bluuebunny/crossref_metadata_2025 huggingface dataset:
Optical coherence tomography in varying aetiologies of renal artery stenosis: a case series
Authors: Vijayvergiya Rajesh , Kanabar Kewal , Krishnappa Darshan , Kasinadhuni Ganesh , Sharma Ashish , Akasaka Takashi
Published: May 2019

Background

Renal artery stenosis (RAS) is a common cause of secondary hypertension. The most common aetiology is atherosclerosis; however, other causes like fibromuscular dysplasia (FMD) and Takayasu arteritis (TA) are also frequently encountered. The lesion characteristics and its response to percutaneous intervention depend upon the aetiology of RAS. Optical coherence tomography (OCT) is an excellent imaging modality to analyse coronary lesions during percutaneous coronary interventions. The data regarding the utility of OCT in renal artery imaging is limited, consisting of a few case reports.

Case summary

We hereby report four cases of RAS, each of different aetiology (atherosclerotic, FMD, post-transplant, and TA), who underwent OCT imaging of the renal artery along with percutaneous renal angioplasty.

Discussion

The advantages of OCT imaging include demonstration of the arterial wall, pathological features of the disease, and to guide percutaneous interventions. The major limitation of OCT is its lower imaging depth, which may render imaging of large vessels difficult.
International Law of Customs Unions: Conceptual Variety, Legal Ambiguity and Diverse Practice
Authors: Ovádek Michal , Willemyns Ines
Published: May 2019

Despite having considerable historical presence – traceable from 19th-century Germany – customs unions (CUs) have long been an understudied phenomenon in international law. This article aims to remedy this gap by critically reviewing the concept of customs union and identifying key issues in CU designs. The article problematizes what is understood by the concept of CU and what is entailed by the foremost definition of CUs found in Article XXIV of the General Agreement on Tariffs and Trade (GATT). It further investigates how recurrent design issues are resolved in practice by different CUs considering the inherent tension between the enactment of common rules and institutions and state sovereignty. We find variety in the historical, economic and legal conceptualizations of CUs, ambiguity and lacunas in Article XXIV of the GATT and diversity of CU designs along with a discernible concern for the impact of legal arrangements on state sovereignty.
Motivating teens to speak English through group work in Storyline
Authors: Ahlquist Sharon
Published: May 2019

Overcoming the reluctance of teenage learners to speak in the language classroom is a challenge for many teachers. This article reports on a study in which 60 Swedish pupils, aged 15–16, took part in a Storyline project based on a young adult fantasy novel. In the Storyline approach, a fictive world is created when learners, taking on the roles of characters in a story, collaborate on tasks to develop the story. A key feature is that the learners work in the same small groups for much of the time. During the six-week period of this study, these learners used English in a variety of speaking and writing tasks. The project showed a number of benefits, the most important of which were an increase in their motivation to speak English and enhanced self-confidence through doing so.
Multimorbidity, polypharmacy and primary prevention in community-dwelling adults in Quebec: a cross-sectional study
Authors: Nguyen Tu N , Ngangue Patrice , Haggerty Jeannie , Bouhali Tarek , Fortin Martin
Published: May 2019

Background

Polypharmacy carries the risk of adverse events, especially in people with multimorbidity.

Objective

To investigate the prevalence of polypharmacy in community-dwelling adults, the association of multimorbidity with polypharmacy and the use of medications for primary prevention.

Methods

Cross-sectional analysis of the follow-up data from the Program of Research on the Evolution of a Cohort Investigating Health System Effects (PRECISE) in Quebec, Canada. Multimorbidity was defined as the presence of three or more chronic diseases and polypharmacy as self-reported concurrent use of five or more medications. Primary prevention was conceptualized as the use of statin or low-dose antiplatelets without a reported diagnostic of cardiovascular disease.

Results

Mean age 56.7 ± 11.6, 62.5% female, 30.3% had multimorbidity, 31.9% had polypharmacy (n = 971). The most common drugs used were statins, renin–angiotensin system inhibitors and psychotropics. Compared to participants without any chronic disease, the adjusted odds ratios (ORs) for having polypharmacy were 2.78 [95% confidence interval (CI): 1.23–6.28] in those with one chronic disease, 8.88 (95% CI: 4.06–19.20) in those with two chronic diseases and 25.31 (95% CI: 11.77–54.41) in those with three or more chronic diseases, P < 0.001. In participants without history of cardiovascular diseases, 16.2% were using antiplatelets and 28.5% were using statins. Multimorbidity was associated with increased likelihood of using antiplatelets (adjusted OR: 2.98, 95% CI: 1.98–4.48, P < 0.001) and statins (adjusted OR: 3.76, 95% CI: 2.63–5.37, P < 0.001) for primary prevention.

Conclusion

There was a high prevalence of polypharmacy in community-dwelling adults in Quebec and a strong association with multimorbidity. The use of medications for primary prevention may contribute to polypharmacy and raise questions about safety.
Structure, plant diversity and future management of Pentadesma butyracea stands, an endangered oil tree species in Burkina Faso, West Africa
Authors: Lankoandé Benjamin , Lykke Anne Mette , Boussim Joseph Issaka , Ouédraogo Amadé
Published: May 2019

