bluuebunny/crossref_metadata_2025 huggingface dataset:
Case 79: Small Fiber Neuropathy and Abnormal Cerebral Blood Flow
Authors: Novak Peter
Published: April 2019

This patient exhibited tilt-induced orthostatic hypotension and reduced orthostatic cerebral blood flow velocity due to combined hypocapnic cerebral hypoperfusion (HYCH) and orthostatic cerebral hypoperfusion syndrome (OCHOS). The patient had small fiber neuropathy, and clinical workup revealed elevated acetylcholine receptor antibodies.
Case 82: Postural Tachycardia Syndrome and Hypovolemia
Authors: Novak Peter
Published: April 2019

Tilt test has shown mild postural tachycardia syndrome (POTS), hypovolemic form. There was no evidence of autonomic failure.
Case 90: Repetitive Dizziness
Authors: Novak Peter
Published: April 2019

Autonomic testing may reveal repetitive dizziness which can be related to cerebral blood flow fluctuations and likely represents episodic cerebral hypoperfusion.
Case 97: Unusual Postural Spells
Authors: Novak Peter
Published: April 2019

Autonomic testing can be useful to evaluate a mixed pattern consisting of postural tachycardia syndrome, cerebral autoregulatory failure, pseudosyncope, and syncope.
Structural and functional adaptations in the athlete’s heart
Authors: Pelliccia Antonio , Caselli Stefano
Published: April 2019

Cardiac changes in athletes have been described for more than a century, with initial observations derived by chest percussion and chest X-rays. Recent advances in cardiovascular imaging have allowed morphological and functional assessment of cardiac remodelling associated with systematic training, and consequently over the last decades a vast literature has been assembled focused on the constellation of alterations known as ‘athlete’s heart’. This chapter provides means for understanding the determinants, extent, and upper limits of cardiovascular adaptation in athletes. A detailed overview of all cardiac chambers is provided to help the physician to recognize the physiological limits of cardiovascular remodelling.
Myocarditis in athletes
Authors: Halle Martin , Schindler Michael
Published: April 2019

Myocardial involvement during viral infection is underestimated (∼5%). Most infections are not perceived and resolve spontaneously. Symptoms may be non-specific, but include new onset of angina in a young athlete, chest pain, increased resting and exercise heart rate, increased dyspnoea, palpitations, syncope, and impairment of exercise capacity. Physical examination, ECG, and echocardiography are the primary diagnostic tools, whereas serology has a low sensitivity and is not generally recommended. Cardiac magnetic resonance should be performed in all athletes with suspected myocarditis, which typically reveals late gadolinium enhancement (LGE) with a patchy pattern. Patients without LGE and with ejection function >60% have a good prognosis. Endomyocardial biopsy should only be performed if there is severe impairment of myocardial function. A detailed clinical work-up should be performed for re-evaluation after 3 and 6 months. Eligibility to participate in sport can be given after 3 months for perimyocarditis and 6 months for myocarditis, if clinical examination is normal.
Cardiovascular causes of sudden death in athletes
Authors: Basso Cristina , Rizzo Stefania , Thiene Gaetano
Published: April 2019

Sudden cardiac death (SCD) is usually the result of an interaction between transient acute events (’triggers’) and either structural or non-structural cardiovascular substrates. The structural culprit resides in any of the cardiovascular components, i.e. aorta, coronary arteries, myocardium, valves, conduction system, or ion channels. Epidemiological studies have demonstrated that the occurrence of SCD in athletes is nearly three times than that in non-athletes, so that sport activity adds a significant risk if the athletes are affected by concealed cardiac diseases. Triggers of SCD in young competitive athletes include exercise-related sympathetic stimulation, abrupt haemodynamic changes, and myocardial ischaemia. In this chapter, we will review the various structural diseases, either congenital or acquired, which pose a risk of SCD in athletes. Disparities among published studies emphasizes the need for uniform reporting (source of data, retrospective versus prospective, autopsy versus no autopsy, etc). Identifying causes of SCD in the athletic population is important for guiding preventive measures.
The risk, aetiology, clinical features, management, and prevention of exercise-related sudden cardiac death and acute cardiac events in adult athletes
Authors: Thompson Paul D.
Published: April 2019

Regular physical activity reduces atherosclerotic coronary artery disease (CAD) events including acute myocardial infarction (AMI) and sudden cardiac death (SCD). Conversely, vigorous exercise acutely and transiently increases the risk of both these CAD events in adult athletes with known or occult CAD. CAD is the cause of most exercise-related SCDs in adult athletes. Exercise-related AMIs are typically caused by atherosclerotic plaque rupture and acute thrombosis, whereas exercise-related SCD can be caused by both plaque rupture and exercise-induce ischaemia. The management of athletes with CAD requires aggressive risk factor reduction plus an assessment of risk for an acute cardiac event based on exercise testing, ventricular function measurement, and an assessment of electrical stability. Whether or not an athlete should return to competition after a CAD event is a joint decision made by the athlete and the clinician based on the risks and benefits of athletic participation for that athlete.
Cardiovascular screening of children and adolescent athletes (<14 years)
Authors: Chessa Massimo , Budts Werner , Sarabia Javier Fernandez
Published: April 2019

