bluuebunny/crossref_metadata_2025 huggingface dataset:
Disseminated Gonococcal Infections in Patients Receiving Eculizumab: A Case Series
Authors: Crew Page E , Abara Winston E , McCulley Lynda , Waldron Peter E , Kirkcaldy Robert D , Weston Emily J , Bernstein Kyle T , Jones S Christopher , Bersoff-Matcha Susan J
Published: November 2018

Background

Gonorrhea is the second most commonly reported notifiable condition in the United States. Infrequently, Neisseria gonorrhoeae can cause disseminated gonococcal infection (DGI). Eculizumab, a monoclonal antibody, inhibits terminal complement activation, which impairs the ability of the immune system to respond effectively to Neisseria infections. This series describes cases of N. gonorrhoeae infection among patients receiving eculizumab.

Methods

Pre- and postmarketing safety reports of N. gonorrhoeae infection in patients receiving eculizumab worldwide were obtained from US Food and Drug Administration safety databases and the medical literature, including reports from the start of pivotal clinical trials in 2004 through 31 December 2017. Included patients had at least 1 eculizumab dose within the 3 months prior to N. gonorrhoeae infection.

Results

Nine cases of N. gonorrhoeae infection were identified; 8 were classified as disseminated (89%). Of the disseminated cases, 8 patients required hospitalization, 7 had positive blood cultures, and 2 required vasopressor support. One patient required mechanical ventilation. Neisseria gonorrhoeae may have contributed to complications prior to death in 1 patient; however, the fatality was attributed to underlying disease per the reporter.

Conclusions

Patients receiving eculizumab may be at higher risk for DGI than the general population. Prescribers are encouraged to educate patients receiving eculizumab on their risk for serious gonococcal infections and perform screening for sexually transmitted diseases (STDs) per the Centers for Disease Control and Prevention STD treatment guidelines or in suspected cases. If antimicrobial prophylaxis is used during eculizumab therapy, prescribers should consider trends in gonococcal antimicrobial susceptibility due to emerging resistance concerns.
Repigmentation in vitiligo universalis after starting dialysis—could they be related?
Authors: Farahbakhsh Navid , Nielson Colton , Gillihan Ryan
Published: November 2018

Vitiligo is an acquired disorder of pigmentation characterized by the development of white macules and patches on the skin. Although multiple theories have been proposed to understand the underlying pathophysiology behind the pigment loss, the exact etiology remains unknown. Vitiligo universalis is an extremely rare variant that causes nearly complete depigmentation of the entire body surface. Treatment is challenging, especially when pigment loss is generalized and diffuse. We present a unique case of a patient with vitiligo universalis that had remained untreated and stable for >20 years until she developed repigmentation shortly after initiation of dialysis.
Extracorporeal immunoadsorption in heparin- and protamine-induced thrombocytopaenia prior to cardiac surgery
Authors: Füreder Lisa , Böhmig Georg A , Schaefer Anne-Kristin , Steinlechner Barbara
Published: November 2018

Exposure to heparin and protamine during cardiac surgery on cardiopulmonary bypass (CPB) may trigger heparin-induced thrombocytopaenia and/or protamine-induced thrombocytopaenia. Further surgery on CPB with heparin and protamine in the presence of these antibodies implies increased thromboembolic risk. We present the successful application of extracorporeal immunoadsorption to deplete antibodies causing heparin-induced and protamine-induced thrombocytopaenia preoperatively.
Metabolic Effects of Breaking Prolonged Sitting With Standing or Light Walking in Older South Asians and White Europeans: A Randomized Acute Study
Authors: Yates Thomas , Edwardson Charlotte L , Celis-Morales Carlos , Biddle Stuart J H , Bodicoat Danielle , Davies Melanie J , Esliger Dale , Henson Joe , Kazi Aadil , Khunti Kamesh , Sattar Naveed , Sinclair Alan J , Rowlands Alex , Velayudhan Latha , Zaccardi Francesco , Gill Jason M R
Published: November 2018

Background

Prolonged sitting is common in older adults and is associated with insulin resistance and poor cardiometabolic health. We investigate whether breaking prolonged sitting with regular short bouts of standing or light walking improves postprandial metabolism in older white European and South Asian adults and whether effects are modified by ethnic group.

Methods

Thirty South Asian (15 women) and 30 white European (14 women) older adults (aged 65–79 years) undertook three experimental conditions in random order. (a) Prolonged sitting: continuous sitting during an observation period if 7.5 hours consuming two standardized mixed meals. (b) Standing breaks: sitting interrupted with 5 minutes of standing every 30 minutes (accumulating 60 minutes of standing over the observation period). (c) Walking breaks: sitting interrupted with 5 minutes of self-paced light walking every 30 minutes (accumulating 60 minutes of walking). Blood samples (glucose, insulin, triglycerides) and blood pressure were sampled regularly throughout each condition.

Results

Compared with prolonged sitting, walking breaks lowered postprandial insulin by 16.3 mU/L, (95% CI: 19.7, 22.0) with greater reductions (p = .029) seen in South Asians (22.4 mU/L; 12.4, 32.4) than white Europeans (10.3 mU/L; 5.9, 14.7). Glucose (0.3 mmol/L; 0.1, 0.5) and blood pressure (4 mm Hg; 2, 6), but not triglycerides, were lower with walking breaks, with no ethnic differences. Standing breaks did not improve any outcome.

