childhood, but poisoning with fireworks and matchsticks is rare. Fireworks usually contain 10% yellow phosphorus and 50% potassium chlorate. Potassium chlorate is an extremely reactive and toxic agent that is used in fireworks and matchstick heads.

Methods

Eleven cases (7 females and 5 males; median age, 36 months [ranging from 24 to 48 months]) of poisoning after ingestion of fireworks and matchstick(s), between February 2008 and June 2014, were reviewed.

Results

The most common initial symptom was vomiting except for 2 cases in this group. Biochemical tests indicated that hyperphosphatemia was present in all patients, 8 patients (72.7%) had subclinical hepatic injury, 1 (9%) had acute hepatic failure, and 2 patients had no clinical or biochemical evidence of hepatic damage. Three patients had renal impairment, but none of them required dialysis. All of the patients recovered with supportive therapy except for 2 cases. One patient underwent cadaveric liver transplantation, whereas the other died because of circulatory dysfunction and respiratory failure due to pulmonary alveolar hemorrhage.

Conclusions

Without prompt intervention, poisoning with fireworks carries high morbidity and mortality in children. It can cause pulmonary hemorrhage, in addition to other organ damage, including liver and kidney. Hyperphosphatemia is common, as it was seen in all of the study patients.
Erythema Ab Igne in an Adolescent With Chronic Pain
Authors: Gmuca Sabrina , Yu JiaDe , Weiss Pamela F. , Treat James R. , Sherry David D.
Published: March 2018

Erythema ab igne (EAI) is a cutaneous finding caused by prolonged heat exposure and is characterized by a reticular, brownish-pigmented, often telangiectatic dermatosis. The eruption is reminiscent of livedo reticularis, which is typically seen in the setting of a number of rheumatologic conditions, most prominently vasculitis. Identification of key features distinguishing EAI from livedo reticularis can aid in the diagnosis of EAI and correct elucidation of the underlying etiology. Our patient presented with heating pad–induced EAI in the setting of chronic pain. Only 6 other pediatric cases of EAI associated with heat sources for chronic pain are reported (Acta Derm Venereol. 2014;94:365–367, J Pediatr. 2013;163:1789, Int J Eat Disord. 2013;46:381–383, Arch Dis Child. 2008;93:389, Arch Pediatr Adolesc Med. 2012;166:185–186, Br J Clin Pract. 1990;44:248–251). Our case highlights the need for awareness of this pathognomonic skin eruption in children with chronic pain conditions to help avoid an extensive workup for vasculitis.
Improving Patient Safety in Public Hospitals: Developing Standard Measures to Track Medical Errors and Process Breakdowns
Authors: Ackerman Sara L. , Gourley Gato , Le Gem , Williams Pamela , Yazdany Jinoos , Sarkar Urmimala
Published: March 2018

Objective

The aim of the study was to develop standards for tracking patient safety gaps in ambulatory care in safety net health systems.

Methods

Leaders from five California safety net health systems were invited to participate in a modified Delphi process sponsored by the Safety Promotion Action Research and Knowledge Network (SPARKNet) and the California Safety Net Institute in 2016. During each of the three Delphi rounds, the feasibility and validity of 13 proposed patient safety measures were discussed and prioritized. Surveys and transcripts from the meetings were analyzed to understand the decision-making process.

Results

The Delphi process included eight panelists. Consensus was reached to adopt 9 of 13 proposed measures. All 9 measures were unanimously considered valid, but concern was expressed about the feasibility of implementing several of the measures.

Conclusions

Although safety net health systems face high barriers to standardized measurement, our study demonstrates that consensus can be reached on acceptable and feasible methods for tracking patient safety gaps in safety net health systems. If accompanied by the active participation key stakeholder groups, including patients, clinicians, staff, data system professionals, and health system leaders, the consensus measures reported here represent one step toward improving ambulatory patient safety in safety net health systems.
Carotid Intima-Media Thickness and Lipid Profile in Children With Kawasaki Disease
Authors: Gopalan Kavitha , Singh Surjit , Vignesh Pandiarajan , Gupta Anju , Rohit Manojkumar , Attri Savita Verma
Published: March 2018

Background

Kawasaki disease (KD) has a predilection to involve coronary arteries, leading to several long-term cardiovascular sequelae. Apart from coronary artery abnormalities, children with KD are also prone to develop premature atherosclerosis, endothelial dysfunction, and lipid abnormalities. Some of these complications may occur even in children who have received appropriate treatment with intravenous immunoglobulin in the acute phase.

