bluuebunny/crossref_metadata_2025 huggingface dataset:
Rapid Patient Discharge Contribution to Bed Surge Capacity During a Mass Casualty Incident: Findings From an Exercise With New York City Hospitals
Authors: Jacobs-Wingo Jasmine L. , Cook Heather A. , Lang William H.
Published: December 2017

Background:

Mass casualty incidents may increase patient volume suddenly and dramatically, requiring hospitals to expeditiously manage bed inventories to release acute care beds for disaster victims. Electronic patient tracking systems combined with unit walk-throughs can identify patients for rapid discharge. The New York City (NYC) Department of Health and Mental Hygiene's 2013 Rapid Patient Discharge Assessment (RPDA) aimed to determine the maximum number of beds NYC hospitals could make available through rapid patient discharge and to characterize discharge barriers.

Methods:

Unit representatives identified discharge candidates within normal operations in round 1 and additional discharge candidates during a disaster scenario in round 2. Descriptive statistics were performed.

Results:

Fifty-five NYC hospitals participated in the RPDA exercise; 45 provided discharge candidate counts in both rounds. Representatives identified 4225 patients through the RPDA: among these, 1138 (26.9%) were already confirmed for discharge; 1854 (43.9%) were round 1 discharge candidates; and 1233 (29.2%) were round 2 discharge candidates. These 4225 patients represented 21.4% of total bed capacity. Frequently reported barriers included missing prescriptions for aftercare or discharge orders.

Conclusion:

The NYC hospitals could implement rapid patient discharge to clear one-fifth of occupied inpatient beds for disaster victims, given they address barriers affecting patients' safe and efficient discharge.
Attitudes Toward and Management of Fibromyalgia
Authors: Agarwal Arnav , Oparin Yvgeniy , Glick Lauren , Fitzcharles Mary-Ann , Adachi Jonathan D. , Cooper Matthew D. , Gallo Lucas , Wong Laura , Busse Jason W.
Published: December 2017

Background

Canadian rheumatologists' attitudes toward and management of fibromyalgia remain uncertain.

Objective

The aim of this study was to explore management strategies and attitudes of Canadian rheumatologists toward fibromyalgia and concordance with guideline recommendations.

Methods

We administered a 17-item cross-sectional survey to Canadian rheumatologists and explored the concordance between respondents' management practices with the 2012 Canadian Guidelines for the diagnosis and management of fibromyalgia.

Results

Among 331 Canadian rheumatologists who were approached, 140 returned the survey for a 42% response rate. The majority felt that fibromyalgia was a useful clinical diagnosis (110/138 [80%]) but was divided as to whether fibromyalgia was objectively defined (75/138 [54%]) or a psychosocial condition (42/138 [30%]) or could result in an inability to work (37/138 [27%]). Contrary to guideline recommendations, most (82/134 [61%]) endorsed that tender points were useful for diagnosis. Half endorsed potentially refusing consultations with fibromyalgia patients, and only 42% (59/139) agreed that there were effective therapies for this syndrome. Consistent with the guideline, most respondents managed fibromyalgia with education, exercise therapy, antidepressants, and nonnarcotic analgesics (≥89% for all); however, fewer than half agreed that any of these modalities were effective (endorsement ranged from 9% to 47%). Assessment of the 2012 guideline revealed a number of important limitations.

Conclusions

Canadian rheumatologists largely do not provide primary care for fibromyalgia. Most adhere to guideline recommendations for management of fibromyalgia, but few endorse these interventions as effective. Further research, including updating of the 2012 Canadian Guidelines for the diagnosis and management of fibromyalgia, is required to inform this disconnect.
Metabolomics and Precision Medicine in Trauma: The State of the Field
Authors: Jayaraman Sudha P. , Anand Rahul J. , DeAntonio Jonathan H. , Mangino Martin , Aboutanos Michel B. , Kasirajan Vigneshwar , Ivatury Rao R. , Valadka Alex B. , Glushakova Olena , Hayes Ronald L. , Bachmann Lorin M. , Brophy Gretchen M. , Contaifer Daniel , Warncke Urszula O. , Brophy Donald F. , Wijesinghe Dayanjan S.
Published: December 2017

Trauma is a major problem in the United States. Mortality from trauma is the number one cause of death under the age of 45 in the United States and is the third leading cause of death for all age groups. There are approximately 200,000 deaths per year due to trauma in the United States at a cost of over $671 billion in combined healthcare costs and lost productivity. Unsurprisingly, trauma accounts for approximately 30% of all life-years lost in the United States. Due to immense development of trauma systems, a large majority of trauma patients survive the injury, but then go on to die from complications arising from the injury. These complications are marked by early and significant metabolic changes accompanied by inflammatory responses that lead to progressive organ failure and, ultimately, death. Early resuscitative and surgical interventions followed by close monitoring to identify and rescue treatment failures are key to successful outcomes. Currently, the adequacy of resuscitation is measured using vital signs, noninvasive methods such as bedside echocardiography or stroke volume variation, and other laboratory endpoints of resuscitation, such as lactate and base deficit. However, these methods may be too crude to understand cellular and subcellular changes that may be occurring in trauma patients. Better diagnostic and therapeutic markers are needed to assess the adequacy of interventions and monitor responses at a cellular and subcellular level and inform clinical decision-making before complications are clinically apparent. The developing field of metabolomics holds great promise in the identification and application of biochemical markers toward the clinical decision-making process.
Vigabatrin: Lessons Learned From the United States Experience
Authors: Foroozan Rod
Published: December 2017