This paper aims to assess the population structure of Pentadesma butyracea Sabine, a local oil tree species and to analyze the occurrence of woody plants in P. butyracea natural stands. Data were collected in 41 plots of 50 × 20 m across natural stands of P. butyracea in two regions of the south-Sudanian phytogeographic zone of Burkina Faso. Stem diameter, total height and tree health were recorded and the woody plant diversity was assessed. Stand data were calculated and the diameter structure was analyzed at the regional level using the Weibull distribution. Significant differences (P < 0.05) were found in density and basal area between regions. In both regions, 32 per cent of trees show signs of poor health. The diameter distributions of individuals showed a structure close to a reverse J-shape (c < 1). Natural stands of P. butyracea exhibit good natural regeneration, but the large trees in the sampled populations commonly had poor health. The data may indicate early signs of stands of P. butyracea changing into savanna in the Banfora region as a consequence of human activities and climate deterioration. P. butyracea is a dominant species in riparian forest, its conservation has a potential to restore the riparian forest; appropriate management guidance and support that involves local communities is required to ensure sustainable management.
The Role of Chromatin Accessibility in cis-Regulatory Evolution
Authors: Peng Pei-Chen , Khoueiry Pierre , Girardot Charles , Reddington James P , Garfield David A , Furlong Eileen E M , Sinha Saurabh
Published: May 2019

Transcription factor (TF) binding is determined by sequence as well as chromatin accessibility. Although the role of accessibility in shaping TF-binding landscapes is well recorded, its role in evolutionary divergence of TF binding, which in turn can alter cis-regulatory activities, is not well understood. In this work, we studied the evolution of genome-wide binding landscapes of five major TFs in the core network of mesoderm specification, between Drosophila melanogaster and Drosophila virilis, and examined its relationship to accessibility and sequence-level changes. We generated chromatin accessibility data from three important stages of embryogenesis in both Drosophila melanogaster and Drosophila virilis and recorded conservation and divergence patterns. We then used multivariable models to correlate accessibility and sequence changes to TF-binding divergence. We found that accessibility changes can in some cases, for example, for the master regulator Twist and for earlier developmental stages, more accurately predict binding change than is possible using TF-binding motif changes between orthologous enhancers. Accessibility changes also explain a significant portion of the codivergence of TF pairs. We noted that accessibility and motif changes offer complementary views of the evolution of TF binding and developed a combined model that captures the evolutionary data much more accurately than either view alone. Finally, we trained machine learning models to predict enhancer activity from TF binding and used these functional models to argue that motif and accessibility-based predictors of TF-binding change can substitute for experimentally measured binding change, for the purpose of predicting evolutionary changes in enhancer activity.
Effect of lipopolysaccharide-induced immune stimulation and maternal fish oil and microalgae supplementation during late pregnancy on nursery pig hypothalamic–pituitary–adrenal function1
Authors: You Lan , Lee Alison V , Oh Se-Young , Fisher-Heffernan Rebecca E , Edwards Michelle , de Lange Kees , Karrow Niel A
Published: May 2019

The present study used Escherichia coli lipopolysaccharide (LPS) to investigate whether maternal immune challenge during late gestation altered programming of the offspring hypothalamus and hypothalamic–pituitary–adrenal axis (HPAA). In addition, interactions of maternal diet, supplementation with fish oil (FO) or microalgae (AL), and complex vs. simple weaning diets were investigated. Briefly, Landrace × Yorkshire sows (N = 48) were randomly assigned to diets supplemented with FO, AL, or a standard gestation control diet (CON) from day 75 of gestation (gd 75) until parturition. On gd 112, half the sows from each dietary treatment were immune challenged with LPS (10 μg/kg BW) or saline as a control. At 21 d postpartum, the offspring were weaned, and half the animals from each maternal treatment were allocated to either a complex or simple weaning diet. At 28 d postpartum, the offspring’s hourly fever and 2-h cortisol responses to LPS immune challenge (40 μg/kg BW) were measured to assess hypothalamus and HPAA function. Results indicated that the maternal temperature of sows on the FO diet returned to baseline levels faster than sows on the AL and CON diets after LPS immune challenge (P < 0.05). In contrast, there was no difference in the maternal cortisol response across the dietary treatments (P > 0.10). Regardless of the dietary treatments, the maternal LPS immune challenge induced a greater cortisol response in male offspring (P = 0.05) and a greater fever response in female offspring (P = 0.03) when they were LPS immune challenged post-weaning. Male offspring from LPS-immune-challenged sows fed the FO and AL diets had a greater fever response than male offspring from the maternal CON diet group (P ≤ 0.05). Last, no effect of the complex or simple weaning diets was observed for the nursery pig cortisol or fever responses to LPS immune challenge. In conclusion, LPS immune challenge during late pregnancy altered responsiveness of the offspring hypothalamus and HPAA to this same microbial stressor, and a sex-specific response was influenced by maternal dietary supplementation with FO and AL.
A new species of Acanthopotamon Kemp, 1918 (Decapoda: Brachyura: Potamidae: Potaminae) from northeastern India, with a key to the species of the genus and notes on their distribution in relation to freshwater ecoregions
Authors: Pati Sameer K , Mitra Santanu , Yeo Darren C J
Published: May 2019

The potamid genus AcanthopotamonKemp, 1918 is known from three species, A. fungosum (Alcock, 1909), A. martensi (Wood-Mason, 1875) (type species), and A. panningi (Bott, 1966), and is found in Bangladesh, India, Nepal, and Pakistan. Within this range, the genus is found in the ‘Ganges Delta and Plain,’ ‘Lower and Middle Indus,’ and ‘Namuda-Tapi’ freshwater ecoregions. Here we describe a fourth species, A. horaisp. nov., from northeastern India (Arunachal Pradesh, Assam, and Mizoram) in the ‘Middle Brahmaputra’ and ‘Ganges Delta and Plain’ freshwater ecoregions. The new species possesses a unique suite of external and gonopod morphological characters, with the slender and narrowly conical terminal segment of the first male gonopod being particularly diagnostic. A key to the species of Acanthopotamon is provided.
Spatial and Seasonal Distribution of Forensically Important Blow Flies (Diptera: Calliphoridae) in Makhanda, Eastern Cape, South Africa
Authors: Williams K A , Villet M H
Published: May 2019