Sport is not in itself the cause of enhanced mortality. During physical activity physiological changes, such as increased catecholamine levels, acidosis, and dehydration, can trigger cardiac arrest in those young athletes who are affected by underlying cardiovascular disorders. Because sports can prompt adverse events from underlying cardiac disease, pre-participation screening has been advised as strategy in the prevention of sudden cardiac death (SCD) in competitive athletes. SCD is rare in young healthy athletes, but remains a tragic and counter-intuitive event, subject to persistently high public visibility, triggering of emotion, and media attention, with potential legal liability considerations. Pre-participation screening in children and adolescent athletes can be done by an experienced specialist (paediatrician, family doctor, cardiologist, or sports medicine specialist); it includes family and personal history, physical examination (including blood pressure), and resting 12-lead ECG. All these issues are discussed in this chapter.
Dietary and environmental exposures in pregnancy
Authors: Taylor Caroline
Published: April 2019

There is increasing recognition of the importance of both nutrition and environmental exposures in pregnancy as prenatal events are increasingly thought to have a significant impact on the emergence of later disease, as well as on many crucial aspects of child development. This chapter provides an overview of the evidence for the importance of nutrition and environmental exposures both preconceptually and in pregnancy on the long-term health and development of the child, and provides some recommendations for action points by health professionals.
Perinatal parental mental health problems
Authors: Glover Vivette , Reynolds Rebecca , Axford Nick , Barlow Jane
Published: April 2019

The effect of the environment on a child’s development starts in the womb. Many studies have shown that if the mother is stressed, anxious, or depressed during pregnancy, this increases the risk of a range of physical and neurodevelopmental problems for the child, even after allowing for relevant confounders. There is also strong evidence concerning the impact of both maternal and paternal anxiety and depression on parent–infant interaction in the postnatal period. Although there is good evidence for interventions that reduce depression and anxiety during the perinatal period for women, less is currently known about effective interventions for men or effective methods of prevention more generally. Overall, the evidence points to the importance of starting interventions in pregnancy.
Intimate partner violence
Authors: McMillan Anita Schrader , Axford Nick
Published: April 2019

This chapter outlines the prevalence of intimate partner violence (IPV) in the UK, describes adverse effects for adult and child survivor-victims, and synthesizes evidence on the effectiveness of interventions to (i) prevent IPV, (ii) identify IPV, (iii) support adults and children affected by IPV, and (iv) treat perpetrators. Prevention covers school- and community-based dating violence prevention as well as media/educational campaigns and home visiting. Identification covers activity in hvealthcare and other services. Interventions for victim-survivors include advocacy, skill-building, counselling, therapy, and groups, and cover both adults and children. Treatments for perpetrators include group and individual and therapeutic and non-therapeutic approaches. The chapter closes with recommendations for practice.
Promoting child development
Authors: Law James , Emond Alan
Published: April 2019

Recent evidence emphasizes the interconnectedness of different aspects of young children’s development, the variability of development, and the way that it unfolds in the context of the family. This chapter describes the role of primary prevention in promoting child development, particularly the cognitive aspects of child development. Parental awareness about child development is central to any child health programme. Professionals have a key role in providing appropriate information about child development to families and also in mediating what is available on the Internet. This highlights the need for regular monitoring with a common understanding of development across professionals and the use of appropriate outcomes which are meaningful to parents. A range of different interventions have been tested, many with positive results, but effective service delivery needs to be multifaceted and systemic. The outcome of promoting early child development should be seen in terms of improving school readiness, and enhancing children’s well-being.
Primary prevention and health promotion in oral health
Authors: Godson Jenny , Seymour Diane
Published: April 2019

Tooth decay, although preventable, is the most common oral disease affecting children and young people. This chapter outlines why child oral health is a priority, the impact of poor oral health on children and families, and what causes poor oral health. It looks at the evidence of what works to improve oral health at an individual level, how we can support children and families to reduce their intake of free sugars, and increase access to fluoride. In addition, it highlights population-based programmes that have evidence that they can improve the oral health of children and what the local return on investment of such a programme would be at 5 and 10 years after commencement. Practitioners, managers, and commissioners all have an important role to play and the chapter concludes with recommendations for action.
Unintentional injuries and their prevention
Authors: Kendrick Denise
Published: April 2019

This chapter quantifies the burden of childhood injuries; describes risk factors for child injury, levels and approaches to injury prevention, and recommendations for effective behaviour change; summarizes evidence for preventing child injuries at home and on the roads; discusses putting injury prevention into practice for practitioners and commissioners; makes recommendations for the injury prevention content of the Healthy Child Programme; and provides a resource list for practitioners, parents, and commissioners.
Conclusions and recommendations
Authors: Emond Alan
Published: April 2019

This concluding chapter draws together and summarise the key points, recommendations, and suggestions for future research of effective evidence-based child health programmes.
Chemical burns
Authors: Mabvuure Nigel Tapiwa , Arham Ali , Herndon David N. , Finnerty Celeste C.
Published: April 2019

Chemical burns account for up to one-third of burn-related deaths, necessitating careful and timely management of these injuries. This chapter will discuss the classes of chemicals that cause burns and their mechanisms of action. It will go on to describe the pathophysiology and clinical features of chemical burns. Laboratory tests and imaging that may be performed for initial assessment will be discussed, along with the care and management of chemical burns. Special considerations that should be taken into account with specific agents are noted.
Outpatient management of minor burns
Authors: Mabvuure Nigel Tapiwa , Yip Christina , Dheansa Baljit
Published: April 2019