Vigabatrin was introduced as an antiseizure medication in the United Kingdom in 1989 and was extensively used until 1997 when concerns arose regarding peripheral visual field loss. When the drug was approved in the United States in 2009, it carried a black box warning for the risk of permanent visual loss, and the pharmaceutical company was mandated to create a drug registry to assess for visual deficits. The vigabatrin drug registry has documented a relatively large percentage (37%) of preexisting, baseline visual deficits and a paucity (2%) of potential new visual findings. The vigabatrin vision study, a prospective, longitudinal, single-arm, open-label study, confirmed that adult patients with refractory complex partial seizures had a large number of visual deficits at baseline. An unexpected finding during the first year of therapy with vigabatrin was an increase in retinal thickness on optical coherence tomography. The experience from vigabatrin in the United States emphasizes the importance of baseline eye findings when considering the potential of drug toxicity involving the visual pathways.
Arabidopsis leaf hydraulic conductance is regulated by xylem-sap pH, controlled, in turn, by a P-type H+-ATPase of vascular bundle sheath cells
Authors: Grunwald Yael , Wigoda Noa , Sade Nir , Yaaran Adi , Torne Tanmayee , Gosa Sanbon Chaka , Moran Nava , Moshelion Menachem
Published: December 2017

The leaf vascular bundle sheath cells (BSCs) that tightly envelop the leaf veins, are a selective and dynamic barrier to xylem-sap water and solutes radially entering the mesophyll cells. Under normal conditions, xylem-sap pH of <6 is presumably important for driving and regulating the transmembranal solute transport. Having discovered recently a differentially high expression of a BSCs proton pump, AHA2, we now test the hypothesis that it regulates this pH and leaf radial water fluxes.

We monitored the xylem-sap pH in the veins of detached leaves of WT Arabidopsis, AHA mutants, andaha2mutants complemented withAHA2gene solely in BSCs. We tested an AHA inhibitor and stimulator, and different pH buffers. We monitored their impact on the xylem-sap pH and the whole leaf hydraulic conductance (Kleaf), and the effect of pH on the water osmotic permeability (Pf) of isolated BSCs protoplasts.

Our results demonstrated that AHA2 is necessary for xylem-sap acidification, and in turn, for elevating Kleaf. Conversely, knocking out AHA2 alkalinized the xylem-sap. Also, elevating xylem sap pH to 7.5 reduced Kleafand elevating external pH to 7.5 decreased the BSCs Pf.

All these demonstrate a causative link between AHA2 activity in BSCs and leaf radial water conductance.

One-sentence summary

Bundle-sheath cells can control the leaf hydraulic conductance by proton-pump-regulated xylem sap pH
High-throughput optical mapping of replicating DNA
Authors: De Carli Francesco , Menezes Nikita , Berrabah Wahiba , Barbe Valérie , Genovesio Auguste , Hyrien Olivier
Published: December 2017

DNA replication is a crucial process for the universal ability of living organisms to reproduce. Existing methods to map replication genome-wide use large cell populations and therefore smooth out variability between chromosomal copies. Single-molecule methods may in principle reveal this variability. However, current methods remain refractory to automated molecule detection and measurements. Their low throughput has therefore precluded genome-wide analyses. Here, we have repurposed a commercial optical DNA mapping device, the Bionano Genomics Irys system, to map the replication signal of single DNA molecules onto genomic position at high throughput. Our methodology (HOMARD) combines fluorescent labelling of replication tracks and nicking endonuclease (NE) sites with DNA linearization in nanochannel arrays and dedicated image processing. We demonstrate the robustness of our approach by providing an ultra-high coverage (23,311 x) replication map of bacteriophage λ DNA in Xenopus egg extracts. HOMARD opens the way to genome-wide analysis of DNA replication at the single-molecule level.
Genetic Analysis ofcallusinitiation inGossypium tomentosumandGossypium darwinii
Authors: Yelena Kolezeva , Vasilyev Nikolay , Alpatov Ivan
Published: December 2017

Wild cotton species can contribute a valuable gene pool for the genetic improvement of cultivated tetraploid cultivars. But the obstacle is the reproductive isolation of different species. Somatic embryogenesis offers a temporary status for genetic manipulation such as somatic hybridization. The present studies aimed at optimizing the conditions for regeneration of wild species of cotton. Callus were successfully induced from hypocotyls ofGossypium tomentosum(C1genome) andGossypium darwinii(D5genome) on MSB5(MS salts and B5vitamins) medium supplemented with 0.01mg/L 2, 4-D (2, 4-dichlorophenoxyacetic acid), 0.01mg/L KT (kinetin), 0.01mg/L IAA (3-indoleacetlc acid) and 0.60mg/L 2, 4-D, 0.25mg/L KT, respectively. Plant growth regulators (PGRs) combinations, adding high inorganic salt stress, and carbohydrate were used to induce embryogenic callus from nonembryogenic callus. Embryogenic cultures were induced from the two cotton species. Based on studying the effect of PGRs, nitrogen sources, molysite, CuSO4and pH value on somatic embryogenesis (SE), we obtained somatic embryogenesis in theG. tomentosumon the medium with 0.1 mg/L 2, 4-D, 0.1 mg/L KT while deprivation of KNO3. The result gives out new exploration on somatic embryogenesis in cotton to create new germplasm sources.
Cdk9, Spt5 and histone H2B mono-ubiquitylation cooperate to ensure antisense suppression by the Clr6-CII/Rpd3S HDAC complex
Authors: Sansó Miriam , Pinto Daniel , Svensson Peter , Pagé Viviane , Parua Pabitra , Bitton Danny A. , Mbogning Jean , Garcia Patricia , Hidalgo Elena , Robert François , Bähler Jürg , Tanny Jason C. , Fisher Robert P.
Published: December 2017

