bluuebunny/crossref_metadata_2025 huggingface dataset:
Mining single-cell time-series datasets with Time Course Inspector
Authors: Dobrzyński Maciej , Jacques Marc-Antoine , Pertz Olivier
Published: November 2019

Thanks to recent advances in live cell imaging of biosensors, microscopy experiments can generate thousands of single-cell time-series. To identify sub-populations with distinct temporal behaviours that correspond to different cell fates, we developed Time Course Inspector (TCI)—a unique tool written in R/Shiny to combine time-series analysis with clustering. With TCI it is convenient to inspect time-series, plot different data views and remove outliers. TCI facilitates interactive exploration of various hierarchical clustering and cluster validation methods. We showcase TCI by analysing a single-cell signalling time-series dataset acquired using a fluorescent biosensor.

Availability and implementation

https://github.com/pertzlab/shiny-timecourse-inspector.

Supplementary information

Supplementary data are available at Bioinformatics online.
MILES: a Java tool to extract node-specific enriched subgraphs in biomolecular networks
Authors: Moris Pieter , Bui-Thi Danh , Laukens Kris , Meysman Pieter
Published: November 2019

The growing availability of biomolecular networks has led to a need for analysis methods that are able to extract biologically meaningful information from these complex data structures. Here we present MILES (MIning Labeled Enriched Subgraphs), a Java-based subgraph mining tool for discovering motifs that are associated to a given set of nodes of interest, such as a list of genes or proteins, in biomolecular networks. It provides a unique extension to the widely used enrichment analysis methodologies by integrating network structure and functional annotations in order to discern novel biological subgraphs which are enriched in the targets of interest. The tool can handle various types of input data, including (un)directed, (un)connected and multi-label networks, and is thus compatible with most types of biomolecular networks.

Availability and implementation

MILES is available as a platform-independent Java application at https://github.com/pmoris/miles-subgraph-miner alongside a user manual, example datasets and the source code.

Supplementary information

Supplementary data are available at Bioinformatics online.
Testing conditional mean independence for functional data
Authors: Lee C E , Zhang X , Shao X
Published: November 2019

We propose a new nonparametric conditional mean independence test for a response variable $Y$ and a predictor variable $X$ where either or both can be function-valued. Our test is built on a new metric, the so-called functional martingale difference divergence, which fully characterizes the conditional mean dependence of $Y$ given $X$ and extends the martingale difference divergence proposed by Shao & Zhang (2014). We define an unbiased estimator of functional martingale difference divergence by using a $\mathcal{U}$-centring approach, and we obtain its limiting null distribution under mild assumptions. Since the limiting null distribution is not pivotal, we use the wild bootstrap method to estimate the critical value and show the consistency of the bootstrap test. Our test can detect the local alternative which approaches the null at the rate of $n^{-1/2}$ with a nontrivial power, where $n$ is the sample size. Unlike the three tests developed by Kokoszka et al. (2008), Lei (2014) and Patilea et al. (2016), our test does not require a finite-dimensional projection or assume a linear model, and it does not involve any tuning parameters. Promising finite-sample performance is demonstrated via simulations, and a real-data illustration is used to compare our test with existing ones.
Bloodstream Infections With a Novel Nontuberculous Mycobacterium Involving 52 Outpatient Oncology Clinic Patients―Arkansas, 2018
Authors: Labuda Sarah M , Garner Kelley , Cima Michael , Moulton-Meissner Heather , Laufer Halpin Alison , Charles-Toney Nadege , Yu Peter , Bolton Erin , Pierce Reid , Crist Matthew B , Gomes Danica , Gable Paige , McAllister Gillian , Lawsin Adrian , Houston Hollis , Patil Naveen , Wheeler J Gary , Bradsher Robert , Vyas Keyur , Haselow Dirk
Published: November 2019

Background

In July 2018, the Arkansas Department of Health (ADH) was notified by hospital A of 3 patients with bloodstream infections (BSIs) with a rapidly growing nontuberculous Mycobacterium (NTM) species; on 5 September 2018, 6 additional BSIs were reported. All were among oncology patients at clinic A. We investigated to identify sources and to prevent further infections.

Methods

ADH performed an onsite investigation at clinic A on 7 September 2018 and reviewed patient charts, obtained environmental samples, and cultured isolates. The isolates were sequenced (whole genome, 16S, rpoB) by the Centers for Disease Control and Prevention to determine species identity and relatedness.

Results

By 31 December 2018, 52 of 151 (34%) oncology patients with chemotherapy ports accessed at clinic A during 22 March–12 September 2018 had NTM BSIs. Infected patients received significantly more saline flushes than uninfected patients (P < .001) during the risk period. NTM grew from 6 unused saline flushes compounded by clinic A. The identified species was novel and designated Mycobacterium FVL 201832. Isolates from patients and saline flushes were highly related by whole-genome sequencing, indicating a common source. Clinic A changed to prefilled saline flushes on 12 September as recommended.