More than 90% of burns can be managed as outpatients by non-specialists e.g. emergency departments, minor injury units and general practice. Outpatient management in supportive home environments aims to reduce unnecessary admissions and improve cost effectiveness without compromising quality of care. This chapter discusses the definition of minor burns, assessment and selection of patients for outpatient management, treatment options, complications, when to admit and typical follow up arrangements. However, since research into burn injuries has largely focused on burns requiring inpatient resuscitation, high level evidence on which to base robust recommendations is limited. This chapter, therefore, summarizes the authors’ practice, widely accepted practice and existing evidence for consideration and does not constitute dogmatic recommendations.
First cosmological results using Type Ia supernovae from the Dark Energy Survey: measurement of the Hubble constant
Authors: Macaulay E , Nichol R C , Bacon D , Brout D , Davis T M , Zhang B , Bassett B A , Scolnic D , Möller A , D’Andrea C B , Hinton S R , Kessler R , Kim A G , Lasker J , Lidman C , Sako M , Smith M , Sullivan M , Abbott T M C , Allam S , Annis J , Asorey J , Avila S , Bechtol K , Brooks D , Brown P , Burke D L , Calcino J , Carnero Rosell A , Carollo D , Carrasco Kind M , Carretero J , Castander F J , Collett T , Crocce M , Cunha C E , da Costa L N , Davis C , De Vicente J , Diehl H T , Doel P , Drlica-Wagner A , Eifler T F , Estrada J , Evrard A E , Filippenko A V , Finley D A , Flaugher B , Foley R J , Fosalba P , Frieman J , Galbany L , García-Bellido J , Gaztanaga E , Glazebrook K , González-Gaitán S , Gruen D , Gruendl R A , Gschwend J , Gutierrez G , Hartley W G , Hollowood D L , Honscheid K , Hoormann J K , Hoyle B , Huterer D , Jain B , James D J , Jeltema T , Kasai E , Krause E , Kuehn K , Kuropatkin N , Lahav O , Lewis G F , Li T S , Lima M , Lin H , Maia M A G , Marshall J L , Martini P , Miquel R , Nugent P , Palmese A , Pan Y-C , Plazas A A , Romer A K , Roodman A , Sanchez E , Scarpine V , Schindler R , Schubnell M , Serrano S , Sevilla-Noarbe I , Sharp R , Soares-Santos M , Sobreira F , Sommer N E , Suchyta E , Swann E , Swanson M E C , Tarle G , Thomas D , Thomas R C , Tucker B E , Uddin S A , Vikram V , Walker A R , Wiseman P ,   (DES Collaboration)
Published: April 2019

We present an improved measurement of the Hubble constant (H0) using the ‘inverse distance ladder’ method, which adds the information from 207 Type Ia supernovae (SNe Ia) from the Dark Energy Survey (DES) at redshift 0.018 < z < 0.85 to existing distance measurements of 122 low-redshift (z < 0.07) SNe Ia (Low-z) and measurements of Baryon Acoustic Oscillations (BAOs). Whereas traditional measurements of H0 with SNe Ia use a distance ladder of parallax and Cepheid variable stars, the inverse distance ladder relies on absolute distance measurements from the BAOs to calibrate the intrinsic magnitude of the SNe Ia. We find H0 = 67.8 ± 1.3 km s−1 Mpc−1 (statistical and systematic uncertainties, 68 per cent confidence). Our measurement makes minimal assumptions about the underlying cosmological model, and our analysis was blinded to reduce confirmation bias. We examine possible systematic uncertainties and all are below the statistical uncertainties. Our H0 value is consistent with estimates derived from the Cosmic Microwave Background assuming a ΛCDM universe.
Phase 1 Safety, Pharmacokinetics, and Fluorescence Imaging Study of Tozuleristide (BLZ-100) in Adults With Newly Diagnosed or Recurrent Gliomas
Authors: Patil Chirag G , Walker David G , Miller Dennis M , Butte Pramod , Morrison Beth , Kittle David S , Hansen Stacey J , Nufer Kaitlin L , Byrnes-Blake Kelly A , Yamada Miko , Lin Lynlee L , Pham Kim , Perry Jeff , Parrish-Novak Julia , Ishak Laura , Prow Tarl , Black Keith , Mamelak Adam N
Published: April 2019

BACKGROUND

Fluorescence-guided surgery (FGS) can improve extent of resection in gliomas. Tozuleristide (BLZ-100), a near-infrared imaging agent composed of the peptide chlorotoxin and a near-infrared fluorophore indocyanine green, is a candidate molecule for FGS of glioma and other tumor types.

OBJECTIVE

To perform a phase 1 dose-escalation study to characterize the safety, pharmacokinetics, and fluorescence imaging of tozuleristide in adults with suspected glioma.

METHODS

Patients received a single intravenous dose of tozuleristide 3 to 29 h before surgery. Fluorescence images of tumor and cavity in Situ before and after resection and of excised tissue ex Vivo were acquired, along with safety and pharmacokinetic measures.

RESULTS

A total of 17 subjects received doses between 3 and 30 mg. No dose-limiting toxicity was observed, and no reported adverse events were considered related to tozuleristide. At doses of 9 mg and above, the terminal serum half-life for tozuleristide was approximately 30 min. Fluorescence signal was detected in both high- and low-grade glial tumors, with high-grade tumors generally showing greater fluorescence intensity compared to lower grade tumors. In high-grade tumors, signal intensity increased with increased dose levels of tozuleristide, regardless of the time of dosing relative to surgery.

