bluuebunny/crossref_metadata_2025 huggingface dataset:
Petunia- and Arabidopsis-Specific Root Microbiota Responses to Phosphate Supplementation
Authors: Bodenhausen Natacha , Somerville Vincent , Desirò Alessandro , Walser Jean-Claude , Borghi Lorenzo , van der Heijden Marcel G. A. , Schlaeppi Klaus
Published: June 2019

Phosphorus (P) is a limiting element for plant growth. Several root microbes, including arbuscular mycorrhizal fungi (AMF), have the capacity to improve plant nutrition and their abundance is known to depend on P fertility. However, how complex root-associated bacterial and fungal communities respond to various levels of P supplementation remains ill-defined. Here we investigated the responses of the root-associated bacteria and fungi to varying levels of P supply using 16S rRNA gene and internal transcribed spacer amplicon sequencing. We grew Petunia, which forms symbiosis with AMF, and the nonmycorrhizal model species Arabidopsis as a control in a soil that is limiting in plant-available P and we then supplemented the plants with complete fertilizer solutions that varied only in their phosphate concentrations. We searched for microbes, whose abundances varied by P fertilization, tested whether a core microbiota responding to the P treatments could be identified and asked whether bacterial and fungal co-occurrence patterns change in response to the varying P levels. Root microbiota composition varied substantially in response to the varying P application. A core microbiota was not identified as different bacterial and fungal groups responded to low-P conditions in Arabidopsis and Petunia. Microbes with P-dependent abundance patterns included Mortierellomycotina in Arabidopsis, while in Petunia, they included AMF and their symbiotic endobacteria. Of note, the P-dependent root colonization by AMF was reliably quantified by sequencing. The fact that the root microbiotas of the two plant species responded differently to low-P conditions suggests that plant species specificity would need to be considered for the eventual development of microbial products that improve plant P nutrition.

[Formula: see text]Copyright © 2019 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Identification of New QTL Contributing to Barley Yellow Dwarf Virus-PAV (BYDV-PAV) Resistance in Wheat
Authors: Choudhury S. , Hu H. , Fan Y. , Larkin P. , Hayden M. , Forrest K. , Birchall C. , Meinke H. , Xu R. , Zhu J. , Zhou M.
Published: June 2019

Barley yellow dwarf (BYD) is a major virus disease which dramatically reduces wheat yield. Introducing BYD resistance genes into commercial varieties has been proven to be effective in reducing damage caused by barley yellow dwarf virus (BYDV). However, only one major resistance gene is readily deployable for breeding; Bdv2 derived from Thinopyrum intermedium is deployed as a chromosomal translocation. In this study, a double haploid (DH) population was developed from a cross between XuBYDV (introduced from China showing very good resistance to BYD) and H-120 (a BYD-sensitive Chinese accession), and was used to identify QTL for BYD resistance. The population was genotyped using an Infinium iSelect bead chip array targeting 90K gene-based SNPs. The disease resistance of DH lines inoculated with BYDV was assessed at the heading stage. The infections were assessed by tissue blot immunoassay (TBIA). Three new QTL were identified on chromosomes 5A, 6A, and 7A for both symptom and TBIA, with all three resistance alleles being inherited from XuBYDV. Some DH lines with the resistance alleles from all three QTL showed high level resistance to BYD. These new QTL will be useful in breeding programs for pyramiding BYD resistance genes.
Lumbosacral Transitional Vertebrae
Authors: Tucker Braden J. , Weinberg Douglas S. , Liu Raymond W.
Published: June 2019

Study Design:

This is a retrospective cohort study.

Objective:

The objective of this study was to verify the prevalence of lumbosacral transitional vertebrae (LSTV) in the general population and measure the resulting spinal arthritic changes.

Summary of Background:

LSTV are a morphologic variation within the lumbar spine that has potentially significant clinical implications. LSTV prevalence has been investigated using nonrandom volunteer samples and patient populations presenting with medical complaints such as abdominal or lumbar pain warranting computed tomography and magnetic resonance imaging scans. The examination of LSTV prevalence and variations using a true random population to our knowledge has yet to be conducted, and the relation between LSTV and spinal arthritis has not been rigorously examined.

Materials and Methods:

A total of 560 cadaveric skeletons were obtained from the Hamann-Todd osteological collection. The transverse processes of the terminal lumbar vertebrae were examined and measured, since the classification at times is based on examination and at times is based on measurement. The lumbar degenerative disease was graded on each specimen.

Results:

Our search revealed 489 (87.3%) nontransitional vertebrae and 71 (12.7%) transitional vertebrae, with the majority of these Castellvi type IA (N=28), type IB (N=19), and type IIA (N=11). Transitional vertebrae as a whole (standardized β=0.090, P=0.015), and in particular type Ia showed a correlation to osteoarthritis in the L4–L5 vertebral level (standardized β=0.089, P=0.015).

Conclusions:

This cadaveric study aids in establishing the prevalence of LSTV (12.7%) in a random population and the frequency of the various Castellvi LSTV morphologies. An association was found between type Ia morphology and L4–L5 osteoarthritis which has not been reported in the past, suggesting that mild LSTV may carry more significance to lumbar pathology than previously considered.
Clinical Impact of Cervical Imbalance on Surgical Outcomes of Laminoplasty
Authors: Tamai Koji , Suzuki Akinobu , Yabu Akito , Terai Hidetomi , Hoshino Masatoshi , Toyoda Hiromitsu , Takahashi Shinji , Ohyama Shoichiro , Hori Yusuke , Nakamura Hiroaki
Published: June 2019

Study Design:

This is a retrospective cohort study.

