bluuebunny/crossref_metadata_2025 huggingface dataset:
ANATOMICAL CHANGES BETWEEN ARGUS II RETINAL PROSTHESIS AND INNER RETINAL LAYERS DETECTED BY SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY IN FIRST YEAR: A CASE REPORT
Authors: Patelli Fabio , Colombo Leonardo , Aly Mohamed Omar M. , Rossetti Luca
Published: September 2018

Purpose:

To report and describe the anatomical changes detected by spectral domain optical coherence tomography between an Argus II retinal prosthesis and the inner retinal layers during 1-year follow-up.

Methods and Results:

A patient presented with epiretinal fibrosis 12 months after implant of an Argus II epiretinal prosthesis. One month after uneventful surgery in March 2016, an evident hyporeflective space was detected between the epiretinal prosthesis and the inner retinal surface by spectral domain optical coherence tomography. An epiretinal hyperreflective band was noticed during follow-up and 1 year after surgery. Spectral domain optical coherence tomography showed close contact of the band with the array, which greatly increased the electrical threshold of stimulation for most of the electrodes. Some electrodes were no longer functioning. No changes in visual performance were detected.

Conclusion:

Argus II epiretinal prosthesis implant may be complicated by the formation of a hyperreflective epiretinal band, detectable by spectral domain optical coherence tomography. The band may alter prosthesis function; to date, the patient did not scored any decrease in visual function.
Efficacy of Plate Expression of Meibum on Tear Function and Ocular Surface Findings in Meibomian Gland Disease
Authors: Aketa Naohiko , Shinzawa Megumi , Kawashima Motoko , Dogru Murat , Okamoto Shosei , Tsubota Kazuo , Shimazaki Jun
Published: September 2018

Purpose:

To evaluate the clinical effectiveness of expression treatment on meibomian gland disease (MGD).

Methods:

Seventeen right eyes of 17 patients with MGD were divided into 3 groups in this randomized prospective clinical study: no expression group: routine treatment with no expression (five patients, five eyes); digital expression group: routine treatment with digital expression (five patients, five eyes); and plate expression group: routine treatment with plate expression (seven patients, seven eyes). All groups received the same routine treatment for 1 month. Tear film break-up time (TBUT), vital staining scores, meibum expressibility, and the dry eye–related quality of life score (DEQS) questionnaire results were assessed before and 1 month after treatment.

Results:

There was a statistically significant difference of posttreatment TBUT among groups as determined by one-way analysis of variance (P<0.05). A post hoc test revealed that TBUT was statistically significantly higher in plate expression group compared with digital expression group. The fluorescein staining score did not show a statistically significant difference among the groups. Meibum expressibility and the DEQS scores improved in all groups.

Conclusion:

Plate expression when used as an adjunct to routine medical management of MGD has been found to be a comparatively effective treatment in terms of improvement of tear film stability compared with no expression or digital expression.
Mindfulness Meditation Reduces Intraocular Pressure, Lowers Stress Biomarkers and Modulates Gene Expression in Glaucoma: A Randomized Controlled Trial
Authors: Dada Tanuj , Mittal Deepti , Mohanty Kuldeep , Faiq Muneeb A. , Bhat Muzaffer A. , Yadav Raj K. , Sihota Ramanjit , Sidhu Talvir , Velpandian Thirumurthy , Kalaivani Mani , Pandey Ravindra M. , Gao Ying , Sabel Bernhard A. , Dada Rima
Published: September 2018

Background:

Reducing intraocular pressure (IOP) in primary open-angle glaucoma (POAG) is currently the only approach to prevent further optic nerve head damage. However, other mechanisms such as ischemia, oxidative stress, glutamate excitotoxicity, neurotrophin loss, inflammation/glial activation, and vascular dysregulation are not addressed. Because stress is a key risk factor affecting these mechanisms, we evaluated whether mindfulness-based stress reduction can lower IOP and normalize typical stress biomarkers.

Materials and Methods:

In a prospective, randomized trial 90 POAG patients (180 eyes; age above 45 y) were assigned to a waitlist control or mindfulness meditation group which practiced daily for 21 days. We measured IOP (primary endpoint), quality of life (QOL), stress-related serum biomarkers [cortisol, β-endorphins, IL6, TNF-α, brain-derived neurotrophic factor (BDNF), reactive oxygen species (ROS), total antioxidant capacity (TAC)], and whole genome expression.

Results:

Between-group comparisons revealed significantly lowered IOP in meditators (OD: 18.8 to 12.7, OS 19.0 to 13.1 mm Hg) which correlated with significantly lowered stress-biomarker levels including cortisol (497.3 to 392.3 ng/mL), IL6 (2.8 to 1.5 ng/mL), TNF-α (57.1 to 45.4 pg/mL), ROS (1625 to 987 RLU/min/104 neutrophils), and elevated β-endorphins (38.4 to 52.7 pg/mL), BDNF (56.1 to 83.9 ng/mL), and TAC (5.9 to 9.3) (allP<0.001). These changes correlated well with gene expression profiling. Meditators improved in QOL (P<0.05).

Conclusions:

A short course of mindfulness-based stress reduction by meditation in POAG, reduces IOP, improves QOL, normalizes stress biomarkers, and positively modifies gene expression. Mindfulness meditation can be recommended as adjunctive therapy for POAG.
Variation in Prostaglandin Analog Prices Paid for Through Medicare Part D
Authors: Priluck Aaron Z. , Havens Shane J.
Published: September 2018

Objective:

Determine the prices and price variation of the prostaglandin analogs (PGAs) used in the United States and examine their trends from 2013 to 2016 using Medicare Part D data.