CONCLUSION

These results support the safety of tozuleristide at doses up to 30 mg and suggest that tozuleristide imaging may be useful for FGS of gliomas.
A Randomized Clinical Trial of Snus Examining the Effect of Complete Versus Partial Cigarette Substitution on Smoking-Related Behaviors, and Biomarkers of Exposure
Authors: Meier Ellen , Lindgren Bruce R , Anderson Amanda , Reisinger Sarah A , Norton Kaila J , Jensen Joni , Strayer Lori , Dick Laura , Tang Mei-Kuen , Chen Menglan , Carmella Steven G , Hecht Stephen S , Murphy Sharon E , Yang Jing , Stepanov Irina , O’Connor Richard J , Shields Peter G , Hatsukami Dorothy K
Published: April 2019

Introduction

This 8-week multisite, randomized controlled trial of snus examined the differential effects of instructions on (1) snus use, (2) smoking and smoking-related measures, and (3) exposure to tobacco-related constituents.

Method

US adult daily cigarette smokers (n = 150; 43.3% female; Medianage = 43.5) were recruited from Minneapolis, Minnesota; Columbus and Coshocton, Ohio; and Buffalo, New York. Following a 1-week sampling phase of snus, participants who used at least 7 pouches were randomized to either (1) partial substitution (PS; “use snus as you like with your cigarettes”), (2) complete substitution (CS; “avoid cigarettes”), or (3) usual brand cigarettes (UB). Analyses included between-group analyses (eg, PS vs. CS) using Wilcoxon rank sum test of cigarettes per day and snus pouches per day, and a linear mixed model (biomarkers).

Results

Compared to the PS and UB groups, smokers assigned to CS reported greater reductions in cigarettes per day (ps < .001), using more snus pouches per day (p = .02), and more smoke-free days (CS median = 14.5, PS and UB medians = 0, p < .001). In addition, results demonstrated reductions in carbon monoxide (p < .001), total nicotine equivalents (p = .02), and four out of five measured volatile organic compounds (ps < .01) over time among the CS group. Exposure to N′-nitrosonornicotine increased by trial end only among the PS group (p < .04). Phenanthrene tetraol increased among all groups by trial end (p = .02) with no difference between groups.

Conclusions

Instructions to completely switch from cigarettes to snus resulted in the greatest reduction in cigarettes and exposure to harmful constituents.

Implications

Directly instructing smokers to switch completely to snus, rather than using ad libitum (with no instructions to avoid cigarettes), is necessary for reductions in smoking and subsequent exposure to harmful constituents.
Effect of saffron supplementation on symptoms of depression and anxiety: a systematic review and meta-analysis
Authors: Marx Wolfgang , Lane Melissa , Rocks Tetyana , Ruusunen Anu , Loughman Amy , Lopresti Adrian , Marshall Skye , Berk Michael , Jacka Felice , Dean Olivia M
Published: April 2019

Context

Saffron (Crocus sativus L.) has gained interest as a potential treatment in psychiatry.

Objective

This systematic review and meta-analysis sought to investigate the effect of saffron supplementation, as both an adjunctive therapy and monotherapy, on symptoms of depression and anxiety in clinical and general populations compared with pharmacotherapy or placebo.

Data sources

Using the PRISMA guidelines, a systematic literature review of randomized controlled trials was conducted.

Data extraction

A meta-analysis was conducted to determine treatment effect. Risk of bias was assessed using the Jadad scale.

Results

Twenty-three studies were included. Saffron had a large positive effect size when compared with placebo for depressive symptoms (g = 0.99, P < 0.001) and anxiety symptoms (g = 0.95, P < 0.006). Saffron also had a large positive effect size when used as an adjunct to antidepressants for depressive symptoms (g = 1.23, P = 0.028). Egger’s regression test found evidence of publication bias.

Conclusions

Saffron could be an effective intervention for symptoms of depression and anxiety; however, due to evidence of publication bias and lack of regional diversity, further trials are required. PROSPERO registration CRD42017070060.
Algorithms for surveying and cataloguing space debris utilizing a wide field of view telescope
Authors: Sun Rongyu , Yu Shengxian , Zhao Changyin , Zhang Wei
Published: April 2019

Optical surveys using astronomical telescopes are an efficient way to observe and catalogue space debris, especially for detecting debris in medium or geostationary Earth orbits. Nowadays, small aperture and wide field of view telescopes are widely used and play significant roles in optical space debris surveys. However, special challenges arise since space debris is moving relatively to the background stars and the optics suffer from defects. This affects the efficiency of traditional source extraction methods. Here, a dedicated image processing technique is developed to automatically detect and measure space debris from consecutive CCD images. In order to improve the detection efficiency and robustness, several innovative algorithms are introduced to eliminate noise and increase the object detection ability, and the whole pipeline is optimized to reduce the raw images in real time. A trial survey with a wide field of view and small aperture telescope is presented to test our technique. In our survey, two observing strategies are adopted according to the dynamical features of space objects in the high Earth orbital region, and large numbers of raw CCD images are obtained for both strategies; the efficiency of our reduction is investigated based on the reduction results. Our technique exhibits a correlation rate higher than 97%, and around 400 objects can be routinely observed and catalogued just utilizing one wide field of view telescope in one night.
Chromatin Signature and Transcription Factor Binding Provide a Predictive Basis for Understanding Plant Gene Expression
Authors: Wu Zefeng , Tang Jing , Zhuo Junjie , Tian Yuhan , Zhao Feiyang , Li Zhaohong , Yan Yubin , Yang Ruolin
Published: April 2019