Conclusions

Breaking prolonged sitting with short bouts of light walking, but not standing, resulted in clinically meaningful improvements in markers of metabolic health in older adults, with South Asians gaining a greater reduction in postprandial insulin.

Trial Registration

NCT02453204
Depression in Later Life: The Role of Adult Children’s College Education for Older Parents’ Mental Health in the United States
Authors: Yahirun Jenjira J , Sheehan Connor M , Mossakowski Krysia N
Published: November 2018

Objectives

Research on the socioeconomic gradient in mental health links disadvantaged family background with subsequent symptoms of depression, demonstrating the “downstream” effect of parental resources on children’s mental health. This study takes a different approach by evaluating the “upstream” influence of adult children’s educational attainment on parents’ depressive symptoms.

Methods

Using longitudinal data from the U.S. Health and Retirement Study (N = 106,517 person-years), we examine whether children’s college attainment influences their parents’ mental health in later life and whether this association increases with parental age. We also assess whether the link between children’s college completion and parents’ depression differs by parents’ own education.

Results

Parents with children who completed college have significantly lower levels of depressive symptoms than parents without college-educated children, although the gap between parents narrows with age. In addition, at baseline, parents with less than a high school education were more positively affected by their children’s college completion than parents who themselves had a college education, a finding which lends support to theories of resource substitution.

Discussion

Offspring education is an overlooked resource that can contribute to mental health disparities among older adults in a country with unequal access to college educations.
Safety Considerations When Working with Humanized Animals
Authors: Villano Jason S , Vleck Susan E , Felt Stephen A , Myers Daniel D , Lester Patrick A
Published: November 2018

Research using laboratory animals has been revolutionized by the creation of humanized animal models, which are immunodeficient animals engrafted with human cells, tissues, or organs. These animal models provide the research community a unique and promising opportunity to mimic a wide variety of disease conditions in humans, from infectious disease to cancer. A vast majority of these models are humanized mice like those injected with human CD34+ hematopoietic stem cells and patient-derived xenografts. With this technology comes the need for the animal research enterprise to understand the inherent and potential risks, such as exposure to bloodborne pathogens, associated with the model development and research applications. Here, we review existing humanized animal models and provide recommendations for their safe use based on regulatory framework and literature. A risk assessment program—from handling the human material to its administration to animals and animal housing—is a necessary initial step in mitigating risks associated with the use of humanized animals in research. Ultimately, establishing institutional policies and guidelines to ensure personnel safety is a legal and ethical responsibility of the research institution as part of the occupational health and safety program and overall animal care and use program.
Inverse J-shaped relation between coronary arterial calcium density and mortality in advanced chronic kidney disease
Authors: Mukai Hideyuki , Dai Lu , Chen Zhimin , Lindholm Bengt , Ripsweden Jonaz , Brismar Torkel B , Heimbürger Olof , Barany Peter , Qureshi Abdul Rashid , Söderberg Magnus , Bäck Magnus , Stenvinkel Peter
Published: November 2018

Background

The coronary artery calcium (CAC) score from cardiac computed tomography (CT) is a composite of CAC volume and CAC density. In the general population, CAC volume is positively and CAC density inversely associated with cardiovascular disease (CVD) events, implying that decreased CAC density reflects atherosclerotic plaque instability. We analysed associations of CAC indices with mortality risk in patients with end-stage renal disease [chronic kidney disease Stage 5 (CKD5)].

Methods

In 296 CKD5 patients undergoing cardiac CT (median age 55 years, 67% male, 19% diabetes, 133 dialysed), the Framingham risk score (FRS), presence of CVD and protein-energy wasting (PEW; subjective global assessment) and high-sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6) were determined at baseline. During follow-up for a median of 35 months, 51 patients died and 75 patients underwent renal transplantation. All-cause mortality risk was analysed with competing-risk regression models. Vascular calcification was analysed in biopsies of the arteria epigastrica inferior in 111 patients.

Results

Patients in the middle tertile of CAC density had the highest CAC score, CAC volume, age, CVD, PEW, FRS, hsCRP and IL-6. In competing risk analysis, the middle {subhazard ratio [sHR] 10.7 [95% confidence interval (CI) 2.0–57.3]} and high [sHR 8.9 (95% CI 1.5–51.8)] tertiles of CAC density associated with increased mortality, independent of CAC volume. The high tertile of CAC volume, independent of CAC density, associated with increased mortality [sHR 8.9 (95% CI 1.5–51.8)]. Arterial media calcification was prominent and associated with CAC volume and CAC density.

Conclusions

In CKD5, mortality increased linearly with higher CAC score and CAC volume whereas for CAC density an inverse J-shaped pattern was observed, with the crude mortality rate being highest for the middle tertile of CAC density. CAC volume and CAC density were associated with the extent of arterial media calcification.
Recent developments in endovascular interventions to sustain vascular access patency in haemodialysis patients
Authors: Kitrou Panagiotis , Papasotiriou Marios , Katsanos Konstantinos , Karnabatidis Dimitrios , Goumenos Dimitrios S , Papachristou Evangelos
Published: November 2018