Design:

This is a retrospective cross-sectional study.

Participants:

All ophthalmologists and optometrists in all 50 states and DC who prescribed any PGA purchased through Part D from 2013 through 2016.

Materials and Methods:

Outcome measures were calculated using Excel 2016 based off of the 2013 to 2016 Medicare Part D Prescriber Data.

Main Outcome Measures:

The 2013 to 2016 nationwide prices of 7 PGAs, the states with the 2016 minimum and maximum average prices, the SDs in PGA prices among the cities in each state, and the nationwide average of these SDs for 2013 to 2016.

Results:

The 2016 nationwide prices of 30-day supplies of bimatoprost, latanoprost, lumigan, travatan Z, travoprost, xalatan, and zioptan in 2016 were: $107.90±25.19, $10.16±1.52, $167.30±17.66, $171.36±19.44, $92.53±15.14, $153.41±15.16, and $162.75±13.22, respectively. Each drug’s SD in city prices within each state averaged nationwide for 30-day supplies in 2016 were $10.89, $1.44, $16.68, $17.23, $10.30, $10.07, and $9.48, respectively. Spending on these drugs totaled $861,180,924 in 2016. There was less price variation within each state as compared with the whole country. No substantial decreases in price variation exist for any drug from 2013 to 2016.

Conclusions:

There is substantial variation in PGA prices when purchased by Medicare Part D enrollees across the United States and within each state itself. Simultaneously, the prices and total expenditure on these medications are increasing yearly. Physicians should be cognizant of this price variation for these expensive and chronically used drugs and should educate patients to optimize their Part D supplemental plan.
Twenty-nine Cases of Enterovirus-D68–associated Acute Flaccid Myelitis in Europe 2016
Authors: Knoester Marjolein , Helfferich Jelte , Poelman Randy , Van Leer-Buter Coretta , Brouwer Oebele F. , Niesters Hubert G. M. ,   on Behalf of the 2016 EV-D68 AFM Working Group
Published: September 2018

Background:

Enterovirus-D68 (EV-D68) is a respiratory virus within the genus Enterovirus and the family of Picornaviridae. Genetically, it is closely related to rhinovirus that replicates in the respiratory tract and causes respiratory disease. Since 2014, EV-D68 has been associated with the neurologic syndrome of acute flaccid myelitis (AFM).

Methods:

In October 2016, questionnaires were sent out to a European network including 66 virologists and clinicians, to develop an inventory of EV-D68–associated AFM cases in Europe. Clinical and virologic information of case patients was requested. In addition, epidemiologic information on EV testing was collected for the period between March and October 2016.

Results:

Twenty-nine cases of EV-D68–associated AFM were identified, from 12 different European countries. Five originated from France, 5 from Scotland and 3 each from Sweden, Norway and Spain. Twenty-six were children (median age 3.8 years), 3 were adults. EV-D68 was detected in respiratory materials (n = 27), feces (n = 8) and/or cerebrospinal fluid (n = 2). Common clinical features were asymmetric flaccid limb weakness, cranial nerve deficits and bulbar symptoms. On magnetic resonance imaging, typical findings were hyperintensity of the central cord and/or brainstem; low motor amplitudes with normal conduction velocities were seen on electromyography. Full clinical recovery was rare (n = 3), and 2 patients died. The epidemiologic data from 16 European laboratories showed that of all EV-D68–positive samples, 99% was detected in a respiratory specimen.

Conclusions:

For 2016, 29 EV-D68–related AFM cases were identified in mostly Western Europe. This is likely an underestimation, because case identification is dependent on awareness among clinicians, adequate viral diagnostics on respiratory samples and the capability of laboratories to type EVs.
Streptococcal Serology in Acute Rheumatic Fever Patients
Authors: Jack Susan , Moreland Nicole J. , Meagher Jess , Fittock Marea , Galloway Yvonne , Ralph Anna P.
Published: September 2018

Background:

Globally, there is wide variation in streptococcal titer upper limits of normal (ULN) for antistreptolysin O (ASO) and anti-deoxyribonuclease B (ADB) used as an evidence of recent group A streptococcal infection to diagnose acute rheumatic fever (ARF).

Methods:

We audited ASO and ADB titers among individuals with ARF in New Zealand (NZ) and in Australia’s Northern Territory. We summarized streptococcal titers by different ARF clinical manifestations, assessed application of locally recommended serology guidelines where NZ uses high ULN cut-offs and calculated the proportion of cases fulfilling alternative serologic diagnostic criteria.

Results:

From January 2013 to December 2015, group A streptococcal serology results were available for 350 patients diagnosed with ARF in NZ and 182 patients in Northern Territory. Median peak streptococcal titers were similar in both settings. Among NZ cases, 267/350 (76.3%) met NZ serologic diagnostic criteria, whereas 329/350 (94.0%) met Australian criteria. By applying Australian ULN titer cut-off criteria to NZ cases, excluding chorea, ARF definite cases would increase by 17.6% representing 47 cases.