Chromatin accessibility and post-transcriptional histone modifications play important roles in gene expression regulation. However, little is known about the joint effect of multiple chromatin modifications on the gene expression level in plants, despite that the regulatory roles of individual histone marks such as H3K4me3 in gene expression have been well-documented. By using machine-learning methods, we systematically performed gene expression level prediction based on multiple chromatin modifications data in Arabidopsis and rice. We found that as few as four histone modifications were sufficient to yield good prediction performance, and H3K4me3 and H3K36me3 being the top two predictors with known functions related to transcriptional initiation and elongation, respectively. We demonstrated that the predictive powers differed between protein-coding and non-coding genes as well as between CpG-enriched and CpG-depleted genes. We also showed that the predictive model trained in one tissue or species could be applied to another tissue or species, suggesting shared underlying mechanisms. More interestingly, the gene expression levels of conserved orthologs are easier to predict than the species-specific genes. In addition, chromatin state of distal enhancers was moderately correlated to gene expression but was dispensable if given the chromatin features of the proximal regions of genes. We further extended the analysis to transcription factor (TF) binding data. Strikingly, the combinatorial effects of only a few TFs were roughly fit to gene expression levels in Arabidopsis. Overall, by using quantitative modeling, we provide a comprehensive and unbiased perspective on the epigenetic and TF-mediated regulation of gene expression in plants.
Development of an Evaluative, Educational, and Communication-Facilitating App for Older Adults with Chronic Low Back Pain: Patient Perceptions of Usability and Utility
Authors: Madill Evan S , Samuels Rachel , Newman David P , Boudreaux-Kelley Monique , Weiner Debra K
Published: April 2019

Objective

The purpose of this study is to examine the usability and utility of an office-based iPad app that we developed for older adults with chronic low back pain (CLBP). The app screens for conditions that contribute to back pain and pain interference and provides personalized education based on patient responses. It also facilitates patient–provider communication regarding treatment targets and expectations.

Methods

Forty-six older adults (age ≥60 years) with CLBP were recruited from the Veterans Affairs and from the Pittsburgh community. Testing was split into two phases. Alpha testing (N = 15) was used to drive design changes to the app. Beta testing (N = 30, after one participant withdrew) used a structured questionnaire to evaluate the app’s usability and utility.

Results

The application was rated highly for usability and utility (9.6 and 8.9 out of 10, respectively). The majority of participants (82.1%) agreed that the app would help them communicate with their doctor and that it gave them useful information about potentially harmful or unnecessary interventions such as opioids and imaging (79.2% and 75.0%). Participants (age ≥60 years, mean age = 75.5 years) were able to successfully use the application without assistance and would be willing to do so in their primary care office.

Conclusions

We present the development of a CLBP app that screens for pain contributors and provides personalized education based on patient responses. Such an app could be employed in a variety of clinical settings to help educate patients about their CLBP and to curtail unnecessary interventions. Patient outcomes are being tested in an ongoing clinical trial.
Weaned piglets prefer feed with hydroxychloride trace minerals to feed with sulfate minerals
Authors: Van Kuijk Sandra J A , Fleuren Marleen A , Balemans Anke P J , Han Yanming
Published: April 2019

The aim of this study was to determine whether newly weaned piglets had a preference for diets containing hydroxychloride trace minerals (HTM). To test this, two preference tests were set up. In Exp. 1, the piglets could choose between HTM or inorganic, originating from sulfate trace minerals (STM) in the form of sulfates. Two treatments were applied with high Cu levels (160 ppm Cu added) or low Cu levels (15 ppm Cu added). All diets contained 110 ppm added Zn from the same source as Cu in the respective diet. The pigs could choose between a diet with hydroxychloride Cu and Zn or with Cu and Zn originating from sulfates at the same mineral levels. The piglets were included in the study from weaning until 34 d after weaning. In Exp. 2, the piglets could also choose between HTM and STM. However, automated feeding stations were used to collect individual feed intake data. Similarly two treatments were applied, one with high Cu levels (160 ppm added Cu) and one with slightly lower Cu levels (140 ppm added Cu until 28 d after weaning, thereafter 15 ppm added Cu). All diets contained 110 ppm added Zn from the same source as Cu in the respective diet. The piglets were followed until 35 d after weaning. The current studies showed that when piglets were given a choice, they preferred diets with HTM. This effect resulted only in a significant (P < 0.05) preference for HTM at high dietary Cu levels (160 ppm) ranging from 76% to 81% in the first and second week of Exp. 1 to between 53.4% and 57.8% in the overall experiment period of Exp. 2. This preference was less pronounced at levels of 140 ppm added or less. Individual feed intake and gain measurements did not show any link between the preference and the performance.
Specific Reconstruction on pRC Plasmid to Facilitate Its Universal Chromosomal Integration in Different Ralstonia solanacearum Species Complex Strains
Authors: Zhang Yong , Gao Shengsheng , Li Peng , Ohnishi Kouhei
Published: April 2019