The seasonal activity of adults of eight forensically important blow fly species [Calliphora croceipalpis (Diptera: Calliphoridae), Jaennicke, Lucilia sericata (Meigen) (Diptera: Calliphoridae), L. cuprina (Wiedemann) (Diptera: Calliphoridae), Chrysomya chloropyga (Wiedemann) (Diptera: Calliphoridae), Ch. albiceps (Wiedemann) (Diptera: Calliphoridae), Ch. marginalis (Wiedemann) (Diptera: Calliphoridae), Ch. putoria (Wiedemann) (Diptera: Calliphoridae), Ch. megacephala (Fabricius) (Diptera: Calliphoridae)] was quantified from collections in Makhanda, South Africa. Flies were collected in traps baited with chicken liver and placed in the field at eight locations for four consecutive days each fortnight for 14 mo. The seasonal distribution of each species compared well to published seasonal distributions of these blow flies elsewhere in South Africa, with evidence of year-to-year variation within seasons that might be explained by weather. This information is important for determining when and where certain species are likely to occur and will be of use in forensic investigations and myiasis management plans.
Potential Successes and Challenges of Targeted Cancer Therapies
Authors: Keefe Dorothy M K , Bateman Emma H
Published: May 2019

The concept and realization of targeted anticancer therapy (TAT) have existed for at least two decades and continue to expand rapidly. It has become clear that there is no “magic bullet” to cure cancer and that even TATs are unlikely to be successful as single agents, necessitating combination with chemotherapy, radiotherapy, or even other targeting agents. The other promise that has not been fulfilled by TAT is that of reduced toxicity. It was thought that by targeting receptors on or within cells, rather than particular phases of the cell cycle, TATs would not be toxic. However, it turns out that the targets also exist on or within normal cells and that there is even cross-reactivity between receptors on nontarget tissues. All of this results in toxicity, the mechanism of which are the same as the mechanism of action of the drugs, making toxicity reduction or prevention very difficult. This leads to new toxicities with new targeted treatments. Nevertheless, all of the above should not detract from the obvious successes of targeted agents, which have turned several acutely fatal cancers into chronic diseases and rendered some hitherto untreatable cancers into treatable diseases.
Public Attitudes towards Refugees in Germany: What Drives Attitudes towards Refugees in Comparison with Immigrant Workers from European Union Countries?
Authors: Meidert Nadine , Rapp Carolin
Published: May 2019

The current global refugee crisis puts both refugees and Western societies to the test. The challenges refugees face within their host countries depend on not only situational circumstances, but also the attitudinal climate they confront. A negative public can have severe consequences for refugees’ integration. This article asks two basic questions that have received little attention in previous studies: How do attitudes towards refugees with different flight reasons differ when compared with attitudes towards immigrants from European Union countries? What factors influence those attitudes? These questions are answered for the exemplary case of Germany based on new data from the German General Social Survey, which was conducted during the height of the refugee crisis in mid-2016. Our results reveal that refugees are perceived less positively than European Union immigrants and the origin of this negative perception mainly lies in increased feelings of threat.
Galactolipid deficiency disturbs spatial arrangement of the thylakoid network in Arabidopsis thaliana plants
Authors: Mazur Radosław , Mostowska Agnieszka , Szach Joanna , Gieczewska Katarzyna , Wójtowicz Joanna , Bednarska Katarzyna , Garstka Maciej , Kowalewska Łucja
Published: May 2019

Monogalactosyldiacylglycerol and digalactosyldiacylglycerol deficiency disturbs the spatial arrangement of the thylakoid network leading to a decreased photosynthetic efficiency.
Deacclimation after cold acclimation—a crucial, but widely neglected part of plant winter survival
Authors: Vyse Kora , Pagter Majken , Zuther Ellen , Hincha Dirk K
Published: May 2019

We review current knowledge of plant deacclimation after cold acclimation, highlighting its role in the winter survival of both woody and herbaceous plants and the molecular basis of its regulation.
Ammonium and nitrate regulate NH4+ uptake activity of Arabidopsis ammonium transporter AtAMT1;3 via phosphorylation at multiple C-terminal sites
Authors: Wu Xiangyu , Liu Ting , Zhang Yongjian , Duan Fengying , Neuhäuser Benjamin , Ludewig Uwe , Schulze Waltraud X , Yuan Lixing
Published: May 2019

In plants, nutrient transporters require tight regulation to ensure optimal uptake in complex environments. The activities of many nutrient transporters are post-translationally regulated by reversible phosphorylation, allowing rapid adaptation to variable environmental conditions. Here, we show that the Arabidopsis root epidermis-expressed ammonium transporter AtAMT1;3 was dynamically (de-)phosphorylated at multiple sites in the cytosolic C-terminal region (CTR) responding to ammonium and nitrate signals. Under ammonium resupply rapid phosphorylation of a Thr residue (T464) in the conserved part of the CTR (CTRC) effectively inhibited AtAMT1;3-dependent NH4+ uptake. Moreover, phosphorylation of Thr (T494), one of three phosphorylation sites in the non-conserved part of the CTR (CRTNC), moderately decreased the NH4+ transport activity of AtAMT1;3, as deduced from functional analysis of phospho-mimic mutants in yeast, oocytes, and transgenic Arabidopsis. Double phospho-mutants indicated a role of T494 in fine-tuning the NH4+ transport activity when T464 was non-phosphorylated. Transient dephosphorylation of T494 with nitrate resupply closely paralleled a transient increase in ammonium uptake. These results suggest that T464 phosphorylation at the CTRC acts as a prime switch to prevent excess ammonium influx, while T494 phosphorylation at the CTRNC fine tunes ammonium uptake in response to nitrate. This provides a sophisticated regulatory mechanism for plant ammonium transporters to achieve optimal ammonium uptake in response to various nitrogen forms.
Deeper roots associated with cooler canopies, higher normalized difference vegetation index, and greater yield in three wheat populations grown on stored soil water
Authors: Li Xiaoxi , Ingvordsen Cathrine H , Weiss Michael , Rebetzke Greg J , Condon Anthony G , James Richard A , Richards Richard A
Published: May 2019