Methods

In 2009, we had studied carotid intima-media thickness (cIMT) and lipid profile in 27 children with KD at least 1 year after the acute episode. In the present study, we have followed up the same cohort of 27 children at least 5 years after the acute episode of KD. We measured the cIMT, a surrogate marker for premature atherosclerosis, and fasting lipid profile in the cohort and compared the results with values obtained in our previous study.

Results

There was significantly higher mean cIMT in children with KD as compared with control subjects. However, there was no significant difference in cIMT among children in the cohort at 1 and 5 years of follow-up. Abnormal lipid profile was seen in 7 of 27 children in the present study, 5 of whom also had had lipid abnormality at 1-year follow-up. This suggests that lipid abnormalities in KD may be long lasting.

Conclusions

Children with KD need careful long-term follow-up even when they do not have overt and persistent coronary artery abnormalities. It is possible that consequences of KD in childhood may impact health status of young adults several years later.
Duodenum Cryptococcosis Mimicking Primary Duodenum Cancer on PET/CT Imaging
Authors: Xiu Yan , Zhang Jie , Shi Hongcheng
Published: March 2018

A 73-year-old man presented with fatigue and anorexia and underwent FDG PET/CT scan to evaluate a right lung nodule revealed by a chest CT. The FDG PET/CT not only showed that the lung nodule was hypermetabolic but also revealed that there was significantly increased activity in the region of the duodenum. The findings were suspected as primary duodenal malignancy with metastases. However, an upper gastrointestinal tract endoscopic examination with further culture led to a diagnosis of duodenal cryptococcosis.
False-Positive Results in 18F-Fluorocholine PET/CT for a Thymoma in Workup of a Hereditary Primary Hyperparathyroidism
Authors: Bricaire Léopoldine , Richard Capucine , Gauthé Mathieu , Cochand-Priollet Béatrix , Gaujoux Sébastien
Published: March 2018

We present the case of a severe familial primary hyperparathyroidism related to a germline deletion in the HRPT2 (CDC73) gene. Morphological explorations revealed 2 potential hyperfunctioning parathyroid glands: a left cervical lesion on the neck ultrasound, and an ectopic mediastinal lesion on the parathyroid scintigraphy using 99mTc-methoxyisobutylisonitrile and on 18F-fluorocholine PET/CT. Surgery removal and histopathological examination determined that the mediastinal mass corresponded to a thymoma and the cervical lesion to a parathyroid adenoma. Those interesting images illustrate that a thymoma can produce false-positive results both on 99mTc-methoxyisobutylisonitrile scintigraphy and 18F-fluorocholine PET/CT.
Cutaneous Manifestation of Sarcoidosis in Lower-Back Tattoo With Increased Uptake of 18F-FDG
Authors: Grosse Jirka , Menhart Karin , Schmidbauer Benedikt , Hellwig Dirk
Published: March 2018

Sarcoidosis, a granulomatous T-cell–mediated multisystem disease with a yearly incidence of 10.9 to 35.5 cases per 100,000 in the United States, affects a variety of organ systems. Although the characteristic radiological finding of a bihilar lymphadenopathy still plays a diagnostic key role, FDG PET/CT is more sensitive in detecting and monitoring various manifestations. We present a rare case of a 37-year-old woman with bihilar, mediastinal, and abdominal lymphadenopathy in conjunction with a histologically proven cutaneous manifestation of sarcoidosis in a tattoo of the lower back exhibiting an increased uptake of FDG.
Lumbar Osteophyte Avid on 68Ga–Prostate-Specific Membrane Antigen PET/CT
Authors: Jochumsen Mads Ryø , Madsen Michael Alle , Gammelgaard Lise , Bouchelouche Kirsten
Published: March 2018

A 75-year-old man with recently diagnosed high-risk prostate cancer was referred for primary staging with 68Ga–prostate-specific membrane antigen (PSMA) PET/CT. The scan revealed intense 68Ga-PSMA uptake in a lumbar osteophyte on the right side of level L2/L3, whereas several other spinal osteophytes showed no 68Ga-PSMA uptake. MRI findings in the L3 vertebra was consistent with a benign Modic type 1 lesion, but MRI showed no signs of malignancy in the osteophyte with high 68Ga-PMSA uptake. This case presents an osteophyte as an addition to the list of potential benign pitfalls to be aware of when interpreting 68Ga-PSMA PET/CT.
RESHAPES: Increasing AAST EGS grade is associated with anastomosis type
Authors: Hernandez Matthew C. , Bruns Brandon R. , Haddad Nadeem N. , Lauerman Margaret , Morris David S. , Arnold Kristen , Phelan Herb A. , Turay David , Murry Jason , Oh John S. , Enniss Toby , Carrick Matthew M. , Scalea Thomas M. , Zielinski Martin D.
Published: March 2018

INTRODUCTION

Threatened, perforated, and infarcted bowel is managed with conventional resection and anastomosis (hand sewn [HS] or stapled [ST]). The SHAPES analysis demonstrated equivalence between HS and ST techniques, yet surgeons appeared to prefer HS for the critically ill. We hypothesized that HS is more frequent in patients with higher disease severity as measured by the American Association for the Surgery of Trauma Emergency General Surgery (AAST EGS) grading system.