There is amassed evidence regarding the use of endovascular procedures for the treatment of vascular access stenosis and thrombosis. A review was conducted based on available randomized trials, cohort studies and retrospective analyses published after 2000 on endovascular treatment of dysfunctional and thrombosed vascular access, with an aim to illustrate the available device and procedural options. The use of paclitaxel-coated balloons, cutting balloons and covered stents is described in the field of vascular access stenosis. The broad spectrum of available devices and endovascular declotting procedures ranging from thrombolysis to thrombectomy is also discussed. Overall, in this review we demonstrate the increasing role of endovascular procedures in vascular access treatment and the improved patency outcomes provided by the implementation of novel endovascular devices. Moreover, the improvement of post-intervention primary patency rates after endovascular declotting procedures and the shift to more thrombectomy-dependent procedures over time is also highlighted. In conclusion, endovascular treatment of dialysis access stenosis and thrombosis has an established role, owing to the implementation of sophisticated devices, allowing, when needed, the simultaneous treatment of thrombosis and the underlying stenosis.
Long-term blood pressure monitoring by office and 24-h ambulatory blood pressure in renal transplant patients: a longitudinal study
Authors: Mallamaci Francesca , Tripepi Rocco , D'Arrigo Graziella , Porto Gaetana , Versace Maria Carmela , Marino Carmela , Sanguedolce Maria Cristina , Testa Alessandra , Tripepi Giovanni , Zoccali Carmine
Published: November 2018

Background

Renal transplant patients have a high prevalence of nocturnal hypertension, and hypertension misclassification by office blood pressure (BP) is quite common in these patients. The potential impact of hypertension misclassification by office BP on hypertension management in this population has never been analysed.

Methods

We performed a longitudinal study in a cohort of 260 clinically stable renal transplant patients. In all, 785 paired office and 24-h ambulatory blood pressure monitoring (24-hABPM) measurements over a median follow-up of 3.9 years were available in the whole cohort.

Results

A total of 74% of patients had nocturnal hypertension (>120/70 mmHg). Average office BP and 24-hABPM remained quite stable over follow-up, as did the prevalence of nocturnal hypertension, which was 77% at the last observation. However, the global agreement between office BP and average 24 h, daytime and night-time BP was unsatisfactory (k-statistics 0.10–0.26). In 193 visits (25% of all visits) where office BP indicated the need of antihypertensive therapy institution or modification (BP >140/90 mmHg), 24-hABPM was actually normal (<130/80 mmHg), while in 94 visits (12%), 24-hABPM was in the hypertensive range while office BP was normal. Overall, in 37% of visits, office BP provided misleading therapeutic indications.

Conclusions

Hypertension misclassification by office BP is a common phenomenon in stable renal transplant patients on long-term follow-up. Office BP may lead to inappropriate therapeutic decisions in over one-third of follow-up visits in these patients.
Is Smoking Cessation in Young Adults Associated With Tobacco Retailer Availability in Their Activity Space?
Authors: Shareck Martine , Datta Geetanjali D , Vallée Julie , Kestens Yan , Frohlich Katherine L
Published: November 2018

Introduction

The presence of tobacco retailers in residential neighborhoods has been inversely associated with residents’ likelihood of quitting smoking. Few studies have yet explored whether this association holds when accounting for tobacco retailers found in the multiple environments where people conduct their daily activities, that is, their activity space.

Methods

We analyzed cross-sectional data from 921 young adults (18- to 25-years old) participating in the Interdisciplinary Study of Inequalities in Smoking (Montreal, Canada). Respondents self-reported sociodemographic, smoking, and activity location data. Log-binomial regression was used to estimate prevalence ratios (PRs) for the association between smoking cessation and (1) the number of tobacco retailers (counts), and (2) the distance to the closest retailer (proximity) in participants’ residential neighborhood and activity space.

Results

Smoking cessation was positively associated with low and intermediate tertile levels of tobacco retailer counts in both the residential neighborhood and activity space, and with the furthest distance level in the activity space [PR (95% CI) = 1.21 (1.02 to 1.43)].

Conclusions

Individuals encounter resources in the course of their regular daily activities that may hamper smoking cessation. This study highlights the relevance of considering the tobacco retail environment of both individuals’ residential neighborhood and activity space to understand its association with smoking cessation.

Implications

This article contributes to the literature on the association between the tobacco retail environment and smoking cessation in young adults by moving beyond the residential neighborhood to also assess individuals’ access to tobacco retailers in the multiple areas where they regularly spend time, that is, their activity space. Findings suggest that lower numbers of tobacco retailers in both the residential neighborhood and activity space, and further distance to tobacco retailers in the activity space are associated with increased smoking cessation.
Upper-Body Exercises With External Resistance Are Well Tolerated and Enhance Muscle Activity in People With Hemophilia
Authors: Calatayud Joaquín , Pérez-Alenda Sofía , Carrasco Juan J , Escriche Adrián , Cruz-Montecinos Carlos , Andersen Lars L , Bonanad Santiago , Querol Felipe , Casaña José
Published: November 2018

Background

Conventional nonresisted therapeutic exercises for people with hemophilia involve a careful, low-intensity approach to avoid injuries. Externally resisted exercise is highly efficient for increasing muscle strength in healthy adults but its feasibility for people with hemophilia remains unknown.

Objective

The purpose of this study was to evaluate muscle activity during upper-body rehabilitation exercises with 2 types of external resistance and without external resistance (conventional) and to examine tolerability, kinesiophobia, and possible adverse effects derived from the session.

Design

This was a cross-sectional study.

Methods

Twelve people with hemophilia A/B (11 with severe hemophilia undergoing prophylactic treatment, 1 with mild hemophilia) participated. During the experimental session, participants completed the Tampa Scale of Kinesiophobia and performed 2 exercises—elbow flexion and shoulder abduction—with 3 conditions for each exercise: elastic resistance (externally resisted), free weights (externally resisted), and conventional nonresisted. Surface electromyography signals were recorded for the biceps brachii, triceps brachii, upper trapezius, and middle deltoid muscles. After the session, exercise tolerability and kinesiophobia were assessed. Adverse effects were evaluated 24 and 48 hours after the session.