Conclusions:

ASO and ADB values were similar in these settings. Use of high ULN cut-offs potentially undercounts definite and probable ARF diagnoses. We recommend NZ and other high-burden settings to use globally accepted, age-specific, lower serologic cut-offs to avoid misclassification of ARF.
Two Randomized Trials of the Effect of the Russian Strain of Bacillus Calmette-Guérin Alone or With Oral Polio Vaccine on Neonatal Mortality in Infants Weighing <2000 g in India
Authors: Jayaraman Kumutha , Adhisivam Bethou , Nallasivan Saravanan , Krishnan R. Gokul , Kamalarathnam Chinnathambi , Bharathi Mangala , McSharry Brent , Namachivayam Siva P. , Shann Frank , Boopalan Sasireka I , David Ponrani , Bhat B. Vishnu
Published: September 2018

Background:

In randomized trials in Guinea-Bissau, the Danish strain of Bacillus Calmette-Guérin (BCG) reduces neonatal mortality, primarily by reducing deaths from pneumonia and sepsis. Because World Health Organization–prequalified BCG-Denmark was not available in India, we conducted 2 randomized trials to test whether BCG-Russia alone or with oral polio vaccine (OPV) has similar effects to BCG-Denmark.

Methods:

We randomized neonates weighing <2000 g to a control group that was not vaccinated before 28 days of age or to receive either BCG-Russia alone (first trial) or BCG-Russia with OPV (second trial) soon after birth. We performed intention-to-treat analysis using Cox hazards models with age as the underlying time and adjusted for weight, sex and inborn versus outborn status.

Results:

Administration of BCG-Russia alone had no effect on neonatal mortality (to 28 days of age): 15.6% of 1537 infants died in the BCG-Russia group and 16.1% of 1535 died in the control group; the adjusted hazard ratio was 0.95 [95% confidence interval (CI): 0.80–1.13]. Administration of BCG-Russia with OPV also had no effect on neonatal mortality: 18.0% of 1103 infants died in the BCG-OPV group and 17.6% of 1104 died in the control group; the adjusted hazard ratio was 1.01 (95% CI: 0.83–1.23). The adjusted hazard ratio for the 2 trials combined was 0.98 (95% CI: 0.85–1.11).

Conclusions:

BCG-Russia with or without OPV had no effect on neonatal mortality. It is important to determine which strains of BCG have the greatest specific effects (on tuberculosis) and nonspecific effects (on infections other than tuberculosis) in high-mortality regions.
When the Patient Is Not an “Ideal” Candidate. The Importance of Early Physical Therapy Intervention Pre- and Post–Lung Transplant: A Case Report
Authors: Bello Romina
Published: September 2018

Purpose:

Each year thousands of patients are placed on lung transplant waiting lists. Despite evidence of the importance of pulmonary rehabilitation programs for this population, minimal literature regarding physical therapy (PT) for the candidate that is admitted to the hospital to await surgery exists. This case report describes a successful rehabilitation approach for this patient population.

Case Presentation:

A 59-year-old male patient with a diagnosis of idiopathic pulmonary fibrosis was admitted to the intensive care unit to await lung transplant. The inability to manage the patient's high oxygen requirements in his home environment, as well as the progression of his disease, prompted the need for constant medical management in an intensive care setting. His presurgical comorbidities classified him as a less than “ideal” transplant candidate. He received early and frequent PT both pre- and posttransplant, with focus on strengthening and gait training activities to improve his functional capacity. Subjective improvements in quality of life and function after bilateral lung transplant were achieved despite potential for a complicated postoperative course related to his medical history.

Conclusion:

Early and frequent PT may be important for patients admitted to the intensive care unit while awaiting transplantation and can play an even greater role for the less than “ideal” transplant candidate. The PT interventions can be provided safely for this population in the hospital setting. A rehabilitation approach focused on maximizing a patient's functional capacity with strength and gait training activities may facilitate improved outcomes for lung transplant recipients deemed less than optimal candidates.
Concussion History, Reporting Behaviors, Attitudes, and Knowledge in Jockeys
Authors: O'Connor Siobhán , Warrington Giles , Whelan Grainne , McGoldrick Adrian , Cullen SarahJane
Published: September 2018

Objective:

To examine concussion history, knowledge, and attitudes among Irish professional and amateur jockeys.

Design:

Cross-sectional survey.

Setting:

Questionnaire was distributed through e-mails sent to all licensed jockeys, over social media and during professional and amateur race meetings.

Participants:

An average of 23.6% (12%-44%) Irish professional and amateur jockeys (n = 119) holding a license in 2017.

Main Outcome Measures:

Jockeys reported their previous concussion history, actions after their most recent concussion and responded to questions examining their knowledge and attitudes toward concussion.

Results:

Amateur (32.4%) and professional (19.6%) jockeys, who were never medically diagnosed over their career, suspected that they had sustained a concussion. Jockeys displayed good knowledge of concussion signs and symptoms; yet, one in 2 jockeys would continue to ride out the same day if they suspected they had a concussion. They were less likely if they had a race that day. Reasons for continuing to ride include not considering a concussion as serious (85.7%); risk of losing the ride (84.0%); not wanting to let anyone down (77.8%); and considered it a sign of weakness (74.1%). Risky behavior was more common after a suspected concussion than a medically diagnosed concussion.

Conclusions:

Underreporting of concussions is proposed as a serious concern, and concussion understanding and attitudes can impact reporting. To address the issue of underreporting of concussions in Irish horseracing, there is a need to educate jockeys and the wider racing community on the importance of timely concussion assessments and access to appropriate management systems.
A Preliminary Study of the Effect of Early Aerobic Exercise Treatment for Sport-Related Concussion in Males
Authors: Leddy John J. , Haider Mohammad N. , Hinds Andrea L. , Darling Scott , Willer Barry S.
Published: September 2018

Objective:

To study the effect of early prescribed aerobic exercise versus relative rest on rate of recovery in male adolescents acutely after sport-related concussion (SRC).