METHODS

We performed a post hoc analysis of the SHAPES database. Operative reports were submitted by volunteering SHAPES centers. Final AAST grade was compared with various outcomes including duration of stay, physiologic/laboratory data, anastomosis type, anastomosis failure (dehiscence, abscess, or fistula), and mortality.

RESULTS

A total of 391 patients were reviewed, with a mean age (±SD) of 61.2 ± 16.8 years, 47% women. Disease severity distribution was as follows: grade I (n = 0, 0%), grade II (n = 106, 27%), grade III (n = 113, 29%), grade IV (n = 123, 31%), and grade V (n = 49, 13%). Increasing AAST grade was associated with acidosis and hypothermia. There was an association between higher AAST grade and likelihood of HS anastomosis. On regression, factors associated with mortality included development of anastomosis complication and vasopressor use but not increasing AAST EGS grade or anastomotic technique.

CONCLUSION

This is the first study to use standardized anatomic injury grades for patients undergoing urgent/emergent bowel resection in EGS. Higher AAST severity scores are associated with key clinical outcomes in EGS diseases requiring bowel resection and anastomosis. Anastomotic-specific complications were not associated with higher AAST grade; however, mortality was influenced by anastomosis complication and vasopressor use. Future EGS studies should routinely include AAST grading as a method for reliable comparison of injury between groups.

LEVEL OF EVIDENCE

Prognostic, level III.
Tranexamic acid in severe trauma patients managed in a mature trauma care system
Authors: Boutonnet Mathieu , Abback Paer , Le Saché Frédéric , Harrois Anatole , Follin Arnaud , Imbert Nicolas , Cap Andrew P. , Trichereau Julie , Ausset Sylvain
Published: March 2018

BACKGROUND

Tranexamic acid (TXA) use in severe trauma remains controversial notably because of concerns of the applicability of the CRASH-2 study findings in mature trauma systems. The aim of our study was to evaluate the outcomes of TXA administration in severely injured trauma patients managed in a mature trauma care system.

METHODS

We performed a retrospective study of data prospectively collected in the TraumaBase registry (a regional registry collecting the prehospital and hospital data of trauma patients admitted in six Level I trauma centers in Paris Area, France). In hospital mortality was compared between patients having received TXA or not in the early phase of resuscitation among those presenting an unstable hemodynamic state. Propensity score for TXA administration was calculated and results were adjusted for this score. Hemodynamic instability was defined by the need of packed red blood cells (pRBC) transfusion and/or vasopressor administration in the emergency room (ER).

RESULTS

Among patients meeting inclusion criteria (n = 1,476), the propensity score could be calculated in 797, and survival analysis could be achieved in 684 of 797. Four hundred seventy (59%) received TXA, and 327 (41%) did not. The overall hospital mortality rate was 25.7%. There was no effect of TXA use in the whole population but mortality was lowered by the use of TXA in patients requiring pRBC transfusion in the ER (hazard ratio, 0.3; 95% confidence interval, 0.3–0.6).

CONCLUSION

The use of TXA in the management of severely injured trauma patients, in a mature trauma care system, was not associated with reduction in the hospital mortality. An independent association with a better survival was found in a selected population of patients requiring pRBC transfusion in the ER.

LEVEL OF EVIDENCE

Therapeutic study, level III.
Enhanced platelet function in cold stored whole blood supplemented with resveratrol or cytochrome C
Authors: Ekaney Michael L. , Gray Gabrielle Gonzalez , McKillop Iain H. , Evans Susan L.
Published: March 2018

BACKGROUND

Limited availability and use of whole blood (WB) following trauma is driven by perceptions that hemostatic function is limited by platelet dysfunction within 5 days storage. We sought to define the hemostatic function of WB stored at 4°C for up to 25 days, elucidate changes in metabolic parameters and mitochondrial dysfunction in platelets in WB, and the effect of supplementation using resveratrol (Res) or cytochrome c (Cyt c).