Objective:

The objective of this study was to identify the impact of preoperative cervical sagittal balance on the 2-year surgical outcomes of laminoplasty.

Summary of Background Data:

The cervical imbalance is considered associated with poor health-related quality of life and poor outcomes for cervical deformity surgery. However, the influences of cervical imbalance on the clinical outcomes of laminoplasty for cervical spondylotic myelopathy (CSM) patients are unclear.

Materials and Methods:

A total of 277 consecutive CSM patients who underwent laminoplasty were analyzed. From the last consecutive 136 patients, matched control group [cervical sagittal vertical axis (cSVA)<40 mm, n=30] and matched imbalance group (≥40 mm, n=30) were selected based on their propensity score adjusted for age, sex, cervical alignment, and preoperative Japanese Orthopaedic Association (JOA) score. Change in clinical outcomes and radiographic parameters at 2 years postoperatively were compared between the 2 matched groups using mixed-effects model. For the validation of the primary results, factors that correlated with the recovery rate of JOA score of another 141 patients were analyzed using multiple linear regression analysis.

Results:

There was no significant interaction between the 2 matched groups in all clinical outcomes, including the severity of myelopathy, patient-oriented health-related quality of life score, physical and mental status, physical functions, and pain score. Regarding the radiographic evaluation, change in cSVA showed significant differences (P=0.038); cSVA was kept stable in the matched control group, whereas its value significantly decreased in the matched imbalance group. Multiple linear regression models demonstrated that preoperative cSVA is not significantly related to the recovery rate of JOA score at 2 years postoperatively (P=0.114).

Conclusions:

Preoperative cervical imbalance did not significantly affect the 2-year surgical outcomes of laminoplasty. Furthermore, cervical imbalance improved after surgery. These results can suggest physicians consider laminoplasty as a treatment for CSM patients regardless of their cervical balance.

Level of Evidence:

Level III—treatment benefits: nonrandomized controlled cohort/follow-up study.
Impact of Early Acute Kidney Injury on Management and Outcome in Patients With Acute Respiratory Distress Syndrome: A Secondary Analysis of a Multicenter Observational Study*
Authors: McNicholas Bairbre A. , Rezoagli Emanuele , Pham Tài , Madotto Fabiana , Guiard Elsa , Fanelli Vito , Bellani Giacomo , Griffin Matthew D. , Ranieri Marco , Laffey John G.
Published: June 2019

Objectives:

To understand the impact of mild-moderate and severe acute kidney injury in patients with acute respiratory distress syndrome.

Design:

Secondary analysis of the “Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure”, an international prospective cohort study of patients with severe respiratory failure.

Setting:

Four-hundred fifty-nine ICUs from 50 countries across five continents.

Subjects:

Patients with a glomerular filtration rate greater than 60 mL/min/1.73 m2 prior to admission who fulfilled criteria of acute respiratory distress syndrome on day 1 and day 2 of acute hypoxemic respiratory failure.

Interventions:

Patients were categorized based on worst serum creatinine or urine output into: 1) no acute kidney injury (serum creatinine < 132 µmol/L or urine output ≥ 0.5 mL/kg/hr), 2) mild-moderate acute kidney injury (serum creatinine 132–354 µmol/L or minimum urine output between 0.3 and 0.5mL/kg/hr), or 3) severe acute kidney injury (serum creatinine > 354 µmol/L or renal replacement therapy or minimum urine output < 0.3 mL/kg/hr).

Measurements and Main Results:

The primary outcome was hospital mortality, whereas secondary outcomes included prevalence of acute kidney injury and characterization of acute respiratory distress syndrome risk factors and illness severity patterns, in patients with acute kidney injury versus no acute kidney injury. One-thousand nine-hundred seventy-four patients met inclusion criteria: 1,209 (61%) with no acute kidney injury, 468 (24%) with mild-moderate acute kidney injury, and 297 (15%) with severe acute kidney injury. The impact of acute kidney injury on the ventilatory management of patients with acute respiratory distress syndrome was relatively limited, with no differences in arterial Co
2 tension or in tidal or minute ventilation between the groups. Hospital mortality increased from 31% in acute respiratory distress syndrome patients with no acute kidney injury to 50% in mild-moderate acute kidney injury (p ≤ 0.001 vs no acute kidney injury) and 58% in severe acute kidney injury (p ≤ 0.001 vs no acute kidney injury and mild-moderate acute kidney injury). In multivariate analyses, both mild-moderate (odds ratio, 1.61; 95% CI, 1.24–2.09; p < 0.001) and severe (odds ratio, 2.13; 95% CI, 1.55–2.94; p < 0.001) acute kidney injury were independently associated with mortality.

Conclusions:

The development of acute kidney injury, even when mild-moderate in severity, is associated with a substantial increase in mortality in patients with acute respiratory distress syndrome.
Intracranial Hypertension and Cerebral Perfusion Pressure Insults in Adult Hypertensive Intraventricular Hemorrhage: Occurrence and Associations With Outcome
Authors: Ziai Wendy C. , Thompson Carol B. , Mayo Steven , McBee Nichol , Freeman William D. , Dlugash Rachel , Ullman Natalie , Hao Yi , Lane Karen , Awad Issam , Hanley Daniel F.
Published: June 2019

Objectives:

Elevated intracranial pressure and inadequate cerebral perfusion pressure may contribute to poor outcomes in hypertensive intraventricular hemorrhage. We characterized the occurrence of elevated intracranial pressure and low cerebral perfusion pressure in obstructive intraventricular hemorrhage requiring extraventricular drainage.

Design:

Prospective observational cohort.