Rooting depth, a hard trait to measure in the field, was negatively correlated with canopy temperature, an easy trait to measure by airborne thermography, in large wheat populations under terminal drought
Empirical derivation of cutoff values for the sleep health metric and its relationship to cardiometabolic morbidity: results from the Midlife in the United States (MIDUS) study
Authors: Brindle Ryan C , Yu Lan , Buysse Daniel J , Hall Martica H
Published: May 2019

Study Objectives

Emerging evidence supports a multidimensional perspective of sleep in the context of health. The sleep health model, and composite sleep health score, are increasingly used in research. However, specific cutoff values that differentiate “good” from “poor” sleep, have not been empirically derived and its relationship to cardiometabolic health is less-well understood. We empirically derived cutoff values for sleep health dimensions and examined the relationship between sleep health and cardiometabolic morbidity.

Methods

Participants from two independent Biomarker Studies in the MIDUS II (N = 432, 39.8% male, age = 56.92 ± 11.45) and MIDUS Refresher (N = 268, 43.7% male, age = 51.68 ± 12.70) cohorts completed a 1-week study where sleep was assessed with daily diaries and wrist actigraphy. Self-reported physician diagnoses, medication use, and blood values were used to calculate total cardiometabolic morbidity. Receiver operating characteristic (ROC) curves were generated in the MIDUS II cohort for each sleep health dimension to determine cutoff values. Using derived cutoff values, logistic regression was used to examine the relationship between sleep health scores and cardiometabolic morbidity in the MIDUS Refresher cohort, controlling for traditional risk factors.

Results

Empirically derived sleep health cutoff values aligned reasonably well to cutoff values previously published in the sleep health literature and remained robust across physical and mental health outcomes. Better sleep health was significantly associated with a lower odds of cardiometabolic morbidity (OR [95% CI] = 0.901 [0.814–0.997], p = .044).

Conclusions

These results contribute to the ongoing development of the sleep health model and add to the emerging research supporting a multidimensional perspective of sleep and health.
Physical Examination Techniques for the Assessment of Pelvic Floor Myofascial Pain: A Systematic Review
Authors: Meister Melanie R. , Shivakumar Nishkala , Sutcliffe Siobhan , Spitznagle Theresa , Lowder Jerry L.
Published: May 2019

(Abstracted from Am J Obstet Gynecol 2018;219:497.e1–497.e13)

Myofascial pain is common in both women and men with chronic pelvic pain (CPP) and pelvic floor disorder symptoms. It is characterized by the presence of trigger points, tenderness to palpation, and local or referred pain and can result in debilitating CPP.
Risk Factors for Intrapartum Acidemia—A Cohort Study
Authors: Wretler Stina , Nordström Lennart , Graner Sophie , Holzmann Malin
Published: May 2019

(Abstracted from J Matern Fetal Neonatal Med 2018;31(24):3232–3237)

Neonatal acidemia is associated with short- and long-term morbidity in the child. Cardiotocography, or electronic fetal monitoring, is one of the most widely used techniques for intrapartum fetal monitoring, and the use of adjunctive technologies such as fetal scalp blood sampling (FBS) is the norm in many countries, increasing the specificity of cardiotocography, and is likely to reduce the rate of cesarean deliveries.
Characterization of the T-Cell Response to Polypropylene Mesh in Women With Complications
Authors: Tennyson Lauren , Rytel Matthew , Palcsey Stacy , Meyn Leslie , Liang Rui , Moalli Pamela
Published: May 2019

(Abstracted from Am J Obstet Gynecol 2019;220:187.e1–187.e8)

Polypropylene mesh has been widely used as surgical treatment for pelvic organ prolapse and stress urinary incontinence. Although mesh provides favorable functional and anatomic outcomes, its use has been limited by complications.
Diagnostic Yield of Chromosomal Microarray Analysis in Fetuses With Isolated Increased Nuchal Translucency: A French Multicenter Study
Authors: Egloff M. , Hervé B. , Quibel T. , Jaillard S. , Le Bouar G. , Uguen K. , Saliou A.-H. , Valduga M. , Perdriolle E. , Coutton C. , Coston A.-L. , Coussement A. , Anselem O. , Missirian C. , Bretelle F. , Prieur F. , Fanget C. , Muti C. , Jacquemot M.-C. , Beneteau C. , Le Vaillant C. , Vekemans M. , Salomon L. J. , Vialard F. , Malan V.
Published: May 2019

(Abstracted from Ultrasound Obstet Gynecol 2018;52:715–721)

Nuchal translucency (NT) is a collection of fluid at the back of the fetal neck; its thickness can be measured by ultrasound between 10 and 13 + 6 weeks of gestation. An increased thickness, often defined as an NT of greater than the 99th centile, which corresponds approximately to a threshold of 3.5 mm, is associated with a risk of chromosomal abnormalities, as well as genetic syndromes such as Noonan and Smith-Lemli-Opitz syndrome, and major structural birth defects.
Severe Acute Maternal Morbidity in Twin Compared With Singleton Pregnancies
Authors: Madar Hugo , Goffinet François , Seco Aurélien , Rozenberg Patrick , Dupont Corinne , Deneux-Tharaux Catherine ,   on behalf of the EPIMOMS (EPIdémiologie de la MOrbidité Maternelle Sévère) Study Group
Published: May 2019

OBJECTIVE:

To investigate the association between twin pregnancy and severe acute maternal morbidity, overall and by timing (before, during or after delivery) and underlying causal condition.