Cyclin-dependent kinase 9 (Cdk9) and histone H2B monoubiquitylation (H2Bub1) are both implicated in elongation by RNA polymerase II (RNAPII). In fission yeast, Cdk9 and H2Bub1 regulate each other through a feedback loop involving phosphorylation of the elongation factor Spt5. Conversely, genetic interactions suggest opposing functions of H2Bub1 and Cdk9 through an Spt5-independent pathway. To understand these interactions, we performed RNA-seq analysis after H2Bub1 loss, Cdk9 inhibition, or both. Either Cdk9 inhibition or H2Bub1 loss increased levels of antisense transcription initiating within coding regions of distinct subsets of genes; ablation of both pathways led to antisense derepression affecting over half the genome. Cdk9 and H2Bub1 cooperate to suppress antisense transcription by promoting function of the Clr6-CII histone deacetylase (HDAC) complex. H2Bub1 plays a second role, in opposition to Clr6-CII, to promote sense transcription in subtelomeric regions. Therefore, functional genomics revealed both collaborative and antagonistic functions of H2Bub1 and Cdk9.
The use of multi‐frequency acquisition to significantly improve the quality of fibre‐optic‐distributed vibration sensing
Authors: Hartog A.H. , Liokumovich L.B. , Ushakov N.A. , Kotov O.I. , Dean T. , Cuny T. , Constantinou A. , Englich F.V.
Published: December 2017

Unlike conventional sensors that measure the passage of seismic waves at a single position, distributed vibration sensing systems, also known as distributed acoustic sensing systems, detect the passage of seismic waves by averaging a measurement of strain over a section of fibre‐optic cable. Distributed vibration sensing systems work by transmitting pulses of light down the fibre and measuring the phase of the Rayleigh backscatter. At random positions along the fibre, however, fading occurs; this is where the amplitude of the backscattered signal is very small due to cancellation of the scattered electric fields, resulting in anomalously noisy traces in a common source gather.

This paper addresses the problem of fading in a particular form of distributed vibration sensors: a new optical arrangement of the instrumentation is described that allows the measurement to be carried out quasi‐simultaneously at multiple optical interrogation frequencies. The interrogation frequencies are chosen to be sufficiently different that their fading properties are distinct and the diversity thus obtained is used to aggregate the data obtained to substantially reduce the noise caused by fading. As well as reducing the effects of fading, the aggregation of the independent results can also help to reduce the overall noise of the measurement and improve the linearity of the distributed vibration sensing system.
Oil and the Naira: A Markov Switching Perspective
Authors: Ayodeji Idowu Oluwasayo
Published: December 2017

Using a Markov switching regression model, the study investigated the relationship between oil price shocks and exchange rates movements in an oil‐exporting economy. On the strength of theoretical and empirical evidence, Nigerian naira exchange rates to US dollars were decomposed into two segmented time trends of depreciation (state 1) and appreciation (state 2). Empirical results provided evidence that exchange rate returns exhibited an asymmetric response to oil price shocks during depreciation and appreciation. We observed that, while the system is in depreciation, nominal oil prices had a positive influence on nominal USD/NGN, whereas nominal oil price shocks had no significant effect on nominal exchange rate movements during appreciation. In addition, real effective exchange rates appreciate with decreasing real oil prices but its depreciation does not depend significantly on real oil prices. Given that a decrease in nominal oil prices induces rapid naira depreciation and topples exchange rates stability, the study suggested that the government works towards a sustainable diversification of the economy to avoid continued over‐dependence on oil exports. Also, to rigorously pursue a sustainable fiscal policy regime in order to boost local productions, encourage non‐oil commodities exportation, and consequently increase avenues for influx of foreign exchange.
Association between dietary pattern scores and the prevalence of colorectal adenoma considering population subgroups
Authors: Haslam Alyson , Wagner Robb Sara , Hébert James R. , Huang Hanwen , Ebell Mark H.
Published: December 2017

Aim

The purpose of the current study is to examine the dietary patterns in a diverse cohort of individuals and to see if the identified dietary patterns predict the prevalence of adenoma in a cross‐sectional study.

Methods

Factor analysis was used to derive both sex‐ and population subgroup‐specific dietary patterns among participants in the screening arm of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Logistic regression was used to assess associations between identified factor scores and colorectal adenoma (CRA) in sex‐specific subgroups.

Results

Three diet patterns were observed in this cohort: ‘Fruits and vegetables’, ‘Western’ and ‘Sweet and salty’. Foods that loaded on each factor were similar between the racial subgroups. In men, being in the highest quintile of ‘Western’ dietary scores was associated with higher odds of any (adjusted odds ratio (aOR) = 1.21; 95% confidence interval (CI) = 1.03–1.42), advanced (aOR = 1.32; 95% CI = 1.07–1.63) or multiple (>1; aOR = 1.51; 95% CI = 1.17–1.94) adenoma, compared to those in the lowest quintile. These results were most notably seen in Caucasian men. In women, having a ‘Fruits and vegetable’ score in the highest quintile was associated with lower odds of multiple adenoma (>1; aOR = 0.53; 95% CI = 0.28–1.00).