Setting:

ICUs of 73 academic hospitals.

Patients:

Four hundred ninety-nine patients enrolled in the CLEAR III trial, a multicenter, randomized study to determine if extraventricular drainage plus intraventricular alteplase improved outcome versus extraventricular drainage plus saline.

Interventions:

Intracranial pressure and cerebral perfusion pressure were recorded every 4 hours, analyzed over a range of thresholds, as single readings or spans (≥ 2) of readings after adjustment for intracerebral hemorrhage severity. Impact on 30- and 180-days modified Rankin Scale scores was assessed, and receiver operating curves were analyzed to identify optimal thresholds.

Measurements and Main Results:

Of 21,954 intracranial pressure readings, median interquartile range 12 mm Hg (8–16), 9.7% were greater than 20 mm Hg and 1.8% were greater than 30 mm Hg. Proportion of intracranial pressure readings from greater than 18 to greater than 30 mm Hg and combined intracranial pressure greater than 20 plus cerebral perfusion pressure less than 70 mm Hg were associated with day-30 mortality and partially mitigated by intraventricular alteplase. Proportion of cerebral perfusion pressure readings from less than 65 to less than 90 mm Hg and intracranial pressure greater than 20 mm Hg in spans were associated with both 30-day mortality and 180-day mortality. Proportion of cerebral perfusion pressure readings from less than 65 to less than 90 mm Hg and combined intracranial pressure greater than 20 plus cerebral perfusion pressure less than 60 mm Hg were associated with poor day-30 modified Rankin Scale, whereas cerebral perfusion pressure less than 65 and less than 75 mm Hg were associated with poor day-180 modified Rankin Scale.

Conclusions:

Elevated intracranial pressure and inadequate cerebral perfusion pressure are not infrequent during extraventricular drainage for severe intraventricular hemorrhage, and level and duration predict higher short-term mortality and long-term mortality. Burden of low cerebral perfusion pressure was also associated with poor short- and long-term outcomes and may be more significant than intracranial pressure. Adverse consequences of intracranial pressure-time burden and cerebral perfusion pressure-time burden should be tested prospectively as potential thresholds for therapeutic intervention.
Comparison of Automated Activity Recognition to Provider Observations of Patient Mobility in the ICU*
Authors: Rawat Nishi , Rao Vishal , Peven Michael , Shrock Christine , Reiter Austin , Saria Suchi , Ali Haider
Published: June 2019

Objectives:

To compare noninvasive mobility sensor patient motion signature to direct observations by physicians and nurses.

Design:

Prospective, observational study.

Setting:

Academic hospital surgical ICU.

Patients and Measurements:

A total of 2,426 1-minute clips from six ICU patients (development dataset) and 4,824 1-minute clips from five patients (test dataset).

Interventions:

None.

Main Results:

Noninvasive mobility sensor achieved a minute-level accuracy of 94.2% (2,138/2,272) and an hour-level accuracy of 81.4% (70/86).

Conclusions:

The automated noninvasive mobility sensor system represents a significant departure from current manual measurement and reporting used in clinical care, lowering the burden of measurement and documentation on caregivers.
Growth and Changing Characteristics of Pediatric Intensive Care 2001–2016
Authors: Horak Robin V. , Griffin John F. , Brown Ann-Marie , Nett Sholeen T. , Christie LeeAnn M. , Forbes Michael L. , Kubis Sherri , Li Simon , Singleton Marcy N. , Verger Judy T. , Markovitz Barry P. , Burns Jeffrey P. , Chung Sarita A. , Randolph Adrienne G.
Published: June 2019

Objectives:

We assessed the growth, distribution, and characteristics of pediatric intensive care in 2016.

Design:

Hospitals with PICUs were identified from prior surveys, databases, online searching, and clinician networking. A structured web-based survey was distributed in 2016 and compared with responses in a 2001 survey.

Setting:

PICUs were defined as a separate unit, specifically for the treatment of children with life-threatening conditions. PICU hospitals contained greater than or equal to 1 PICU.

Subjects:

Physician medical directors and nurse managers.

Interventions:

None.

Measurements and Main Results:

PICU beds per pediatric population (< 18 yr), PICU bed distribution by state and region, and PICU characteristics and their relationship with PICU beds were measured. Between 2001 and 2016, the U.S. pediatric population grew 1.9% to greater than 73.6 million children, and PICU hospitals decreased 0.9% from 347 to 344 (58 closed, 55 opened). In contrast, PICU bed numbers increased 43% (4,135 to 5,908 beds); the median PICU beds per PICU hospital rose from 9 to 12 (interquartile range 8, 20 beds). PICU hospitals with greater than or equal to 15 beds in 2001 had significant bed growth by 2016, whereas PICU hospitals with less than 15 beds experienced little average growth. In 2016, there were eight PICU beds per 100,000 U.S. children (5.7 in 2001), with U.S. census region differences in bed availability (6.8 to 8.8 beds/100,000 children). Sixty-three PICU hospitals (18%) accounted for 47% of PICU beds. Specialized PICUs were available in 59 hospitals (17.2%), 48 were cardiac (129% growth). Academic affiliation, extracorporeal membrane oxygenation availability, and 24-hour in-hospital intensivist staffing increased with PICU beds per hospital.