Conclusions

Mycobacterium FVL 201832 caused BSIs in oncology clinic patients. Laboratory data allowed investigators to rapidly link infections to contaminated saline flushes; cooperation between multiple institutions resulted in timely outbreak resolution. New state policies being considered because of this outbreak include adding extrapulmonary NTM to ADH’s reportable disease list and providing more oversight to outpatient oncology clinics.
Burn Nurse Competency Utilization: Report From the 2019 Annual American Burn Association Meeting
Authors: Carrougher Gretchen J , Burton-Williams Kristen , Gauthier Kristy , Gloger Amy , Remington Lois , Yukon Kelli
Published: November 2019

Competence in healthcare is a recognized expectation by consumers. In 2018 following an extensive review and consensus-building process, burn nursing practice competencies were published. Clinical nurse leaders were called upon to use these published competencies in practice as a basis for the requisite knowledge and skills needed in the care of the burn-injured individual. In 2019 at the 51st Annual Meeting of the American Burn Association, nurses from four U.S. burn centers reported on their center’s incorporation of the competencies within their educational nursing curriculums. This paper provides a forum for each of the lead authors from Rhode Island Hospital Burn Center, the University of Utah Health Burn Trauma Intensive Care Unit, Parkland Regional Burn Center, and the University of Chicago Medicine Burn Center to outline their current utilization of the new burn nurse competencies and plans for future use.

Competence in nursing practice is a recognized expectation by the U.S. healthcare consumer. The ability to demonstrate competence is also important to authoritative entities such as The Joint Commission (TJC) and other verifying agencies or societies (e.g., the American Burn Association for burn center verification). Without established and recognized standards of nursing care and documented educational preparation for staff, burn centers cannot ensure consistent and competent care.
Changes of Extravascular Lung Water as an Independent Prognostic Factor for Early Developed ARDS in Severely Burned Patients
Authors: Wang Weiyi , Xu Ning , Yu Xiaofeng , Zuo Fengli , Liu Jie , Wang Yuan , Zhu Guoqin , Jia Naixin , Ren Hui , Zhang Jiaping
Published: November 2019

An important feature of acute respiratory distress syndrome (ARDS) is fluid lost into the interstitium of lung combined with its compromised reabsorption, resulting in the elevation of extravascular lung water (EVLW). Although ARDS is known as an early, common, and life-threatening complication in major burns, the issue of whether or how the EVLW index (EVLWI) correlates with its prognosis has not been identified yet. In this retrospectively study, 121 severely burned adults with ARDS occurred in 2 weeks postburn were analyzed and divided into two groups: survivors (73 patients) and nonsurvivors (48 patients) according to the 28-day outcome after injury. Compared with nonsurvivors, survivors exhibited bigger EVLWI reduction in day 2 after ARDS onset (ΔEVLWI2), with no differences in ARDS timing and other EVLWI variables. ΔEVLWI2, rather than EVLWI on 2 days after ARDS onset, was identified as an independent prognostic factor even after adjusting other significant factors by Cox proportional hazard analysis. ROC curve analysis showed that ΔEVLWI2 [AUC = 0.723, 95% CI = (0.631–0.816), P < .001] was a relative predictor for survival on 28-day postburn, with a threshold of 1.9 ml/kg (63.0% sensitivity, 77.1% specificity). Kaplan–Meier survival curve analysis confirmed a significantly higher survival rate on 28-day postburn in patients with ΔEVLWI2 > 1.9 ml/kg (log-rank test: χ 2 =14.780, P < .001). Taken together, our study demonstrated that ΔEVLWI2 is an independent prognostic factor for early ARDS in severe burns. ΔEVLWI2 higher than 1.9 ml/kg might predict a higher survival rate in those patients.
Inpatient Data of Occupational Burn Injuries Treated at a Tertiary Burn Center
Authors: Basaran Abdulkadir , Ozlu Ozer
Published: November 2019

Occupational burns are among the important causes of work-related injuries. We aimed to investigate the epidemiology and reasons of occupational burns and thereby to emphasize preventive measures. Between January 2017 and December 2018, the data of major occupational burn injury patients admitted to our burn center were evaluated in this cross-sectional retrospective study. During the study period 342 patients older than 16 years were admitted to the burn center. Among them 80 patients with occupational burns (23.4%) were identified. The mean age of the patients was 34.73 ± 12.3 years. Seventy-eight patients (97.5%) were male. Electrical burns and flame burns were the two leading type of occupational burns. The most common occupation of our patients was construction work. Dangerous behavior, carelessness, lack of protective equipment, and failure to follow instructions were causes of injury. Only 14 patients (17.5%) experienced unavoidable accident. Thirty-seven patients (46.3%) worked on temporary basis. Occupational experience was under 5 years in majority of the cases (62.5%). For the occupational burns the percentage of burned TBSA was 17.08 ± 14.5 (1–60) and the length of hospital stay was 23.94 ± 21.9 days (2–106). There were no significant differences between occupational and nonoccupational burn injuries considering TBSA, total length of hospital stay, and complications (P > .05). Occupational burn injuries are common in less experienced and younger workers. Therefore, recognition of the problem and maintaining awareness is important. In order to prevent occupational accidents and burns, occupational health and safety rules must be obeyed.
Woman’s entrepreneurship as a gendered niche: the implications for regional development policy
Authors: Harrison Richard T , Leitch Claire M , McAdam Maura
Published: November 2019