Conclusions

Of the three dietary factors, the ‘Western’ diet pattern was most strongly associated with prevalent CRA in Caucasian men. Further research is needed to examine the association between dietary factor scores and adenomas in the proximal colon, where there are larger racial disparities in prevalence.
The relative validity of a food record using the smartphone application MyFitnessPal
Authors: Teixeira Vitor , Voci Silvia M. , Mendes‐Netto Raquel S. , da Silva Danielle G.
Published: December 2017

Aim

The present study aimed to validate food records on the application MyFitnessPal (MFP), comparing them with paper‐based food records (P‐FR).

Methods

Thirty university students, including males and females, volunteered and recorded dietary intakes on P‐FR and MFP food records (MFP‐FR). The values of energy, macronutrients and fibre from MFP‐FR were compared with data from P‐FR, calculated using Brazilian food composition tables. Adjustments for in‐person variability and energy intake were performed, and comparisons were made between each data set, using the Wilcoxon signed‐rank test, Spearman's correlation and Bland–Altman agreement plots.

Results

Positive moderate correlations between P‐FR and MFP‐FR for all variables, and non‐significant associations for energy and fibre were found. The Bland–Altman plots showed tendency to underestimation and relatively narrow limits of agreement. Carbohydrate and lipids show trends of increasing the degree of overestimation with increased intake, even after data normalisation.

Conclusions

MFP tends to underestimate ingestion of nutrients probably due to inadequacies in the MFP database. However, MFP showed good relative validity, especially for energy and fibre. Its use, as well as other similar applications, should be encouraged, due to ease of assessing dietary information, although careful usage is recommended because of database gaps.
Global Governance in Practice
Authors: Pouliot Vincent , Thérien Jean‐Philippe
Published: December 2017

We argue that a focus on practices can enrich the study of global governance by drawing attention to a wealth of informal processes and their politics. After explaining the usefulness of a practice approach, we examine four pervasive practices in contemporary world politics: hosting a global conference, accreditingNGOs, mandating a group of experts, and forming multistakeholder partnerships. For each of these established ‘ways of doing things,’ we provide a definition, decline its variations, and analyze its politics. Through our case studies, we show that global governance practices often generate competing social effects, by which inclusionary trends combine with more exclusionary tendencies. This common dialectic of inclusion and exclusion provides an analytical key to better understand the politics of global public policy making, including its power dynamics.
Senescence promotes in vivo reprogramming through p16INK4a and IL‐6
Authors: Mosteiro Lluc , Pantoja Cristina , de Martino Alba , Serrano Manuel
Published: December 2017

Cellular senescence is a damage response aimed to orchestrate tissue repair. We have recently reported that cellular senescence, through the paracrine release of interleukin‐6 (IL6) and other soluble factors, strongly favors cellular reprogramming by Oct4, Sox2, Klf4, and c‐Myc (OSKM) in nonsenescent cells. Indeed, activation of OSKM in mouse tissues triggers senescence in some cells and reprogramming in other cells, both processes occurring concomitantly and in close proximity. In this system, Ink4a/Arf‐null tissues cannot undergo senescence, fail to produce IL6, and cannot reprogram efficiently; whereas p53‐null tissues undergo extensive damage and senescence, produce high levels of IL6, and reprogram efficiently. Here, we have further explored the genetic determinants of in vivo reprogramming. We report that Ink4a, but not Arf, is necessary for OSKM‐induced senescence and, thereby, for the paracrine stimulation of reprogramming. However, in the absence of p53, IL6 production and reprogramming become independent of Ink4a, as revealed by the analysis of Ink4a/Arf/p53 deficient mice. In the case of the cell cycle inhibitor p21, its protein levels are highly elevated upon OSKM activation in a p53‐independent manner, and we show that p21‐null tissues present increased levels of senescence, IL6, and reprogramming. We also report that Il6‐mutant tissues are impaired in undergoing reprogramming, thus reinforcing the critical role of IL6 in reprogramming. Finally, young female mice present lower efficiency of in vivo reprogramming compared to male mice, and this gender difference disappears with aging, both observations being consistent with the known anti‐inflammatory effect of estrogens. The current findings regarding the interplay between senescence and reprogramming may conceivably apply to other contexts of tissue damage.
Mood disorders and prospective suicidality in young adults: a population‐based cohort study
Authors: Vieira D. C. , de Azevedo Cardoso T. , Mondin T. C. , Jansen K. , da Silva R. A. , de Mattos Souza L. D. , Kapczinski F. , Magalhães P. V. S.
Published: December 2017

Objective

To assess the prospective associations of mood disorders and suicidality in a community sample of young adults from south Brazil.

Method

Prospective population‐based cohort study. Young adults (18–24 years old) were recruited and followed up on 5 years later; people were interviewed at their homes. Suicidality, as well as mood and anxiety disorders, was assessed using the Mini‐International Neuropsychiatric Interview. The impact of mood episodes on suicidality was both evaluated when they occurred in the same wave (a current episode) and when suicidality occurred prospectively, with suicidality measured at follow‐up (a past episode).

Results

The sample included 1560 young adults at baseline, with 1244 reassessed at follow‐up (80.6%). Depressive episodes, both current and past, had a significant impact on suicidality in the final multivariable model. Manic episodes, however, were less consistently associated with suicidality.