Conclusions:

U.S. PICU bed growth exceeded pediatric population growth over 15 years with a relatively small percentage of PICU hospitals containing almost half of all PICU beds. PICU bed availability is variable across U.S. states and regions, potentially influencing access to care and emergency preparedness.
Comparative Cost of Virtual Reality Training and Live Exercises for Training Hospital Workers for Evacuation
Authors: Farra Sharon L. , Gneuhs Matthew , Hodgson Eric , Kawosa Burhan , Miller Elaine T. , Simon Ashley , Timm Nathan , Hausfeld Jackie
Published: June 2019

Adoption of virtual reality technology may be delayed due to high up-front costs with unknown returns on that investment. In this article, we present a cost analysis of using virtual reality as a training tool. Virtual reality was used to train neonatal intensive care workers in hospital evacuation. A live disaster exercise with mannequins was also conducted that approximated the virtual experience. Comparative costs are presented for the planning, development, and implementation of both interventions. Initially, virtual reality is more expensive, with a cost of $229.79 per participant (total cost $18 617.54 per exercise) for the live drill versus $327.78 (total cost $106 951.14) for virtual reality. When development costs are extrapolated to repeated training over 3 years, however, the virtual exercise becomes less expensive with a cost of $115.43 per participant, while the cost of live exercises remains fixed. The larger initial investment in virtual reality can be spread across a large number of trainees and a longer time period with little additional cost, while each live drill requires additional costs that scale with the number of participants.
Exposure to Fine Particulate Matter and Ovarian Reserve Among Women from a Fertility Clinic
Authors: Gaskins Audrey J. , Mínguez-Alarcón Lidia , Fong Kelvin C. , Abdelmessih Sarah , Coull Brent A. , Chavarro Jorge E. , Schwartz Joel , Kloog Itai , Souter Irene , Hauser Russ , Laden Francine
Published: June 2019

Background:

An increasing number of studies have linked air pollution to decreased fertility. Whether this is due to an effect on ovarian reserve is unknown.

Method:

Our study included 632 women attending the Massachusetts General Hospital Fertility Center (2004–2015) who had a measured antral follicle count. Validated spatiotemporal models estimated daily particulate matter <2.5 µg/m3 (PM2.5) (based on residential address) for the 3 months before the antral follicle count. We analyzed associations with Poisson regression.

Results:

Every 2 µg/m3 increase in estimated PM2.5 exposure was associated with a −7.2% (95% confidence interval = −10.4%, −3.8%) lower antral follicle count adjusting for age, body mass index, smoking status, and year and season of the count. The association of PM2.5 with antral follicle count was stronger among women with female factor infertility (−16.3% per 2 µg/m3).

Conclusions:

Among women from an infertility clinic, higher PM2.5 exposure was associated with lower ovarian reserve, raising concern that air pollution may accelerate reproductive aging.
Subcutaneous and Intravenous Treprostinil Pharmacokinetics in Children With Pulmonary Vascular Disease
Authors: Hall Keeley , Ogawa Michelle , Sakarovitch Charlotte , Hopper Rachel K. , Adamson Gregory T. , Hanna Brian , Ivy David D. , Miller-Reed Kathleen , Yung Delphine , McCarthy Elisa , Siehr-Handler Stephanie L. , Feinstein Jeffrey A.
Published: June 2019

This study evaluated the pharmacokinetics of intravenous (IV) and subcutaneous (SC) treprostinil in pediatric patients with pulmonary vascular disease, and compared them with existing adult data from a similar cohort. Blood samples were collected from pediatric patients receiving steady-state IV or SC treprostinil and were assessed for plasma treprostinil concentration using liquid chromatography and tandem mass spectrometry. Forty participants, 15 receiving IV and 25 receiving SC treprostinil, were included in the analysis. Age ranged from 0.1 to 15.6 years. The median dose of treprostinil was 45.5 ng·kg−1·min−1 with a range of 8–146 ng·kg−1·min−1. There was a linear relationship between treprostinil dose and plasma concentration with an R
2 of 0.57. On average, there were higher blood concentrations per given dose of IV treprostinil compared with those per given dose of SC, but the difference was not significant. Compared with adult data, the slope of the pediatric data was similar, but the y-intercept was significantly lower. Additionally, the concentration per dose ratio was significantly higher in adults compared with children. Pediatric patients have significantly lower average blood concentrations of treprostinil per given dose compared with adults, and higher, but not significantly so, blood concentrations when treprostinil is administered IV as compared with SC administration.
Cardiac and hepatic siderosis in myelodysplastic syndrome, thalassemia and diverse causes of transfusion‐dependent anemia: the TIMES study
Authors: Ho P. Joy , Hiwase Devendra , Ramakrishna Raj , Viiala Nicholas , Solterbeck Ann , Traficante Robert , Zor Evren , Gervasio Othon L. , High Laura M. , Ross David M. , Bowden Donald K.
Published: June 2019

Supplemental Digital Content is available in the text
XEN Gel Stent in Pseudoexfoliative Glaucoma: 2-Year Results of a Prospective Evaluation
Authors: Gillmann Kevin , Bravetti Giorgio E. , Mermoud André , Rao Harsha L. , Mansouri Kaweh
Published: June 2019

Précis:

This study confirms the safety and efficacy of XEN gel stents in the management of pseudoexfoliative glaucoma 2 years after implantation, with success rates similar to primary open-angle glaucoma regardless of the definition of success.

Purpose:

To compare the long-term safety and efficacy of XEN gel implant surgery (Allergan Inc., Irvine, CA) in patients with pseudoexfoliative glaucoma (PEXG) and primary open-angle glaucoma (POAG).

Setting:

Prospective, interventional study in a tertiary glaucoma center.

Methods:

A total of 110 eyes of 85 patients with POAG (57 eyes) or PEXG (53 eyes) and uncontrolled intraocular pressure (IOP) despite medical treatment underwent combined XEN+cataract surgery or standalone XEN surgery. Mean IOP, mean number of medications, needling rates, and incidence of adverse effects were compared between the 2 groups. Complete surgical success was defined as an unmedicated IOP≤12, 15, 16, or 18 mm Hg at 2 years, both with and without a 20% reduction from baseline.