Design:

Quasi-experimental design.

Setting:

University sports medicine centers.

Participants:

Exercise group (EG, n = 24, 15.13 ± 1.4 years, 4.75 ± 2.5 days from injury) and rest group (RG, n = 30, 15.33 ± 1.4 years, 4.50 ± 2.1 days from injury).

Interventions:

Exercise group performed a progressive program of at least 20 minutes of daily subthreshold aerobic exercise. Rest group was prescribed relative rest (no structured exercise). Both groups completed daily online symptom reports (Postconcussion Symptom Scale) for 14 days.

Main Outcome Measures:

Days to recovery after treatment prescription. Recovery was defined as return to baseline symptoms, exercise tolerant, and judged recovered by physician examination.

Results:

Recovery time from initial visit was significantly shorter in EG (8.29 ± 3.9 days vs 23.93 ± 41.7 days, P = 0.048). Mixed-effects linear models showed that all symptom clusters decreased with time and that there was no significant interaction between treatment group and time. No EG participants experienced delayed recovery (>30 days), whereas 13% (4/30) of RG participants experienced delayed recovery.

Conclusions:

These preliminary data suggest that early subthreshold aerobic exercise prescribed to symptomatic adolescent males within 1 week of SRC hastens recovery and has the potential to prevent delayed recovery.
Fecal calprotectin is significantly linked to azathioprine metabolite concentrations in Crohn’s disease
Authors: Essmann Julian , Keil Carsten , Unruh Olesya , Otte Anita , Manns Michael P. , Bachmann Oliver
Published: September 2018

Background

The value of therapeutic drug monitoring during azathioprine (AZA) therapy with respect to clinical outcomes has been convincingly demonstrated in recent meta-analyses. However, the association between AZA metabolites and the mucosal state in inflammatory bowel disease is largely unclear.

Aims

We investigated the association between AZA’s active metabolite 6-thioguanine nucleotides (6-TGN) and fecal calprotectin (FC) as a well-validated surrogate marker of mucosal inflammation in patients with Crohn’s disease (CD) on AZA monotherapy.

Patients and methods

Of 443 6-TGN measurements, 140 values from 88 patients with CD on AZA monotherapy visiting the inflammatory bowel disease outpatient clinic between 2009 and 2016 were retrospectively analyzed. In a subcohort with serial 6-TGN measurements, longitudinal FC measurements in patients with versus without intervention (dose increase, allopurinol, and education) were assessed.

Results

In patients with 6-TGN concentrations within a predefined range (250–450 pmol/8×108 red blood cells), FC was significantly lower (median: 119.5 vs. 327.2 mg/kg, P=0.003), and hemoglobin as well as serum protein concentrations were significantly higher than in patients with 6-TGN outside of this range. C-reactive protein and transferrin saturation were not different. In the longitudinal cohort, 6-TGN increased in the intervention group, but only a minority reached the defined range; no significant change in FC was observed.

Conclusion

This study is the first to show that in patients with CD receiving AZA monotherapy, 6-TGN concentrations within a defined range (250–450 pmol/8×108 red blood cells) are associated with significantly lower FC. A treat-to-target concept directed by 6-TGN to reach mucosal healing may thus be a promising approach (DRKS00013246).
Marijuana is not associated with progression of hepatic fibrosis in liver disease: a systematic review and meta-analysis
Authors: Farooqui Muhammad T. , Khan Muhammad A. , Cholankeril George , Khan Zubair , Mohammed Abdul Mubeen K. , Li Andrew A. , Shah Neha , Wu Lin , Haq Khwaja , Solanki Shantanu , Kim Donghee , Ahmed Aijaz
Published: September 2018

Background

An estimated 22 million adults use marijuana in the USA. The role of marijuana in the progression of hepatic fibrosis remains unclear.

Aims

We carried out a systematic review and meta-analysis to evaluate the impact of marijuana on prevalence and progression of hepatic fibrosis in chronic liver disease.

Patients and methods

We searched several databases from inception through 10 November 2017 to identify studies evaluating the role of marijuana in chronic liver disease. Our main outcome of interest was prevalence/progression of hepatic fibrosis. Adjusted odds ratios (ORs) and hazards ratios (HRs) were pooled and analyzed using random-effects model.

Results

Nine studies with 5 976 026 patients were included in this meta-analysis. Prevalence of hepatic fibrosis was evaluated in nonalcoholic fatty liver disease (NAFLD), hepatitis C virus (HCV), and hepatitis C and HIV coinfection by two, four, and one studies. Progression of hepatic fibrosis was evaluated by two studies. Pooled OR for prevalence of fibrosis was 0.91 (0.72–1.15), I
2=75%. On subgroup analysis, pooled OR among NAFLD patients was 0.80 (0.75–0.86), I
2=0% and pooled OR among HCV patients was 1.96 (0.78–4.92), I
2=77%. Among studies evaluating HR, pooled HR for progression of fibrosis in HCV–HIV co-infected patients was 1.03 (0.96–1.11), I
2=0%.

Conclusion

Marijuana use did not increase the prevalence or progression of hepatic fibrosis in HCV and HCV–HIV-coinfected patients. On the contrary, we noted a reduction in the prevalence of NAFLD in marijuana users. Future studies are needed to further understand the therapeutic impact of cannabidiol-based formulations in the management of NAFLD.
Evaluating the Impact of Eliminating Copayments for Tobacco Cessation Pharmacotherapy
Authors: Young-Wolff Kelly C. , Adams Sara R. , Klebaner Daniella , Adams Alyce S. , Campbell Cynthia I. , Satre Derek D. , Prochaska Judith J.
Published: September 2018

Objectives:

We examined the impact of the Affordable Care Act–mandated elimination of tobacco cessation pharmacotherapy (TCP) copayments on patient use of TCP, overall and by income.