METHODS

Whole blood was collected, aliquoted, and stored at 4°C without agitation. Resveratrol or Cyt c was supplemented before storage, or 10 days post-storage. Serial samples were collected and analyzed for hemostatic function by platelet mapping thromboelastography. Platelets isolated from WB were counted and mitochondrial function assessed by oxygen consumption, mitochondrial membrane potential, and biochemical parameters.

RESULTS

Platelet function of WB was maintained up to 15 days at 4°C before a significant decrease was observed at 25 days. Resveratrol or Cyt c improved WB aggregation potential when supplemented 10 days post-storage. Platelet oxygen consumption was maintained until 10-day storage but significantly decreased thereafter in the absence of change in platelet count. Cytochrome c increased oxygen consumption on Day 15 and platelet mitochondrial membrane potential steadily decreased over time, an effect attenuated by Res or Cyt c supplementation 10 days post-storage. Potassium and lactate levels increased during storage, while pH levels decreased, with no observed effect following Res or Cyt c supplementation.

CONCLUSION

Storing cold WB with Res or Cyt c supplementation enhances ex vivo aggregation by improving platelet function, thereby extending overall storage life. These findings have potential significance for improving WB availability in immediate trauma situations, including treatment in a battlefield trauma setting.

LEVEL OF EVIDENCE

Translational study, diagnostic test or criteria, level II.
Attenuation of endothelial phosphatidylserine exposure decreases ischemia-reperfusion induced changes in microvascular permeability
Authors: Strumwasser Aaron , Bhargava Aditi , Victorino Gregory P.
Published: March 2018

BACKGROUND

Translocation of phosphatidylserine from the inner leaflet to the outer leaflet of the endothelial membrane via phospholipid scramblase-1 (PLSCR1) is an apoptotic signal responsible for the loss of endothelial barrier integrity after ischemia-reperfusion injury (IRI). We hypothesized that inhibiting phosphatidylserine expression on endothelial cells would attenuate IRI induced increases in hydraulic permeability (Lp).

METHODS

Mesenteric Lp was measured in rat post-capillary mesenteric venules subjected to IRI via superior mesenteric artery (SMA) occlusion (45 minutes) and release (300 minutes) in conjunction with several inhibitors of phosphatidylserine exposure as follows: (1) inhibition of PLSCR1 translocation (dithioerythritol, n = 3), (2) inhibition of PLSCR1 membrane trafficking (2-bromopalmitate [2-BP], n = 3), and (3) inhibition of ion exchange necessary for PLSCR1 function (4,4′-Diisothiocyano-2,2′-stilbenedisulfonic acid [DIDS], n = 3). Under the same IRI conditions, rats were also administered targeted inhibitors of phosphatidylserine exposure including knockdown of PLSCR1 (n = 3) using RNA interference (RNAi), and as a potential therapeutic tool Diannexin, a selective phosphatidylserine blocker (n = 3).

RESULTS

During IRI net Lp increased by 80% (p < 0.01). Net reductions of Lp were accomplished by 2-BP (46% reduction, p = 0.005), combined DET + 2-BP + DIDS (32% reduction, p = 0.04), RNAi (55% reduction, p = 0.002), Diannexin administered pre-SMA artery occlusion (73% reduction, p = 0.001), and post-SMA occlusion (70% reduction, p = 0.002).

CONCLUSION

Phosphatidylserine exposure is a key event in the pathogenesis of microvascular dysfunction during IRI. Clinically, inhibition of phosphatidylserine exposure is a promising strategy that may 1 day be used to mitigate the effects of IRI.
Preparation of leukoreduced whole blood for transfusion in austere environments; effects of forced filtration, storage agitation, and high temperatures on hemostatic function
Authors: Sivertsen Joar , Braathen Hanne , Lunde Turid Helen F. , Spinella Philip C. , Dorlac Warren , Strandenes Geir , Apelseth Torunn O. , Hervig Tor A. , Kristoffersen Einar K.
Published: March 2018

BACKGROUND

Damage control resuscitation principles advocate the use of blood to treat traumatic hemorrhage. Hemorrhage is a leading cause of preventable death on the battlefield, but making blood components available far forward presents logistical challenges due to shelf life and storage requirements. Whole blood simplifies logistics and enables collection in the field but can cause leukocyte-related transfusion reactions. A field-adapted leukoreduction system must be fast and safe, and storage of whole blood should preserve hemostatic function.