Results:

Combined XEN+cataract surgery was performed in 72% of POAG and 76% of PEXG eyes (P=0.67), the remainder underwent standalone XEN surgery. Patient characteristics were similar between the 2 groups except for older age for the patients with PEXG (78.5±8.5 vs. 71.3±8.7 y; P<0.005). Mean medicated IOP were 19.8±5.8 mm Hg (POAG) versus 19.8±8.2 mm Hg (PEXG) at baseline (P=0.98), and 14.5±3.6 mm Hg (−26.8%) versus 14.2±3.8 mm Hg (−28.3%), respectively, at 2 years (P=0.75). Mean medications concomitantly dropped from 1.9±1.6 (POAG) versus 2.0±1.3 (PEXG) to 0.6±0.9 versus 0.4±0.7, respectively (P=0.29). Using the 16 mm Hg threshold, 51.4% (POAG) versus 57.1% (PEXG) eyes achieved complete success (P=0.70) at 2 years. The difference in success rates between the 2 groups was not statistically significant under any of the definitions of success. By 24 months, needling was performed in 42.8% (POAG) and 43.2% (PEXG) (P=0.64), with an average time to needling of 162.8 and 134.9 days, respectively (P=0.46). The rates of adverse effects were 30.6% (POAG) and 36.4% (PEXG) (P=0.66), and additional glaucoma surgeries were carried out in 14.3% (POAG) versus 15.9% (PEXG) (P=0.89).

Conclusions:

The XEN gel implant as a standalone or combined procedure demonstrated similar efficacy and safety results in PEXG and POAG eyes.
Trichoadenoma of the Upper Eyelid Mimicking Comedo-Like Lesions
Authors: Cheng Huanhuan , Deng Juan
Published: June 2019

The purpose of this report is to detail the unique occurrence of comedo-like trichoadenoma of the upper eyelid. A 54-year-old man underwent surgical resection of the lesions of the left upper eyelid that were suspected to be dilated pores. The lesions were studied with histopathological examination. Histopathology showed lesions in the dermis and epidermis containing keratinous cysts surrounded by interstitial edema and infiltration of lymphocytes. The lesions were finally diagnosed as trichoadenoma.
Nutritionally Variant Streptococcal Bacteremia in the 21st Century
Authors: Wright Edward A. , Myers Joseph P.
Published: June 2019

We report the results of a 12-year retrospective study of nutritionally variant streptococcal (NVS) bacteremia in a 510-bed, a large medical school-affiliated teaching hospital. Twenty-six episodes of NVS bacteremia were identified in this institutional review board—approved study of all positive blood cultures for NVS from January 1, 2006, to December 31, 2017. Most patients with NVS bacteremia were 50 years and older. Detection of bacteremia in the microbiology laboratory took from 2 to 11 days of incubation with an average of 4.65 days. Endocarditis was the most common source of bacteremia (7 patients), followed by primary bacteremia, skin and soft tissue infections, bone and joint infections, and device-associated infections. The mortality of patients in the study was 15% despite all but 1 patient who died receiving appropriate antimicrobial therapy immediately upon hospital admission. Nutritionally variant streptococcal bacteremia is uncommon, is frequently associated with infective endocarditis, is often detected late in the hospital course because of delayed growth of NVS organisms in blood culture media, and had a 15% mortality rate.
A Retrospective Descriptive Study of Nurses With Substance Use Disorders in Texas
Authors: Mumba Mercy N. , Baxley Susan M. , Snow Diane E. , Cipher Daisha J.
Published: June 2019

There are approximately 3.1 million nurses in the Unites States (U.S. Census Bureau, 2016), and approximately 8% of them experience substance use disorders (Kunyk, 2015). Nurses with impaired practice are referred to peer assistance programs as they seek rehabilitation. As of 2016, 348 nurses in Texas Peer Assistance Program for Nurses were actively participating in the program for substance-abuse-related offenses. Over the last 6 years (2010–2016), 1,553 nurses were referred to Texas Peer Assistance Program for Nurses specifically for substance-abuse-related problems. These represent 2% of the population of nurses in Texas. The average age of participants was 40.1 years. Women represented 75% of participants, and 76% were registered nurses. About 41% successfully completed the program without relapsing, and 32% reported at least one relapse. Varieties of drugs were abused including prescription drugs and illegal drugs. Opioids were the most frequently abused class of drugs, followed by alcohol and stimulants. Most nurses obtained their drugs by diverting from patients. Contrary to what is in the literature, nurses working in long-term care, medical–surgical units, and home health care had the highest prevalence of impaired practice. Psychiatric comorbidity was not significantly associated with relapse, but self-report status was significantly associated with gender, age category, license type, relapse, and drug of choice. There was a significant inverse relationship between time it takes to enroll and number of abstinent days. Men were also more likely to be employed while in the program.
Perceptions of Persons Who Inject Drugs About Nursing Care They Have Received
Authors: Dion Kimberly
Published: June 2019

The experience and meaning attributed to care by nurses and received by nine persons who inject drugs during a healthcare encounter in the acute care medical setting was examined. A descriptive case study approach using an interpersonal nursing model served as the theoretic framework. Four overarching themes were discovered: marginalization, defensiveness, repeated victimization, and understanding addiction. Findings suggest that role support, application of an interpersonal nursing theory, and implementations of addiction-trained healthcare teams were missing from the hospital experience of persons who inject drugs. However, when the nurse connected with the patient who injects drugs on an interpersonal level, positive outcomes followed.
Prison Nurses' Professional Identity
Authors: Goddard Donna , de Vries Kay , McIntosh Tania , Theodosius Catherine
Published: June 2019