The pRC system is an efficient tool for genetic studies in Ralstonia solanacearum, ensuring direct insertion of foreign gene elements into Ralstonia chromosome downstream of glms. This system is designed for double recombination across glms and the downstream region, which considerably simplifies genetic studies of complementation, overexpression, pathogenicity, and in-vivo promoter activity assays with monocopy in R. solanacearum, one of the most destructive plant-pathogenic bacteria worldwide. R. solanacearum is extremely heterogeneous and is currently referred to as a Ralstonia solanacearum species complex (RSSC). The glms gene is greatly conserved, but its downstream regions are mostly different in the RSSC, which limits the application of the current pRC plasmid in the RSSC. We compared all existing 132 genome sequences in a precise genomic glms downstream region and confirmed that the pRC system is appropriate for application of chromosomal integration in all RSSC strains but needs respective reconstruction on current pRC plasmids, since glms downstream regions are greatly variable in the RSSC. RSSC strains can be grouped according to identical glms downstream regions. This grouping provides valuable information for gene insertion in this chromosomal region, as it facilitates universal application of the pRC system in RSSC strains.
Assessment of Subjective Sleep Problems in Men With Opioid Dependence Maintained on Buprenorphine
Authors: Tripathi Richa , Dhawan Anju , Rao Ravindra , Mishra Ashwani Kumar , Jain Raka , Sinha Sanjeev
Published: April 2019

Objectives:

To assess the rates of sleep disturbances in male patients with opioid dependence maintained on buprenorphine and to assess the factors associated with sleep disturbances in this population.

Methods:

Observational, cross-sectional study. Male patients with opioid dependence aged 18 years and older, and started on buprenorphine at least 6 months before were screened. Those with history of comorbid psychiatric illnesses (except sleep disorders), on any other substance in high-risk category (based on WHO-Alcohol Smoking Substance Involvement Screening Test (ASSIST)), or on any other psychotropic medications (in addition to OAT with buprenorphine) were excluded. Sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI), Sleep-50, and Epworth Sleepiness Scale (ESS). Each participant was interviewed in a single session lasting 60 minutes.

Results:

One hundred six participants were included. Their mean age was 41.1 (SD 14.3) years. The participants had been on OAT with buprenorphine for a median duration of 60 months (IQR 17–120), with excellent adherence rate in past 1 month. The mean current dose of buprenorphine was 10.2 (SD 3.8) mg per day. The mean subjective total sleep time was 403.5 minutes (SD 94.8) and the median sleep latency was 35 minutes (IQR 18.8–62.5). The mean PSQI score was 6.6 (SD 3.4). Nearly 63% (n = 67) participants had PSQI scores more than 5 (PSQI > 5) suggesting sleep problems. Sociodemographic, substance use, and treatment variables were compared between participants who scored more than 5 and those who scored less than 5 on PSQI. No significant difference was found between the 2 groups.

Conclusions:

Substantial proportion of male patients with opioid dependence maintained on buprenorphine have sleep problems. The sleep problems in buprenorphine-maintained patients seem to be independent of substance use and treatment-related attributes.
Anterior Atlantooccipital Transarticular Screw Fixation
Authors: Ji Wei , Xu Xiaolin , Liu Qi , Lin Junyu , Huang Zucheng , Chen Jianting , Zhu Qingan
Published: April 2019

Study Design.

Retrospective analysis of collected data and operative experiment on human cadavers.

Objective.

To describe a novel technique of the anterior atlantooccipital (AC) transarticular screw fixation, and to analyze the pertinent anatomy with cadaveric and radiographic assessment of the feasibility, safety, and general applicability of this technique.

Summary of Background Data.

In some situations, the posterior AC fixation techniques may not be possible, or may require supplemental fixation, which include the congenital hypoplasia, absence of the bony elements, and even revision surgery. However, an anterior screw fixation technique may add stability to further attempts at obtaining an arthrodesis.

Methods.

A detailed description of the surgical technique was presented. Three-dimensional (3D) CT reconstruction of the cranioverteral region of 30 patients were performed to determine screw entry points, target points, and proposed screw trajectories. Following screw insertion in eight fresh frozen human cadaver spine specimens, dissection verified screw location relative to structures at risk.

Results.

The ideal entry point is located caudal to the C1 superior facet joint in line with the medial third of the C1 superior facet. The ideal screw is directed 41.7° posteriorly in the sagittal plane and 11.6° laterally in the coronal plane with a length around 30.4 mm. The feasibility of anterior AC screw fixation was 92% (35/38 cases). There is a risk of injury to the vertebral artery and the hypoglossal nerve.

Conclusion.

Anterior AC transarticular screw fixation is feasible and can be considered as a salvage technique or an alternative for the posterior AC fixation, as well as the supplement to the anterior occipitocervical fixation.

Level of Evidence: 3
Global microRNA profiling of metastatic conjunctival melanoma
Authors: Mikkelsen Lauge H. , Andersen Mette K. , Andreasen Simon , Larsen Ann-Cathrine , Tan Qihua , Toft Peter B. , Wadt Karin , Heegaard Steffen
Published: April 2019