METHODS:

We conducted a cohort-nested case-control analysis from the EPIMOMS prospective study conducted in six French regions from 2012–2013 (N=182,309 deliveries). The case group comprised 2,500 women with severe acute maternal morbidity (defined by a national expert consensus process) occurring from 22 weeks of gestation and up to 42 days postpartum. A random sample of 3,650 women who gave birth without severe acute maternal morbidity made up the control group. The association between twin pregnancy and severe acute maternal morbidity was analyzed with multilevel multivariable logistic regression. The role of cesarean delivery as an intermediate factor between twin pregnancy and severe acute maternal morbidity was assessed by path analysis.

RESULTS:

The population-based incidence of severe acute maternal morbidity was 6.2% (n=197/3,202, 95% CI 5.3–7.1) in twin pregnancies, and 1.3% (n=2,303/179,107, 95% CI 1.2–1.3) in singleton pregnancies. After controlling for confounders, the risk of severe acute maternal morbidity was higher in twin than in singleton pregnancies (adjusted odds ratio [OR] 4.2, 95% CI 3.1–5.8), both antepartum and intrapartum or postpartum, and regardless of the category of causal condition (severe hemorrhage, severe hypertensive complications, or other conditions). The association was also found for the most severe near-miss cases (adjusted OR 5.1, 95% CI 3.5–7.3). In path analysis, cesarean delivery mediated 20.6% (95% CI 12.9–28.2) of the total risk of intrapartum or postpartum severe acute maternal morbidity associated with twin pregnancy.

CONCLUSION:

Compared with women with singleton pregnancies, women with twin pregnancies have a fourfold increased risk for severe maternal complications both before and after delivery. About one fifth of the association between twin pregnancy and intrapartum or postpartum severe acute maternal morbidity may be mediated by cesarean delivery.
Patterns of Prescription Opioid Use in Women With Endometriosis
Authors: Lamvu Georgine , Soliman Ahmed M. , Manthena Shivaji R. , Gordon Keith , Knight Julie , Taylor Hugh S.
Published: May 2019

OBJECTIVE:

To examine opioid use, opioid prescribing patterns, and timing of the first opioid prescription in endometriosis patients compared with matched women in the control group without endometriosis.

METHODS:

We conducted a retrospective analysis of the Clinformatics Datamart database. Women diagnosed with endometriosis from January 2006 through December 2016 and aged 18–49 years were compared with women in the control group matched on age, region, race, insurance payer, and plan type. Key outcomes included: filled prescription for an opioid, multiple opioid prescriptions, number of days' supply, daily dose (morphine milligram equivalents), and concomitant opioid and benzodiazepine prescriptions. Cohorts were descriptively analyzed using t- and χ2 statistics and multivariable regression analyses yielded adjusted relative risk (RR) ratios and 95% CI.

RESULTS:

The study sample included 53,847 endometriosis patients and 107,694 patients in the control group. The mean age was 38 years, 62.4% of patients were white, and 51.6% lived in the South. Women in the endometriosis case group, compared with women in the control group, were more likely to fill an opioid prescription (42,705 [79.3%] women in the case group vs 26,106 [24.2%] women in the control group; adjusted RR ratio 2.91; 2.87–2.94), had higher likelihood of filling prescriptions with a dose of 50 morphine milligram equivalents or more (24,544 [45.6%] vs 10,463 [9.7%]; adjusted RR ratio 4.07; 3.98–4.16) or 100 morphine milligram equivalents or more (8,013 [14.9%] vs 3,582 [3.3%]; adjusted RR ratio 3.56; 3.43–3.70). Women in the case group were more likely to have concomitant opioid and benzodiazepine prescriptions (5,453 [10.1%] vs 3,711 [3.5%]; adjusted RR ratio 1.95; 1.88–2.03) and to have used these drugs concurrently for at least 30 days (1,596 [3.0%] vs 1,265 [1.2%]; adjusted RR ratio 1.43; 1.34–1.52) or at least 90 days (875 [1.6%] vs 777 [0.7%]; adjusted RR ratio 1.27; 1.17–1.37). Similar results were obtained after excluding opioid prescriptions received during a 30-day postsurgery window.

CONCLUSION:

Women with endometriosis had higher probabilities of prolonged use of opioids and concomitant use with benzodiazepines compared with women without this condition.

FUNDING SOURCE:

This study was funded by AbbVie, Inc.
Second-Trimester Fetal Loss in a Patient With Hyperemesis Gravidarum Complicated by Refeeding Syndrome
Authors: Mayer Kaitlyn Huegel , McGill April L.
Published: May 2019

BACKGROUND:

Refeeding syndrome is a rare constellation of electrolyte abnormalities after reintroduction of glucose during an adaptive state of starvation and malnutrition, resulting in fluid shifts, end-organ damage, and, potentially, death. We present a case of fetal death in a patient with hyperemesis gravidarum complicated by refeeding syndrome.