In this article, we argue that entrepreneurship is a socio-spatial embedded activity and that the social construction of gender, time, space, economy and culture is manifest in the masculinities that are ascribed a normative role in entrepreneurship development policies. Drawing on feminist approaches to articulate and perform resistance to the hegemonic ‘masculinist’ discourses on entrepreneurship, we argue that women’s entrepreneurship is contextually embedded in institutional and social structures that both limit and provide opportunities for its enactment. Regional economic development policy has focused, inter alia, on stimulating and supporting women’s entrepreneurship through the establishment of women-only entrepreneurial networks to provide support, role models and access to resources. Grounded in feminist geography and based on a detailed qualitative study of network managers and members of formally established women-only networks, we provide evidence of the disconnect between the emancipatory intent and the actual impact of these initiatives. While these networks aim to empower and encourage women into entrepreneurship, in practice, they perpetuate women’s marginalisation and ghettoisation in gendered niches.
Failure behaviour and acoustic emission characteristics of different rocks under uniaxial compression
Authors: Wang Zhaohui , Wang Jiachen , Yang Shengli , Li Lianghui , Li Meng
Published: November 2019

In the present study, mechanical behaviour of three types of rocks has been investigated under uniaxial compression. The stress–strain responses of the tested rocks are composed of four regions: the compaction stage; elastic stage; strain hardening stage and strain softening stage. The elastic modulus and uniaxial compressive strength increase in order from the result of the coal to the mudstone and then to the sandstone, while the Poisson ratio shows a reverse order. In coal and mudstone, volumetric dilation behaviour vanishes gradually with an increase in damage degree, while it remains stable in the sandstone where the strain hardening behaviour is less obvious. Regarding acoustic emission (AE) characteristics, AE hit and AE energy show a similar evolutionary trend in the loading process. A sudden increase in AE energy is accompanied with drastic drop or local fluctuation in the load-bearing capacity of the rock while AE hit fails in predicting such variation in the load-bearing capacity. A quiet stage of AE signal prior to the peak stress is captured, which can be taken as a precursor for rock failure. Failure pattern of the coal, mudstone and sandstone varies from shear faulting to tension-shear mixed fracturing and then to axial splitting, which is in good accordance with that deduced from AE location analysis.
Novel email spam detection method using sentiment analysis and personality recognition
Authors: Ezpeleta Enaitz , Velez de Mendizabal Iñaki , Hidalgo José María Gómez , Zurutuza Urko
Published: November 2019

Unsolicited email campaigns remain as one of the biggest threats affecting millions of users per day. During the past years several techniques to detect unsolicited emails have been developed. This work provides means to validate the hypothesis that the identification of the email messages’ intention can be approached by sentiment analysis and personality recognition techniques. These techniques will provide new features that improve current spam classification techniques. We combine personality recognition and sentiment analysis techniques to analyse email content. We enrich a publicly available dataset adding these features, first separately and after in combination, of each message to the dataset, creating new datasets. We apply several combinations of the best email spam classifiers and filters to each dataset in order to compare results.
A flexible logic-based approach to closeness using order of magnitude qualitative reasoning
Authors: Burrieza Alfredo , Muñoz-Velasco Emilio , Ojeda-Aciego Manuel
Published: November 2019

In this paper, we focus on a logical approach to the important notion of closeness, which has not received much attention in the literature. Our notion of closeness is based on the so-called proximity intervals, which will be used to decide the elements that are close to each other. Some of the intuitions of this definition are explained on the basis of examples. We prove the decidability of the recently introduced multimodal logic for closeness and, then, we show some capabilities of the logic with respect to expressivity in order to denote particular positions of the proximity intervals.
Functions of the major abasic endonuclease (APE1) in cell viability and genotoxin resistance
Authors: McNeill Daniel R , Whitaker Amy M , Stark Wesley J , Illuzzi Jennifer L , McKinnon Peter J , Freudenthal Bret D , Wilson David M
Published: November 2019

DNA is susceptible to a range of chemical modifications, with one of the most frequent lesions being apurinic/apyrimidinic (AP) sites. AP sites arise due to damage-induced (e.g. alkylation) or spontaneous hydrolysis of the N-glycosidic bond that links the base to the sugar moiety of the phosphodiester backbone, or through the enzymatic activity of DNA glycosylases, which release inappropriate bases as part of the base excision repair (BER) response. Unrepaired AP sites, which lack instructional information, have the potential to cause mutagenesis or to arrest progressing DNA or RNA polymerases, potentially causing outcomes such as cellular transformation, senescence or death. The predominant enzyme in humans responsible for repairing AP lesions is AP endonuclease 1 (APE1). Besides being a powerful AP endonuclease, APE1 possesses additional DNA repair activities, such as 3′–5′ exonuclease, 3′-phophodiesterase and nucleotide incision repair. In addition, APE1 has been shown to stimulate the DNA-binding activity of a number of transcription factors through its ‘REF1’ function, thereby regulating gene expression. In this article, we review the structural and biochemical features of this multifunctional protein, while reporting on new structures of the APE1 variants Cys65Ala and Lys98Ala. Using a functional complementation approach, we also describe the importance of the repair and REF1 activities in promoting cell survival, including the proposed passing-the-baton coordination in BER. Finally, results are presented indicating a critical role for APE1 nuclease activities in resistance to the genotoxins methyl methanesulphonate and bleomycin, supporting biologically important functions as an AP endonuclease and 3′-phosphodiesterase, respectively.
Considerations for a surgical RCT for diffuse low-grade glioma: a survey
Authors: Mansouri Alireza , Brar Karanbir , Cusimano Michael D
Published: November 2019

Background

Diffuse low-grade gliomas (DLGGs) are heterogeneous tumors that inevitably differentiate into malignant entities, leading to disability and death. Recently, a shift toward up-front maximal safe resection of DLGGs has been favored. However, this transition is not supported by randomized controlled trial (RCT) data. Here, we sought to survey the neuro-oncology community on considerations for a surgical RCT for DLGGs.