Conclusion

Depressive episodes have a strong, independent, and robust association with prospective suicidality. The association between manic episodes and suicidality, on the other hand, was dependent on the analysis and deserves further exploration.
Direct and indirect effects of false safety behaviors on cannabis use and related problems
Authors: Buckner Julia D. , Zvolensky Michael J. , Businelle Michael S. , Gallagher Matthew W.
Published: December 2017

Background and Objectives

In light of increasing rates of cannabis use and use‐related problems, efforts to understand malleable psychological vulnerability factors related to use and related problems remain important as they can inform prevention and treatment efforts. Recent data indicate that false safety behaviors (FSB; ie, behaviors that may be effective in decreasing anxiety in the short‐term, but can maintain and even exacerbate anxiety in the long‐term) are related to cannabis problem severity. Thus, an important next step is to identify factors implicated in the relation between FSB and cannabis use behavior. The current study tested whether FSB were uniquely related to cannabis use problems and high‐risk cannabis use motives. We also tested whether FSB were indirectly related to cannabis outcomes via high‐risk motives.

Method

The sample consisted of 349 current (69.6% female) cannabis‐using undergraduates who completed an online survey.

Results

FSB was robustly related to cannabis‐related problems and cannabis use motives (ie, coping and availability) after controlling for anxiety and cannabis use frequency. FSB was indirectly related to cannabis problems via coping and availability motives and to cannabis use frequency via coping motives.

Discussion and Conclusions

Results add to a growing literature indicating that FSB are related to cannabis problem severity and extend this work by identifying mechanisms underlying this relationship.

Scientific Significance

Data indicate that FSB may be an under recognized, yet clinically important, vulnerability factor related to cannabis use problems. (Am J Addict 2018;27:29–34)
Itching for answers: Prevalence and severity of pruritus in psoriasis
Authors: Dickison Philippa , Swain Grace , Peek Jonathan J , Smith Saxon D
Published: December 2017

Background/Objectives

Pruritus is the most frequently reported complaint or symptom for psoriasis patients. Despite the morbidity associated with pruritus in psoriasis few studies have evaluated the prevalence of itch in psoriasis with the current use of biological agents.

Method

This was a multi‐site cross‐sectional observational study conducted in New South Wales, Australia. Psoriasis patients were approached during their outpatient clinic, phototherapy or private consultations. Data on psoriasis characteristics, severity and treatment were collected. The patients were then asked to complete a survey regarding the frequency, severity and aggravators of their psoriasis.

Results

Data were collected from 179 patients with a mean age of 52.3 years, of whom 55% were male. Altogether 63 (35%) had a psoriasis area severity index (PASI) > 10, 42 (24%) were on biological agents and 84 (47%) were receiving phototherapy. The number of patients who reported itch all the time was 40 (22%), most of the time 48 (27%), and never 19 (11%). Patients with nail psoriasis were significantly less likely to have itch all or most of the time (P = 0.01). Itch all or most of the time was significantly more likely in patients with PASI > 10 (P = 0.013). No treatment was associated with reduced itch. Itch was reported to be most frequent in the winter season.

Conclusion

Few patients with psoriasis do not suffer from pruritus. Despite their promise, biological agents are not associated with reduced itch.
Mycosis fungoides occurring at the site of previous herpes zoster eruption
Authors: Huang Simo , Kim Esther J , Lewis Daniel J , Chan Warren H , Miranda Roberto N , Duvic Madeleine
Published: December 2017

Numerous clinicopathological variants of mycosis fungoides have been described in the literature. Dermatomal or zosteriform mycosis fungoides is one reported variant but a clear aetiology has never been documented. We report a case of mycosis fungoides proved by biopsy and immunohistochemistry that developed in a 55‐year‐old man at the site of previous herpes zoster eruption. We also present a review of the relevant literature to add to the understanding of rare variants of mycosis fungoides and aid in the clinical recognition of zosteriform mycosis fungoides.
Sludge reflects intra‐amniotic inflammation with or without microorganisms
Authors: Yoneda Noriko , Yoneda Satoshi , Niimi Hideki , Ito Masami , Fukuta Kaori , Ueno Tomohiro , Ito Mika , Shiozaki Arihiro , Kigawa Mika , Kitajima Isao , Saito Shigeru
Published: December 2017

Problem

To investigate whether amniotic fluid (AF) “sludge” in patients with preterm labor (PTL) with intact membranes is related to intra‐amniotic infection or inflammation.

Method of study

105 PTL patients before 29 weeks’ gestation were enrolled. AF “sludge” was evaluated by transvaginal sonography. Microorganisms were identified in AF by our newly established PCR method using a eukaryote‐made thermostable DNA polymerase.

Results

AF “sludge” was present in 18.1% (19/105) of patients. The results obtained in the AF “sludge” group vs the no “sludge” group were as follows: (i) a similar positive rate of microorganisms in AF by PCR, 31.6% (6/19) vs 38.4% (33/86); (ii) a higher level of AF interleukin‐8, 15.2 (0.2‐381.5) ng/mL vs 5.8 (0.1‐413.7) ng/mL; P = .005); and (3) a higher frequency of histological chorioamnionitis, 52.6% (10/19) vs 23.3% (20/86); P = .010.