In the United Kingdom, health and justice services nurses are a diverse group working across a range of contexts and settings such as police custody, sexual assault referral centers, young offenders' institutes, and prisons and probation. Recruitment and retention to the specialist field of health and justice services nursing, specifically prison nursing, is problematic in the United Kingdom. In this article, we consider the background to the current situation in prison nursing and summarize some of the existing literature and research relating to this specialty to raise, for discussion and debate, issues that are pertinent to the concept of professional identity and professionalism. Role definition, resilience and burnout, and education within prison nursing are identified in relation to the development of professional identity. It could be that professional identity is the missing link to recruitment and retention.
Further phenotypic characterization of Kaufman oculocerebrofacial syndrome: report of five new cases and literature review
Authors: Galarreta Carolina I. , Wigby Kristen M. , Jones Marilyn C.
Published: June 2019

Kaufman oculocerebrofacial syndrome is a rare autosomal recessive disorder caused by biallelic variants in UBE3B. Kaufman oculocerebrofacial syndrome is characterized by a recognizable pattern of malformations including moderate to severe intellectual disability, growth deficiency, microcephaly and a distinctive facial gestalt. Common craniofacial features include short upslanting palpebral fissures, blepharophimosis or ptosis, ear anomalies, hearing loss, palate anomalies and stridor/laryngomalacia. The aim of this study was to describe the phenotypic features and the genotype of five new individuals from three unrelated families, and to review systematically the published information of 26 cases. The main features are summarized contributing to further characterize the natural history of the disease. Novel phenotypic features and two novel pathogenic variants in UBE3B are reported: A splice site variant (c.2569-1G > C) and a nonsense variant (c.518C > A, p.Ser173Ter). Kaufman oculocerebrofacial syndrome is likely an underdiagnosed disorder which can be clinically recognized based on its distinctive facial gestalt and relatively homogenous natural history.
Genotyping and diversity of virulence genes among Shigella sonnei isolated from children with diarrhoea
Authors: Memariani Hamed , Memariani Mojtaba
Published: June 2019

Shigella sonnei, which has historically prevailed in industrialized countries, is currently undergoing an unprecedented expansion throughout the developing world. The harshness of shigellosis relies on certain virulence factors produced by the pathogen. Available information regarding virulence genes and epidemiological relatedness of S. sonnei strains in Iran is relatively scarce. In this study, 3540 stool specimens were obtained from children with diarrhoea in Tehran, Iran, from September 2016 through January 2018. PCR assays were performed to evaluate the presence of virulence genes among S. sonnei strains. The genetic relatedness of these strains was also assessed by multiple-locus variable number tandem repeat (VNTR) analysis (MLVA). A total of 50 S. sonnei strains were obtained, all of which harboured ipaH, sigA, and virA, whereas ial, invE, and sen were positive in 70% (n = 35), 62% (n = 31), and 54% (n = 27) of the strains, respectively. None of the S. sonnei strains carried set1A, set1B, and sat. The most frequent virulence profile was VP1 (positive for ipaH, ial, invE, sen, sigA, and virA), which was observed in 16 (32%) strains. Using MLVA, 12 genotypes were identified. According to the minimum spanning tree (MST) analysis, S. sonnei strains were grouped into three clonal complexes. CC1, which consisted of 44 (88%) isolates, was the largest clonal complex identified. No association was observed between virulence profiles and genotypes. Overall, it was shown that S. sonnei strains were virulent and clonally related. Furthermore, MLVA can be used as a helpful method for epidemiological investigations.
Disruption Ahead
Authors: Fuller Ryan , Hansen April
Published: June 2019

“Innovation” has become a ubiquitous term in the business of health care. The concept of disruptive innovation adds a new complexity to this popular notion. The emergence of artificial intelligence, virtual reality, and venture capitalists generates excitement, doubt, and curiosity for stakeholders across health care organizations. As companies such as Amazon, Apple, CVS, and JP Morgan enter this sector, disruptions will emerge that aim to improve the quality of care while reducing overall cost. The purpose of this article is to differentiate the concepts of innovation and disruptive innovation, explore their significance to the nursing profession, and outline 3 key roles nurse leaders can occupy as they navigate the future ever-changing trajectory of health care.
International Nursing
Authors: Caruso Rosario , Rocco Gennaro , Shaffer Franklin A. , Arrigoni Cristina , Pittella Francesco , Fiorini Tiziana , Stievano Alessandro
Published: June 2019

It is strategic to describe and disseminate available examples of how nurses find the modus operandi to being fully integrated in their organizations, including the nurse role in determining improvements in clinical practice, management, education, and/or research. This article describes the recent experiences of Gruppo San Donato International Nursing Academy. The disruptive case shared here underlines the worth of nursing within health care organizations. The Gruppo San Donato International Nursing Academy aims to be a striking model to innovate health care delivery through the optimal utilization of the nursing workforce, uniting the areas of nursing management, nursing education, and research into a unique organizational platform.
HPNA 2019-2022 Research Agenda
Authors: Romo Rafael D. , Carpenter Joan G. , Buck Harleah , Lindley Lisa C. , Xu Jiayun , Owen John A. , Sullivan Suzanne S. , Bakitas Marie , Dionne-Odom J. Nicholas , Zubkoff Lisa , Matzo Marianne
Published: June 2019