Results

Externally resisted exercises provided greater muscle activity than conventional nonresisted therapeutic exercises. The exercises were generally well tolerated and there was no change in kinesiophobia following the session. No adverse effects were observed in the following days.

Limitations

Small sample size was the main limitation.

Conclusions

In people with severe hemophilia undergoing prophylactic treatment, elbow flexion and shoulder abduction exercises with external resistance at moderate intensities are feasible and provide greater muscle activity than nonresisted conventional exercises.
ASSESSMENT OF ANNUAL EFFECTIVE DOSE FROM EXPOSURE TO NATURAL RADIOACTIVITY SOURCES IN A CASE–CONTROL STUDY IN BIHOR COUNTY, ROMANIA
Authors: Dicu T , Burghele B D , Cucoș A , Mishra R , Sapra B K
Published: November 2018

The purpose of the article is to evaluate the annual effective dose for 80 women divided into two samples; one sample located in the former uranium Băiţa-Ştei area, hereinafter referred to as case sample, respectively for a control sample, located in the same county, but exposed in most cases to indoor radon activity concentrations <300 Bq m−3. In this regard, the homemade ‘RaThoGamma’ kit was used, which contained two thermoluminescent dosimeters, a CR-39 track detector (RSKS) for indoor radon activity concentration, two CR-39 track detectors (Radtrak2®/ Radtrak2T®) for radon and thoron activity concentrations as well as Direct Radon Progeny Sensors/Direct Thoron Progeny Sensors for measuring time-averaged radon and thoron progenies concentrations. In addition, a total of 80 water samples were collected in order to evaluate the ingestion dose due to radon and radium activity concentrations in drinking water. The maximum total annual effective dose in the control sample was 14.1 mSv, while in the case sample the maximum annual effective dose was 60.5 mSv. This difference is mainly due to radon progenies inhalation. Other pathways did not show a statistically significant difference between the two samples, showing a minor contribution to the annual effective dose.
Is Schizophrenia a Risk Factor for Breast Cancer?—Evidence From Genetic Data
Authors: Byrne Enda M , Ferreira Manuel A R , Xue Angli , Lindström Sara , Jiang Xia , Yang Jian , Easton Douglas F , Wray Naomi R , Chenevix-Trench Georgia
Published: November 2018

Observational epidemiological studies have found an association between schizophrenia and breast cancer, but it is not known if the relationship is a causal one. We used summary statistics from very large genome-wide association studies of schizophrenia (n = 40675 cases and 64643 controls) and breast cancer (n = 122977 cases and 105974 controls) to investigate whether there is evidence that the association is partly due to shared genetic risk factors and whether there is evidence of a causal relationship. Using LD-score regression, we found that there is a small but significant genetic correlation (rG) between the 2 disorders (rG = 0.14, SE = 0.03, P = 4.75 × 10–8), indicating shared genetic risk factors. Using 142 genetic variants associated with schizophrenia as instrumental variables that are a proxy for having schizophrenia, we estimated a causal effect of schizophrenia on breast cancer on the observed scale as bxy = 0.032 (SE = 0.009, P = 2.3 × 10–4). A 1 SD increase in liability to schizophrenia increases risk of breast cancer 1.09-fold. In contrast, the estimated causal effect of breast cancer on schizophrenia from 191 instruments was not significantly different from zero (bxy = −0.005, SE = 0.012, P = .67). No evidence for pleiotropy was found and adjusting for the effects of smoking or parity did not alter the results. These results provide evidence that the previously observed association is due to schizophrenia causally increasing risk for breast cancer. Genetic variants may provide an avenue to elucidating the mechanism underpinning this relationship.
Interleukin-4/interleukin-13 versus interleukin-5: a comparison of molecular targets in biologic therapy for the treatment of severe asthma
Authors: Wu Albert Y. , Sur Sanjiv , Grant J. Andrew , Tripple Julia W.
Published: November 2018

Purpose of review

Asthma is a chronic, inflammatory disorder of the airways caused by a complex interplay of various biologic mechanisms. Several monoclonal antibody therapies targeting interleukin (IL)-4/IL-13 and IL-5 cytokine pathways have been developed for the treatment of severe eosinophilic asthma. As individuals can display biomarkers and clinical features characteristic of several asthma phenotypes, selection of anoptimal biologic can be difficult.

Recent findings

Dupilumab, a monoclonal antibody that binds to the α subunit of the IL-4 receptor (IL-4Rα) and has been approved for the treatment of adults with severe atopic dermatitis, has been shown in recent phase 3 trials to also have significant clinical benefits in the asthmatic population irrespective of baseline eosinophil counts.

As monoclonal antibodies targeting either IL-4 or IL-13 cytokines individually have failed to demonstrate significant clinical benefits, biologics that target cytokine receptors may be more efficacious compared to those that target cytokines. Furthermore, inhibition of the IL-4/IL-13 signaling cascades may disrupt a broader Th2 inflammatory response compared to a more selective impairment of eosinophil proliferation and activity via blockage of the IL-5 pathway. Future research with independently funded, head-to-head trials of approved biologics is needed to elucidate a favorable therapeutic option.
Strategies to reduce corticosteroid-related adverse events in asthma
Authors: Heffler Enrico , Bagnasco Diego , Canonica Giorgio W.
Published: November 2018

Purpose of review

Severe asthmatics, despite the chronic use of high inhaled corticosteroids (ICS) doses and frequent intake of systemic corticosteroids, remains clinically and/or functionally uncontrolled. These patients are also often affected by rhinitis or chronic rhinosinusitis requiring frequent use of intranasal corticosteroids. Therefore, severe asthmatics are exposed to an overload of corticosteroids that is frequently associated with relevant and costly adverse events. This clinical problem and the strategies to overcome it are here summarized.