This study aimed to investigate the microRNA (miRNA) profile in primary tumors from conjunctival melanoma with and without subsequent metastatic spread along with their coupled distant metastases to identify miRNAs likely to be involved in metastatic progression. This observational study included 13 patients with metastatic conjunctival melanoma (follow-up: 1–39 years) treated at a Danish referral center. Twenty-five patients with nonmetastatic conjunctival melanoma (follow-up: 5–17 years) were included for comparison. Global miRNA profiling was performed with the Affymetrix GeneChip 4.1 microarray. Taqman qPCR arrays were used for validation. Significant differentially expressed miRNAs were defined as having a false discovery rate of less than 0.05. Primary conjunctival melanoma with and without subsequent metastatic spread clustered separately according to miRNA expression, and 15 miRNAs were found to have significant differential expression. Six miRNAs (hsa-miR-4528, hsa-miR-1270, hsa-miR-1290, hsa-mir-548f-4, hsa-mir-4278, and hsa-miR-34a-3p) were downregulated and nine miRNAs were upregulated (hsa-mir-575, hsa-miR-527, hsa-miR-518a-5p, hsa-miR-6759-5p, hsa-miR-8078, hsa-mir-4501, hsa-mir-622, hsa-mir-4698, and hsa-mir-4654) in primary conjunctival melanoma with subsequent metastatic spread. A comparison of primary conjunctival melanoma with their pair-matched metastases identified six significant differentially expressed miRNAs (hsa-miR-1246 and hsa-miR-302d-5p, hsa-mir-6084, hsa-miR-184, hsa-mir-658, and hsa-mir-4427). qPCR confirmed downregulation of hsa-miR-184 in the distant metastases when compared with the corresponding primary tumor. Primary conjunctival melanoma with and without subsequent metastatic spread separated clearly on the miRNA level when profiled with microarray-based methods. qPCR was able to replicate expression levels of one miRNA (hsa-miR-184) that was downregulated in metastases when compared with corresponding primary tumors.
Mycosis Fungoides Associated With Lesions in the Spectrum of Primary Cutaneous CD30+ Lymphoproliferative Disorders: The Same Process or 3 Coexisting Lymphomas?
Authors: Cieza-Díaz Deysy E. , Prieto-Torres Lucía , Rodríguez-Pinilla Socorro M. , Córdoba Mascuñano Raúl , Manso Alonso Rebeca , Machan Salma , Piris Pinilla Miguel Ángel , Requena Caballero Luis
Published: April 2019

Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma, primary cutaneous CD30+ lymphoproliferative disorders (pc CD30+ LPD) being the second most prevalent. There is evidence that MF and pc CD30+ LPD may coexist and share T-cell clonality, suggesting a common origin. These findings were supported by a T-cell receptor clonality assessment by the polymerase chain reaction coupled with capillary electrophoresis, although results produced by this method may be ambiguous. We describe an otherwise healthy 46-year-old man who developed, over the course of 5 months, a tumor consisting of primary cutaneous anaplastic large cell lymphoma and, subsequently, several papules of lymphomatoid papulosis (LyP). Both lymphomas appeared on a single patch of MF, which had been present on the patient's right buttock for at least 2 years. T-cell receptor clonality of the 3 types of neoplastic lesions and apparently non-involved skin were assessed by a next-generation sequencing-based method. We found that MF, primary cutaneous anaplastic large cell lymphoma and LyP harbored the same top 2 clones. Non-involved skin harbored other T-cell clones. In this patient, these findings suggest that MF, LyP and pc CD30+ LPD were different clinicopathological manifestations arising from the neoplastic proliferation of the same T-cell clone.
The Effect of Infection Control Course on Nursing Students' Knowledge of and Compliance With Universal Precautions
Authors: Tawalbeh Loai Issa , AL-Rawajfah Omar M. , Habiballah Laila
Published: April 2019

Background

Knowledge of and compliance with universal isolation precautions are important issues and were found to be low in many previous studies. However, there were no Jordanian studies that have examined the effect of an infection control teaching course on nursing students' knowledge of and compliance with universal precautions.

Purpose

This study aimed to assess knowledge and compliance levels, assess the relationships between knowledge and compliance, and examine the effect of infection control teaching courses on knowledge of and compliance with universal precautions among university nursing students.

Methods

A quasi-experimental pretest/posttest design using a convenient sample of 130 third-year nursing students was applied. The experimental group (n = 60) were third-year nursing students who registered for infection control clinical course for 3 months. On the other side, the control group (n = 70) were students at the same academic level but did not register for the course and never attended the course.

Results

The mean knowledge of and compliance with universal precaution were quite low, with a mean (SD) of 7.82 (1.98) and 49.36 (11.13) respectively. There was a statistically significant weak positive correlation between knowledge of and compliance with standard precaution (r = 0.28, P = .003). An independent t test indicated a significant effect of the infection control clinical course (t119 = −5.36, P = .01) on knowledge mean score (mean [SD], 15.51 [1.41]) and compliance with universal precaution mean score (mean [SD], 89.00 [10.17]; t119 = 6.26, P = .02) compared to the control group. Paired t test revealed that knowledge and compliance were significantly higher in the posttest than in the pretest in the experimental group compared with the control group.