Building on the strong work of previous research agendas (2009-2012, 2012-2015, 2015-2018), the Hospice and Palliative Nurses Association Research Advisory Council developed the 2019-2022 Research Agenda in consultation with Hospice and Palliative Nurses Association (HPNA) membership and assessment of major trends in palliative nursing. The HPNA Research Advisory Council identified 5 priority areas and asked subject experts in each area to summarize the state of the science, identify critical gaps, and provide recommendations for future research. This document expands the executive summary published on the HPNA website (www.advancingexpertcare.org/hpna/) and provides supporting evidence for the 2019-2022 recommendations. The 5 priority areas are as follows: (1) pediatric hospice and palliative nursing research; (2) family caregiving; (3) interprofessional education and collaborative practice; (4) big data science, precision health, and nursing informatics; and (5) implementation science.
Tracheal Size and Morphology on the Reconstructed CT Imaging*
Authors: Mizuguchi Soichi , Motomura Yoshitomo , Maki Jun , Baba Rieko , Ichimiya Yuko , Tokuda Kentaro , Kaku Noriyuki , Takada Hidetoshi , Maehara Yoshihiko , Ohga Shouichi
Published: June 2019

Objectives:

To characterize the real size and morphology of tracheas in childhood for the optimal selection of endotracheal tube.

Design:

A retrospective cohort study of pediatric patients who received CT scan of the cervical spine from July 2011 to March 2018. Cross-sectional CT images vertical to trachea were reconstructed and the accurate tracheal diameters were measured. The validity of the traditional age-based formula for predicting the endotracheal tube size was assessed for the best fit to trachea.

Setting:

Tertiary Emergency and Critical Care Center of Kyushu University Hospital.

Patients:

Children, who are 1 month to 15 years old, received CT scan of the cervical spine.

Interventions:

None.

Measurements and Main Results:

We enrolled 86 children with median age of 53 months. The cross-sectional shape of pediatric trachea was circular at the cricoid level and elliptical at the infraglottic level. The narrowest part of pediatric trachea was the transverse diameter at the infraglottic level at any age. Significant positive correlation between age and the narrowest diameter was observed. When compared the transverse diameter at the infraglottic level with the outer diameter of endotracheal tubes, uncuffed endotracheal tubes selection based on the traditional age-based formula ran a significant risk of oversized endotracheal intubation until 10 years old compared with cuffed endotracheal tubes selection (60.0% vs 23.8%; p < 0.05).

Conclusions:

These findings indicate the safety and efficacy of cuffed endotracheal tubes in infants and children and the reconsideration for the airway management in pediatric anesthesia and intensive care.
Postoperative Imaging After Lobectomy: Predicting the Displacement and Change in Orientation of Nonresected Lung Nodules
Authors: Digumarthy Subba R. , Shukla Priya K. , Mendoza Dexter P. , Guo Lancia , Chretien Yves R. , Shepard Jo-Anne O. , Kalra Mannudeep K.
Published: June 2019

Objectives

The objective of this study was to determine the effect of a lobectomy to the location and orientation of nonresected lung nodule and its corresponding airway.

Methods

We reviewed preoperative and postoperative computed tomography of patients who underwent lobectomies and have a separate nonresected nodule in the ipsilateral lung. Displacement of the nonresected nodule and angulation of its corresponding segmental bronchus were measured.

Results

Fifty nodules from 40 patients (30 females, 10 male; mean ± SD age, 67 ± 7 years) were assessed. Nodules are displaced clockwise after right upper, right middle, and left lower lobectomies and counterclockwise after right lower and left upper lobectomies. Displacement of the remaining nodules was greater in the craniocaudal plane, followed by anteroposterior and transverses planes (mean, 3.7, 2.5, and 1.9 cm, respectively).

Conclusions

Remaining ipsilateral nodules and their associated segmental airways are displaced in a predictable fashion after lobectomy. This may help in the assessment of follow-up imaging.
Artifact Reduction in the Diagnosis of Vasospasm in Computed Tomographic Perfusion: Potential of Iterative Metal Artifact Reduction
Authors: Hauser Till-Karsten , Oergel Anja , Hurth Helene , Ernemann Ulrike , Seeger Achim
Published: June 2019

Objective

This study aimed to analyze the possibility of artifact reduction using a new iterative metal artifact reduction algorithm (iMAR) in the diagnosis of perfusion deficits due to vasospasms and to evaluate its clinical relevance.

Methods

Sixty-one volume perfusion computed tomographies of 24 patients after coiling or aneurysm clipping were reconstructed using standard-filtered back-projection and iMAR retrospectively. The degree of artifacts was evaluated as well as the size of the nonevaluable area. Diagnostic performance was evaluated compared with digital subtraction angiography.

Results

Artifacts were present in 39 of 61 volume perfusion computed tomography examinations. Image quality (score, 1.0 vs 1.6; P < 0.01) was higher and the size of the signal loss was reduced significantly by iMAR (intracranial metal artifacts, 887 mm2 vs 359 mm2 [P < 0.01]; cranial bolt, 3008 mm2 vs 837 mm2 [P < 0.01]). Digital subtraction angiography confirmed vasospasms in 11 (92%) of 12 patients.

Conclusion

The iMAR yields higher image quality by reducing artifacts compared with filtered back-projection.
Development of a Standardized Grading Scale for Atherosclerotic Disease of the Head and Neck
Authors: Bonfante Eliana , Calle Susana , Solomon Natalia , Jagolino Amanda , Cai Chunyan , Arevalo-Espejo Octavio , Riascos Roy , Sitton Clark
Published: June 2019

Objective

For research and risk factor analysis, a reproducible method quantifying atherosclerosis is necessary. Our aim was to develop a computed tomography (CT) angiography grading system to quantify atherosclerotic disease of the head and neck.