Recent findings

Different therapeutic options may help in reducing the corticosteroid load in asthmatics, ranging from allergy immunotherapy (nonsuitable for severe uncontrolled patients), immunosuppressant agents like methotrexate or cyclosporine, novel biologic drugs (mainly anti-IgE, anti-IL5 and anti-IL4-receptor-alpha), and aspirin desensitization (for patients with anti-inflammatory drugs exacerbated respiratory disease).

The evidence of even serious corticosteroid-related adverse events associated with consistent health-care costs, should prompt the entire scientific community and health regulatory authorities to promote actions to increase the use of well tolerated and effective strategies to reduce the corticosteroid need in asthmatics; the most promising option seems to be the add-on use of biologic agents.
Clinical and functional outcomes of patients undergoing anterolateral versus anteromedial surgical approaches for pilon fractures
Authors: Crist Brett D. , Worley John R. , Jenkins Tyler J. , Khazzam Michael S. , Della Rocca Gregory J.
Published: November 2018

Background:

This study examined the clinical and functional outcomes for two of the most common surgical approaches for pilon fractures: the anteromedial (AM) and anterolateral (AL) approaches to the distal tibia.

Methods:

A retrospective chart review was performed for 75 patients who underwent operative management of pilon fractures between September 2005 and July 2009. Clinical data points included patient demographics, comorbidities, fracture classification, complications, and days from surgery to clinical and radiographic fracture union. Outcome scores were obtained via phone interview at a single cross-section time point.

Results:

The AL group had a significantly higher average AO/OTA fracture classification than the AM group (AO/OTA 43 C3 vs. C1) in both the retrospective chart review and the phone interview subanalysis. Despite this difference, the AL group had significantly fewer amputations and shorter time to radiographic healing (P<0.05). In the phone interview subanalysis, functional outcome scores were not significantly different (P>0.05). Average time from surgery to survey collection was 3.28 yr for the AL group and 3.54 yr for the AM group.

Conclusions:

The approach to pilon fractures should be dictated by the specific fracture pattern and associated soft-tissue injury. Our study shows that both AL and AM approaches had equivalent functional outcomes. This study highlights the importance of choosing the correct surgical approach when operating on pilon fractures and that the AL approach can successfully be used to treat the most complex fractures with fewer soft-tissue complications and faster radiographic healing versus the AM approach.
Nervous system involvement in Behçet's syndrome
Authors: Uygunoğlu Uğur , Siva Aksel
Published: November 2018

Purpose of review

Neurological involvement in Behçet's syndrome is defined as ‘the occurrence of neurological symptoms and signs in a patient who meets the International Diagnostic Criteria for BS not otherwise explained by any other known systemic or neurological disease or treatment, and in whom objective abnormalities consistent with neuro-Behçet's syndrome (NBS) are detected either on neurological examination, neuroimaging studies (magnetic resonance imaging [MRI]), and/or on cerebrospinal fluid (CSF) examination’. Given that the neurological involvement of Behçet's syndrome carries a poor prognosis, we aimed to describe the differential diagnosis of NBS and highlight the different radiological patterns together with the treatment options.

Recent findings

Two distinct MRI patterns of spinal cord involvement in Behçet's syndrome according to T2-weighted axial images were described: ‘Bagel Sign’ pattern: a central lesion with hypointense core and hyperintense rim with or without contrast enhancement; and ‘Motor Neuron’ pattern: a symmetric involvement of the anterior horn cells. Infliximab prevents patients from having further attacks and even led to improvement in the neurological examination.

As the treatment options completely differ, a NBS diagnosis should be carefully made in patients with clinical and MRI features mimicking other central nervous system inflammatory disorders.
Learning Curve of Robotic Lobectomy for Early-Stage Non-Small Cell Lung Cancer by a Thoracic Surgeon Adept in Open Lobectomy
Authors: Gallagher Shea P. , Abolhoda Amir , Kirkpatrick Vincent E. , Saffarzadeh Areo G. , Thein May S. , Wilson Samuel E.
Published: November 2018

Objective

The aim of the study was to characterize the clinical outcomes and learning curve during the adoption of a robotic platform for lobectomy for early-stage non-small cell lung cancer by a thoracic surgeon experienced in open thoracotomy.

Methods

Retrospective review of 157 consecutive patients (57 open thoracotomies, 100 robotic lobectomies) treated with lobectomy for clinical stage I or II non-small cell lung cancer between 2007 and 2014. Clinical outcomes were compared between the open thoracotomy group and five consecutive groups of 20 robotic lobectomies. We used the following six metrics to evaluate learning curve: operative time, conversion to open, estimated blood loss, hospitalization duration, overall morbidity, and pathologic nodal upstaging.