Methods

A 21-question survey focusing on a surgical RCT for DLGGs was developed and validated by 2 neurosurgeons. A sample case of a patient for whom management might be debatable was presented to gather additional insight. The survey was disseminated to members of the Society for Neuro-Oncology (SNO) and responses were collected from March 16 to July 10, 2018.

Results

A total of 131 responses were collected. Sixty-three of 117 (54%) respondents thought an RCT would not be ethical, 39 of 117 (33%) would consider participating, and 56 of 117 (48%) believed an RCT would be valuable for determining the differing roles of biopsy, surgery, and observation. This was exemplified by an evenly distributed selection of the latter management options for our sample case. Eighty-three of 120 (69.2%) respondents did not believe in equipoise for DLGG patients. Quality of life and overall survival were deemed equally important end points for a putative RCT.

Conclusions

Based on our survey, it is evident that management of certain DLGG patients is not well defined and an RCT may be justified. As with any surgical RCT, logistic challenges are anticipated. Robust patient-relevant end points and standardization of perioperative adjuncts are necessary if a surgical RCT is undertaken.
Embracing Religious Freedom?: A Battle Over Public School Prayer in the USA and Japan
Authors: Yokotsuka Shino
Published: November 2019

This article examines why the USA and Japan have different public reactions to the issues of public school prayer, despite the fact that the countries have almost identical constitutional frameworks on religious freedom. Recent religious freedom studies tend to centre around the debates that prioritize Western perspectives of religion in public schools. In contrast, this article focuses on the specific social and cultural contexts emphasizing their importance in understanding the governance issues arising from an ever-widening religious gap. This study particularly addresses the role cultural differences play in the unequal interpretations of religious freedom within different national backgrounds. Using a comparative case study analysis, I argue that these cultural differences directly impact the varying perspectives on religious freedom as applied in policy, law, and practice across the countries.
Rewards Enhance Proactive and Reactive Control in Adolescence and Adulthood
Authors: Magis-Weinberg Lucía , Custers Ruud , Dumontheil Iroise
Published: November 2019

Cognitive control allows the coordination of cognitive processes to achieve goals. Control may be sustained in anticipation of goal-relevant cues (proactive control) or transient in response to the cues themselves (reactive control). Adolescents typically exhibit a more reactive pattern than adults in the absence of incentives. We investigated how reward modulates cognitive control engagement in a letter-array working memory (WM) task in 30 adolescents (12–17 years) and 20 adults (23–30 years) using a mixed block- and event-related functional magnetic resonance imaging design. After a Baseline run without rewards, participants performed a Reward run where 50% trials were monetarily rewarded. Accuracy and reaction time (RT) differences between Reward and Baseline runs indicated engagement of proactive control, which was associated with increased sustained activity in the bilateral anterior insula (AI), right dorsolateral prefrontal cortex (PFC) and right posterior parietal cortex (PPC). RT differences between Reward and No reward trials of the Reward run suggested additional reactive engagement of cognitive control, accompanied with transient activation in bilateral AI, lateral PFC, PPC, supplementary motor area, anterior cingulate cortex, putamen and caudate. Despite behavioural and neural differences during Baseline WM task performance, adolescents and adults showed similar modulations of proactive and reactive control by reward.
The atypical lymphocyte count: a novel predictive factor for severe thrombocytopenia related to dengue
Authors: Abeysuriya Visula , Choong Clarice Shi Hui , Thilakawardana Basuru Uvindu , de Mel Primesh , Shalindi Malka , de Mel Chandima , Chandrasena Lal , Seneviratne Suranjith L , Yip Christina , Yap Eng-Soo , de Mel Sanjay
Published: November 2019

Background

Early identification of patients at risk of severe dengue disease (DD) is critical to guide its management. We evaluated whether the atypical lymphocyte count (ALC), generated from the Sysmex automated full blood count analyzer, is predictive of severe thrombocytopenia secondary to Dengue infection.

Methods

We prospectively collected data on patients admitted with DD between December 2017 and October 2018. ALC data were extracted from the Sysmex XS500i analyzer from day 1 to day 7 of admission. Clinical data were obtained from patients' medical records.

Results

We enrolled 256 patients with DD. A negative correlation between ALC on admission and platelet count on day 5 to day 7 (Spearmen's correlation; day 5:-0.485, day 6:-0.428 and day 7:-0.344) (p=0.001) was observed. Based on receiver operator characteristic curve analysis, we found that an ALC of >0.5x103/L had 90% sensitivity and 70% specificity for severe thrombocytopenia (platelet count <50x109/L) on day 5. The positive and negative predictive values were 74.4 and 91.2%, respectively (power 84.7).