CASE:

A 32-year-old obese, multigravid patient was admitted at 16 weeks of gestation with hyperemesis gravidarum and laboratory abnormalities concerning for refeeding syndrome after consuming a sugar-rich beverage. She was admitted to the hospital for electrolyte and fluid repletion; however, on hospital day 2, fetal death was diagnosed.

CONCLUSION:

Refeeding syndrome is a potentially fatal complication of hyperemesis gravidarum. Caution should be taken when reintroducing glucose during prolonged states of malnutrition to prevent the development of refeeding syndrome.
Prevention of the Infected Fracture: Evidence-Based Strategies for Success!
Authors: Mauffrey Cyril , Hak David J. , Rojas David , Doan Kent , Southam Brendan R. , Archdeacon Michael T. , Boyer Martin , McKee Michael , Giannoudis Peter V. , Schemitsch Emil H.
Published: May 2019

There is a significant burden of disease associated with infected fractures, and their management is challenging. Prevention of infection after musculoskeletal trauma is essential because treatment of an established infection continues to be a major obstacle. Despite the need for evidence-based decision making, there is a lack of consensus around strategies for prevention and surgical management of the infected fracture. The current evidence for the prevention of the infected fracture is reviewed here with a focus on evidence for antibiotic therapy and debridement, the induced membrane technique, management of soft-tissue defects, patient optimization, and adjuncts to prevent infection.
Validation of PROMIS Physical Function Instruments in Patients With an Orthopaedic Trauma to a Lower Extremity
Authors: Rothrock Nan E. , Kaat Aaron J. , Vrahas Mark S. , O'Toole Robert V. , Buono Sarah K. , Morrison Suzanne , Gershon Richard C.
Published: May 2019

Objectives:

To evaluate the reliability, convergent validity, known-groups validity, and responsiveness of the Patient-Reported Outcomes Measurement Information System (PROMIS) Mobility Computer Adaptive Test (CAT) and PROMIS Physical Function 8a Short Form.

Design:

Prospective cohort study.

Setting:

Two Level-I trauma centers.

Patients:

Eligible adults with an isolated lower extremity trauma injury receiving treatment were approached consecutively (n = 402 consented at time 1, median = 80 days after treatment). After 6 months, 122 (30.3%) completed another assessment.

Intervention:

Cross-sectional and longitudinal monitoring of patients.

Main Outcome Measurements:

Floor and ceiling effects, reliability (marginal reliability and Cronbach's alpha), convergent validity, known-groups discriminant validity (weight-bearing status and fracture severity), and responsiveness (Cohen's d effect size) were evaluated for the PROMIS Mobility CAT, PROMIS Physical Function 8a Short Form, and 5 other measures of physical function.

Results:

PROMIS PFSF8a and Foot and Ankle Ability Measure Activities of Daily Living Index had ceiling effects. Both PROMIS measures demonstrated excellent internal consistency reliability (mean marginal reliability 0.94 and 0.96; Cronbach's alpha = 0.96). Convergent validity was supported by high correlations with other measures of physical function (r = 0.70–0.87). Known-groups validity by weight-bearing status and fracture severity was supported as was responsiveness (Mobility CAT effect size = 0.81; Physical Function Short Form 8a = 0.88).

Conclusions:

The PROMIS Mobility CAT and Physical Function 8a Short Form demonstrated reliability, convergent and known-groups discriminant validity, and responsiveness in a sample of patients with a lower extremity orthopaedic trauma injury.
Nebivolol Improves Obesity-Induced Vascular Remodeling by Suppressing NLRP3 Activation
Authors: Gao Jing , Xie Qihai , Wei Tong , Huang Chenglin , Zhou Weijun , Shen Weili
Published: May 2019

Nebivolol is a novel β-adrenergic receptor (β-AR) blocker with anti-inflammatory and antioxidant properties. The NLRP3 inflammasome plays a pivotal role in the pathogenesis of obesity-induced vascular dysfunction. Our study aimed to explore the effect of nebivolol on the NLRP3 inflammasome and vascular remodeling in diet-induced obese rats. Eight-week-old Sprague–Dawley male rats were fed with either a standard chow diet or a high-fat diet (HFD) for 8 weeks. Next, the obese rats were subdivided into 3 groups as follows: (1) HFD control group, (2) HFD with low doses of nebivolol (5 mg/kg·d−1), and (3) HFD with high doses of nebivolol (10 mg/kg·d−1). A 4-week treatment with nebivolol improved acetylcholine-induced vascular relaxation in accordance with an increased aortic endothelial nitric oxide synthase. Nebivolol attenuated NLRP3 inflammasome activation and suppressed autophagy. In parallel, nebivolol enhanced the levels of phase-II detoxifying enzymes, including superoxide dismutase and catalase. These effects were associated with an increased β3-AR level. Moreover, nebivolol treatment significantly increased Adenosine 5′-monophosphate (AMP)-activated protein kinase activity and decreased phosphorylation of the mammalian target of rapamycin. These results demonstrated that nebivolol improves obesity-induced vascular remodeling by attenuating NLRP3 inflammasome activation and restoring the antioxidant defense.
Mechanism of Emulsified Isoflurane Postconditioning–Induced Activation of the Nrf2–Antioxidant Response Element Signaling Pathway During Myocardial Ischemia-Reperfusion: The Relationship With Reactive Oxygen Species
Authors: Chen Wei , Chen Xi-Yuan , Wang Ying , Wang Hai-Ying , Zhou Wen-Jing , Yu Tian
Published: May 2019