Methods

Institutional review board–approved, retrospective analysis was performed on 152 patients who underwent head/neck CT angiography. A grading scale was designed to calculate plaque burden at multiple sites with the sum referred to as atherosclerosis score. Three radiologists calculated scores with an overlap of cases to calculate the intraclass correlation coefficient.

Results

Without any prior training, the intraclass correlation coefficient between readers was considered fair. After a short tutorial, intraclass correlation coefficient was recalculated using separate patients, showing excellent correlation.

Statistically significant positive correlation was found between atherosclerosis scale and age, hyperlipidemia, hypertension, and diabetes, but no correlation with sex or smoking status.

Conclusions

A simple, visual grading scale for atherosclerosis in head/neck CT angiography was used to standardize reporting and better characterize a patient's risk of stroke.
Abnormal Neural Activity in Children With Diffuse Intrinsic Pontine Glioma Had Manifested Deficit in Behavioral Inhibition: A Resting-State Functional MRI Study
Authors: Cheng Xu , Gao Pei-Yi
Published: June 2019

Purpose

The purpose of this study was to investigate whether alterations of regional neural function in children with diffuse intrinsic pontine glioma (DIPG) had manifested deficit in behavioral inhibition using resting-state functional MRI (rs-fMRI).

Methods

There were 17 participants with DIPG who took part in the study. Eight children were with deficit in behavioral inhibition, whereas the other 9 children did not obtain deficit in behavioral inhibition. Five healthy children with age, sex, and education matched to the study group also participated as the control group. These 3 groups underwent rs-fMRI, and the results were then converted to amplitude of low-frequency fluctuation (ALFF) data. Amplitude of low-frequency fluctuation data were further analyzed by single-factor analysis of variance comparing among 3 groups based on the whole brain levels. Amplitude of low-frequency fluctuation results were subjected to t test of voxel-wised comparison to derive the rs-fMRI brain function differences between the 2 DIPG groups. The Pearson correlation between ALFF values of abnormal regions found in 3 groups and the scores obtained according to the Child Behavior Checklist were analyzed.

Results

The 3 groups had shown significant differences in terms of the ALFF results, with the ALFF increased in several brain regions (P < 0.05, corrected with AlphaSim, clusters >59 voxels), which include left supramarginal gyrus, left dorsolateral superior frontal gyrus, right precentral gyrus, and right middle frontal gyrus. Participants with deficit in behavioral inhibition had shown significant differences (ALFF decreased) in several brain regions, including left dorsolateral superior frontal gyrus and right fusiform gyrus (P < 0.05, corrected with AlphaSim, clusters >123 voxels), whereas other brain regions had shown ALFF increased, including left supramarginal gyrus, left middle frontal gyrus, and right medial superior frontal gyrus (P < 0.05, corrected with AlphaSim, clusters >123 voxels). There was no significant correlation between ALFF values and Child Behavior Checklist scores (P > 0.05).

Conclusions

These findings of focal spontaneous hyperfunction and hypofunction, which correlate with deficit in behavioral inhibition processing, and the abnormal brain regions are considered to be inefficient (in regions of the brain that may relate to compensatory brain and behavioral functioning, and it may be that the brain region needs to exert extra energy to perform a task to the same degree as the control group) or inability (inability in a certain region, or underpowered), pointing to a pathophysiologic process in executive dysfunction.
18F-Fluorocholine Uptake by a Head and Neck Meningeal Inflammatory Pseudotumor
Authors: Savelli Giordano , Morassi Mauro , Cobelli Milena , Stefanelli Antonella , Zaniboni Alberto
Published: June 2019

18F-Fluoro-ethyl-choline (18F-FCH) PET/CT is widely used to study patients affected by prostate cancer. However, 18F-FCH may be taken-up by other neoplastic diseases, infections, and non-infective inflammatory processes. While this behavior may be an opportunity to study different diseases, on the other hand, this condition brings with it the source of error in the evaluation of the images. Here we present the case of a meningeal inflammatory pseudotumor evidenced by 18F-FCH.
Alveolar Sarcoidosis With Intense FDG Uptake, Mimicking Multi-focal Pneumonia and Infiltrative Lung Malignancy
Authors: Ansari-Gilani Kianoush , Yang Michael , Ramaiya Nikhil H.
Published: June 2019

Alveolar sarcoidosis is an uncommon radiologic manifestation of pulmonary sarcoidosis which appears as infiltrative or mass-like opacities mimicking multifocal pneumonia or infiltrative lung malignancies such as multi-focal adenocarcinoma or pulmonary lymphoma. It has correlation with a more acute and symptomatic phase of thoracic sarcoidosis and therefore expected to show a more severely increased metabolic activity on FDG PET. Alveolar sarcoidosis shows a relatively rapid radiological improvement after initiation of corticosteroid therapy. Tissue diagnosis might be needed in some cases to exclude malignancy.
Esthesioneuroblastoma on 68Ga DOTANOC PET/CT
Authors: Tripathy Sarthak , Kumar Rakesh , Kakkar Aanchal , Kumar Rajeev , Sharma Prateek , Shamim Shamim Ahmed
Published: June 2019

Esthesioneuroblastoma is a rare neoplasm arising from the neural crest cells of olfactory epithelium mostly in the nasal vault. We describe the 68Ga DOTANOC PET/CT findings of a 44-year-old woman who was operated for right nasal mass diagnosed as paraganglioma in the past and then develop a mass in the right nasal cavity after 2 years which upon surgery diagnosed to be esthesioneuroblastoma on histopathology.