Methods:

Electronic health record data captured any and combination (eg, nicotine gum plus patch) TCP use among adult smokers newly enrolled in Kaiser Permanente Northern California (KPNC). KPNC eliminated TCP copayments in 2015. We included current smokers newly enrolled in the first 6 months of 2014 (before copayment elimination, N=16,199) or 2015 (after elimination, N=16,469). Multivariable models estimated 1-year changes in rates of any TCP fill, and of combination TCP fill, and tested for differences by income (<$50k, $50≥75k, ≥$75k). Through telephone surveys in 2016 with a subset of smokers newly enrolled in 2014 (n=306), we assessed barriers to TCP use, with results stratified by income.

Results:

Smokers enrolled in KPNC in 2015 versus 2014 were more likely to have a TCP fill (9.1% vs. 8.2%; relative risk, 1.19; 95% confidence interval, 1.11–1.27), and combination TCP fill, among those with any fill (42.3% vs. 37.9%; relative risk, 1.12; 95% confidence interval, 1.02–1.23); findings were stronger for low-income smokers. Low-income patients (<$50k) were less likely to report that clinicians discussed smoking treatments with them (58%) compared with higher income smokers ($50≥75k, 67%; ≥$75k, 83%), and were less aware that TCP was free (40% vs. 53% and 69%, respectively, P-values<0.05).

Conclusions:

The Affordable Care Act’s copayment elimination was associated with a modest increase in TCP use and a greater effect among low-income smokers. Uptake may have been enhanced if promoted to patients directly and via providers.
Innovations in Occupational Health Care Delivery Can Prevent Entry into Permanent Disability
Authors: Wickizer Thomas M. , Franklin Gary M. , Fulton-Kehoe Deborah
Published: September 2018

Background:

Long-term work disability is known to have an adverse effect on the nation’s labor force participation rate. To reduce long-term work disability, the Washington State Department of Labor and Industries established a quality improvement initiative that created 2 pilot Centers of Occupational Health and Education (COHE).

Objectives:

To document the level of work disability in a sample of injured workers with musculoskeletal injuries and to examine (8-y) work disability outcomes associated with the COHE health care model.

Research Design:

Prospective nonrandomized intervention study with nonequivalent comparison group using difference-in-difference regression models.

Subjects:

Intervention group represents 18,790 workers with musculoskeletal injuries treated by COHE providers. Comparison group represents 20,992 workers with similar injuries treated within the COHE catchment area by non-COHE providers.

Measures:

Long-term disability outcomes include: (1) on disability 5 years after injury; (2) received a state pension for total permanent disability; (3) received total disability income support through the Social Security Disability Insurance program; or (4) a combined measure including any one of the 3 prior measures.

Results:

COHE patients had a 30% reduction in the risk of experiencing long-term work disability (odds ratio=0.70, P=0.02). The disability rate (disability days per 1000 persons) over the 8-year follow-up for the intervention and comparison groups, respectively, was 49,476 disability days and 75,832 disability days.

Conclusions:

Preventing long-term work disability is possible by reorganizing the delivery of occupational health care to support effective secondary prevention in the first 3 months following injury. Such interventions may have promising beneficial effects on reversing the nation’s progressively worsening labor force participation rate.
Migraine in children: presentation, disability and response to treatment
Authors: Slater Shalonda K. , Powers Scott W. , O’Brien Hope L.
Published: September 2018

Purpose of review

The current review presents findings from investigations of migraine in children. The presentation of pediatric migraine, related consequences, and medication treatments are reviewed.

Recent findings

A number of advancements have been made in the study of the presentation, disability, and treatments for migraine in children. However, recent research suggests that not all approaches are equally effective in the treatment of migraine in children. Specifically, a recent study comparing pharmacological interventions found that preventive medications were not statistically more effective than placebo in children. Consistent findings showing clinically meaningful placebo response rates, shorter duration of headaches and other characteristic features (e.g. frontal, bilateral location) have been barriers to the design of randomized clinical trials in children and adolescents with migraine. Better understanding of treatment mechanisms for medication interventions is needed.

Several migraine treatments have determined to be effective for use in children but few controlled studies have evaluated the effectiveness of medication treatments. Recent research suggests that preventive medications may not be more effective than placebo. Additional research is needed to evaluate the effectiveness of medication treatment in migraine headache care.
Recent progress in porcine islet isolation, culture and engraftment strategies for xenotransplantation
Authors: Kemter Elisabeth , Wolf Eckhard
Published: September 2018

Purpose of review

Xenotransplantation of porcine islets is a realistic option to restore β-cell function in type 1 diabetic patients. Among other factors, such as islet donor age (fetal, neonatal and adult) and genotype (wild type and genetically modified), choice of the transplantation site, and immune protection of the islets, efficient strategies for islet isolation, culture and engraftment are critical for the success of islet xenotransplantation.

Recent findings

Neonatal porcine islets (NPIs) are immature at isolation and need to be matured in vitro or in vivo before they become fully functional. Recent developments include a scalable protocol for isolation of clinically relevant batches of NPIs and a stepwise differentiation protocol for directed maturation of NPIs. In addition, different sources of mesenchymal stem cells were shown to support survival and functional maturation of NPIs in vitro and in various transplantation models in vivo.