Conclusions

We propose that ALC on admission may be a novel negative predictive factor for severe thrombocytopenia on day 5 to day 7 of DD. Further studies are required to validate our findings and evaluate whether ALC is predictive of other complications of DD.
Viruses Reveal the Secrets of Plasmodesmal Cell Biology
Authors: Reagan Brandon C. , Burch-Smith Tessa M.
Published: November 2019

Plasmodesmata (PD) are essential for intercellular trafficking of molecules required for plant life, from small molecules like sugars and ions to macromolecules including proteins and RNA molecules that act as signals to regulate plant development and defense. As obligate intracellular pathogens, plant viruses have evolved to manipulate this communication system to facilitate the initial cell-to-cell and eventual systemic spread in their plant hosts. There has been considerable interest in how viruses manipulate the PD that connect the protoplasts of neighboring cells, and viruses have yielded invaluable tools for probing the structure and function of PD. With recent advances in biochemistry and imaging, we have gained new insights into the composition and structure of PD in the presence and absence of viruses. Here, we first discuss viral strategies for manipulating PD for their intercellular movement and examine how this has shed light on our understanding of native PD function. We then address the controversial role of the cytoskeleton in trafficking to and through PD. Finally, we address how viruses could alter PD structure and consider possible mechanisms of the phenomenon described as ‘gating’. This discussion supports the significance of virus research in elucidating the properties of PD, these persistently enigmatic plant organelles.
Modeling Yield Losses and Fungicide Profitability for Managing Fusarium Head Blight in Brazilian Spring Wheat
Authors: Duffeck Maíra Rodrigues , dos Santos Alves Kaique , Machado Franklin Jackson , Esker Paul David , Del Ponte Emerson Medeiros
Published: November 2019

Fusarium head blight (FHB) and wheat yield data were gathered from fungicide trials to explore their relationship. Thirty-seven studies over 9 years and 11 locations met the criteria for inclusion in the analysis: FHB index in the untreated check ≥ 5% and the range of index in a trial ≥ 4 percentage points. These studies were grouped into two baseline yields, low (Yl ≤ 3,631 kg ha−1) or high (Yh > 3,631 kg ha−1), defined based on the median of maximum yields across trials. Attainable (disease-free) yields and FHB index were predicted using a wheat crop and a disease model, respectively, in 280 simulated trials (10 planting dates in a 28-year period, 1980 to 2007) for the Passo Fundo location. The damage coefficient was then used to calculate FHB-induced yield loss (penalizing attainable yield) for each experiment. Losses were compared between periods defined as before and after FHB resurge during the early 1990s. Disease reduction from the use of one or two sprays of a triazole fungicide (tebuconazole) was also simulated, based on previous meta-analytic estimates, and the response in yield was used in a profitability analysis. Population-average intercepts but not the slopes differed significantly between Yl (2,883.6 kg ha−1) and Yh (4,419.5 kg ha−1) baseline yields and the damage coefficients were 1.60%−1 and 1.05%−1, respectively. The magnitudes and trends of simulated yield losses were in general agreement with literature reports. The risk of not offsetting the costs of one or two fungicide sprays was generally higher (>0.75) prior to FHB resurgence but fungicide profitability tended to increase in recent years, depending on the year. Our simulations allowed us to reproduce trends in historical losses, and may be further adjusted to test the effect and profitability of different control measures (host resistance, other fungicides, etc.) on quality parameters such as test weight and mycotoxin contamination, should the information become available.
Circulatory support during lung transplantation
Authors: Kiziltug Hannah , Falter Florian
Published: November 2019

Purpose of review

Lung transplantation can be performed off-pump, with sequential one-lung ventilation, or using mechanical circulatory support (MCS). MCS can either be in the form of cardiopulmonary bypass (CPB) or veno-arterial or veno-venous extracorporeal membrane oxygenation (VA ECMO or VV ECMO).

This article reviews the indications, benefits and limitations of these different techniques and evaluates their effect on outcomes.

Recent findings

Recently, there has been a shift toward intraoperative ECMO support and away from CPB. The first results of this strategy are promising. The use of intraoperative ECMO with the possibility of prolongation of MCS into the postoperative period has been shown to lead to improved survival when compared with lung transplants not receiving ECMO. Recipients of organs from extended criteria donors show encouraging survival rates when the lungs are reperfused using MCS. A recent metaanalysis comparing ECMO versus CPB showed favourable outcomes supporting the use of ECMO despite not finding a difference in mortality between the two methods.

The trend toward ECMO and away from cardiopulmonary bypass is backed up with good survival rates. However, to date, there has not been a randomized controlled trial to further guide the choice of MCS strategy for lung transplantation.
How to communicate between surgeon and intensivist?
Authors: Misseri Giovanni , Cortegiani Andrea , Gregoretti Cesare
Published: November 2019

Purpose of review

Communication and teamwork are essential to enhance the quality of care, especially in operating rooms and ICUs. In these settings, the effective interprofessional collaboration between surgeons and intensivists impacts patients’ outcome. This review discusses current opinions and evidence for improving communication strategies and the relationship between surgeons and intensivists/anesthesiologist.

Recent findings

Effective teamwork has been demonstrated to improve patient outcome and foster healthier relationships between professionals.