Conclusion

Knowledge of and compliance with universal precautions were relatively low among nursing students. The application of an infection control teaching course helps improve both knowledge of and compliance with universal precautions among university nursing students.
Diagnosis and Treatment of Rectal Gastrointestinal Stromal Tumors
Authors: Kane William James , Friel Charles M
Published: April 2019

Case Summary:

A 69-year-old man presented with a rectal mass that was noted on physical examination. Flexible sigmoidoscopy confirmed the presence of a well-defined mass 3 cm from the anal verge (Fig. 1). Magnetic resonance imaging of the pelvis identified a 5.8-cm heterogeneous mass with intersphincteric extension. Positron emission tomography-computed tomography revealed no evidence of distant metastatic disease. Endoscopic ultrasound (EUS) with fine-needle aspiration revealed a noncircumferential submucosal hypoechoic mass (Fig. 2) with pathology significant for spindle cells staining positive for CD117, consistent with a GI stromal tumor (GIST). The patient received 5 months of neoadjuvant imatinib with great response (Fig. 3) and subsequently underwent transanal endoscopic microsurgical resection. He continues on adjuvant imatinib and is currently without signs of recurrence at 18 months postprocedure; he is undergoing restaging CT chest/abdomen/pelvis and surveillance flexible sigmoidoscopy every 6 months.
A retrospective analysis of factors associated with difficult endotracheal tube passage with use of the hyper-angled GlideScope blade
Authors: Schechtman Samuel A. , Mathis Michael , Muller Geoffrey , Thompson Aleda , Shanks Amy , Stam Benjamin , Hart William K. , Tremper Kevin K. , Healy David W.
Published: April 2019

Introduction:

Videolaryngoscopy is a valuable tool for tracheal intubation. Some videolaryngoscopes such as the GlideScope, use a hyper-angled blade to improve the glottic view. Despite improved visualization, difficulty during GlideScope laryngoscopy may occur during manipulation of the endotracheal tube (ETT). This investigation seeks to identify characteristics and procedural factors associated with difficult or failed ETT passage.

Methods:

A single institution retrospective cohort analysis was performed for adult GlideScope intubations utilizing a hyper-angled blade. Tube passage was recorded as easy (T1), difficult (T2), or failed (T3). The primary outcome was difficult or failed ETT passage. A nonparsimonious logistic regression model was developed to determine independent predictors of this outcome, with an exploratory analysis conducted by bootstrapping the data across 1000 samples. Subgroup analysis was performed for head and neck surgical cases.

Results:

A total of 6109 patients met inclusion criteria. In all, 5412 (88.6%) had easy ETT passage, 666 (10.9%) difficult, and 31 (0.5%) failed. Limited view (grades 2a, 2b, 3, and 4) and short thyromental distance (<6 cm) were independent predictors of difficulty or failure. The absence of teeth and use of standard oral ETT sizes 6–8 were negative predictors (protective) for difficulty or failure. In the subgroup analysis, use of laser-safe ETTs also independently predicted difficulty or failure.

Conclusions:

A relatively high incidence of difficulty during tracheal tube passage using GlideScope hyper-angled blades was observed. Limited videolaryngoscopic view, short thyromental distance, and use of nonstandard ETTs were independent predictors of procedural difficulty.
The SuperNO2VA to treat upper airway obstruction and respiratory compromise after major head and neck surgery: a case report
Authors: Cataldo Steven H. , Pedro Michael J. , Straker Tracey , Osborn Irene
Published: April 2019

Postoperative pulmonary complications are common after major neck surgery, with airway compromise a leading cause for hypoxemia, hypercarbia, and reintubation. There are advantages to tracheal extubation upon emergence from anesthesia when appropriate. Recognizing that reintubation in the setting of upper airway obstruction or respiratory compromise may be challenging with presence of a cervical collar or anatomic changes following surgery. We present a 42-year-old man who underwent emergent cervical decompression and fusion with corpectomy following blunt force trauma. Upon emergence, a deep extubation was performed directly to the SuperNO2VA nasal mask connected to a Mapleson C circuit. This is a nasal positive pressure device used to maintain upper airway patency and provide ventilatory support during emergence. While in the intensive care unit, the patient was weaned to nasal cannula. However, mental status remained poor; and upper airway obstruction ensued leading to hypoxemic respiratory insufficiency, as shown by arterial blood gas. The SuperNO2VA was replaced with normalization of respiratory function and blood gas analysis. After 14 hours, including the use of SuperNO2VA during transport to and use inside the computed tomography scanner, the patient’s mental status recovered and ventilatory support was downgraded to nasal cannula without further events. Nasal positive pressure via the SuperNO2VA device as described may offer an inexpensive, transportable option for providing airway and ventilatory support in high-risk patients with anticipated difficult airways.
INVOLUTION OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION AFTER ENDOPHTHALMITIS
Authors: Kokame Gregg T. , Yannuzzi Nicolas A. , Shantha Jessica G. , Yamane Maya , Relhan Nidhi , Gross Jeffrey , Ryan Edwin H. , Flynn Harry W.
Published: April 2019

Purpose:

To report patients who demonstrated an alteration in the clinical and optical coherence tomography features of neovascular age-related macular degeneration after resolution of endophthalmitis.

Methods:

Retrospective case series of the subsequent changes in the macula and need for anti–vascular endothelial growth factor therapy in patients with neovascular age-related macular degeneration who developed endophthalmitis after intravitreal injection.

Results:

The study included seven eyes of seven patients with follow-up ranging between 3 months and 11 years. The vitreous cultures (n = 7) before intravitreal antibiotic injection were the following: culture-negative (4) and coagulase-negative Staphylococcus (3). Initial treatment included vitreous tap and injection (4) and pars plana vitrectomy (3). In 5/7 eyes, the optical coherence tomography showed resolution of subretinal fluid and serous pigment epithelial detachment, and there was no additional anti–vascular endothelial growth factor treatment administered.

Conclusion:

After successful treatment of endophthalmitis in patients with neovascular age-related macular degeneration, there was relative involution of the maculopathy and reduced anti–vascular endothelial growth factor treatment burden in this series.