Conclusion

The presence of AF “sludge” is related to intra‐amniotic inflammation with or without microorganisms.
Muscles of the trunk and pelvis are responsive to testosterone administration: data from testosterone dose–response study in young healthy men
Authors: Tapper J. , Arver S. , Pencina K. M. , Martling A. , Blomqvist L. , Buchli C. , Li Z. , Gagliano‐Jucá T. , Travison T. G. , Huang G. , Storer T. W. , Bhasin S. , Basaria S.
Published: December 2017

Testosterone dose‐dependently increases appendicular muscle mass. However, the effects of testosterone administration on the core muscles of the trunk and the pelvis have not been evaluated. The present study evaluated the effects of testosterone administration on truncal and pelvic muscles in a dose–response trial. Participants were young healthy men aged 18–50 years participating in the 5α‐Reductase (5aR) Trial. All participants received monthly injections of 7.5 mg leuprolide acetate to suppress endogenous testosterone production and weekly injections of 50, 125, 300, or 600 mg of testosterone enanthate and were randomized to receive either 2.5 mg dutasteride (5aR inhibitor) or placebo daily for 20 weeks. Muscles of the trunk and the pelvis were measured at baseline and the end of treatment using 1.5‐Tesla magnetic resonance imaging. The dose effect of testosterone on changes in the psoas major muscle area was the primary outcome; secondary outcomes included changes in paraspinal, abdominal, pelvic floor, ischiocavernosus, and obturator internus muscles. The association between changes in testosterone levels and muscle area was also assessed. Testosterone dose‐dependently increased areas of all truncal and pelvic muscles. The estimated change (95% confidence interval) of muscle area increase per 100 mg of testosterone enanthate dosage increase was 0.622 cm2 (0.394, 0.850) for psoas; 1.789 cm2 (1.317, 2.261) for paraspinal muscles, 2.530 cm2 (1.627, 3.434) for total abdominal muscles, 0.455 cm2 (0.233, 0.678) for obturator internus, and 0.082 cm2 (0.003, 0.045) for ischiocavernosus; the increase in these volumes was significantly associated with the changes in on‐treatment total and free serum testosterone concentrations. In conclusion, core muscles of the trunk and pelvis are responsive to testosterone administration. Future trials should evaluate the potential role of testosterone administration in frail men who are predisposed to falls and men with pelvic floor dysfunction.
Managing Traps and Pitfalls During Initial Steps of an ECMO Retrieval Program Using a Miniaturized Portable System: What Have We Learned From the First Two Years?
Authors: Sabashnikov Anton , Djordjevic Ilja , Deppe Antje‐Christin , Kuhn Elmar W. , Merkle Julia , Weber Carolyn , Sindhu Dirk , Eghbalzadeh Kaveh , Zeriouh Mohamed , Liakopoulos Oliver J. , Rahmanian Parwis B. , Kuhn‐Régnier Ferdinand , Choi Yeong‐Hoon , Madershahian Navid , Wahlers Thorsten
Published: December 2017

The aim of this study was to provide early and mid‐term results of the newly established extracorporeal membrane oxygenation (ECMO) retrieval service in a tertiary cardiothoracic center using the miniaturized portable Cardiohelp System (Maquet, Rastatt, Germany). A particular attention was paid to organizational and logistic specifics as well as challenges and pitfalls associated with initial phase of the program. From January 2015 until January 2017 a heterogenic group of 28 consecutive patients underwent ECMO implantation in distant hospitals for acute cardiac, pulmonary or combined failure as a bridge‐to‐decision and were subsequently transported to our institution. Each cannulation was performed bedside on intensive care units (ICU) using the Seldinger's technique. Early outcomes and mid‐term overall survival with up to two‐year follow‐up along with the impact of ongoing cardiopulmonary resuscitation (CPR) on outcome were presented. Also, changes in hemodynamics and tissue perfusion factors 24 h after ECMO implantation were evaluated. ECMO implantations were performed in 15 distant departments with the median distance of 23(10;40) (maximum 60) km. A total of 15 patients (54%) were cannulated under CPR with the median duration of 30(20;110) (maximum 180) min. After 24 h of support there were significant improvements in SvO2 (P = 0.021), mean arterial pressure (P = 0.027), FiO2 (P = 0.001), lactate (P = 0.001), and pH (P < 0.001). The mean ECMO support duration was 96 ± 100 (maximum 384) hours, whereas 11 patients (40%) were weaned off support and discharged from hospital. Overall cumulative survival in patients without the need for CPR was 61.5% at one week and 38.5% at 1 month, 6 month, and 1 year, whereas patients requiring CPR survived in 40% at one week, and 33.3% at 1 month, 6 month, and 1 year (Log‐Rank (Mantel‐Cox) P = 0.374, Breslow (Generalized Wilcoxon) P = 0.162). Our initial experience shows that launching new ECMO retrieval programs in centers with sufficient ICU capacities and local ECMO experience can be feasible and associated with acceptable “real world” results despite the initial learning curve. Rapid logistical organization and team flexibility are the key points to ensure comparable survival of patients requiring prolonged CPR.
Systematic review and meta‐analysis found higher levels of behavioural problems in male left‐behind children aged 6–11 years
Authors: Qu Guang‐Bo , Wu Wei , Wang Ling‐Ling , Tang Xue , Sun Ye‐Huan , Li Jie , Wang Jun
Published: December 2017

Aim

Left‐behind children (LBC) now account for more than 1 in 5 Chinese children, and they often suffer from behavioural problems when their parents leave their rural homes to seek work in urban areas. The primary aim of this meta‐analysis was to compare the incidence rates and factor scores of behavioural problems in LBC, who now account for more than one‐fifth of Chinese children, and non‐LBC.