With the expansion of new medical superspecialist disciplines and the latest medical developments, patient care has been put through a progressive fragmentation, rather than a holistic approach. Operating theaters and ICU are the common fields where surgeons and anesthesiologists/intensivists work. However, communication challenges may frequently arise. Therefore, effective communication, relational coordination, and team situation awareness are considered to affect quality of teamwork in three different phases of the patient-centered care process: preoperatively, intraoperatively, and postoperatively.

Although limited, current evidence suggests to improve communication and teamwork in patient perioperative care. Further research is needed to strengthen the surgeon–intensivist relationship and to deliver high-quality patient care.
Development of an Undergraduate Medical Education Critical Care Content Outline Utilizing the Delphi Method
Authors: Smith Andrew G. , Brainard Jason C. , Campbell Kristine A.
Published: November 2019

Objectives:

No consensus exists on a standardized critical care content outline for medical student education. The aim of this research is to develop a national undergraduate medical education critical care content outline.

Design:

The authors used a Delphi process to reach expert consensus on a content outline that identified the core critical care knowledge topics and procedural skills that medical students should learn prior to entering residency. Over three iterative rounds, the expert panel reached consensus on a critical care content outline.

Setting:

An electronic survey of critical care medical educators, residency program directors, and residents in the United States.

Subjects:

The expert panel included three groups as follows: 1) undergraduate medical education critical care educators, 2) residency program directors representing all core specialties, and 3) residents representing their core specialties.

Interventions:

None.

Measurements and Main Results:

The expert panel included 28 members. Experts represented the following medical specialties: anesthesiology, emergency medicine, internal medicine, obstetrics and gynecology, pediatrics, and surgery. Seventeen experts had subspecialty training in critical care. The expert panel identified 19 highly recommended critical care knowledge topics and procedural skills. These topics and procedural skills were grouped into five broad categories as follows: 1) neurologic, 2) respiratory, 3) cardiovascular, 4) renal and electrolytes, and 5) supplemental ICU topics. Bag-mask ventilation was the only procedural skill identified as highly recommended.

Conclusions:

This study provides a national consensus undergraduate medical education critical care content outline. By including experts from multiple specialties, this content outline is meaningful for medical student education, independent of medical specialty. The content outline represents a first step in the development of a national undergraduate medical education critical care curriculum.
Beyond tissue biopsy: a diagnostic framework to address tumor heterogeneity in lung cancer
Authors: Voigt Wieland , Manegold Christian , Pilz Lothar , Wu Yi-Long , Müllauer Leonard , Pirker Robert , Filipits Martin , Niklinski Jacek , Petruzelka Lubos , Prosch Helmut
Published: November 2019

Purpose of review

The objective of this review is to discuss the strength and limitations of tissue and liquid biopsy and functional imaging to capture spatial and temporal tumor heterogeneity either alone or as part of a diagnostic framework in non-small cell lung cancer (NSCLC).

Recent findings

NSCLC displays genetic and phenotypic heterogeneity – a detailed knowledge of which is crucial to personalize treatment. Tissue biopsy often lacks spatial and temporal resolution. Thus, NSCLC needs to be characterized by complementary diagnostic methods to resolve heterogeneity. Liquid biopsy offers detection of tumor biomarkers and for example, the classification and monitoring of EGFR mutations in NSCLC. It allows repeated sampling, and therefore, appears promising to address temporal aspects of tumor heterogeneity. Functional imaging methods and emerging image analytic tools, such as radiomics capture temporal and spatial heterogeneity. Further standardization of radiomics is required to allow introduction into clinical routine.

To augment the potential of precision therapy, improved diagnostic characterization of tumors is pivotal. We suggest a comprehensive diagnostic framework combining tissue and liquid biopsy and functional imaging to address the known aspects of spatial and temporal tumor heterogeneity on the example of NSCLC. We envision how this framework might be implemented in clinical practice.
Next-generation sequencing identified somatic alterations that may underlie the etiology of Chinese papillary thyroid carcinoma
Authors: Yang Chuanjia , Gong Jian , Xu Weixue , Liu Zhen , Cui Dongxu
Published: November 2019

To better understand the etiology of papillary thyroid carcinoma, we did next-generation sequencing for the exomes and transcriptomes of a Chinese cohort of 28 pairs of DNA and RNA samples extracted from papillary thyroid carcinoma tumors and adjacent normal thyroid samples. The Chinese papillary thyroid carcinoma tumors harbored somatic mutations in the known driver genes, such as KRAS, TP53, BRAF, ERBB2, and MET. In addition, we identified novel papillary thyroid carcinoma candidate genes that had not been well studied before. We also identified a gene mutation signature involving SPTA1, MAP2, SYNE1, and SLIT3 that is significantly associated with survival of papillary thyroid carcinoma patients. Transcriptome analysis using the initial papillary thyroid carcinoma tumor samples and a new Chinese papillary thyroid carcinoma dataset identified six commonly upregulated oncogenic pathways in both datasets including eukaryotic translation initiation factor 2, phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K)/serine/threonine kinase (AKT), Ephrin Receptor, Rho Family GTPase signaling, nuclear factor, erythroid 2 like 2 (NRF2)-mediated oxidative stress response, and remodeling of epithelial adherens junctions. Overall, we identified novel candidate genes and oncogenic pathways important to the etiology of papillary thyroid carcinoma in Chinese patients and found the association of a gene signature with the survival outcome of the thyroid cancer patients. These findings may help in moving toward the more comprehensive and effective personalized treatment of papillary thyroid carcinoma in Chinese.
Invasive Melanoma and Melanoma in Situ Treated With Modified Mohs Micrographic Surgery With En Face Permanent Sectioning: A 10-Year Retrospective Review
Authors: Heath Michael , Woody Meghan , Leitenberger Justin , Latour Emile , Bar Anna
Published: November 2019

BACKGROUND

Successful surgical treatment of cutaneous melanoma is dependent on margin control.