Emulsified isoflurane (EI) has been shown to alleviate myocardial ischemia-reperfusion (IR) injury. However, previous reports have not been focused on the underlying mechanism. We used models of IR injury in Langendorff-isolated rat hearts to determine the relationship between the mechanism underlying EI postconditioning (EIP)-induced activation of the nuclear factor-E2–related factor 2 (Nrf2)-antioxidant response element signaling pathway during myocardial IR, and its relationship with reactive oxygen species. In comparison with the IR group, the EIP group showed a significant reduction in myocardial ultrastructural damage, significant increase in function [heart rate, left ventricular developed pressure, left ventricular end-diastolic pressure, and maximal rate of the increase in left ventricular pressure (+dp/dtmax)], and upregulated expression of Nrf2, HO-I, NQO1, and SOD1 mRNA and proteins at the end of reperfusion. After treatment with N-(2-mercaptopropionyl)-glycine (MPG), the significant reduction in myocardial ultrastructural damage and significant increases in function, and mRNA and protein expression were no longer evident in the M + EIP group. These results show that EIP can regulate reactive oxygen species levels and activate the Nrf2–antioxidant response element signaling pathway, thereby attenuating myocardial IR injury in rats.
Multiple pregnancies and the risk of diabetes mellitus in postmenopausal women
Authors: Lv Chengjie , Chen Chi , Chen Qi , Zhai Hualing , Zhao Li , Guo Yuyu , Wang Ningjian
Published: May 2019

Objective:

We aimed to investigate whether the number of pregnancies during childbearing age was associated with diabetes in postmenopausal women with no history of gestational diabetes.

Methods:

Our data source was the continuous National Health and Nutrition Examination Survey 1999 to 2014. We selected 9,138 postmenopausal women over 40 years old who did not have a history of gestational diabetes during pregnancy. Logistic regression analyses were applied for the association of the number of pregnancies with diabetes.

Results:

We found women with ≥4 pregnancies had significantly greater fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), 2-hour plasma glucose, and the Homeostatic Model Assessment of Insulin Resistance than those with two to three pregnancies (all P < 0.01). These women also had a significantly higher prevalence of diabetes (28.4% vs 20.7%; P < 0.001). Using the two to three pregnancies group as the reference, we observed a positive association of log-FPG and log-HbA1c with 4 or more pregnancies after adjustment for sociodemographic, lifestyle, and reproductive factors, and body mass index (both P < 0.05). Compared to women with two to three pregnancies, the odds ratios for diabetes were 1.31 (95% confidence interval [CI] 1.01-1.71) for women who never got pregnant and 1.28 (95% CI 1.10-1.48) for those with at least 4 pregnancies after multivariate adjustment.

Conclusions:

At least 4 pregnancies through childbearing age may be a potential risk factor for diabetes in postmenopausal women without a history of gestational diabetes.
The Amygdala in Schizophrenia and Bipolar Disorder: A Synthesis of Structural MRI, Diffusion Tensor Imaging, and Resting-State Functional Connectivity Findings
Authors: Ho New Fei , Chong Pearlynne Li Hui , Lee Daryl Renick , Chew Qian Hui , Chen Guoyang , Sim Kang
Published: May 2019

Frequently implicated in psychotic spectrum disorders, the amygdala serves as an important hub for elucidating the convergent and divergent neural substrates in schizophrenia and bipolar disorder, the two most studied groups of psychotic spectrum conditions. A systematic search of electronic databases through December 2017 was conducted to identify neuroimaging studies of the amygdala in schizophrenia and bipolar disorder, focusing on structural MRI, diffusion tensor imaging (DTI), and resting-state functional connectivity studies, with an emphasis on cross-diagnostic studies. Ninety-four independent studies were selected for the present review (49 structural MRI, 27 DTI, and 18 resting-state functional MRI studies). Also selected, and analyzed in a separate meta-analysis, were 33 volumetric studies with the amygdala as the region-of-interest. Reduced left, right, and total amygdala volumes were found in schizophrenia, relative to both healthy controls and bipolar subjects, even when restricted to cohorts in the early stages of illness. No volume abnormalities were observed in bipolar subjects relative to healthy controls. Shape morphometry studies showed either amygdala deformity or no differences in schizophrenia, and no abnormalities in bipolar disorder. In contrast to the volumetric findings, DTI studies of the uncinate fasciculus tract (connecting the amygdala with the medial- and orbitofrontal cortices) largely showed reduced fractional anisotropy (a marker of white matter microstructure abnormality) in both schizophrenia and bipolar patients, with no cross-diagnostic differences. While decreased amygdalar-orbitofrontal functional connectivity was generally observed in schizophrenia, varying patterns of amygdalar-orbitofrontal connectivity in bipolar disorder were found. Future studies can consider adopting longitudinal approaches with multimodal imaging and more extensive clinical subtyping to probe amygdalar subregional changes and their relationship to the sequelae of psychotic disorders.
Chemically Assisted Dissection With Sodium 2-Mercaptoethanesulfonate (MESNA) in the Surgical Management of Pediatric Cholesteatoma
Authors: de la Torre Carlos , Villamor Perla
Published: May 2019

Objective:

To evaluate the effectiveness of the chemically assisted dissection with sodium 2-mercaptoethanesulfonate (MESNA), in the reduction of residual and recurrent cholesteatoma after mastoidectomy in children with chronic cholesteatomatous otitis media (CCOM).

Study Design:

Retrospective case–control study.

Setting:

Tertiary referral center.

Population:

One hundred forty mastoidectomies performed in patients under 18 years of age for the treatment of CCOM.

Interventions:

Chemically assisted dissection (CAD) with MESNA compared with surgical dissection without MESNA.

Main Outcome Measures:

Recidivism of cholesteatoma (recurrence and residual disease), variations in the average of bone conduction threshold after treatment, and complications.