METHODS

Blood was collected using Imuflex WB-SP and leukoreduced at 0, 150, or 300 mm Hg. Additional bags were stored at 4°C for 21 days unagitated, mixed daily, agitated or head-over-heel rotated, at 22°C for 3 days, or 32°C for 2 hours. Hematology, coagulation, CD62P/CD42b, thromboelastography (TEG)/thromboelastometry (ROTEM), and Multiplate was performed.

RESULTS

Filtration time was 35 ± 1, 14 ± 0, and 9 ± 0 minutes at 0, 150, and 300 mm Hg, respectively. One of 10 units at 150 mm Hg and 4 of 11 at 300 mm Hg had residual whole blood cells greater than 5.0 × 106 per unit. One of 11 at 300 mm Hg had platelet recovery of less than 80%. Hemolysis was less than 0.2%. Filtration decreased thromboelastography/thromboelastometry and Multiplate aggregation response. Stored at 4°C, α and MA/MCF moderately decreased regardless of mixing. Significant loss of aggregation response and increased CD62P expression was seen by Day 10. By Day 3, storage at 22°C caused loss of most aggregation. Two-hour storage at 32°C did not significantly affect hemostatic capacity.

CONCLUSION

Forced filtration reduced leukoreduction time, but increased residual whole blood cells reduced hemostatic function. Aggregation response deteriorated early in storage, while viscoelastic assays decreased more gradually. Mixing showed no benefits.

LEVEL OF EVIDENCE

Diagnostic study, level IV.
Adaptive introgression: a plant perspective
Authors: Suarez-Gonzalez Adriana , Lexer Christian , Cronk Quentin C. B.
Published: March 2018

Introgression is emerging as an important source of novel genetic variation, alongside standing variation and mutation. It is adaptive when such introgressed alleles are maintained by natural selection. Recently, there has been an explosion in the number of studies on adaptive introgression. In this review, we take a plant perspective centred on four lines of evidence: (i) introgression, (ii) selection, (iii) phenotype and (iv) fitness. While advances in genomics have contributed to our understanding of introgression and porous species boundaries (task 1), and the detection of signatures of selection in introgression (task 2), the investigation of adaptive introgression critically requires links to phenotypic variation and fitness (tasks 3 and 4). We also discuss the conservation implications of adaptive introgression in the face of climate change. Adaptive introgression is particularly important in rapidly changing environments, when standing genetic variation and mutation alone may only offer limited potential for adaptation. We conclude that clarifying the magnitude and fitness effects of introgression with improved statistical techniques, coupled with phenotypic evidence, has great potential for conservation and management efforts.
Alexander Lamb Cullen OBE. 30 April 1920—27 December 2013
Authors: Davies J. Brian
Published: March 2018

Alex Cullen combined the sharpest of scientific minds with a gentle personality and a great sense of humour. He was Professor and Head of the Department of Electrical Engineering at Sheffield from 1955 to 1967, and then Head of the Department of Electrical Engineering at University College London (UCL) until 1980. He continued his research there as a Science and Engineering Research Council Senior Fellow until 1985, and for some years as Research Fellow of UCL. His research concerned electromagnetic waves over a wide range of microwave devices and measurement techniques, the latter at a fundamental level. These contributions were of a highly innovative and ‘ground-breaking’ nature. He was appointed OBE in 1960, and elected Fellow of the Royal Society in 1977. He was an accomplished jazz musician, playing drums and clarinet. He was a signatory of a letter to
The Times
in January 1986, calling on Prime Minister Margaret Thatcher to ‘Save British Science’. This led to the foundation of the Save British Science pressure group, now the Campaign for Science and Engineering (CaSE), which has built up an enviable reputation with politicians and the media in representing the concerns of scientists and engineers. When (now Sir) Eric Ash left UCL in 1985 to become Rector of Imperial College, he remarked that Alex was ‘the last gentleman in the business’.
Anthony Ledwith CBE. 14 August 1933—5 January 2015
Authors: Feast W. J.
Published: March 2018

Tony Ledwith's early work at University of Liverpool is best known for the identification, characterization and use of free carbocations; in particular, demonstrating their advantages in allowing very high rates of vinyl addition and ring opening polymerizations. During a long career in academia and industry, his research predominantly focused on cationic and cation-radical mechanisms, but ranged across many aspects of polymerization mechanisms, properties and the applications of polymeric materials. His interests were always very wide, for example in surface characterization and modification. In his industrial career, his company was one of the very early adopters of scanning probe microscopies. He was an energetic enthusiast and became heavily involved in science politics, to the considerable benefit of the UK community, particularly chemists and polymer chemists.