OBJECTIVE

To determine efficacy of modified Mohs micrographic surgery (mMMS) with en face permanent margins in management of invasive melanoma (IM) and melanoma in situ (MIS).

METHODS

A retrospective cohort study evaluating local recurrence, 5-year recurrence-free survival, and 5-year melanoma-specific survival. Overall, 657 melanomas (128 IM and 529 MIS) from 631 patients were treated using mMMS during a 10-year period. Follow-up information was obtained from medical records and telephone encounters.

RESULTS

The median follow-up time was 5.18 years. Most melanomas were located on the head and neck 93.6% (615/657). Margins required for clearance were 0.77 ± 0.44 cm (mean ± SD). Local recurrence was identified in 1.98% (13/657) of melanomas with no local recurrences in IM. Five-year local recurrence-free and melanoma-specific survival rates were estimated to be 96.9% (95% confidence interval [CI]: 94.6%–98.2%) and 99.0% (95% CI: 97.7%–99.6%). There were 5 melanoma-related deaths.

CONCLUSION

Modified Mohs micrographic surgery is an effective treatment of melanoma as evidenced by low local recurrence rates and high melanoma-specific survival.
Use of Lasers for Iron-Induced Accidental Tattoos: Experience at a Tertiary Referral Center
Authors: Eggenschwiler Corinne D.C. , Dummer Reinhard , Imhof Laurence
Published: November 2019

BACKGROUND

Awareness of accidental tattoos after iron injections with paravenous leakage is low. No larger patient cohorts have been analyzed. The lesions are a burden to the patients. The only known treatment is laser therapy.

OBJECTIVE

To characterize the clinical appearance and development of iron-induced tattoos and to demonstrate safe and efficient removal with quality-switched (QS) and picosecond lasers.

MATERIALS AND METHODS

The authors conducted a retrospective systematic analysis on patients who presented at the Dermatology Department of the University Hospital of Zurich between Year 2008 and 2017 with accidental hyperpigmentations after iron injections. From 29 collected patients, 13 received laser treatment and were analyzed with reference to the lasers used, including wavelength, fluence, spot size, intervals, number of sessions, and overall success. The authors defined the latter as a complete removal or as patients' satisfaction.

RESULTS

The authors treated 13 patients and completed the treatment in 8 patients, with an average of 5.6 sessions. No complications occurred.

CONCLUSION

Spontaneous regression of iron-induced tattoos is possible within 1 to 2 years, but not guaranteed. Removal with QS ruby, Nd:YAG, and picosecond lasers can be achieved within a mean number of 5.6 sessions. Assuring a valid indication before intravenous iron administration is important.
The Effect and Safety of Aerobic Interval Training According to Exercise Intensity in Acute Coronary Syndrome
Authors: Kim Chul , Choi Hee Eun
Published: November 2019

Purpose:

To evaluate the effect of increasing the maximal oxygen uptake (

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2max) and the safety of maximal-intensity aerobic interval training (MAIT) compared with high-intensity aerobic interval training (HAIT).

Methods:

Forty-seven patients with first-ever acute coronary syndrome were assigned to MAIT or HAIT. Subjects underwent adaptation period during the first 2 wk of cardiac rehabilitation and then MAIT at 95-100% of the heart rate reserve or HAIT at 85% of the heart rate reserve, 3 d/wk for 4 wk. The primary outcome was

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2max. The secondary outcomes were major cardiovascular complications, hemodynamic responses, myocardial oxygen demand, cardiometabolic health, and echocardiographic findings.

Results:

A total of 670.5 hr of MAIT and HAIT were completed. After 6 wk of aerobic interval training,

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2max was significantly increased in both groups. However, the increment of

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2max was significantly greater in the MAIT group than in the HAIT group (P < .05). The percentage increases for MAIT and HAIT were 31% and 17%, respectively. No major cardiovascular or musculoskeletal complications were noted.

Conclusions:

The results of this study indicate that 6 wk of MAIT resulted in statistically significantly better improvement in

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2max than 6 wk of HAIT at a similar total work in patients with acute coronary syndrome. Moreover, both MAIT and HAIT may be safe to use in the cardiac rehabilitation setting.
Blood pressure dipping and sleep quality in the Wisconsin Sleep Cohort
Authors: Lyu Beini , Hagen Erika W. , Ravelo Laurel A. , Peppard Paul E.
Published: November 2019

Aims:

Nondipping blood pressure (BP) is associated with higher risk for hypertension and advanced target organ damage. Insomnia is the most common sleep complaint in the general population. We sought to investigate the association between sleep quality and insomnia and BP nondipping cross-sectionally and longitudinally in a large, community-based sample.