A plethora of different culture media and supplements have been tested; however, a unique best culture system for NPIs is still missing. New insights, for example from single-cell analyses of islets or from stem cell differentiation toward β cells may help to optimize culture of porcine islets for xenotransplantation in an evidence-based manner.
Progress and challenges in lung xenotransplantation: an update
Authors: Burdorf Lars , Azimzadeh Agnes M. , Pierson Richard N.
Published: September 2018

Purpose of review

Recent progress in genetic engineering has facilitated development of transgenic donor animals designed to overcome the known barriers to discordant xenotransplantation, and greatly accelerated progress in the field of xenotransplantation. Here we review and summarize recent progress in lung xenotransplantation, and discuss possible additional genetic modifications and other interventions that may further advance the use of pulmonary xenografts towards clinical applications based on known mechanisms of xeno lung injury.

Recent findings

Ex-vivo lung perfusion experiments have shown that the addition of human complement (hCD46, hCD55), coagulation (hEPCR, hVWF, hTBM, hTFPI, hCD39), or anti-inflammatory pathway regulatory genes (HO-1, HLA-E), and the knockout (KO) of major porcine carbohydrates (GalT, Neu5Gc, B4Gal) have each protective effects on lung survival and function. The use of these transgenes in multitransgenic donor organs, targeting several known xenogeneic rejection mechanisms, combined with drug treatments addressing remaining known rejection pathways, have led to prolonged recipient survival of up to 31 days with in some cases preserved live-supporting organ function of the transplanted graft for several days. Pulmonary vascular resistance elevation, which has been found to be associated with high thromboxane levels and has been the major failure reason of xenogeneic lung grafts in the past years, has been successfully attenuated by the addition of a thromboxane synthase inhibitor (1-Benzylimidazole). Currently, the predominant failure mechanism of xenogeneic lung grafts is an inflammatory process, leading to vascular barrier function injury with interstitial and trachea edema. Work with other pig organs in primate models show that regimens based on costimulatory pathway blocking antibodies prolong xenograft function for months to years, suggesting that once initial lung inflammation mechanisms are fully controlled, clinically useful application of pig lung xenografts may be feasible.

The use of multitransgenic donor pigs coupled with drugs targeting complement activation, coagulation, and inflammation have significantly improved the survival of xenogeneic pig lungs both during ex vivo human blood perfusion and in life-supporting in vivo models, and for the first time allowed consistent life-supporting function of lung xenografts. Overcoming delayed loss of vascular barrier function injury appears to be within reach, and will be essential to make lung xenografts a clinically relevant treatment option.
Role of Incentives in Long‐term Nutritional and Growth Studies in Children
Authors: Fidler Mis Nataša , Kennedy Kathy , Fewtrell Mary , Campoy Cristina , Koletzko Berthold ,   Working Group on Early Nutrition Research, European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)
Published: September 2018

Objectives:

Available published advice on use of incentives is limited and generally refers to short‐term studies without longer follow‐up, predominantly conducted in developed countries. We aim to summarize published information related to the use of incentives in long‐term nutrition studies involving infants, children, and adolescents and the views of researchers in the field, to provide guidance on acceptable incentives. We conducted a literature review and a short online survey of researchers regarding their opinions on the use of incentives in paediatric long‐term (follow‐up) clinical studies. Responses from 38 researchers from 14 different countries indicated that 41% had used incentives to increase participation and 29% to 73%, depending on child's age and type of procedure, thought incentives may be used to increase compliance with follow‐up visits. A small number of respondents thought incentives would not be approved by national ethics boards. Based on the literature review and the survey results, and European Society for Paediatric Gastroenterology, Hepatology and Nutrition working group concluded that incentives for children and adolescents up to the value of 30 Euros, based on average EU income levels, may be offered as cash, vouchers, or age‐appropriate gifts or toys, in addition to reimbursing expenses. Additional incentives may be offered if a study includes more burdening procedures, techniques that may appear frightening for younger children, or requires sustained participation (eg, dietary diaries or activity monitoring). There was agreement that it is preferable to give toys or gifts rather than money to younger children.
The Brussels Infant and Toddler Stool Scale
Authors: Huysentruyt Koen , Koppen Ilan , Benninga Marc , Cattaert Tom , Cheng Jiqiu , De Geyter Charlotte , Faure Christophe , Gottrand Frédéric , Hegar Badriul , Hojsak Iva , Miqdady Mohamad , Osatakul Seksit , Ribes‐Koninckx Carmen , Salvatore Silvia , Saps Miguel , Shamir Raanan , Staiano Annamaria , Szajewska Hania , Vieira Mario , Vandenplas Yvan ,   BITSS working group
Published: September 2018

Objectives:

The Bristol Stool Form Scale (BSFS) is inadequate for non‐toilet trained children. The Brussels Infant and Toddler Stool Scale (BITSS) was developed, consisting of 7 photographs of diapers containing stools of infants and toddlers. We aimed to evaluate interobserver reliability of stool consistency assessment among parents, nurses, and medical doctors (MDs) using the BITSS.

Methods:

In this multicenter cross‐sectional study (2016–2017), BITSS photographs were rated according to the BSFS. The reliability of the BITSS was evaluated using the overall proportion of perfect agreement and the linearly weighted κ statistic.