Results

The robotic and open thoracotomy groups had equivalent preoperative characteristics, except for a higher proportion of clinical stage IA patients in the robotic cohort. The robotic group, as a whole, had lower intraoperative blood loss, less overall morbidity, shorter chest tube duration, and shorter length of hospital stay as compared with the open thoracotomy group. Operative time demonstrated a bimodal learning curve. Conversion rate diminished from 22.5% in the first two robotic groups to 6.7% in the latter three groups. The rate of pathologic nodal upstaging was statistically equivalent to the open thoracotomy group.

Conclusions

Adoption of a robotic platform for lobectomy for early-stage non-small cell lung cancer by an experienced open thoracic surgeon is safe and feasible, with fewer complications, less blood loss, and equivalent nodal sampling rate even during the learning curve. The conversion to open rate significantly dropped after the first 40 robotic lobectomies, and operative time for robotic lobectomy approached open thoracotomy after 60 cases, after a bimodal curve.
Nonrobotic Total Endoscopic Coronary Artery Bypass Grafting
Authors: Gorki Hagen , Liu Jun , Sabau Marius , Albrecht Guenther , Liebold Andreas
Published: November 2018

Objective

At present, minimal invasive direct coronary artery grafting is the least invasive nonrobotic surgical approach to revascularize the left anterior descending artery with the left internal mammary artery. Total endoscopic coronary bypass grafting is performed with the help of a telemanipulator (“robot”). A prospective proof-of-concept study was initiated to investigate a nonrobotic total endoscopic coronary bypass grafting approach.

Methods

Twenty patients with significant left anterior descending artery or left main stem lesion were operated on via three or four left thoracic access ports. Under exclusive endoscopic vision, the left internal mammary artery was harvested and anastomosed to the left anterior descending artery manually. Cardiopulmonary bypass and cardioplegic arrest were planned in all cases.

Results

In 10 patients, the operation was completed successfully as nonrobotic total endoscopic coronary bypass grafting. Reasons for conversions to minimal invasive direct coronary artery grafting or conventional sternotomy were dense pleural adhesions (3 patients), bleeding of the anastomosis (3), diffuse bleeding during left internal mammary artery harvesting (2), identification problems of the target artery (1), or left internal mammary artery failure (1). Postoperative angiography in five primarily successful nonrobotic total endoscopic coronary bypass grafting patients showed patent anastomoses in four cases. One patient was reoperated on for early anastomotic failure in a 1.0-mm target vessel. Until now, a percutaneous coronary intervention of remaining lesions as staged hybrid procedure was performed in three patients (2 nonrobotic total endoscopic coronary bypass grafting, 1 minimal invasive direct coronary artery grafting).

Conclusions

With a thoroughly surveyed learning curve, nonrobotic total endoscopic coronary bypass grafting procedure could become an alternative to other available treatment options; however, the value of the procedure has to be further investigated.
Right Mini-thoracotomy Bentall Procedure
Authors: Johnson Carl A. , Siordia Juan A. , Wood Katherine L. , Robinson Davida A. , Knight Peter A.
Published: November 2018

Objective

Bentall procedures are traditionally performed through a median sternotomy. The right mini-thoracotomy approach is increasingly used in aortic valve replacement. This approach has been shown to have decreased blood loss and hospital length of stay compared with sternotomy. A right mini-thoracotomy approach may also be beneficial in selected patients requiring aortic root surgery. We present our initial clinical experience of patients who have undergone a right mini-thoracotomy Bentall.

Methods

This is a single-center retrospective review of seven patients who underwent a primary elective right anterior mini-thoracotomy Bentall. A thoracoscope was used in each case. Automated suturing technology was used for annular suturing in three of the seven patients. Clinical outcomes evaluated include 30-day mortality, intensive care and hospital length of stay, time to extubation, operative times, as well as postoperative sequelae including stroke, infection, and bleeding.

Results

Median cardiopulmonary bypass, cross-clamp, and circulatory arrest time were 217, 153, and 28 minutes, respectively. Median time to extubation was 10 hours and median intensive care unit and hospital stay was 1 and 4 days, respectively. One patient had a wound infection and one returned to the operating room for bleeding. There were no in-hospital or 30-day mortalities.

Conclusions

The Bentall procedure can be performed through a right anterior mini-thoracotomy in selected patients with excellent clinical results.
Assessment of Craniometric Sexual Dimorphism Using Multidetector Computed Tomographic Imaging in a Sample of Egyptian Population
Authors: Adel Rana , Ahmed Hala Mohamed , Hassan Osama A. , Abdelgawad Ehab A.
Published: November 2018

Sex determination is an initial and essential component of any medicolegal investigations. However, sometimes only cranial remains are available. The objective of this study was to determine sex using 12 craniofacial measurements in multidetector computed tomographic images of 150 Egyptian subjects (80 men and 70 women), with age ranging from 18 to 60 years. The results revealed a significant increase in the mean of all craniofacial measurements in men in comparison with women (P < 0.05). Bizygomatic breadth was the single most discriminant dimorphic parameter with an accuracy of 74%. Multiple discriminant functional analysis for sex prediction showed increased accuracy to 78.7% in all cases. Using multiple stepwise discriminants, functional analysis showed that the most predictive variables selected were maximal cranial breadth, minimal frontal breadth, bizygomatic breadth, orbital height, bimastoidale, and basion-prosthion length, which showed an accuracy of 80%. On the basis of this study, it is concluded that the cranial measurements obtained from multidetector computed tomographic images could be useful for forensic sex determination in Egyptians, especially in cases of skeletal remains.
Diagnostic Value of Quantitative Perfusion Computed Tomography Technique in the Assessment of Tumor Response to Sorafenib in Patients With Advanced Hepatocellular Carcinoma
Authors: Ippolito Davide , Querques Giulia , Pecorelli Anna , Talei Franzesi Cammillo , Okolicsanyi Stefano , Strazzabosco Mario , Sironi Sandro
Published: November 2018

Aim

The aim of this study was to assess the role of dynamic contrast-enhanced perfusion computed tomography (pCT) imaging in the early detection of blood flow changes related to antiangiogenic treatment with sorafenib, in patients with advanced hepatocellular carcinoma (HCC), being the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria the standard of reference.