Methods

This systematic review and meta‐analysis explored the children's characteristic behavioural problems using the Achenbach Child Behaviour Check List. A subgroup analysis was conducted to compare the different behavioural problems of LBC with different characteristics. The meta‐analysis assessed 1405 papers and analysed 13 papers from 2007 to 2015, covering 10 264 LBC and 8909 non‐LBC from 2 to 19 years of age.

Results

The incidence rates of behavioural problems were higher in LBC than non‐LBC. The highest risks were noted in boys aged between 6 and 11 years of age, who were more likely to be withdrawn and be affected by somatic complaints, schizophreniform disorder, compulsive behaviour and depression.

Conclusion

Interventions and policies are urgently needed to tackle behavioural issues among LBC, especially high‐risk males aged 6–11 years.
Paediatricians’ expectations and perspectives regarding genetic testing for children with developmental disorders
Authors: Tremblay Isabelle , Laberge Anne‐Marie , Cousineau Dominique , Carmant Lionel , Rowan Anita , Janvier Annie
Published: December 2017

Aim

To investigate paediatricians' expectations and perspectives of genetic testing for children with developmental disorders.

Methods

Paediatricians working in a developmental clinic were surveyed each time they ordered a chromosomal microarray (CMA) for a child with developmental disorders. Clinical charts were reviewed. Results were analysed using mixed methodology.

Results

Ninety‐seven % (73/76) of surveys were completed. Paediatricians reported that 36% of parents had difficulties understanding genetic testing and that 40% seemed anxious. The majority expected testing to have positive impacts on children/families. The themes raised were (i) clarifying the diagnosis (56%), (ii) understanding the aetiology of the condition (55%), (iii) enabling prenatal diagnosis/counselling (43%), (iv) improving medical care for the child (15%) and (v) decreasing parental guilt/anxiety (8%). Less than half anticipated negative impacts; 74% expected that the most helpful result for their patient would be an abnormal result explaining the disorder. Among the 73 children for whom CMA was ordered, 81% got tested: 66% of the results were normal, 19% were abnormal and contributed to explain the condition and 12% were abnormal but of unknown significance.

Conclusion

Paediatricians generally expect many positive and less negative impacts of genetic testing for children with developmental disorders. Parental perspectives are needed.
The Cumulative Daily Tolerance Levels of Potentially Toxic Excipients Ethanol and Propylene Glycol Are Commonly Exceeded in Neonates and Infants
Authors: Valeur Kristine Svinning , Hertel Steen Axel , Lundstrøm Kaare Engell , Holst Helle
Published: December 2017

Polymedicated neonates and young infants may be at risk of harmful cumulative exposure to toxic excipients like ethanol, propylene glycol and benzyl alcohol during routine clinical care. The aim of this study was to calculate the cumulative daily alcohol exposure (mg/kg/day) in polymedicated neonates and infants and compare these levels to the tolerance limits found in guidelines published by European Medicines Agency (EMA). As part of the SEEN study, all medicinal products administered to neonates and infants were recorded. All included neonates received ≥2 medicinal products/day and infants ≥3 medicinal products/day. Daily excipient levels were calculated based on quantities obtained from manufacturers or databases. Excipient levels were compared to tolerance limits proposed by the EMA. Altogether, 470 neonates and 160 infants were included, recording 4207 prescriptions and 316 products. In total, 45% (n = 288) of patients were exposed to an alcohol of interest; 2% (n = 14) were exposed to benzyl alcohol (BA), 38% (n = 237) to ethanol and 23% (n = 146) to propylene glycol (PG). Of the total number of prescriptions involving ethanol‐containing medicinal products (n = 334), 51% would alone exceed tolerance limit of 6 mg/kg/day. Of the total number of prescriptions involving PG‐containing medicinal products (n = 174), 70% would alone exceed a maximum tolerance limit of 50 mg/kg/day. Maximal daily exposure to ethanol (1563 mg/kg/day) or PG (954 mg/kg/day) exceeded the tolerance limits recommended by EMA 260.5 and 19.1 times, respectively. Tolerance limits for ethanol and PG as proposed by the EMA are frequently exceeded in polymedicated neonates and infants due to the cumulative effect of these alcohols. Alternative formulations may minimize excipient exposure.
Systematic genetic analyses of genome‐wide association study data reveal an association between the key nucleosome remodeling and deacetylase complex and bipolar disorder development
Authors: Xiang Bo , Liu Kezhi , Yu Minglan , Liang Xuemei , Zhang Jin , Lei Wei , Huang Chaohua , Chen Jing , Gu Xiaochu , Li Nian , Wu Guoying , Wang Yan , He Wenying , Tan Jinhua , Zhang Tao
Published: December 2017

Background

Genome‐wide association studies (GWASs) are used to identify genetic variants for association with bipolar disorder (BD) risk; however, each GWAS can only reveal a small fraction of this association. This study systematically analyzed multiple GWAS data sets to provide further insights into potential causal BD processes by integrating the results of Psychiatric Genomics Consortium Phase I (PGC‐I) for BD with core human pathways and functional networks.