Results:

A total of 2462 observers participated: 1181 parents (48.0%), 624 nurses (25.3%), and 657 MDs (26.7%). The best‐performing BITSS photographs corresponded with BSFS type 7 (87.5%) and type 4 (87.6%), followed by the BITSS photographs representing BSFS type 6 (75.0%), BSFS type 5 (68.0%), BSFS type 1 (64.8%), and BSFS type 3 (64.6%). The weakest performing BITSS photograph corresponded with BSFS type 2 (49.7%). The overall weighted κ‐value was 0.72 (95% CI 0.59–0.85; good agreement). Based on these results, photographs were categorized per stool group as hard (BSFS type 1–3), formed (BSFS type 4), loose (BSFS types 5 and 6), or watery (BSFS type 7) stools. According to this new categorization system, correct allocation for each photograph ranged from 83 to 96% (average: 90%). The overall proportion of correct allocations was 72.8%.

Conclusions:

BITSS showed good agreement with BSFS. Using the newly categorized BITSS photographs, the BITSS is reliable for the assessment of stools of non‐toilet trained children in clinical practice and research. A multilanguage translated version of the BITSS can be downloaded at https://bitss‐stoolscale.com/.
Outcome of High-risk Langerhans Cell Histiocytosis (LCH) in Egyptian Children, Does Intermediate-dose Methotrexate Improve the Outcome?
Authors: Sedky Mohamed S. , Hamouda Asmaa , Taha Hala , Zaky Iman , Hassanain Omayma , El Hemaly Ahmed , ElHaddad Alaa
Published: September 2018

High-risk multisystem organ (RO+) Langerhans cell histiocytosis (LCH) has the least survival. We present the outcome of RO+ LCH in a pediatric single center. Fifty RO+ LCH patients, treated between 07/2007 and 07/2015, were retrospectively analyzed. Induction vinblastine (VBL) and prednisone (PRED) with intermediate-dose methotrexate (idMTX) was adopted until 2012 (n=20) wherein idMTX was omitted (n=30). The 3-year overall survival (OS) of MTX and non-MTX groups was 75% and 63%, respectively, P=0.537, while the event-free survival (EFS) was 36.9% and 13.2%, respectively, P=0.005. At week 12 of induction, “better status” was obtained in 80% of those receiving MTX, and 55% of those who were not. The statistically significant factors associated with both poor OS and EFS were trihemopoietic cytopenias, hepatic dysfunction, tri RO+ combination, and single induction. The factors associated with disease progression (DP) on induction were trihemopoietic cytopenias, hepatic dysfunction, and lack of idMTX, while those for disease reactivations (REA), the season of autumn/winter, lung disease, male sex, and idMTX were the associated factors. The 1-year OS was remarkably affected with the occurrence of DP versus REA versus none, wherein it was 47%, 93%, and 95%, respectively, P=0.001. In conclusion, idMTX is associated with better EFS. DP on induction remains of dismal prognosis in relation to disease REA afterwards. Risk stratification should highlight the role of trihemopoietic cytopenias, hepatic dysfunction, tri RO+, central nervous system risk site, and lung association.
Probiotics and their increasing importance in human health and infection control
Authors: Ghasemian Abdolmajid , Eslami Majid , Shafiei Morvarid , Najafipour Sohrab , Rajabi Ali
Published: September 2018

Probiotics include a group of microorganisms with numerous effects acting as normal flora and masking binding sites of pathogens and inhibition of their colonization. Most common probiotic species include Bifidobacterium spp., Lactobacilli and Saccharomyces boulardii. Some other beneficial properties of probiotics include cancer prevention, reduction of blood cholesterol and its absorption from the intestine (by bile digestion), stimulation and strengthen of the immune system, treatment and prevention of acute diarrhea, reducing inflammation in the intestines, and food allergies or eczema in children, improving the symptoms of irritable bowel syndrome and colitis, and remedy of vaginal yeast infections, and also antibiotics associated diarrhea, oral lesions, dental caries, and vaginal swelling. Furthermore, probiotics contribute to prevent viral infections, athlete's foot and fungal infections, and improvement of digestion and enhancing nutrition absorbance, inhibition of biofilm formation and increase in vitamins biosynthesis; especially those in groups B and K. Probiotics use in defined amounts has desirable outcomes. Side effects of probiotics are rare which occur among immunocompromised patients and pediatrics, thus care should be taken to avoid their side effects. Use of germ-free animals and study of symbiotic interactions among probiotics is possibly helpful for future perspectives.
Quality of Life in Patients With Non–Small Cell Lung Cancer
Authors: Lee Jung Lim , Jeong Younhee
Published: September 2018

Background

Quality of life (QOL) is important for cancer patients, even for survival. However, factors affecting QOL of non–small cell lung cancer (NSCLC) patients have not been studied sufficiently.

Objective

The aims of this study were to understand the relationships among social support, resilience, distress, and symptom and to identify predictors of QOL for NSCLC patients.

Methods

Participants were 212 adult patients who visited an outpatient department at a tertiary hospital located in Seoul, Korea. Data were collected using self-reported questionnaires and clinical records.

Results

Social support, resilience, distress, symptom burden, and QOL explained 99.9% of the variance in QOL. Social support was not a significant predictor of distress and QOL, but a significant predictor of resilience. Resilience was a significant predictor of both distress and QOL. Distress was not a significant predictor of QOL, but a significant predictor of symptom burden. Symptom burden was a significant predictor of QOL and had the largest direct effect on QOL. Resilience also had an important impact on QOL because resilience influenced QOL in various paths.