Methods:

A subset of the Wisconsin Sleep Cohort (n = 502 for cross-sectional analysis and n = 260 for longitudinal analysis) were enrolled in the analysis. Polysomnography measures were used to evaluate sleep quality. Insomnia symptoms were obtained by questionnaire. BP was measured by 24-h ambulatory BP monitoring. Logistic regression models estimated cross-sectional associations of sleep quality and insomnia with BP nondipping. Poisson regression models estimated longitudinal associations between sleep quality and incident nondipping over a mean 7.4 years of follow-up. Systolic and diastolic nondipping were examined separately.

Results:

In cross-sectional analyses, difficulty falling asleep, longer waking after sleep onset, shorter and longer total sleep time, lower sleep efficiency and lower rapid eye movement stage sleep were associated with higher risk of SBP and DBP nondipping. In longitudinal analyses, the adjusted relative risks (95% confidence interval) of incident systolic nondipping were 2.1 (1.3–3.5) for 1-h longer waking after sleep onset, 2.1 (1.1–5.1) for 7–8 h total sleep time, and 3.7 (1.3–10.7) for at least 8-h total sleep time (compared with total sleep time 6–7 h), and 1.9 (1.1–3.4) for sleep efficiency less than 0.8, respectively.

Conclusion:

Clinical features of insomnia and poor sleep quality are associated with nondipping BP. Our findings suggested nondipping might be one possible mechanism by which poor sleep quality was associated with worse cardiovascular outcomes.
Supraciliary Microstent Revision in a Patient With Corneal Edema and Primary Open Angle Glaucoma: A Case Report
Authors: Wang Ye Elaine , Galor Anat , Junk Anna K.
Published: November 2019

A 56-year-old Hispanic male individual with moderate primary open-angle glaucoma on maximal tolerated topical therapy with recent visual field progression presented with excessive glare due to cataract in the right eye. The patient underwent uncomplicated phacoemulsification with supraciliary microstent implantation. Ten weeks postoperatively, he presented with global Descemet folds and focal corneal edema overlying the CyPass implant despite apparent adequate implant position (1 retention ring visible). The revision proved challenging as the anterior chamber portion of the implant was short. Nonetheless, the device was trimmed under gonioscopic view using intraocular lens cutting scissors and a Sinskey hook. Postoperatively, the implant was flush with the iris root with a patent lumen. Bilateral global guttae indicating unrecognized Fuchs endothelial corneal dystrophy diagnosed postoperatively may have contributed to the corneal edema that improved after the revision.
Relationship between heart failure and central serous chorioretinopathy: A cohort study in Taiwan
Authors: Huang Ke-Hao , Chen Yi-Hao , Lee Lung-Chi , Tai Ming-Cheng , Chung Chi-Hsiang , Chen Jiann-Torng , Liang Chang-Min , Chien Wu-Chien , Chen Ching-Long
Published: November 2019

Background:

Both central serous chorioretinopathy (CSCR) and heart failure (HF) are disorders with a complex pathogenesis, whereas the two diseases might share similar pathogenesis. This study aimed to evaluate whether patients with HF are exposed to potential risk of CSCR by using the National Health Insurance Research Database (NHIRD).

Methods:

Data were collected from the NHIRD over a 14-year period. Variables were analyzed with the Pearson chi-square test and Fisher’s exact test. The risk factors for disease development were examined by adjusted hazard ratio (aHR). Kaplan–Meier analysis was performed to compare the cumulative incidence of CSCR.

Results:

A total of 24 426 patients with HF were enrolled in the study cohort, and there were 24 426 patients without HF in the control cohort. The incidence rate of CSCR was higher in the study cohort than in the control cohort (aHR = 4.572, p < 0.001). CSCR occurred more commonly in males than in females. The overall incidence of CSCR was 30.07 per 100 000 person-years in the study cohort and 23.06 per 100 000 person-years in the control cohort. Besides, subgroup analysis revealed that no matter in gender or age group, HF patients were in an increased risk of CSCR diagnosis (male/female, aHR = 3.268/7.701; 20-59 years/≥60 years, aHR = 3.405/5.501, p < 0.001).

Conclusion:

HF is a significant indicator for CSCR. Patients with HF should stay alert for potential disorder of visual impairment. Further prospective studies to investigate the relationship between HF and CSCR could provide more information.
Family physician system in Taiwan
Authors: Jan Chyi-Feng , Hwang Shinn-Jang , Chang Che-Jui , Huang Cheng-Kuo , Yang Hsiao-Yu , Chiu Tai-Yuan
Published: November 2019

Following economic development and increasing healthcare demand, Taiwan has not only built a universal healthcare coverage payment system in 1995, but has also developed an accountable family physician system, called the Family Practice Integrated Care Project (FPICP), to deal with the pressures of an ageing society, since 2003. The community healthcare group-based family physician system is not only an important milestone for the development of family medicine in Taiwan but may also even serve as a global example for future family doctor systems. In this review, we aim to review the development of family medicine in Taiwan, the implementation and achievement of the FPICP, as well as the future prospects of system-based healthcare system. We firmly believe that only when the family physician system is well developed and put into practice with person-centered, family as a care unit, and community-oriented holistic care, can the objective of “everyone has their own family doctor” and sustainable operation of National Health Insurance be achieved.