Methods

Between 2012 and 2016, 43 cirrhotic patients (male, n = 39; female, n = 4) with biopsy-proven multifocal HCC underwent multi–detector-row computed tomography, and pCT examinations were performed before and every 2 months after sorafenib administration. Perfusion CT technique is based on the acquisition of 16 dynamic slices/scan per 40 scans, performed on a 256-slice multi–detector-row computed tomography scanner, after intravenous bolus injection of 50 mL of iodinated contrast agent (350 mg I/mL) at a flow rate of 5 mL/s. According to mRECIST, patients were stratified into complete (CR) or partial response (PR) and stable (SD) or progressive disease (PD). The following pCT parameters were calculated: hepatic perfusion (mL/s per 100 g), time to peak (seconds), arterial perfusion (mL/s), and hepatic perfusion index (%). Perfusion CT values at baseline and first follow-up were reported for all mRECIST groups and then compared between the nonprogressor (CR, PR, SD) and progressor groups (PD).

Results

Most pCT values were significantly higher (P < 0.01) between baseline and follow-up in the CR and PR groups, whereas nonsignificant differences were found among SD patients, and a nonsignificant trend (P > 0.05) toward increase was observed among PD patients. Moreover, pCT values were significantly higher (P = 0.05) at baseline in the nonprogressor group compared with the progressor.

Conclusion

Preliminary results suggest that pCT adds quantitative data of vascularization, thus demonstrating its usefulness in the assessment of therapeutic response to sorafenib in advanced HCC, in line with mRECIST criteria, offering 1-step information on tissue cellularity and vascularization.
Updated Imaging Features of Dysplastic Cerebellar Gangliocytoma
Authors: Dhamija Radhika , Wood Christopher P. , Porter Alyx B. , Hu Leland S. , Weindling Steven M. , Hoxworth Joseph M.
Published: November 2018

Objective

The aim of this study was to perform an updated review of the imaging features of dysplastic cerebellar gangliocytoma (DCG).

Methods

Imaging findings were retrospectively reviewed in 14 patients with DCG. The analysis included size, location, cyst formation, calcification, intralesional hemorrhage, enhancement pattern, and apparent diffusion coefficient (ADC).

Results

In addition to revisiting many well-established imaging features of DCG, enhancement was much more common (64.3%) than previously reported, and small enhancing veins were also frequently encountered within or along the periphery of the lesions (50%). Dysplastic cerebellar gangliocytomas had an elevated ADC compared with normal cerebellum (967.8 ± 115.7 vs 770.4 ± 47.3 × 10−6 mm2/s; P < 0.0001).

Conclusions

Enhancement on magnetic resonance imaging within DCG should be an accepted imaging finding rather than being viewed as uncommon or atypical. Dysplastic cerebellar gangliocytomas typically have an elevated ADC compared with normal cerebellum, which may assist in differentiation from other posterior fossa neoplasms.
Assessment of Liver and Spleen in Children With Gaucher Disease Type 1 With Chemical Shift Imaging
Authors: Abdel Razek Ahmed Abdel Khalek , Barakat Tarik , Ali Khadiga
Published: November 2018

Purpose

The aim of this study was to assess of liver and spleen in children with Gaucher disease type 1 with chemical shift imaging.

Methods

Retrospective analysis was conducted on 36 untreated children with Gaucher disease type 1 and 15 age- and sex-matched control children who underwent chemical shift imaging of the abdomen. The hepatic and splenic fat fraction was calculated. The Pediatric Gaucher Severity Scoring System, hematologic parameters, and enzyme assay of the disease were calculated and correlated with hepatic and splenic fat fraction.

Results

The mean hepatic fat fraction in Gaucher disease was 14.1 ± 3.1 (95% confidence interval [CI], 12.9–15.2) was significantly higher (P = 0.001) than that of control subjects 5.2 ± 0.9 (95% CI, 4.7–5.7). The mean splenic fat fraction in Gaucher disease was 11.2 ± 2.9 (95% CI, 11.2 ± 2.9), and that of control was 4.5 ± 0.9 (95% CI, 4.02–5.2). The thresholds of hepatic and splenic fat fraction used to differentiate patients from control subjects were 0.47 and 0.39 with areas under the curve of 0.947 and 0.999, respectively. The hepatic and splenic fat fraction is correlated with the Pediatric Gaucher Severity Scoring System (r = −0.523, −0.602), hemoglobin concentration (r = −0.491, −0.505), platelet count (r = −0.593, −0.24), β-glucosidase (r = 0.519, 0.549), and chitotriosidase (r = −0.03, 0.267), respectively.