Results:

Recidivism of cholesteatoma was significantly lower when CAD with MESNA was used (p < 0.0001). No difference was found in the mean variation of the average of bone conduction thresholds between the groups, confirming its safety profile regarding auditory function. Meatoplasty stenosis after surgery was more prevalent within CAD with MESNA group (p: 0.049).

Conclusion:

Recurrent and residual cholesteatoma remains a problem, especially in children and despite surgical techniques such as canal wall down mastoidectomy and endoscopic ear surgery. CAD with MESNA can be safe and effective to reduce recurrence rates. Multicenter and prospective studies with larger number of patients are needed to validate these findings. The higher rate of meatoplasty stenosis after CAD with MESNA merits additional clinical research to confirm these findings, as well as in vitro studies evaluating the effect of the drug on the activity of fibroblasts and other growth factors that may be involved.
Enteral nutrition better than proton pump inhibitors?
Authors: Jalil Bilal A. , El-Kersh Karim
Published: May 2019

Purpose of review

Stress ulcer prophylaxis in critically-ill patients has been a subject of extensive research, with multiple clinical trials attempting to study the best method of stress ulcer prophylaxis with the least adverse effects. Until recently, pharmacologic prophylaxis has prevailed as the primary choice for the prevention of stress ulcers but recent clinical studies have attempted to evaluate the role of enteral nutrition in stress ulcer prophylaxis.

Recent findings

The incidence of stress ulcers that result in clinically important gastrointestinal bleeding (CIGIB) has drastically decreased over the last two decades. Furthermore, in the current era CIGB in the ICU does not seem to be associated with an increased mortality. Multiple recent clinical studies aimed to evaluate the role of proton pump inhibitors (PPIs) in patients who tolerate enteral nutrition in the ICU.

The results of multiple recent clinical studies call for re-evaluation of the routine use of PPIs in critically ill patients who tolerates enteral nutrition in the ICU. Despite the promising preliminary results, definitive recommendations need larger clinical trials that are powered to evaluate any added benefits of using PPI in critically ill patients who tolerate enteral nutrition given the low incidence of CIGB in the current era.
Detection and classification the breast tumors using mask R-CNN on sonograms
Authors: Chiao Jui-Ying , Chen Kuan-Yung , Liao Ken Ying-Kai , Hsieh Po-Hsin , Zhang Geoffrey , Huang Tzung-Chi
Published: May 2019

Breast cancer is one of the most harmful diseases for women with the highest morbidity. An efficient way to decrease its mortality is to diagnose cancer earlier by screening. Clinically, the best approach of screening for Asian women is ultrasound images combined with biopsies. However, biopsy is invasive and it gets incomprehensive information of the lesion. The aim of this study is to build a model for automatic detection, segmentation, and classification of breast lesions with ultrasound images. Based on deep learning, a technique using Mask regions with convolutional neural network was developed for lesion detection and differentiation between benign and malignant. The mean average precision was 0.75 for the detection and segmentation. The overall accuracy of benign/malignant classification was 85%. The proposed method provides a comprehensive and noninvasive way to detect and classify breast lesions.
Dual-interventional therapy for multiple splenic artery aneurysms in a patient with portal hypertension
Authors: Niu Hongtao , Junfeng Sha , Jianli An , Zibo Zou , Yanchao Dong
Published: May 2019

Rationale:

Portal hypertension (PHT) is either a significant risk factor of development of splenic artery aneurysm (SAA), or predisposing factor of rupture.

Patient concerns:

A 57-year-old patient was admitted to our hospital because of multiple SAAs with PHT, suffered from episodes of haematemesis.

Diagnosis:

Emergency ultrasound of the abdomen showed remarkable cirrhosis and splenomegaly. Two days later, CT angiography reveal two SAA located in the splenic artery, as well as splenomegaly and features of PHT.

Interventions:

Transjugular intrahepatic portosystemic shunt (TIPS) was performed to decrease portal venous pressure and control esophagogastric variceal hemorrhage. Coil embolization of the main splenic artery was performed to complete thrombosis of the two SAAs and relieve critical hypersplenism.

Outcomes:

After 3 months, follow-up enhanced CT confirmed complete thrombosis of the main splenic artery and the two aneurysm sac, and partial splenic infarction (approximately 50%).

Lessens:

TIPS can control easophagogastric variceal hemorrhage and decrease portal venous pressure, coil embolization of the main splenic artery can promote permanent thrombosis of aneurysm sac and relieve hypersplenism.
Laparoscopic extralevator abdominoperineal excision for the treatment of perianal Paget's disease
Authors: Zeng Dong , Chen Jianghong , Zhu Bo , Li Junke , Wu Hongyu , Ma Dan
Published: May 2019

Rational:

Perianal Paget's disease (PPD) is a very rare intraepithelial adenocarcinoma. Very few cases of PPD have been reported till date, so the treatment remains controversial and more experience is needed.

Patient concerns:

A 73-year-old female was admitted to several hospitals with diagnosed as “perianal eczema” in perianal lesion. After a variety of treatments, the patient's condition did not improve.

Diagnoses:

Abdominopelvic computed tomography and rectal magnetic resonance imaging showed thickening of the soft tissue around the anus, with significant enhancement. Histologic examination revealed the state of Paget's cells.

Interventions:

Laparoscopic Extralevator Abdominoperineal Excision (ELAPE) surgery was performed at our department.

Outcomes:

The patient recovered well. After 10 months, a check-up revealed that her perianal area was disease-free.

Lessons:

The aim of this report was to present the characteristics of PPD in order to improve its diagnosis and treatment. Laparoscopic ELAPE is a successful therapy.