Methods

The i‐Gsea4GwasV2 program was used to analyze data from the PGC‐I GWAS for BD (the pathways came from Reactome), as well as the nominally significant pathways. We established a gene network of the significant pathways and performed a gene set analysis for each gene cluster of the Enhancing Neuroimaging Genetics through Meta‐Analysis (ENIGMA) GWAS data for the volumes of the intracranial region and seven subcortical regions.

Results

A total of 30 of 1816 Reactome pathways were identified and showed associations with BD risk. We further revealed 22 interconnected functional and topologically interacting clusters (Clusters 0‐21) that were associated with BD risk. Moreover, we obtained brain transcriptome data from BrainSpan and found significant associations between common variants of the genes in Cluster 1 with the hippocampus (HIP; P = .026; family‐wise error [FWE] correction) and amygdala (AMY; P = .016; FEW correction) in Cluster 8 with HIP (P = .022; FWE correction). The genes in Cluster 1  were  enriched  for the transcriptional co‐expression profile in the prenatal AMY, and core genes (CDH4, MTA2, RBBP4, and HDAC2) were identified to be involved in regulating early brain development.

Conclusion

This study demonstrated that the HIP and AMY play a central role in neurodevelopment and BD risk.
Company Closures and the Erosion of the Political Centre: Evidence from Germany
Authors: Braakmann Nils
Published: December 2017

This article investigates the link between company closures and political preferences using German panel data. I first show that job loss due to a company closure leads to similar adverse labor market outcomes as those found in other countries. I then show that men become less likely to identify with political parties and mainstream parties in particular, while women become less interested in politics. Effects are stronger for individuals who see job creation and protection as a state responsibility and for lower skilled workers, but do not vary with the routine intensity or offshorability of the former job.
Evolution of optic nerve photography for glaucoma screening: a review
Authors: Myers Jonathan S , Fudemberg Scott J , Lee Daniel
Published: December 2017

Visual evaluation of the optic nerve has been one of the earliest and most widely used methods to evaluate patients for glaucoma. Photography has proven very useful for documentation of the nerve's appearance at a given time, allowing more detailed scrutiny then, and later comparison for change. Photography serves as the basis for real‐time or non‐simultaneous review in telemedicine and screening events allowing fundus and optic nerve evaluation by experts elsewhere. Expert evaluation of disc photographs has shown diagnostic performance similar to other methods of optic nerve evaluation for glaucoma. Newer technology has made optic nerve photography simpler, cheaper and more portable creating opportunities for broader utilization in screening in underserved populations by non‐physicians. Recent investigations suggest that non‐physicians or software algorithms for disc photograph evaluation have promise to allow more screening to be done with fewer experts.
Hypopharyngeal evaluation in obstructive sleep apnea with awake flexible laryngoscopy: Validation and updates to Cormack‐Lehane and Modified Cormack‐Lehane scoring systems
Authors: Torre C. , Zaghi S. , Camacho M. , Capasso R. , Liu S. Y.
Published: December 2017

Objective

To validate the use of Cormack‐Lehane and Modified Cormack‐Lehane scoring systems to classify patterns of hypopharyngeal airway visualization seen during awake flexible laryngoscopy among patients with obstructive sleep apnoea.

Study design

Validation study using samples collected from a prospective database.

Setting

University Medical Center.

Participants

Data were obtained from a retrospective review of a prospective database of flexible fiberoptic examination recordings in 274 consecutive OSA subjects (Stanford Sleep Medicine/Surgery Clinic).

Main outcome measures

Single still images from awake fiberoptic laryngoscopy examinations of the vocal cords from 90 different patients were presented to 2 experts and 4 novice raters. Raters used two grading systems (Cormack‐Lehane scale and Modified Cormack‐Lehane) to rate vocal cord visualization. Percent agreement and Cohen's kappa statistical analysis were used to evaluate inter‐rater reliability and intrarater reliability for each grading system. Feedback from the participants was then used to propose updates to further improve upon the existing grading scales for their applicability to awake flexible endoscopy.

Results

The Cormack‐Lehane and Modified Cormack‐Lehane scale both communicate unobstructed and restricted views of the vocal cords reliably. Compared to the 4‐grade scale, however, a modified 5‐grade Vocal Cord Grading System allows for better objective communication of common variations in hypopharyngeal airway visualization.

Conclusion

We propose a 5‐Grade Vocal Cord Grading System that builds upon existing grading systems to allow for efficient and reliable communication of hypopharyngeal airway examination during awake fiberoptic laryngoscopy.
Once a French Speaker, Always a French Speaker? Bilingual Children's Thinking About the Stability of Language
Authors: Dautel Jocelyn B. , Kinzler Katherine D.
Published: December 2017

Despite early emerging and impressive linguistic abilities, young children demonstrate ostensibly puzzling beliefs about the nature of language. In some circumstances monolingual children even express the belief that an individual's language is more stable than her race. The present research investigated bilingual children's thinking about the relative stability of language and race (Kinzler & Dautel, 2012). Five‐to six‐year‐old bilingual children were asked to judge whether a target child who varied in race (White or Black) and language (English or French) would grow up to be an adult who maintained the target child's race or her language. Similar to many monolingual children, a heterogeneous group of bilingual children on average chose the language‐match. Yet French‐English bilingual children were relatively more likely to choose the race‐match, especially when tested in their non‐dominant language. Specific experience with relevant languages, and communicating in a non‐dominant language, may contribute to children's developing metalinguistic success and their thinking about social categorization.