Conclusions

Hepatic and splenic fat fraction is a promising quantitative imaging parameter for detection and quantification of hepatic and splenic infiltration in children with Gaucher disease and correlated with clinical scoring, hematologic parameters, and enzyme assay of the disease.
Phase-Contrast Magnetic Resonance Quantification of Aortic Regurgitation in Patients With Turbulent Aortic Flow
Authors: Lee Elizabeth , Richards Blair , Lu Jimmy C. , Mahani Maryam Ghadimi , Dorfman Adam L. , Balasubramanian Sowmya , Agarwal Prachi P.
Published: November 2018

Objective

This study aimed to assess variability in measurements and accurately quantify aortic regurgitation in patients with coexisting turbulent aortic flow using phase-contrast magnetic resonance.

Methods

All patients (n = 21) underwent phase-contrast magnetic resonance at 2 or more sites: ascending aorta, sinuses of Valsalva, and left ventricular outflow tract. The net flow/minute (NF), forward flow/minute (FF), regurgitant flow/minute (RF), and regurgitant fraction (RF%) were compared with the sum of superior vena cava and descending aortic flow/minute, left ventricular cardiac output, difference between the 2, and percentage difference, respectively.

Results

The NF, FF, and RF were significantly different between each site. The combination of FF in the left ventricular outflow tract and NF from the superior vena cava + descending aorta provided the best reliability of RF and regurgitant fraction (intraclass correlation coefficients, 0.881 [95% confidence interval, 0.882–0.878] and 0.838 [95% confidence interval, 0.837–0.838]).

Conclusion

Combining flow measurements from more than 1 site provides the most accurate quantification of aortic regurgitation in patients with turbulent aortic flow.
A well-preserved respiratory system in a Silurian ostracod
Authors: Siveter David J. , Briggs Derek E. G. , Siveter Derek J. , Sutton Mark D.
Published: November 2018

Ostracod crustaceans are diverse and ubiquitous in aqueous environments today but relatively few known species have gills. Ostracods are the most abundant fossil arthropods but examples of soft-part preservation, especially of gills, are exceptionally rare. A new ostracod,
Spiricopia aurita
(Myodocopa), from the marine Silurian Herefordshire Lagerstätte (430 Mya), UK, preserves appendages, lateral eyes and gills. The respiratory system includes five pairs of gill lamellae with hypobranchial and epibranchial canals that conveyed haemolymph. A heart and associated vessels had likely evolved in ostracods by the Mid-Silurian.
A wood-warbler produced through both interspecific and intergeneric hybridization
Authors: Toews David P. L. , Streby Henry M. , Burket Lowell , Taylor Scott A.
Published: November 2018

Hybridization between divergent taxa can provide insight into the breakdown of characters used in mate choice, as well as reproductive compatibility across deep evolutionary timescales. Hybridization can also occur more frequently in declining populations, as there is a smaller pool of conspecific mates from which to choose. Here, we report an unusual combination of factors that has resulted in a rare, three-species hybridization event among two genera of warblers, one of which is experiencing significant population declines. We use bioacoustic, morphometric and genetic data, to demonstrate that an early generation female hybrid between a golden-winged warbler (
Vermivora chrysoptera
) and a blue-winged warbler (
V. cyanoptera
) went on to mate and successfully reproduce with a chestnut-sided warbler (
Setophaga pensylvanica
)
.
We studied the product of this event—a putative
chrysoptera
×
cyanoptera
×
pensylvanica
hybrid—and show that this male offspring sang songs like
S. pensylvanica
, but had morphometric traits similar to
Vermivora
warblers. The hybrid's maternal parent had
V. chrysoptera
mitochondrial DNA and
,
with six plumage-associated loci, we predicted the maternal parent's phenotype to show that it was likely an early generation
Vermivora
hybrid
.
That this hybridization event occurred within a population of
Vermivora
warblers in significant decline suggests that females may be making the best of a bad situation, and that wood-warblers in general have remained genetically compatible long after they evolved major phenotypic differences.
Daniel McGillivray Brown. 3 February 1923—24 April 2012
Authors: Gait Michael J.
Published: November 2018

Dan Brown was a nucleic acids chemist of the highest order, beginning with pioneering work under Lord Alexander Todd in the 1950s at University of Cambridge on chemical methods for synthesis of nucleosides and nucleotides. This work helped to confirm the furanose chemical structure of the sugar in nucleosides as well as the 3′-5′ phosphodiester linkage in DNA and RNA, perhaps the most well thought of achievement of his career. Later, as a chemistry department lecturer, he established the chemical structures of glycerol monophosphoinositides as well as triphosphoinositides. Turning back to the nucleic acids in 1961, he became fascinated by the effect of mutagens on DNA. He elucidated the mechanism for the reaction of hydroxylamine on cytidine to form an initial ‘bis-adduct’ and thereafter N
6
-hydroxycytidine. Moving in 1982 to the MRC Laboratory of Molecular Biology, he developed a method to prepare single-stranded DNA probes for detection of RNA sequences and in addition worked on a novel automated device for oligonucleotide synthesis. Reverting to his interest in mutagens, he then designed and synthesized hydrogen bonding degenerate bases and developed novel P and K modified pyrimidine and purine bases respectively as transition mutagens. Finally, he synthesized the base analogue 5-nitroindole as a potential universal base, which became useful in cycle DNA sequencing, and in addition developed the concept of ‘error catastrophe’ for the ribonucleoside of the P base as an antiviral agent. The P, K and 5-nitroindole bases became the most valued chemical entities of his career to molecular biologists. His legacy to the nucleic acids includes both his significant contributions to studies of the chemical nature of DNA and RNA and their constituents as well as a variety of enabling nucleic acids chemistry methods and mechanisms of DNA mutagenicity.