Conclusion

This study suggests that social support, resilience, distress, and symptom burden are predictors of QOL in an NSCLC population. These predictors had direct and indirect effects on each other and on QOL.

Implications for Practice

Developing an interventional program to increase resilience and social support as well as to decrease symptom burden and distress may be necessary to improve QOL of NSCLC patients.
Comparing Outcomes of Active Student and Observer Roles in Nursing Simulation
Authors: Bates Teresa A. , Moore Leslie C. , Greene Debbie , Cranford Joan S.
Published: September 2018

Background

Because of large class sizes and limited resources, students participating in high-fidelity simulation experiences may be assigned to an observer role as opposed to an active nursing role.

Purpose

Educators need to determine if anxiety levels and student learning outcomes are comparable for students in active and observer roles.

Methods

A quasi-experimental study was conducted with 132 prelicensure baccalaureate students. Active nursing roles consisted of primary care, documentation, and medication nurse roles. Observer role students were provided with resources to guide them with developing their observational skills and achieving the simulation objectives.

Results

There were no significant differences between simulation roles for anxiety levels, satisfaction with learning, self-confidence in learning, clinical ability, problem solving, confidence in clinical practice, and collaboration.

Conclusions

These findings suggest that either role is an appropriate assignment during simulation. Educators should identify ways to be supportive and reduce anxiety in students during simulation experiences.
Four Approaches for Determining Composite Scores for the Measurement of Transition in Cancer Scale
Authors: Jeon Sangchoon , Schulman-Green Dena , McCorkle Ruth , Dixon Jane K.
Published: September 2018

Background

We created the Measurement of Transitions in Cancer Scale to assess patients’ perceptions of the extent of change they experience with cancer-related transitions and how well they feel they are managing these transitions. For some transitions, we found that the more change that was reported, the worse management was reported; however, the benchmark by which patients assess how well they have managed may vary with the extent of change.

Objectives

The aim of the study was to identify approaches to combine reports of extent and management of change.

Methods

Among women with breast cancer, we explored relationships of composite measures (arithmetic and geometric means, subtractive and proportional need for improvement) with other indicators of well-being (symptoms, anxiety, depression, uncertainty, self-efficacy, knowledge of care options, medical communication competence). We examined statistical significance using false rate discovery for multiple tests on correlations with clinical outcomes.

Results

Greater extent and less management were significantly associated with higher total symptoms, anxiety, depression, uncertainty, and less self-efficacy in Personal Transitions, but not in Care Transitions. The arithmetic and geometric means had weak correlations with clinical outcomes, whereas the subtractive and proportional need for improvement had significant correlations with most clinical outcomes both in Personal and Care Transitions. The combined proportional need for improvement in Personal Transitions was significantly associated with total symptoms, anxiety, depression, uncertainty, and self-efficacy. The Care Transitions score was also significantly associated with total symptoms, anxiety, uncertainty, and self-efficacy.

Discussion

These approaches can be applied to other aspects of self-management that require assessment of the extent and management of an experience. The four approaches yield different results. We recommend the need for improvement composites to capture correlations with the clinical outcomes.
A Novel Nested Real-time Polymerase Chain Reaction for Treponema pallidum DNA in Syphilis Biospecimens
Authors: Zhang Yi , Dai Xiangnong , Ren Zefang , Lin Hongda , Cao Wenling , Ye Xingdong
Published: September 2018

Background

Early diagnosis of Treponema pallidum infection is helpful for disease management, and conventional PCR is suitable for lesion swabs of patients with probable early syphilis. We thus tested nested and real-time PCR (NR-PCR) in various biosamples from syphilitic patients.

Methods

Samples were collected from syphilis patients before treatment. Specific primer sequences targeting the T. pallidum gene polA were designed for NR-PCR.

Results

Across syphilis types, most samples assayed with NR-PCR returned a positive result, including earlobe blood (92.0%), cerebrospinal fluid (CSF) (90.2%), lesion swabs (74.3%), serum (66.9%), and whole blood (64.2%). No significant differences were observed in positive samples for whole blood, serum, and lesion swabs between primary and secondary syphilis (P > 0.05 for all comparisons). However, more whole-blood samples from patients with secondary syphilis were positive for NR-PCR than whole blood samples from patients with tertiary and latent syphilis (P < 0.05 for all comparisons). For neurosyphilis patients, significantly more earlobe blood samples tested positive than did whole-blood samples (P < 0.05), but there was no difference in positive results for earlobe blood and whole blood in latent syphilis. Significantly more serum samples tested positive in latent syphilis patients with rapid plasma regain (RPR) titers of 1:8 or greater, compared to those with RPR of 1:4 or less.

Conclusions

Nested and real-time PCR can be used to identify T. pallidum DNA in biosamples from syphilitic patients, especially earlobe blood.
The Frequency of Discordant Gyrase A Genotypes Among Cases of Multiple Neisseria gonorrhoeae Infections at Different Anatomic Sites
Authors: Allan-Blitz Lao-Tzu , Ellis Olivia L. , Bolan Robert , Hemarajata Peera , Humphries Romney M. , Shahkolahi Akbar , McGrath Mark , Klausner Jeffrey D.
Published: September 2018

Gyrase A genotyping reliably predicts Neisseria gonorrhoeae susceptibility to ciprofloxacin. It is unknown whether concurrent infections at different anatomic sites harbor different susceptibility profiles. We found a 3.2% frequency of discordant gyrase A genotypes among concurrent but anatomically separate N. gonorrhoeae infections diagnosed at 2 laboratories in Los Angeles.